Seth Lawrence Sherman, MD

All Publications

• Knee Osteotomy Plus Cartilage Restoration Is Not Always Superior to Osteotomy Alone. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Sherman, S. L., Mastrocola, M. 2025

  Abstract

  The treatment of cartilage defects in the setting of varus malalignment remains a challenge. Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used joint-preserving procedure for medial compartment osteoarthritis (OA) and varus malalignment. It is well known that MOWHTO effectively redistributes load across the knee joint, reduces pain, and improves function, with survival rates of up to 90% at 10 years post-operatively. When treating malalignment along with cartilage damage, combined procedures, such as MOWHTO with cartilage restoration or meniscal transplantation may be performed. While cartilage microfracture may improve early cartilage appearance on arthroscopy, it does not necessarily translate to superior long-term clinical outcomes. Furthermore, the conjunction fallacy-the mistaken belief that combining procedures must lead to better outcomes-may contribute to overtreatment, increased surgical morbidity, and higher costs. The conjunction rule is amongst the most basic qualitative laws of probability. It states that the probability of a conjunction P(A+B) cannot exceed the probability of its constituents, A and B. For us surgeon mortals who have likely left statistics at the bedside, this rule implies that the estimated success of combined procedures is not exponential, but is, in fact, no greater than the success rate of either intervention alone. Close colleague William "Bill" Bugbee of the Scripps Institute has popularized the "conjunction fallacy" as it applies to knee joint preservation. He points out that surgeons often make the mistake of assuming that the probability of success must be better if two or more procedures are combined versus any one procedure alone. Medical doctors unfortunately believe similarly. In a recent JAMA survey, 78% of clinicians committed this conjunction fallacy and overestimated the effectiveness of combined treatments.1 In our field, overtreatment has consequences including the potential for increased surgical morbidity, reduced quality of care, and elevated cost.

  View details for DOI 10.1016/j.arthro.2025.04.005

  View details for PubMedID 40228679

• One High-Volume Posteromedial Knee Capsular Injection Can Provide Safe Anesthetic Infiltration Across the Entire Posterior Knee Capsule ARTHROPLASTY TODAY Atzmon, R., Polakof, L., Wang, A., Sherman, S., Giori, N. 2025; 32

  View details for DOI 10.1016/j.artd.2025.101651

  View details for Web of Science ID 001446708100001

• One High-Volume Posteromedial Knee Capsular Injection Can Provide Safe Anesthetic Infiltration Across the Entire Posterior Knee Capsule. Arthroplasty today Atzmon, R., Polakof, L., Wang, A., Sherman, S., Giori, N. J. 2025; 32: 101651

  Abstract

  Anesthetic injection through the central or posterolateral knee capsule for analgesia after knee surgery risks popliteal vessel and tibial and peroneal nerve injury. We evaluated the distribution of a high volume of fluid injected through only the posteromedial capsule and compared it to a technique involving injections through the posteromedial and posterolateral capsules.Four fresh cadaveric knees were injected with 50 ml of Omnipaque 350 diluted 1:4 with normal saline through the posteromedial knee capsule. In four other specimens, we followed a published protocol by injecting 12.5 ml posteromedially and 12.5 ml posterolaterally. The knees were then ranged 20 times over 20 minutes before obtaining a computed tomography scan to evaluate the spread of injected contrast fluid.Both techniques demonstrated broad distribution of injected fluid posterior to the capsule. An average of 80% of the capsular width at the level of the injection was within 5 mm of the injected contrast with the single injection, while 63% was with the two-injection technique.One 50 mL injection through the posteromedial knee capsule can provide broad medial, lateral, superior, and inferior distribution of anesthetic without risking injury to neurovascular structures. This has become our preferred method of anesthetizing the posterior knee during knee surgery.

  View details for DOI 10.1016/j.artd.2025.101651

  View details for PubMedID 40134740

  View details for PubMedCentralID PMC11932871

• Preserving Knee Health and Delivering Specialized Care for Active Older Athletes. Sports health Bartsch, A., Sherman, S. L., Tramer, J., Vel, M. S., Fredericson, M. 2025: 19417381251326527

  Abstract

  Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population.Nonsystematic review with critical appraisal of existing literature.Clinical review.Level 4.Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy.With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.

  View details for DOI 10.1177/19417381251326527

  View details for PubMedID 40145656

  View details for PubMedCentralID PMC11951129

• Mechanisms of Action of Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis: A Targeted Review of the Literature AMERICAN JOURNAL OF SPORTS MEDICINE Sherman, S. L., Gudeman, A. S., Kelly, J. D., Dimeff, R. J., Farr, J. 2025: 3635465241302820

  Abstract

  The knee is the most commonly afflicted joint in osteoarthritis (OA). Injection of intra-articular of hyaluronic acid (IAHA) is a frequently used therapy for the management of knee OA with varying product characteristics.To describe and characterize the mechanism of action (MoA) of IAHA products concerning nociception, chondroprotection, and anti-inflammatory properties via a targeted literature review.Systematic review; Level of evidence, 2.We followed the standard methodologies for conducting and reporting targeted reviews as recommended by the Cochrane Handbook for Systematic Reviews of Interventions, adapted for conducting a targeted literature review. Relevant studies were identified by searching the Embase database using predefined search strategies via the Ovid platform. The results of the review were reported according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses).A total of 182 studies were included in this targeted literature review. Of these, 107 reported chondroprotective action, 59 anti-inflammatory activity, 18 analgesic properties, 30 proteoglycan or glycosaminoglycan synthesis, 8 subchondral bone effects, 2 mechanical effects, and 1 other effects of IAHA. These MoAs were studied through diverse types of studies: in vitro biochemistry, animal physiological studies, or human physiological and clinical studies. The chondroprotective effect was the most studied MoA and showed an increase in anabolic biomarkers, such as collagen types II, IX, and XI, and a reduction in catabolic biomarkers, such as matrix metalloproteinases, which play a primary role in the downstream signaling pathways in OA and cartilage degradation in the synovial fluid. IAHA was widely reported by studies to reduce soluble inflammatory mediators, such as interleukins 1β and 6 and tumor necrosis factor α, thereby decreasing the production of degradative enzymes (eg, matrix metalloproteinases, aggrecanases). IAHA was also reported to enhance the synthesis of intrinsic proteoglycan (eg, aggrecan) and glycosaminoglycans, thus delaying the progression of OA. IAHA also reported improvement in the mechanical function of the knee by increasing the viscosity of the synovial fluid, reducing the coefficient of friction, and improving its lubrication. Overall, a significant decrease in knee pain was observed after IAHA treatments.Preclinical and clinical studies established evidence for varied MoAs by which IAHA preparations may produce a desired effect in patients with knee OA.

  View details for DOI 10.1177/03635465241302820

  View details for Web of Science ID 001448213400001

  View details for PubMedID 40108507

• Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability: Data From the JUPITER Cohort. The American journal of sports medicine McGinley, J. J., Ellis, H. B., Propp, B., Veerkamp, M. W., Wilson, P. L., Kramer, D. E., Heyworth, B. E., Strickland, S., Wall, E., Koh, J., Yen, Y. M., Halsey, M., Magnussen, R., Roberts, D., Farr, J., Green, D., Fabricant, P., Brady, J., Tompkins, M., Redler, L. H., Yanke, A. B., Sherman, S. L., Parikh, S. N., Shubin Stein, B. E. 2025: 3635465251315170

  Abstract

  Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.Case-control study; Level of evidence, 3.Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.

  View details for DOI 10.1177/03635465251315170

  View details for PubMedID 39939854

• A Cadaveric Study of the Sagittal Patellar Insertion of the Medial Patellofemoral Ligament in Children: Implications for Reconstruction. The American journal of sports medicine Alayleh, A., Hollyer, I., Johnstone, T., Khoo, B., Obilo, C., McFarlane, K., Baird, W., Chan, C., Tompkins, M., Ellis, H., Schmitz, M., Yen, Y. M., Ganley, T., Sherman, S. L., Shea, K. G. 2025: 3635465241313239

  Abstract

  Patellofemoral instability is a common problem, and medial patellofemoral ligament (MPFL) reconstruction is a standard treatment approach for recurrent instability. The accurate restoration of anatomy in MPFL reconstruction is essential. While coronal-plane anatomy of the MPFL patellar insertion has been previously reported, sagittal-plane anatomy has not been widely studied.To evaluate the sagittal patellar insertion of the MPFL in pediatric specimens to guide future anatomic reconstruction.Descriptive laboratory study.A total of 11 pediatric cadaveric knee specimens were dissected. The patella and sagittal MPFL insertion were evaluated. The maximal anterior-posterior patellar width, distance from the posterior patella to the posterior MPFL insertion, distance from the medial patellar articular cartilage edge to the MPFL insertion, maximal MPFL thickness, and distance from the anterior MPFL insertion to the anterior patella were measured. The proportion of patellar coverage by the sagittal MPFL insertion footprint was calculated.The pediatric knee specimens had a mean age of 9.3 ± 1.4 years (range, 6-11 years). The mean maximal transverse patellar width was 19.0 ± 2.7 mm (range, 13.7-22.7 mm). The mean posterior patella-to-posterior MPFL distance was 10.5 ± 1.6 mm (range, 7.7-12.6 mm). The mean patellar articular cartilage edge-to-MPFL distance was 2.3 ± 0.6 mm (range, 1.5-3.5 mm). The mean maximal MPFL thickness was 4.0 ± 0.9 mm (range, 2.6-5.5 mm). The mean anterior MPFL-to-anterior patella distance was 4.4 ± 1.1 mm (range, 2.6-5.8 mm). The sagittal MPFL insertion footprint spanned a mean of 21.0% (range, 16.1%-29.7%) of the medial patella.This study, utilizing skeletally immature cadaveric specimens, demonstrated that the sagittal MPFL insertion consistently resided in the anterior third of the patella, averaging 21% of the total sagittal patellar width. Additionally, the distance from the MPFL insertion to the medial patellar articular cartilage edge showed minimal variation, representing a consistent intraoperative landmark for MPFL graft placement.This research characterized MPFL insertion anatomy on the medial patella in the sagittal plane. This knowledge provides a clear target area for anatomic graft placement during MPFL reconstruction.

  View details for DOI 10.1177/03635465241313239

  View details for PubMedID 39912699

• Video Analysis of Acute Lower Extremity Injury Mechanisms in Soccer Demonstrates Most Anterior Cruciate Ligament, Achilles, and Muscle Injuries Occur Without Direct Contact: A Systematic Review and Meta-Analysis. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Xiao, M., Lee, J. J., Boissiere, J. C., Sherman, S. L., Safran, M. R., Abrams, G. D., Hwang, C. E. 2025

  Abstract

  To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players.The study was pre-registered on PROSPERO. PRISMA guidelines were followed. Three databases were searched for Level I-IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) Scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury.Nineteen articles (mean QA-SIVAS score 14.3 + 1.9; all Level IV evidence, 1,652 videos, 17 professional male, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42% - 55%]), muscle strains (hamstring: 71% [47% - 87%] ), and Achilles tears (80-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament (MCL) sprains (14% NC) and foot/ankle sprains (6% [4% - 10%] NC). A majority of ACL injuries (68% [61% - 75%]) occurred while defending, and quadriceps strains (81-89%) occurred while attacking.In soccer, video analysis demonstrates that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while MCL and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half.Systematic review and meta-analysis of Level IV studies.

  View details for DOI 10.1016/j.arthro.2025.01.049

  View details for PubMedID 39914612

• Improved Biomechanical Performance of Tibial Spine Fracture Repair With Suture and Anchor Fixation in Pediatric Cadaveric Knees. Orthopaedic journal of sports medicine Johnstone, T. M., Hollyer, I., McFarlane, K., Alayeh, A., Tompkins, M., Ganley, T., Yen, Y. M., Ellis, H. B., Chan, C. K., Green, D. W., Sherman, S. L., Shea, K. G. 2025; 13 (2): 23259671241306194

  Abstract

  Prior studies in porcine and adult human bone suggest that suture fixation is superior to screw fixation of pediatric tibial spine fractures (TSFs). However, we have previously demonstrated that 2-suture repair was biomechanically comparable with 2-screw repair in human pediatric cadaveric knees.To evaluate whether TSF fixation with sutures attached to anchors placed in stronger metadiaphyseal bone would produce biomechanically superior repair to 2-screw and 2-suture constructs.Controlled laboratory study.Six pediatric cadaveric knees were acquired. We applied the same TSF creation protocol used in our previous study, then repaired the fractures by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament, with sutures passed through bony tunnels and secured to two 2.8-mm anchors in the metadiaphyseal cortex. This construct of suture plus suture anchor (suture anchor group) underwent the same biomechanical loading protocol used in our prior study, in which pediatric knees were randomly assigned to either screw fixation (n = 6; fractures reduced with two 4.0-mm cannulated screws and washers) or suture fixation (n = 6; fractures repaired as in the suture anchor group except the sutures were tied across a metaphyseal bony bridge after their exit from the bony tunnels). All specimens were mounted in flexion and biomechanically tested with cyclic loading followed by a load-to-failure test. New data were statistically compared with the prior study's results.The suture anchor group had a median age of 9.00 years, while the screw and suture groups had identical median ages (8.50 years). All groups had an identical number of samples of each laterality. The ultimate failure load differed significantly across fixation methods (P = .006), primarily driven by higher ultimate failure loads in the suture anchor group (225.50 ± 46.46 N) when compared with the screw group (143.52 ± 41.97 N; P = .01) and suture group (135.35 ± 47.94 N; P = .009).TSF fixation with sutures tied to metadiaphyseal suture anchors provided significantly stronger repair than 2-suture and 2-screw constructs.The suture anchor fixation method for TSF may offer enhanced stability and durability to reduce the risk of postoperative complications while improving functional patient outcomes.

  View details for DOI 10.1177/23259671241306194

  View details for PubMedID 39991650

  View details for PubMedCentralID PMC11843678

• No Difference in Chondrocyte Viability Using Manual Versus Custom-Cutting Technique for Matrix-Induced Autologous Chondrocyte Implantation. Orthopaedic journal of sports medicine Chang, W. T., Atzmon, R., Vel, M. S., Lin, K. M., Abrams, G. D., Sherman, S. L. 2025; 13 (2): 23259671241308855

  Abstract

  Matrix-induced autologous chondrocyte implantation (MACI) was developed for knee cartilage restoration involving seeding autologous chondrocytes onto a collagen membrane. Maintaining chondrocyte viability and achieving proper membrane size and contour are crucial for successful outcomes. Scissor cutting (Sc) has traditionally been used to shape the membrane, but recently, custom cutting (CC) have gained popularity for their enhanced preparation efficiency.To determine the difference in chondrocyte viability using the Sc versus CC methods.Controlled laboratory study.Using Sc and CC methods, 15 mm-diameter circular specimens were cut from 5 residual membranes. Membranes were stained, and confocal microscopy was used to visualize live/dead cells. Three zones were defined: the impact zone (the outermost zone at the cut edge), the central zone (the least manipulated zone), and the adjacent zone (the intermediate zone between the central and impact zones). For each circular specimen, the following measurements were recorded: the dimension of the impact zone, cell viability (percentage of live cells among total) for each zone, and the total number of cells within each zone (as cell density ×105/cm2).The width of the impact zone (mean ± standard error) was 355 ± 31 μm and 342 ± 24 μm for CC and Sc, respectively, and the impact zone occupied approximately 10% of the specimen. With both cutting techniques, cell viability was significantly lower in the impact zone (mean ± standard error: CC, 36.42% ± 3.85%; Sc, 40.94% ± 2.85%) compared with the adjacent zone (CC, 77.69% ± 2.97%; Sc, 74.17% ± 2.8%). The cell density from all zones varied from 5.84 ± 0.26 to 6.49 ± 0.34 × 105/cm2, with no significant difference in cell viability in the impact zones between the cutting methods.Both cutting techniques led to a significant reduction in cell viability in the impact zone compared with other zones of the MACI specimen. There was no significant difference in chondrocyte viability or cell density for membranes cut by Sc or CC.This evaluation of the newly introduced CC method on the chondrocyte viability of the MACI membrane will enable surgeons to make a more informed decision regarding cutting techniques.

  View details for DOI 10.1177/23259671241308855

  View details for PubMedID 39931633

  View details for PubMedCentralID PMC11808760

• Management of Isolated Partial ACL Tears: A Survey of International ACL Surgeons ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Frey, C. S., Pierre, K. J., Pham, N. S., Abrams, G. D., Sherman, S. L., Spalding, T., Safran, M. R. 2025; 13 (2): 23259671241311603

  Abstract

  Partial anterior cruciate ligament (ACL) tears, particularly injuries detected with magnetic resonance imaging (MRI) but stable on ligamentous examination, appear to be recognized more frequently; however, there remains no consensus management for this complex pathology.To present the results of a survey of a group of international ACL experts on the management of partial ACL injuries.Survey study; Level of evidence, 5.The ACL Study Group is an international group of orthopaedic surgeons with a special interest in the ACL. There are 169 members overall, with 135 clinically active surgeons. A branching logic survey was developed and circulated to members of the ACL Study Group via electronic mail. Categories included member demographics as well as recommended management strategies of partial ACL injuries, including recommendations on return to play.Of the 135 clinically active surgeon members, 113 responded to the survey (84%). Nonoperative management of partial ACL injuries was selected by 92% of respondents. Of those who managed nonoperatively, 75% indicated they would not restrict weightbearing and 59% would not recommend a knee brace. When those who managed the patient nonoperatively determined criteria for return to sports (RTS), 33% would use differential knee laxity, 87% would assess functional testing, 26% would utilize imaging, and 40% selected time from injury. When using time as a guide for RTS, 13% chose RTS between 7 and 11 weeks postinjury, 56% selected no sport before 3 months, and 22% favored waiting 4 to 6 months before allowing an athlete with a partial ACL injury to RTS. With regard to function as a tool to determine RTS, painless Lachman, strength, swelling, and functional performance tests were all chosen by a majority of respondents.This study presented the results of a survey on partial ACL injury management administered to ACL Study Group active surgical members. The majority favored nonoperative management for partial ACL injuries (stable ligament examination but MRI changes in the ligament). Nonoperative treatment and RTS protocols varied and must be customized to the patient.

  View details for DOI 10.1177/23259671241311603

  View details for Web of Science ID 001417301300001

  View details for PubMedID 39931635

  View details for PubMedCentralID PMC11808748

• Suture Anchor Fixation of the Pediatric Posteromedial and Posterolateral Menisco-Tibial Ligament Complex Matches or Exceeds Native Tissue Strength: A Cadaveric Study. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Hollyer, I., Johnstone, T., Alayleh, A., vanDeursen, W., McFarlane, K., Baird, W., Chan, C., Tompkins, M., Ellis, H., Ganley, T., Yen, Y. M., Sherman, S., Shea, K. 2025: 100385

  Abstract

  To compare the biomechanical strength and stiffness of the native posteromedial and posterolateral meniscotibial ligament complex (MTLC) to suture anchor repair of the MTLC.Biomechanical testing was performed on 24 fresh-frozen pediatric human knees. Four conditions were tested: native posteromedial MTLC (n=14), native posterolateral MTLC (n=14), posteromedial MTLC repair (n=5), and posterolateral MTLC repair (n=5). Load-to-failure and stiffness were measured for all conditions.The load-to-failure for the posteromedial suture anchor construct was significantly higher than the native MTLC (p < 0.01). The posterolateral suture anchor construct had a significantly greater stiffness than the native MTLC (p = 0.03). Posterolateral MTLC load-to-failure and posteromedial MTLC stiffness were similar between native tissue and suture-anchor repair. All native MTLC failed at the meniscus-MTLC interface. The suture anchor groups had various failure modes, including suture pullout and breakage.Suture anchor fixation can match or exceed the native tissue's load-to-failure. This study supports the viability of suture anchor-based posterior MTLC repairs of the medial and lateral meniscus in pediatric bone.

  View details for DOI 10.1016/j.jisako.2025.100385

  View details for PubMedID 39798603

• Systematic Review of Randomized Controlled Trials Evaluating the Use of Platelet-Rich Plasma for Knee Osteoarthritis: Adherence to Minimum Information for Studies Evaluating Biologics in Orthopaedics. The American journal of sports medicine Nakagawa, H. F., Kim, J., Rinaldi, J., Rabinowitz, J., Mautner, K., DeMers, A., Sherman, S., Borg-Stein, J., Sussman, W. I. 2025: 3635465241249996

  Abstract

  BACKGROUND: The Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were developed in May 2017 to encourage improved reporting standards, promote increased transparency and reproducibility, and enhance clinical evaluation capabilities. The MIBO guidelines consist of 23 checklist items considered necessary to critically appraise clinical studies evaluating platelet-rich plasma (PRP).PURPOSE: To assess randomized controlled trials that evaluated PRP for the treatment of knee osteoarthritis in order to systematically review their adherence to the MIBO guidelines.STUDY DESIGN: Systematic review. Level 1a.METHODS: A search was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were randomized controlled trials reporting on knee osteoarthritis treated with intra-articular PRP. The studies were categorized into pre-, peri-, and post-MIBO groups based on the start date of data collection. The overall MIBO scores, defined as percentage of checklist items out of the 23 checklist items reported in 1 study, individual item scores, defined as percentage of studies reporting the checklist item within a specified group, and overall item score defined as the average of the individual item scores from all the included studies were calculated.RESULTS: The review included 87 studies (7925 patients; 8118 knees). Of these, 51 studies were assigned to the pre-MIBO group, 19 studies to the peri-MIBO group, and 17 studies to the post-MIBO group. The overall MIBO score was 72%. No statistically significant differences in MIBO scores were found among the 3 MIBO groups (P = .345). The majority of the studies (62 studies; 71%) had MIBO scores <80%. MIBO items with particularly low item scores included reporting of whole-blood characteristics (20%), platelet recovery rate (22%), PRP analysis (30%), and PRP activation (47%). No significant difference among the 3 MIBO groups was found for the item scores except for the reporting of the recipient details (P = .012).CONCLUSION: This study highlights the deficiencies in adherence to the MIBO guidelines, particularly in reporting key variables such as whole-blood characteristics, platelet recovery rate, PRP analysis, and PRP activation. These findings suggest that the publication of the MIBO guidelines has not resulted in improved reporting practices in studies investigating intra-articular PRP for the treatment of knee osteoarthritis.

  View details for DOI 10.1177/03635465241249996

  View details for PubMedID 39754417

• T2 Clusters Are More Sensitive Than Mean T2 Change to Detect Early and Longitudinal Changes in Anterior Cruciate Ligament Reconstructed and Healthy Knees. Journal of magnetic resonance imaging : JMRI Pai S, A., Gatti, A. A., Black, M. S., Young, K. A., Desai, A. D., Barbieri, M., Asay, J. L., Sherman, S. L., Gold, G. E., Kogan, F., Hargreaves, B. A., Chaudhari, A. S. 2024

  Abstract

  Post-traumatic osteoarthritis (PTOA) often follows anterior cruciate ligament reconstruction (ACLR), leading to early cartilage degradation. Change in mean T2 fails to capture subject-specific spatial-temporal variations, highlighting the need for robust quantitative methods for early PTOA detection and monitoring.Develop and apply 3D T2 cluster analysis to ACLR and healthy knees over 2.5 years.Longitudinal case-control study.ACLR and contralateral knees of 15 subjects (9 male/6 female, 37.7 ± 10 years) and right knee of 15 matched controls (9 male/6 female, 37.1 ± 12 years) were scanned at 3 weeks, 3, 9, 18, and 30 months post-ACLR.3 T Quantitative double echo steady state sequence."T2 cluster analysis" was developed, incorporating registration and thresholding methods to identify and quantify elevated T2 regions (T2 clusters, T2C) in femoral cartilage. Percentage of cartilage covered by T2 clusters (T2C%), mean cluster size (T2Csize), the number of clusters (T2Ccount), and ΔT2Mean (change in mean femoral cartilage T2 relative to visit 1) were computed for all knees.A linear mixed model assessed knee, time, and knee-time interaction effects on each outcome metric (P < 0.05), with effect sizes (ηp 2) describing the sensitivity of these effects to longitudinal changes.T2C% (ηp 2 = 0.22), T2Csize, (ηp 2 = 0.14), and T2Ccount (ηp 2 = 0.51) showed significant and systematic difference between knees (ACLR > contralateral > control). T2C% (ηp 2 = 0.24), T2Csize (ηp 2 = 0.17), and T2Ccount (ηp 2 = 0.11) showed significant longitudinal change across all knees. Specifically, ACLR knees exhibited a significant increase in T2C% (ηp 2 = 0.21), T2Csize (ηp 2 = 0.13), and a decrease in T2Ccount (ηp 2 = 0.07) with time. ΔT2Mean showed significant difference between knees (ηp 2 = 0.15), increase with time (ηp 2 = 0.04), with no significant knee-time interaction (ηp 2 = 0.00, P = 0.772 [contralateral], P = 0.482 [control]).T2C metrics are more sensitive than ΔT2Mean for longitudinal monitoring of femoral cartilage post ACLR. Our findings suggest potential merging of T2 clusters overtime, forming larger areas of cartilage degradation in ACLR knees.1 TECHNICAL EFFICACY: Stage 2.

  View details for DOI 10.1002/jmri.29689

  View details for PubMedID 39740037

• Surgical Excision of a Cyclops Lesion After ACL Reconstruction in an Elite College Athlete. Video journal of sports medicine Money, A. J., Pullen, W. M., Safran, M. R., Abrams, G. D., Sherman, S. L. 2024; 4 (6): 26350254241293462

  Abstract

  Cyclops lesion after anterior cruciate ligament (ACL) reconstruction can appear on magnetic resonance imaging (MRI) in up to 30% of patients and is symptomatic in up to 9%. Arthroscopic cyclops removal can help restore motion and limit recurrence.Patient is an 18-year-old male high-level collegiate athlete with a mechanical block to full extension. Patient underwent ACL reconstruction with bone-patellar tendon-bone autograft 15 months prior by an outside physician. The patient had a stable Lachman and pivot-shift examination, but there was a palpable clunk when attempting to extend his knee the final 10°. Patient was unable to perform sport due to symptoms. Postoperative MRI demonstrated a large cyclops lesion.Bilateral ligamentous examination under anesthesia was performed prior to draping. Standard arthroscopy portals were used. Diagnostic arthroscopy was performed by assessing all critical structures in the knee (ie, meniscus, cartilage, and ligaments). The cyclops lesion was visualized in the intercondylar notch with clear evidence of superior notch impingement with knee extension. Using a standard shaver and radiofrequency ablation, the cyclops lesion was resected with care not to injure the ACL graft or disrupt its integrity. A small superior soft tissue resection was then performed with resection of scar tissue that had formed within the notch. A repeat examination with an arthroscope in the knee revealed no further impingement.Patient was able to return fully to sport at 8 weeks postoperatively with no limitations, with no return of clicking or loss of motion.Symptomatic cyclops lesion after ACL reconstruction can be effectively treated with arthroscopic debridement. Postoperatively, patients can return to full sport at 6 to 8 weeks.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.

  View details for DOI 10.1177/26350254241293462

  View details for PubMedID 40309481

  View details for PubMedCentralID PMC11752171

• Increasing incidence of concussion and head injury due to electric biking: a 10-year sex and age-specific analysis of national injury data. The Physician and sportsmedicine Koehne, N. H., Locke, A. R., Alley, A. A., Ramey, M. D., Namiri, N. K., Dhanjani, S., Yendluri, A., Waterman, B. R., Sherman, S. L., Parisien, R. L. 2024

  Abstract

  Electric biking (e-biking) is a rapidly growing recreation, sport, and mode of transportation that often presents to emergency departments (EDs) with high-impact head injuries. This study aimed to evaluate the epidemiology of e-bike-related concussions and closed head injuries (CHI) to inform more effective injury prevention strategies.The National Electronic Injury Surveillance (NEISS) was queried for e-bike related concussions and CHIs presented to national EDs from 1 January 2013-31 December 2022. Patient demographics, diagnoses, and dispositions were recorded, and injury narratives were reviewed to identify mechanisms of injury and motor vehicle (MV) involvement.A total of 11,052 nationally estimated (NE) e-bike head injuries presented to US EDs from 2013-2022. E-bike head injuries increased significantly from 2013-2022 (p = .006, β = 372.5), with 40.8% of all head injuries occurring in 2022. Nearly one-third of patients (31.0%) required hospital admission, with hospitalization occurring most frequently among ages 51 and older (44.5%). MV involvement accounted for 27.6% of head injuries, and caused a higher proportion of hospitalizations than mechanisms without MVs (35.6% vs. 29.4% respectively; p < 0.001). High school age riders had the most MV incidents (53.2%), while the middle school age group had the highest proportion of concussions (26.5%) among all age groups. Relative to females, males were more likely to be involved in a MV incident (28.5% vs. 15.5%; p < 0.001) and were more likely to be hospitalized (33.0% vs. 25.4%; p < 0.001).The incidence of concussions and CHIs due to e-bikes increased significantly from 2013-2022, while high proportions of hospitalization indicate serious injury severity and large medical costs associated with these injuries. The prevalence of crashes involving MVs, especially among teenagers, calls for further research on commuter and recreational e-bike use along with new traffic legislation to protect young e-bikers.

  View details for DOI 10.1080/00913847.2024.2440309

  View details for PubMedID 39647170

• Effect of Anatomic Variations in the Anterior Tibial Artery on Risk of Injury During Orthopaedic Knee Surgeries. Orthopaedic journal of sports medicine Frey, C., Bugarinovic, G., Zhou, J., Sherman, S., Abrams, G., Segovia, N., Cheah, J. W. 2024; 12 (12): 23259671241301461

  Abstract

  Injury to the posterior vasculature is a potential complication in orthopaedic knee surgery that may be associated with variations in its anatomy, such as the type II-A2 variant, which places the anterior tibial artery (ATA) in closer proximity to the tibia. However, how close surgical instrumentation comes to injuring the ATA is not well described.To determine how the type II-A2 variant of the popliteal vasculature affects proximity of the ATA to instrumentation for orthopaedic knee procedures.Cross-sectional study; Level of evidence, 3.A total of 222 knee magnetic resonance imaging (MRI) scans from a single academic tertiary referral center were evaluated, and ATA branching patterns were characterized. The distances from the ATA to simulated instrumentation of high tibial osteotomy (HTO), posterolateral corner anatomic reconstruction, posterior cruciate ligament (PCL) reconstruction, lateral meniscus posterior horn repair, and lateral meniscus posterior root repair on axial plane MRI scans were measured by 2 authors independently using imaging software. Intrarater and interrater reliability of the measurements was calculated using the intraclass correlation coefficient.ATAs with the type II-A2 pattern passed anterior to the popliteus on 3.15% (n = 7) of the 222 MRI scans. The distance between the ATA and the simulated instrumentation was significantly closer in type II-A2 compared with normal (type I) knees for the lateral meniscus posterior root repair tunnel (11.1 vs 15.7 mm; P = .014), HTO cuts (0.6 vs 8.2 mm; P < .001), and PCL reconstruction tunnel (4.1 vs 11.7 mm; P < .001). Interrater reliability was good to excellent for all measurements, and intrarater reliability ranged from moderate to excellent.HTO cut, PCL reconstruction tunnel, and lateral meniscus posterior root tunnel instrumentation were significantly closer to the ATA in knees with type II-A2 anatomy compared with normal (type I) anatomy. Careful analysis of vasculature using MRI may be of utility for select surgery about the knee to guide surgical technique.

  View details for DOI 10.1177/23259671241301461

  View details for PubMedID 39711610

  View details for PubMedCentralID PMC11662312

• Older Age is Not a Contraindication to Meniscus Repair. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Sherman, S. L., Albersheim, M. 2024

  Abstract

  Meniscus tears effect patients of all ages, with varying presentations, influence on function, and treatment requirements. Classic dogma suggests older patients should be treated non-operatively or offered meniscectomy when conservative treatment fails. However, recent data suggests improved subjective outcomes and reduced rate of degenerative change following meniscus repair, even in patients >40 years. Controversy exists regarding the comparative reoperation rates of meniscectomy and meniscus repair in the older cohort. While higher levels of evidence are lacking, it is unlikely that chronological age should be the major driver of surgical decision making for meniscus repair. Patient, joint, limb, and meniscus specific factors, including physiologic age, better guide the surgeon towards successful treatment.

  View details for DOI 10.1016/j.arthro.2024.11.058

  View details for PubMedID 39571951

• Paratenon-Sparing Quad Tendon Graft Harvest. Video journal of sports medicine Atzmon, R., Bartsch, A., Pierre, K., Vel, M. S., Trivedi, N. N., Sherman, S. L. 2024; 4 (6): 26350254241266857

  Abstract

  In recent years, the quadriceps tendon has gained popularity for primary anterior cruciate ligament (ACL) reconstruction surgery due to its robustness, easy access, and ability to be tailor-made to each patient. However, concerns remain regarding potential complications associated with quadriceps tendon harvest, including impaired healing and damage to the extensor mechanism.Preserving the quadriceps paratenon, which is a source of blood supply, nutrients, and therapeutic cells during ACL reconstruction surgery, may improve postoperative outcomes by mitigating potential adverse effects associated with quadriceps harvest. As a result, it may also facilitate the quadriceps healing process and postoperative rehabilitation.The incision area is marked approximately 1 cm below to 3 cm above the proximal patellar pole, and the skin is dissected from the underlying tendon, exposing both the quadriceps and its paratenon. Once the tendon insertion to the patella's proximal pole is visualized, a double-blade knife is used to make a full-thickness 2-cm longitudinal cut, taking care not to cut over 2 cm of the overlying paratenon. Then, the distal end of the tendon is safely detached from the patella followed by placing continuous whip sutures, which are then loaded on a graft harvesting system and cannula. The cannula is gently plunged underneath the paratenon while applying tension on the whip sutures with the knee flexed to 90°. Then, the cannula is twisted repeatedly under the paratenon until the desired length of 61/2 to 7 cm is reached. Again, care is taken not to lever the tendon and to harvest it along its anatomic course. Finally, the quad tendon cutter is used to transect the quad at its proximal end. During the procedure, knee extension and flexion are used to aid visualization and access to the tendon's ends.Preservation of the quadriceps paratenon during its harvest for ACL reconstruction surgery can potentially improve postoperative outcomes by facilitating healing and reducing friction between the tendon and neighboring tissue.Preserving the quadriceps paratenon during ACL reconstruction surgery is a technique that can be easily performed and has the potential to improve postoperative outcomes. By preserving the paratenon, surgeons can reduce potential adverse effects associated with quadriceps harvest, such as impaired healing and damage to the extensor mechanism. Based on our experience and the available literature, we believe that preserving the paratenon during quadriceps tendon harvest is a valuable technique that surgeons should consider when performing ACL reconstruction surgery.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.

  View details for DOI 10.1177/26350254241266857

  View details for PubMedID 40309487

  View details for PubMedCentralID PMC11752537

• Trends in lateral extra-articular augmentation use and surgical technique with anterior cruciate ligament reconstruction from 2016-2023, an ACL Study Group Survey. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Hollyer, I., Sholtis, C., Loughran, G., Raji, Y., Akhtar, M., Smith, P. A., Musahl, V., Verdonk, P. C., Sonnery-Cottet, B., Getgood, A., Sherman, S. L. 2024: 100356

  Abstract

  To survey the ACL study group (ACLSG) members to determine the current practice patterns surrounding the use and methodology of lateral extra-articular procedures (LEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) during ACL reconstruction (ACLR).A web-based questionnaire was distributed to members of the ACLSG during the 2016, 2018, 2020, and 2023 biennial meetings. Questions explored the indications and techniques when incorporating LEAPs in ACLR.Analysis of survey responses found that the reported use of LEAPs in both primary and revision ACLR significantly increased between 2016 and 2023 and that surgeons were using lateral augmentation more frequently over time. Surgical techniques were stable across survey years, with most surgeons using iliotibial band (ITB) autograft attached at Gerdy's tubercle, passed under the lateral collateral ligament (LCL), and anchored proximal/posterior to the lateral femoral epicondyle.Survey responses demonstrate that LEAPs are becoming more common among ACL surgeons in the ACL SG, with the modified Lemaire LET being the predominant technique. This aligns with recent clinical studies showing improved outcomes and reduced risk of failure in ACLR with lateral augmentation compared to ACLR alone.Level V, Expert Opinion.

  View details for DOI 10.1016/j.jisako.2024.100356

  View details for PubMedID 39481853

• Corrigendum to "The Number of Patellar Dislocation Events Is Associated With Increased Chondral Damage of the Trochlea" (Vol 52, 2541, 2024) AMERICAN JOURNAL OF SPORTS MEDICINE Bram, J. T., Lijesen, E., Green, D. W., Heyworth, B. E., Veerkamp, M. W., Chipman, D. E., Propp, B. E., Brady, J. M., Parikh, S. N., Stein, B., Strickland, S. M., Fabricant, P. D., Koh, J. L., Farr, J., Yen, Y., Kramer, D. E., Milewski, M. D., Wall, E. J., Tompkins, M. A., Chambers, C. C., Ellis, H. B., Wilson, P. L., Magnussen, R. A., Redler, L. H., Yanke, A. B., Sherman, S. L., JUPITER Study Grp 2024

  View details for DOI 10.1177/03635465241294256

  View details for Web of Science ID 001339212300001

• Medial Patellofemoral Ligament Augmented With a Reinforced Bioinductive Implant Is Biomechanically Similar to the Native Medial Patellofemoral Ligament at Time Zero in a Cadaveric Model. Arthroscopy, sports medicine, and rehabilitation Millan, S. M., Sherman, S., Brown, Z. R., Brewer, E., Ford, E. 2024; 6 (5): 100975

  Abstract

  To biomechanically compare primary medial patellofemoral ligament (MPFL) repair (MPFLr) augmented with a reinforced bioinductive implant (RBI) to the native MPFL ligament and a semitendinosus (semi-T) MPFL reconstruction (MPFLR) at time zero.Four fresh-frozen matched pair cadavers (8 knees) were used to biomechanically compare the native MPFL to augmented MPFLr (n = 4) and semi-T MPFLR (n = 4). The native MPFL (n = 8) was isolated, preserving the femoral and patellar attachments, and pulled to failure. The semi-T was harvested from 1 of the matched pairs and whipstitched, as was a 250-mm × 5-mm RBI. A standard double-bundle docking technique was utilized. The patella was potted and mechanically pulled parallel to the transverse axis until failure in both cohorts. Cyclic creep, load and displacement at failure, failure mode, and stiffness were recorded.Failure load was highest in the RBI with repair group (287 ± 130 N) compared to the native MPFL (219 ± 64 N) and the semi-T group (84 ± 29 N). No statistically significant difference in failure load between the RBI augmentation with repair group and the native ligament (P = .19) were found. The semi-T reconstruction group failed at the least amount of displacement (7.93 ± 3.4 mm) compared to the native MPFL (20.9 ± 9 mm) (P < .01) and the RBI with repair group (33.2 ± 17.7 mm) (P < .02). At 10 mm of displacement, the RBI group (8.3 ± 1.2 N/mm) demonstrated stiffness in the midrange compared to the native MPFL (14.1 ± 7.1 N/mm). Early anchor/tendon pullout failure on the patella side was noted in the semi-T group compared to the RBI group. One reconstruction was excluded from analysis due to poor bone quality.No statistically significant difference was seen between the augmented MPFL repair and the native MPFL in load-to-failure testing. The augmented MPFL repair was observed to have biomechanical properties similar to the native MPFL. MPFLr with RBI augmentation provided consistent stiffness at clinically relevant displacement.Primary MPFL repair and reconstruction using the semi-T graft, while effective, are nevertheless imperfect procedures. MPFL repair has been shown to have higher instability recurrence rates, while the stiffness profile of MPFLR with semi-T is higher than the native MFPL and may lead to knee stiffness, loss of motion, or cartilage damage. The results of this time-zero biomechanical study indicate that the use of an RBI for augmentation of a primary MPFL repair may be a viable alternative to traditional MPFL repair or reconstruction using a semi-T graft.

  View details for DOI 10.1016/j.asmr.2024.100975

  View details for PubMedID 39534041

  View details for PubMedCentralID PMC11551335

• Quantification Of 3D Knee Morphology In Patients With Patellar Instability Lee, M. R., Gatti, A. A., Wright, C. E., Bartsch, A., Veerkamp, M. W., Parikh, S. N., Chaudhari, A. S., Shea, K. G., Sherman, S. L., Delp, S. L. LIPPINCOTT WILLIAMS & WILKINS. 2024: 61-62

  View details for Web of Science ID 001315123200134

• Editorial Commentary:Varus Recurrence After Medial Opening Wedge HTO. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Sherman, S. L., Putko, R. M. 2024

  Abstract

  Medial opening-wedge high tibia osteotomy (MOWHTO) is a powerful tool in the surgical armamentarium to correct varus malalignment in patients with symptomatic medial compartment disease. This procedure has demonstrated proven results and long-term survivorship. Complications include cortical hinge fracture, symptomatic hardware, infection, delayed or non-union, and nerve injury. Varus recurrence is a known complication following MOWHTO. Risk factors are multifactorial, thought to include degree of alignment correction, extent of meniscus and cartilage pathology, and effectiveness of soft tissue balancing. Medial meniscus extrusion has been implicated in meniscus dysfunction and progression of degenerative joint disease. It is a recognized issue after meniscus preserving and transplant procedures that may have long-term sequela. This loss of hoop stress can lead to increased contact pressure, putting the diseased compartment at further risk. While it is certainly possible that extrusion matters for varus recurrence after MOWHTO, its role must be considered in the context of multiple other confounding factors.

  View details for DOI 10.1016/j.arthro.2024.08.042

  View details for PubMedID 39245229

• Tibial Tubercle Osteotomy: Indications, Outcomes, and Complications. Current reviews in musculoskeletal medicine Stokes, D. J., Elrick, B. P., Carpenter, M. L., Raji, Y., McQuivey, K. S., Sherman, S. L., Frank, R. M. 2024

  Abstract

  The tibial tubercle osteotomy (TTO) is a versatile surgical technique used to treat a range of patellofemoral disorders, including patellar instability, painful malalignment, focal chondral defects, and patellar maltracking that have failed conservative therapies. TTO is a personalized procedure that can be tailored to the pathoanatomy of the patient based on physical examination and imaging. The complication rate associated with TTO strongly depends on the indication for surgery, the severity of the patient's condition, and the surgical approach. Despite the literature on TTO, to our knowledge, no single source has addressed the indications, techniques, outcomes, and complications of this procedure. The purpose of this article is to serve as such a valuable resource.Highlights from recent studies we would like to emphasize are two-fold. First, maintaining a distal cortical hinge yields lower complication rates than osteotomies involving complete tubercle detachment with classic or standard techniques. Second, based on current evidence, TTO consistently provides symptomatic relief, and most patients can return to work or sport at their pre-operative level within 3 and 6 months, respectively. TTO is a personalizable surgical technique that may be utilized for multiple patellofemoral disorders and is associated with good outcomes.

  View details for DOI 10.1007/s12178-024-09915-w

  View details for PubMedID 39102076

  View details for PubMedCentralID 5095937

• Anterior Cruciate Ligament Repair-Here to Stay or History Repeating Itself? Clinics in sports medicine Sherman, S. L., Raji, Y., Calcei, J. G., Sherman, M. F. 2024; 43 (3): 433-448

  Abstract

  Anterior cruciate ligament (ACL) injuries continue to be a prevalent concern among athletes and individuals with an active lifestyle. Traditionally, the standard of care for ACL tears has involved surgical reconstruction using autograft or allograft. This article aims to provide an overview of the evolving landscape of primary ACL repair, examining the current evidence, surgical techniques, patient selection criteria, outcomes, and potential future directions in this field.

  View details for DOI 10.1016/j.csm.2023.09.001

  View details for PubMedID 38811120

• Biomechanical and Biological Factors of Sexual Dimorphism in Anterior Knee Pain: Current Concepts. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Bartsch, A., Anderson, F. L., Fredericson, M., Sherman, S. L. 2024

  Abstract

  Female gender is one of the commonly mentioned risk factors for anterior knee pain (AKP), among a spectrum of other factors including anatomical, biomechanical, hormonal, behavioral, and psychological elements contributing to its development. Despite the focus on individual risk factors, there's a notable gap in comprehending how gender influences and interacts with other risk factors. The objective of this review was to identify and emphasize the connections between these interactions, gender-related risk factors for AKP, and the potential mechanisms that explain their associations with other risk factors, aiming to aid in the creation of precise prevention and treatment approaches. Gender influences the majority of risk factors for AKP, including anatomical, biomechanical, hormonal, behavioral, and psychological factors. Women have on average smaller patellae, higher patellofemoral cartilage stress and for AKP, disadvantageous trochlear morphology, ligament and muscle composition and unfavorable neuromuscular control pattern. In contrast, men show on average an increased ability to strengthen their hip external rotators, which are both protective against AKP. Particularly in kinetic and kinematic analysis, men have been shown to have a distinctly different risk factor profile than women. Sex hormones may also play a role in the risk of AKP, with estrogen potentially influencing ligamentous laxity, increasing midfoot loading and affecting neuromuscular control of the lower extremities and testosterone positively affecting muscle mass and strength. The higher incidence of AKP in women is likely due to a combination of slightly increased risk factors. Although all risk factors can be present in both men and women and the holistic evaluation of each individual's risk factor composition is imperative regardless of gender, knowing distinctive risk factors may help with focused evaluation, treatment, and implementing preventive measures of AKP.

  View details for DOI 10.1016/j.jisako.2024.05.014

  View details for PubMedID 38908481

• Tibial Tubercle Anteromedialization Using the Multi-Directional Tibial Tubercle Transfer System. Video journal of sports medicine Bartsch, A., Atzmon, R., Pierre, K., Vel, M. S., Sherman, S. L. 2024; 4 (3): 26350254241227439

  Abstract

  Tibial tubercle osteotomy (TTO) can realign the patellofemoral joint and reduce patellofemoral contact stress. Anteriorization can reduce compressive patellofemoral loads and medialization shifts the pulling direction on the patella, thereby lowering the load on the lateral compartments.Patellofemoral instability, patellofemoral malalignment, and distal and lateral chondral defects.The Multi-Directional Tibial Tubercle Transfer System (MD3T) uses a generic 3-dimensional cutting template to create 2 compound wedges that are individually transposed and adjusted to achieve multiplanar correction. For isolated tibial tubercle anteriorization, the primary wedge is solely used and the proximal bone defect is filled with autograft taken from the distal part of the wedge and synthetic bone graft substitution. For tibial tubercle medialization, the primary and secondary wedges are transposed, filling each other's respective spaces. Through the transposition of the primary and secondary wedges, partial filling of the defect with the patient's own bone is achieved, reducing the bone defect. For combined anteromedialization, both of these techniques are merged.During walking fatigue test and chair rising test in a cadaveric simulated 42-day healing period, no loosening or cracking occurred. Clinical study results on this technique are pending.The MD3T system achieves with its wedge technique a precise and reproducible multiplanar correction in TTO.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.

  View details for DOI 10.1177/26350254241227439

  View details for PubMedID 40308522

  View details for PubMedCentralID PMC11752184

• Articular Cartilage Defects in the Athlete. Sports medicine and arthroscopy review Sherman, S. L., Farr, J. 2024; 32 (2): 59

  View details for DOI 10.1097/JSA.0000000000000409

  View details for PubMedID 38978198

• Patellofemoral Osteoarthritis, Should We Replace or Osteotomize? OPERATIVE TECHNIQUES IN SPORTS MEDICINE Bartsch, A., Oeding, J. F., Raji, Y., Vel, M., Pierre, K., Sherman, S. L. 2024; 32 (2)

  View details for DOI 10.1016/j.otsm.2024.151083

  View details for Web of Science ID 001260286100001

• Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study. The American journal of sports medicine Lin, K. M., Brinson, K., Atzmon, R., Chan, C. K., Sherman, S. L., Safran, M. R., Freehill, M. T. 2024: 3635465241236465

  Abstract

  Elbow ulnar collateral ligament (UCL) repair with suture brace augmentation shows good time-zero biomechanical strength and a more rapid return to play compared with UCL reconstruction. However, there are concerns about overconstraint or stress shielding with nonabsorbable suture tape. Recently, a collagen-based bioinductive absorbable structural scaffold has been approved by the Food and Drug Administration for augmentation of soft tissue repair.This study aimed to assess the initial biomechanical performance of UCL repair augmented with this scaffold. We hypothesized that adding the bioinductive absorbable structural scaffold to primary UCL repair would impart additional time-zero restraint to the valgus opening.Controlled laboratory study.Eight cadaveric elbow specimens-from midforearm to midhumerus-were utilized. In the native state, elbows underwent valgus stress testing at 30o, 60o, and 90o of flexion, with a cyclical valgus rotational torque. Changes in valgus rotation from 2- to 5-N·m torque were recorded as valgus gapping. Testing was then performed in 4 states: (1) native intact UCL-with dissection through skin, fascia, and muscle down to an intact UCL complex; (2) UCL-transected-distal transection of the ligament off the sublime tubercle; (3) augmented repair with bioinductive absorbable scaffold; and (4) repair alone without scaffold. The order of testing of repair states was alternated to account for possible plastic deformation during testing.The UCL-transected state showed the greatest increase in valgus gapping of all states at all flexion angles. Repair alone showed similar valgus gapping to that of the UCL-transected state at 30° (P = .62) and 60° of flexion (P = .11). Bioinductive absorbable scaffold-augmented repair showed less valgus gapping compared with repair alone at all flexion angles (P = .021, P = .024, and P = .024 at 30°, 60°, and 90°, respectively). Scaffold-augmented repair showed greater gapping compared with the native state at 30° (P = .021) and 90° (P = .039) but not at 60° of flexion (P = .059). There was no difference when testing augmented repair or repair alone first.UCL repair augmented with a bioinductive, biocomposite absorbable structural scaffold imparts additional biomechanical strength to UCL repair alone, without overconstraint beyond the native state. Further comparative studies are warranted.As augmented primary UCL repair becomes more commonly performed, use of an absorbable bioinductive scaffold may allow for improved time-zero mechanical strength, and thus more rapid rehabilitation, while avoiding long-term overconstraint or stress shielding.

  View details for DOI 10.1177/03635465241236465

  View details for PubMedID 38650304

• High Accuracy of Intra-articular Needle Position during Anterior Landmark Guided Glenohumeral Injections. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Bartels, D., Pullen, W. M., Curtis, D., Sherman, S. L., Abrams, G. D., Cheung, E. V., Freehill, M. T., Wang, T. 2024

  Abstract

  Image-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates, but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referral or equipment. An optimal technique would be safe, accurate, and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization.A consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. Time required to perform the injection, precise location of the needle-tip, and factors that affected accuracy of injection were also assessed.A standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery and location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by Sports Medicine and Shoulder/elbow fellowship trained orthopaedic surgeons was confirmed in 93.8% (76/81) of patients. Average time to complete the procedure was 24.8 seconds. There were no patient-related variables associated with non-intra-articular injection in the cohort.This study demonstrated a technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 seconds to perform. This method is safe, yields similar accuracy to image-guided procedures with improved cost-and time-efficiency, and less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.Level 5.

  View details for DOI 10.1016/j.jisako.2024.03.016

  View details for PubMedID 38574995

• An All-Suture-Based Technique for Meniscal Repair Is Cost-Effective in Comparison to Partial Meniscectomy for Horizontal Cleavage Tears. Arthroscopy, sports medicine, and rehabilitation Sherman, S. L., Askew, N., Nherera, L. M., Searle, R. J., Flanigan, D. C. 2024; 6 (2): 100847

  Abstract

  To determine the cost-effectiveness of meniscal repair (MR) using an all-suture-based technique when compared to partial meniscectomy (PM) for horizontal cleavage tears (HCTs) from a payor's perspective in the United States.A state-transition model and cost-utility analysis were developed from a US payor's perspective to project treatment costs and quality-adjusted life-years (QALYs) in a cohort of 35-year-old patients without osteoarthritis at baseline and presenting with either a lateral or medial HCT. Two outpatient costing perspectives were used, namely ambulatory surgical centers (ASCs) and hospitals. The state-transition model had 7 health states with transition probabilities, costs, and utilities obtained from the existing literature. Cost-effectiveness was assessed using a willingness-to-pay threshold of $100,000/QALY, and sensitivity analysis considered the effects of parameter uncertainty on model results. MR failure rates were focused on an all-suture-based technique; however, in a separate scenario, this study considered effectiveness data from various MR techniques and devices.MR dominated PM over a lifetime horizon, increasing QALYs by 0.43 per patient and decreasing the cost by $12,227 per patient within a hospital setting (and by $12,570 within an ASC). MR with an all-suture-based technique continued to be the dominant treatment when age at primary treatment was varied between 30 and 60 years. Sensitivity analysis showed that MR was not cost-effective in year 1, was cost-effective from year 2, and was cost-saving from year 6 onward from both ASC and hospital perspectives. Probabilistic sensitivity analysis found that MR was cost-effective over a lifetime horizon in 99% of 10,000 iterations on base-case analysis.Using a lifetime horizon, this study found that from a payor's perspective, MR is a cost-saving intervention when compared with PM in patients with an HCT.Level III, economic analysis.

  View details for DOI 10.1016/j.asmr.2023.100847

  View details for PubMedID 38379597

  View details for PubMedCentralID PMC10877196

• 3D CLUSTERING OF T2 MAPS IDENTIFIES FOCAL CARTILAGE CHANGES FROM 3-WEEKS TO 2-YEARS FOLLOWING ACL RECONSTRUCTION Pai, A. S., Gatti, A. A., Black, M., Young, K., Asay, J., Kogan, F., Sherman, S., Gold, G. E., Hargreaves, B., Chaudhari, A. ELSEVIER SCI LTD. 2024: S360-S361

  View details for Web of Science ID 001280544200514

• Letter to the editor regarding "Bipolar Lesions of the Knee Are Associated With Inferior Clinical Outcome Following Articular Cartilage Regeneration. A Propensity Score-Matched Analysis Including 238 Patients of the German Cartilage Registry (KnorpelRegister DGOU)". Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Danilkowicz, R., Cole, B., Sherman, S., Bugbee, W., Yanke, A. 2024

  View details for DOI 10.1016/j.arthro.2024.02.005

  View details for PubMedID 38342283

• Patellofemoral Imaging and Analysis OPERATIVE TECHNIQUES IN SPORTS MEDICINE Loughran, G. J., Rhodes, N. G., Vel, M., Sherman, S. L. 2024; 31 (4)

  View details for DOI 10.1016/j.otsm.2023.151030

  View details for Web of Science ID 001154881200001

• High Tibial Osteotomy in Knee Reconstruction and Joint Preservation. The Journal of the American Academy of Orthopaedic Surgeons Pullen, W. M., Slone, H., Abrams, G., Sherman, S. L. 2024

  Abstract

  High tibial osteotomy is a dynamic operation, used as an effective procedure in both joint preservation and knee stability. Applications and indications are expanding, with good results in the treatment of malalignment associated with arthrosis, knee instability, meniscus deficiency or transplants, and/or cartilage restoration. Appropriate patient selection and preoperative planning are critical to achieving good outcomes after surgery. Coronal and sagittal plane corrections made through the proximal tibia can effectively alter joint mechanics creating a more favorable environment for cartilage, meniscus, and ligamentous structures about the knee. Advancing techniques and technologies have allowed for more precise planning and execution of osteotomies.

  View details for DOI 10.5435/JAAOS-D-23-00323

  View details for PubMedID 38175969

• A modified Delphi consensus statement on patellar instability: part I. The bone & joint journal Hurley, E. T., Hughes, A. J., Savage-Elliott, I., Dejour, D., Campbell, K. A., Mulcahey, M. K., Wittstein, J. R., Jazrawi, L. M., Alaia, M. J., Arendt, E. A., Ayeni, O. R., Bassett, A. J., Bonner, K. F., Camp, C. L., Carter, C. W., Chahla, J., Ciccotti, M. G., Cosgarea, A. J., Edgar, C. M., Erickson, B. J., Espregueira-Mendes, J., Farr, J., Farrow, L. D., Frank, R. M., Freedman, K. B., Fulkerson, J. P., Getgood, A., Gomoll, A. H., Grant, J. A., Gursoy, S., Gwathmey, F. W., Haddad, F. S., Hiemstra, L. A., Hinckel, B. B., Koh, J. L., Krych, A. J., LaPrade, R. F., Li, Z. I., Logan, C. A., Gonzalez-Lomas, G., Mannino, B. J., Lind, M., Matache, B. A., Matzkin, E., McCarthy, T. F., Mandelbaum, B., Musahl, V., Neyret, P., Nuelle, C. W., Oussedik, S., Pace, J. L., Verdonk, P., Rodeo, S. A., Rowan, F. E., Salzler, M. J., Schottel, P. C., Shannon, F. J., Sheean, A. J., Sherman, S. L., Strickland, S. M., Tanaka, M. J., Waterman, B. R., Zacchilli, M., Zaffagnini, S. 2023; 105-B (12): 1259-1264

  Abstract

  The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach.A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous.Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus.The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed.

  View details for DOI 10.1302/0301-620X.105B12.BJJ-2023-0109.R1

  View details for PubMedID 38037678

• A modified Delphi consensus statement on patellar instability: part II. The bone & joint journal Hurley, E. T., Sherman, S. L., Chahla, J., Gursoy, S., Alaia, M. J., Tanaka, M. J., Pace, J. L., Jazrawi, L. M., Hughes, A. J., Arendt, E. A., Ayeni, O. R., Bassett, A. J., Bonner, K. F., Camp, C. L., Campbell, K. A., Carter, C. W., Ciccotti, M. G., Cosgarea, A. J., Dejour, D., Edgar, C. M., Erickson, B. J., Espregueira-Mendes, J., Farr, J., Farrow, L. D., Frank, R. M., Freedman, K. B., Fulkerson, J. P., Getgood, A., Gomoll, A. H., Grant, J. A., Gwathmey, F. W., Haddad, F. S., Hiemstra, L. A., Hinckel, B. B., Savage-Elliott, I., Koh, J. L., Krych, A. J., LaPrade, R. F., Li, Z. I., Logan, C. A., Gonzalez-Lomas, G., Mannino, B. J., Lind, M., Matache, B. A., Matzkin, E., Mandelbaum, B., McCarthy, T. F., Mulcahey, M., Musahl, V., Neyret, P., Nuelle, C. W., Oussedik, S., Verdonk, P., Rodeo, S. A., Rowan, F. E., Salzler, M. J., Schottel, P. C., Shannon, F. J., Sheean, A. J., Strickland, S. M., Waterman, B. R., Wittstein, J. R., Zacchilli, M., Zaffagnini, S. 2023; 105-B (12): 1265-1270

  Abstract

  The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process.This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous.Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus.Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport.

  View details for DOI 10.1302/0301-620X.105B12.BJJ-2023-0110.R1

  View details for PubMedID 38035602

• Editorial Commentary: Absent Extreme Bony Malalignment, Medial Patellofemoral Reconstruction Is a Sufficient Primary Surgery for Adolescents with Recurrent Patella Instability. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Sherman, S. L., Bartsch, A. 2023

  Abstract

  When planning an adolescent's primary surgery for recurrent patella instability, the surgeon must weigh the failure risk of performing medial patellofemoral reconstruction (MPFLR) versus the potential morbidity of adding a concomitant bony procedure, such as tibial tubercle osteotomy (TTO). In this age group, isolated MPFLR is an excellent operation with high clinical success, low failure rates, and favorable complication profile. Patients with high grade J-sign and severe trochlea dysplasia, apprehension into deep flexion, and extremes of bony malalignment, including elevated tibial tubercle-trochlear groove distance may benefit from "doing more" than MPFLR alone. Other factors to be considered include patella alta, generalized ligament laxity, femoral rotation, tibial torsion, and valgus malalignment. In challenging situations, such as syndromic patients (e.g., neuromuscular disorders), congenital (habitual) patella dislocation, fixed dislocations, and failed prior MPFL reconstruction, a combined surgical approach is likely needed. Patients who require "unloading" for symptomatic chondrosis also benefit from combined bony and soft tissue surgery. However, for the majority of patients with recurrent instability and no prior surgery, an isolated soft tissue reconstruction is a rational, safe, efficient, and evidence-based selection.

  View details for DOI 10.1016/j.arthro.2023.10.040

  View details for PubMedID 38219109

• Editorial Commentary: Evaluation of Patellofemoral Instability Is Complex and Multifactorial. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Sherman, S. L., Gudeman, A. 2023; 39 (11): 2352-2353

  Abstract

  The work-up of patellofemoral instability is complex and multifactorial. Patient factors (i.e., age, activity demand, goals/expectations), clinical presentation (pain, instability, or both), and physical examination (i.e., J-sign, apprehension into flexion), must be correlated with imaging findings (radiographs, magnetic resonance imaging, computed tomography) and anatomic risk factors, including patella alta, trochlear dysplasia, patellar tilt, lateralized force vector, valgus, femoral anteversion, and tibial torsion. Thus, developing a standard battery of reliable and reproducible radiographic measures of patellofemoral instability is a challenge. Imaging cut-offs provide insight into relative risk of recurrent instability. We still fall short in using imaging parameters to predict when to operate, what procedure(s) to perform, and how the patient might do. Future directions include the use of artificial intelligence and 3-dimensional measurements to help simplify a complex problem.

  View details for DOI 10.1016/j.arthro.2023.05.026

  View details for PubMedID 37866875

• Association of Hip Dysplasia With Trochlear Dysplasia in Skeletally Mature Patients. Orthopaedic journal of sports medicine Fithian, A. T., Richey, A. E., Sherman, S. L., Shea, K. G., Pun, S. Y. 2023; 11 (10): 23259671231200805

  Abstract

  Developmental dysplasia of the hip (DDH) and trochlear dysplasia (TD) are distinct pathologies with several important features in common. In addition to shared risk factors, both forms of dysplasia cause abnormal joint kinematics and force transmission, predisposing patients to pain, injuries to cartilage and soft tissue stabilizers, and ultimately arthritis.To evaluate for an association between hip dysplasia and TD in skeletally mature patients with symptomatic hip dysplasia.Cross-sectional study; Level of evidence, 3.A total of 48 patients with DDH who underwent periacetabular osteotomy were compared with 48 sex-matched patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) between July 2014 and February 2021. All patients were skeletally mature. The Tönnis angle and lateral center-edge angle were measured on preoperative pelvis radiographs. Femoral version, trochlear depth, lateral trochlear inclination (LTI), tibial tubercle-trochlear groove distance (TTTG-d), and posterior lateral condylar angle (PLCA) were measured on preoperative magnetic resonance imaging scans of the symptomatic hip and ipsilateral knee. Continuous variables were compared between the patient groups using 2-sample t tests. Interobserver reliability was measured using the intraclass correlation coefficient.Patients with DDH demonstrated a reduced trochlear depth compared with patients with FAI (3.6 vs 4.6 mm; P < .001). There were no differences between groups in femoral anteversion, LTI, TTTG-d, or PLCA. Two (4.2%) patients with FAI and 17 (35.4%) patients with DDH had a trochlear depth <3 mm (P < .001). One (2.1%) patient with FAI and 7 (14.6%) patients with DDH had an LTI <11° (P = .027). There was no difference between groups in frequency of a convex proximal trochlea, patient-reported ipsilateral knee pain, or ipsilateral knee procedures.Patients with DDH had reduced trochlear depth compared with patients with FAI, demonstrating a higher incidence of dysplastic trochlear features that may predispose patients to patellofemoral joint disease. Further research is needed to determine whether screening at-risk patients and treating TD will help to prevent symptomatic patellofemoral disease.

  View details for DOI 10.1177/23259671231200805

  View details for PubMedID 37822419

  View details for PubMedCentralID PMC10563471

• MRI of patellar stabilizers: Anatomic visibility, inter-reader reliability, and intra-reader reproducibility of primary and secondary ligament anatomy. Skeletal radiology Zandee van Rilland, E. D., Payne, S. R., Gorbachova, T., Shea, K. G., Sherman, S. L., Boutin, R. D. 2023

  Abstract

  To compare MRI features of medial and lateral patellar stabilizers in patients with and without patellar instability.Retrospective study of 196 patients (mean age, 33.1 ± 18.5 years; 119 women) after diagnosis of patellar instability (cohort-1, acute patellar dislocation; cohort-2, chronic patellar maltracking) or no patellar instability (cohort-3, acute ACL rupture; cohort-4, chronic medial meniscus tear). On MRI, four medial and four lateral stabilizers were evaluated for visibility and injury by three readers independently. Inter- and intra-reader agreement was determined.Medial and lateral patellofemoral ligaments (MPFL and LPFL) were mostly or fully visualized in all cases (100%). Of the secondary patellar stabilizers, the medial patellotibial ligament was mostly or fully visualized in 166 cases (84.7%). Other secondary stabilizers were mostly or fully visualized in only a minority of cases (range, 0.5-32.1%). Injury scores for all four medial stabilizers were higher in patients with acute patellar dislocation than the other 3 cohorts (p < .05). Visibility inter- and intra-reader agreement was good for medial stabilizers (κ 0.61-0.78) and moderate-to-good for lateral stabilizers (κ 0.40-0.72). Injury inter- and intra-reader agreement was moderate-to-excellent for medial stabilizers (κ 0.43-0.90) and poor-to-moderate for lateral stabilizers (κ 0-0.50).The MPFL and LPFL were well visualized on MRI while the secondary stabilizers were less frequently visualized. The secondary stabilizers were more frequently visualized medially than laterally, and patellotibial ligaments were more frequently visualized compared to the other secondary stabilizers. Injury to the medial stabilizers was more common with acute patellar dislocation than with chronic patellar maltracking or other knee injuries.

  View details for DOI 10.1007/s00256-023-04432-2

  View details for PubMedID 37704830

  View details for PubMedCentralID 7723147

• Medial Meniscal Allograft Transplantation: The Bone Plug Technique. Video journal of sports medicine Bartsch, A., Anderson, F. L., Neubauer, M., Vel, M. S., Sherman, S. L. 2023; 3 (5): 26350254231195090

  Abstract

  The medial and lateral menisci act as shock absorbers for the knee joint by converting and redistributing axial load into circumferential hoop stresses. Disruptions of these hoop stresses occur in the setting of meniscal deficiency and lead to long-term degenerative changes. Therefore, maintaining the distinctive composition and organization of the menisci is essential. In selective cases of meniscal deficiency, meniscus allograft transplantation can be a valuable treatment option.Meniscus transplantation should be considered in patients with symptomatic meniscal deficiency, without the presence of advanced degenerative pathologies, who have failed all conservative treatments.We can divide the surgery into 4 steps: (1) graft preparation, (2) arthroscopic joint preparation, (3) allograft attachment preparation, and (4) graft fixation.Meniscus allograft transplantation yields good to excellent results in up to 85% of cases. Improvement of pain and knee function occurs in approximately 70% of the patients at 10 years. The associated complications are mainly joint stiffness, early osteoarthritis, and incomplete healing accompanied by graft failure. Graft failure is the most feared complication, yet shows good results over the midterm.The bone plug technique we have shown here is a hybrid approach combining soft tissue and bone fixation techniques. It provides synergistic advantages with good osseous integration and is minimally invasive through arthroscopy without true arthrotomy. In our experience, this approach elegantly eases the complexity of this demanding surgery while yielding excellent results for patients.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.

  View details for DOI 10.1177/26350254231195090

  View details for PubMedID 40308437

  View details for PubMedCentralID PMC11962952

• Infra-patellar fat pad-derived mesenchymal stem cells maintain their chondrogenic differentiation potential after arthroscopic harvest with blood-product supplementation. International orthopaedics Neubauer, M., Otahal, A., Kuten, O., Sherman, S. L., Moser, L., Kramer, K., DeLuna, A., Neugebauer, J., Dammerer, D., Muellner, T., Nehrer, S. 2023

  Abstract

  PURPOSE: Mesenchymal stem cells/medicinal signaling cells (MSCs) possess therapeutic potential and are used in regenerative orthopaedics. The infra-patellar fat pad (IFP) is partially resected during knee arthroscopy (KASC) and contains MSCs. Heat, irrigation, and mechanical stress during KASC may decrease MSC's therapeutic potential. This study assessed MSCs' regenerative potential after arthroscopic IFP harvest and potential effects of two blood products (BP) (platelet-rich plasma (PRP), hyperacute serum (HAS)) on MSCs' viability and chondrogenic differentiation capacity.METHODS: IFP was arthroscopically harvested, isolated, and counted (n=5). Flow cytometry was used to assess cell viability via staining with annexin V/7-AAD and stemness markers via staining for CD90, CD73, and CD105. MSCs were incubated with blood products, and metabolic activity was determined via an XTT assay. Deposition of cartilage extracellular matrix was determined in histologic sections of chondrogenically differentiated 3D pellet cultures via staining with Alcian Blue. Expression of cartilage-specific genes (SOX9, MMP3/13, ACAN, COL1/2) was analyzed via quantitative PCR.RESULTS: MSC isolation from IFP yielded 2.66*106±1.49*106 viable cells from 2.7 (0.748) g of tissue. MSC markers (CD 90/105/73) were successfully detected and annexin V staining showed 81.5% viable cells. XTT showed increased metabolic activity. Within the BP groups, this increase was significant (days 0-14, p<0.05). PCR showed expression of cartilage-specific genes in each group. COL2 (p<0.01) as well as ACAN (p<0.001) expression levels were significantly higher in the HAS group. Histology showed successful differentiation.CONCLUSION: Arthroscopic harvest of IFP-MSCs yields sufficient cells with maintained regenerative potential and viability. Blood products further enhance MSCs' viability.

  View details for DOI 10.1007/s00264-023-05930-7

  View details for PubMedID 37646823

• The Principles of Knee Joint Preservation: Operative Treatment Strategies. The Journal of bone and joint surgery. American volume Kraeutler, M. J., McCulloch, P. C., Sherman, S. L., Vidal, A. F. 2023

  Abstract

  ➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.

  View details for DOI 10.2106/JBJS.23.00212

  View details for PubMedID 37616413

• Experts Achieve Consensus on a Majority of Statements Regarding Platelet-Rich Plasma Treatments for Treatment of Musculoskeletal Pathology. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Hurley, E. T., Sherman, S. L., Stokes, D. J., Rodeo, S. A., Shapiro, S. A., Mautner, K., Buford, D. A., Dragoo, J. L., Mandelbaum, B. R., Zaslav, K. R., Cole, B. J., Frank, R. M. 2023

  Abstract

  To establish consensus statements on platelet-rich plasma (PRP) for the treatment of musculoskeletal pathologies.A consensus process on the treatment of PRP using a modified Delphi technique was conducted. Thirty-five orthopaedic surgeons and sports medicine physicians participated in these consensus statements on PRP. The participants were composed of representatives of the Biologic Association, representing 9 international orthopaedic and musculoskeletal professional societies invited due to their active interest in the study of orthobiologics. Consensus was defined as achieving 80% to 89% agreement, strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement.There was consensus on 62% of statements about PRP.(1) PRP should be classified based on platelet count, leukocyte count, red blood count, activation method, and pure-plasma versus fibrin matrix; (2) PRP characteristics for reporting in research studies are platelet count, leukocyte count, neutrophil count, red blood cell count, total volume, the volume of injection, delivery method, and the number of injections; (3) the prognostic factors for those undergoing PRP injections are age, body mass index, severity/grade of pathology, chronicity of pathology, prior injections and response, primary diagnosis (primary vs postsurgery vs post-trauma vs psoriatic), comorbidities, and smoking; (4) regarding age and body mass index, there is no minimum or maximum, but clinical judgment should be used at extremes of either; (5) the ideal dose of PRP is undetermined; and (6) the minimal volume required is unclear and may depend on the pathology.Level V, expert opinion.

  View details for DOI 10.1016/j.arthro.2023.08.020

  View details for PubMedID 37625660

• Common Soft Tissue Injuries About the Knee in American Football. HSS journal : the musculoskeletal journal of Hospital for Special Surgery Lin, K. M., Atzmon, R., Pierre, K. J., Vel, M. S., Brinson, K., Sherman, S. L. 2023; 19 (3): 330-338

  View details for DOI 10.1177/15563316231165298

  View details for PubMedID 37435123

  View details for PubMedCentralID PMC10331270

• Bifocal Avulsion Fracture And Fixation Of The Patellar Tendon: A Case Report. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Atzmon, R., Iohanes, E., Dubin, J., Rosenthal, A., Drexler, M., Sherman, S. L. 2023

  Abstract

  Acute distal patella tendon avulsion from the tibial tubercle (TT) is a relatively rare injury that is usually described in the adolescents or elderly population in their 7 thor 8 thdecades. Bifocal avulsion fractures of the patella tendon from the tibial tubercle and the distal pole of the patella are exceptionally rare in adults. In this case report, we present a 52-year healthy old male who was treated for bifocal avulsion of the patellar tendon with open reduction and internal fixation augmented with two ULTRA-TAPES. To our knowledge, this is the first case report to describe this injury in a healthy middle-aged patient.

  View details for DOI 10.1016/j.jisako.2023.07.001

  View details for PubMedID 37487912

• Knee MRI: Meniscus Roots, Ramps, Repairs, and Repercussions. Radiographics : a review publication of the Radiological Society of North America, Inc Tomsan, H., Gorbachova, T., Fritz, R. C., Abrams, G. D., Sherman, S. L., Shea, K. G., Boutin, R. D. 2023; 43 (7): e220208

  Abstract

  Menisci play an essential role in maintaining normal pain-free function of the knee. While there are decades of MRI literature on the tears involving the meniscus body and horns, there is now a surge in knowledge regarding injuries at the meniscus roots and periphery. The authors briefly highlight new insights into meniscus anatomy and then summarize recent developments in the understanding of meniscus injuries that matter, emphasizing meniscus injuries at the root and peripheral (eg, ramp) regions that may be missed easily at MRI and arthroscopy. Root and ramp tears are important to diagnose because they may be amenable to repair. However, if these tears are left untreated, ongoing pain and accelerated cartilage degeneration may ensue. The posterior roots of the medial and lateral menisci are most commonly affected by injury, and each of these injuries is associated with distinctive clinical profiles, MRI findings, and tear patterns. Specific diagnostic pitfalls can make the roots challenging to evaluate, including MRI artifacts and anatomic variations. As with root tears, MRI interpretation and orthopedic treatment have important differences for injuries at the medial versus lateral meniscus (LM) periphery (located at or near the meniscocapsular junction). Medially, ramp lesions typically occur in the setting of an anterior cruciate ligament rupture and are generally classified into five patterns. Laterally, the meniscocapsular junction may be injured in association with tibial plateau fractures, but disruption of the popliteomeniscal fascicles may also result in a hypermobile LM. Updated knowledge of the meniscus root and ramp tears is crucial in optimizing diagnostic imaging before repair and understanding the clinical repercussions. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available in the Online Learning Center.

  View details for DOI 10.1148/rg.220208

  View details for PubMedID 37384542

• Screws or Sutures? A Pediatric Cadaveric Study of Tibial Spine Fracture Repairs. The American journal of sports medicine Johnstone, T. M., Baird, D. W., Cuellar-Montes, A., van Deursen, W. H., Tompkins, M., Ganley, T. J., Yen, Y. M., Ellis, H. B., Chan, C. K., Green, D. W., Sherman, S. L., Shea, K. G. 2023: 3635465231181059

  Abstract

  Tibial spine fractures are common in the pediatric population because of the biomechanical properties of children's subchondral epiphyseal bone. Most studies in porcine or adult human bone suggest that suture fixation performs better than screw fixation, but these tissues may be poor surrogates for pediatric bone. No previous study has evaluated fixation methods in human pediatric knees.To quantify the biomechanical properties of 2-screw and 2-suture repair of tibial spine fracture in human pediatric knees.Controlled laboratory study.Cadaveric specimens were randomly assigned to either 2-screw or 2-suture fixation. A standardized Meyers-Mckeever type 3 tibial spine fracture was induced. Screw-fixation fractures were reduced with two 4.0-mm cannulated screws and washers. Suture-fixation fractures were reduced by passing 2 No. 2 FiberWire sutures through the fracture fragment and the base of the anterior cruciate ligament. Sutures were secured through bony tunnels over a 1-cm tibial cortical bridge. Each specimen was mounted at 30° of flexion. A cyclic loading protocol was applied to each specimen, followed by a load-to-failure test. Outcome measures were ultimate failure load, stiffness, and fixation elongation.Twelve matched pediatric cadaveric knees were tested. Repair groups had identical mean (8.3 years) and median (8.5 years) ages and an identical number of samples of each laterality. Ultimate failure load did not significantly differ between screw (mean ± SD, 143.52 ± 41.9 7 N) and suture (135.35 ± 47.94 N) fixations (P = .760). Screws demonstrated increased stiffness and decreased elongation, although neither result was statistically significant at the .05 level (21.79 vs 13.83 N/mm and 5.02 vs 8.46 mm; P = .076 and P = .069, respectively).Screw fixation and suture fixation of tibial spine fractures in human pediatric tissue were biomechanically comparable.Suture fixations are not biomechanically superior to screw fixations in pediatric bone. Pediatric bone fails at lower loads, and in different modes, compared with adult cadaveric bone and porcine bone. Further investigation into optimal repair is warranted, including techniques that may reduce suture pullout and "cheese-wiring" through softer pediatric bone. This study provides new biomechanical data regarding the properties of different fixation types in pediatric tibial spine fractures to inform clinical management of these injuries.

  View details for DOI 10.1177/03635465231181059

  View details for PubMedID 37382335

• Biomechanical Forces of the Lateral Knee Joint Following Meniscectomy and Meniscus Transplantation in Pediatric Cadavers. The Journal of the American Academy of Orthopaedic Surgeons Gupta, A., Sanchez, M., Storaci, H. W., Rohde, M. S., Shea, K. G., Sherman, S. L. 2023

  Abstract

  Lateral meniscus transplantation successfully treats symptomatic meniscus deficiency in children. Although clinical outcomes are well-characterized, joint forces in meniscus-deficient and transplant states are unknown. The purpose of this study was to characterize contact area (CA) and contact pressures (CP) of transplanted lateral meniscus in pediatric cadavers. We hypothesize that (1) compared with the intact state, meniscectomy will decrease femorotibial CA and increase CP, and increase contact pressure (CP) and (2) compared with the meniscectomy state, meniscus transplantation will improve contact biomechanics toward the intact meniscus state.Pressure-mapping sensors were inserted underneath the lateral meniscus of eight cadaver knees aged 8 to 12 years. CA and CP on the lateral tibial plateau were measured in the intact, meniscectomy, and transplant states each at 0°, 30°, and 60° of knee flexion. Meniscus transplant was anchored with transosseous pull-out sutures and sutured to the joint capsule with vertical mattresses. The effects of meniscus states and flexion angle on CA and CP were measured by a two-way analysis of variance repeated measures model. One-way analysis of variance measured pairwise comparisons between meniscus states.Regarding CA, at 0°, no differences between the groups reached significance. Meniscectomy reduced CA at 30° (P = 0.043) and 60° (P = 0.001). Transplant and intact states were comparable at 30°. At 60°, transplant significantly increased CA (P = 0.04). Regarding contact pressure, the average pressure increased with meniscectomy at all angles of flexion (0° P = 0.025; 30° P = 0.021; 60° P = 0.016) and decreased with transplant relative to respective intact values. Peak pressure increased with meniscectomy at 30° (P = 0.009) and 60° (P = 0.041), but only reached intact comparable values at 60°. Pairwise comparisons support restoration of average CP with transplant, but not peak CP.Pediatric meniscus transplantation improves average CP and CA more than peak CP, but does not completely restore baseline biomechanics. Net improvements in contact biomechanics after transplant, relative to the meniscectomy state, support meniscus transplant.Descriptive laboratory study, Level III.

  View details for DOI 10.5435/JAAOS-D-22-00832

  View details for PubMedID 37285585

• Patellar Tracking: An Old Problem with New Insights. Radiographics : a review publication of the Radiological Society of North America, Inc Watts, R. E., Gorbachova, T., Fritz, R. C., Saad, S. S., Lutz, A. M., Kim, J., Chaudhari, A. S., Shea, K. G., Sherman, S. L., Boutin, R. D. 2023; 43 (6): e220177

  Abstract

  Patellofemoral pain and instability are common indications for imaging that are encountered in everyday practice. The authors comprehensively review key aspects of patellofemoral instability pertinent to radiologists that can be seen before the onset of osteoarthritis, highlighting the anatomy, clinical evaluation, diagnostic imaging, and treatment. Regarding the anatomy, the medial patellofemoral ligament (MPFL) is the primary static soft-tissue restraint to lateral patellar displacement and is commonly reconstructed surgically in patients with MPFL dysfunction and patellar instability. Osteoarticular abnormalities that predispose individuals to patellar instability include patellar malalignment, trochlear dysplasia, and tibial tubercle lateralization. Clinically, patients with patellar instability may be divided into two broad groups with imaging findings that sometimes overlap: patients with a history of overt patellar instability after a traumatic event (eg, dislocation, subluxation) and patients without such a history. In terms of imaging, radiography is generally the initial examination of choice, and MRI is the most common cross-sectional examination performed preoperatively. For all imaging techniques, there has been a proliferation of published radiologic measurement methods. The authors summarize the most common validated measurements for patellar malalignment, trochlear dysplasia, and tibial tubercle lateralization. Given that static imaging is inherently limited in the evaluation of patellar motion, dynamic imaging with US, CT, or MRI may be requested by some surgeons. The primary treatment strategy for patellofemoral pain is conservative. Surgical treatment options include MPFL reconstruction with or without osseous corrections such as trochleoplasty and tibial tubercle osteotomy. Postoperative complications evaluated at imaging include patellar fracture, graft failure, graft malposition, and medial patellar subluxation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

  View details for DOI 10.1148/rg.220177

  View details for PubMedID 37261964

• Survival analyses and their applications in orthopaedics. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Pruneski, J. A., Varady, N. H., Pareek, A., Gulotta, L. V., Pearle, A. D., Karlsson, J., Sherman, S. L., Chahla, J., Williams, R. J. 2023

  Abstract

  Survival analyses are a powerful statistical tool used to analyse data when the outcome of interest involves the time until an event. There is an array of models fit for this goal; however, there are subtle differences in assumptions, as well as a number of pitfalls, that can lead to biased results if researchers are unaware of the subtleties. As larger amounts of data become available, and more survival analyses are published every year, it is important that healthcare professionals understand how to evaluate these models and apply them into their practice. Therefore, the purpose of this study was to present an overview of survival analyses, including required assumptions and important pitfalls, as well as examples of their use within orthopaedic surgery.

  View details for DOI 10.1007/s00167-023-07371-6

  View details for PubMedID 36947234

• A scoping review of portable sensing for out-of-lab anterior cruciate ligament injury prevention and rehabilitation. NPJ digital medicine Tan, T., Gatti, A. A., Fan, B., Shea, K. G., Sherman, S. L., Uhlrich, S. D., Hicks, J. L., Delp, S. L., Shull, P. B., Chaudhari, A. S. 2023; 6 (1): 46

  Abstract

  Anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) surgery are common. Laboratory-based biomechanical assessment can evaluate ACL injury risk and rehabilitation progress after ACLR; however, lab-based measurements are expensive and inaccessible to most people. Portable sensors such as wearables and cameras can be deployed during sporting activities, in clinics, and in patient homes. Although many portable sensing approaches have demonstrated promising results during various assessments related to ACL injury, they have not yet been widely adopted as tools for out-of-lab assessment. The purpose of this review is to summarize research on out-of-lab portable sensing applied to ACL and ACLR and offer our perspectives on new opportunities for future research and development. We identified 49 original research articles on out-of-lab ACL-related assessment; the most common sensing modalities were inertial measurement units, depth cameras, and RGB cameras. The studies combined portable sensors with direct feature extraction, physics-based modeling, or machine learning to estimate a range of biomechanical parameters (e.g., knee kinematics and kinetics) during jump-landing tasks, cutting, squats, and gait. Many of the reviewed studies depict proof-of-concept methods for potential future clinical applications including ACL injury risk screening, injury prevention training, and rehabilitation assessment. By synthesizing these results, we describe important opportunities that exist for clinical validation of existing approaches, using sophisticated modeling techniques, standardization of data collection, and creation of large benchmark datasets. If successful, these advances will enable widespread use of portable-sensing approaches to identify ACL injury risk factors, mitigate high-risk movements prior to injury, and optimize rehabilitation paradigms.

  View details for DOI 10.1038/s41746-023-00782-2

  View details for PubMedID 36934194

• Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS reviews Goodell, P. B., Johansen, P. M., Bartels, D. W., Sherman, S. L., Amanatullah, D. F. 2023; 11 (3)

  Abstract

  Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) allow for compartment-specific intervention on an arthritic knee joint that preserves bone stock and native soft tissue compared to a total knee arthroplasty (TKA). Both operations give a more natural feeling with native proprioception compared with a TKA.HTO is better suited in patients who are younger (<55 years-of-age), have a body mass index (BMI) <30 kg/m2, high activity requirements, mechanical malalignment, asymmetric varus, isolated anterior cruciate ligament insufficiency, need for multiplanar correction, and a preference for joint preserving interventions. Recent data suggest that age (>55 years-of-age) should not solely contraindicate a HTO.UKA may be chosen in patients who are older (>55 years-of-age), low activity requirements, have a BMI <40 kg/m2, severe osteoarthritis with significant joint space narrowing, acceptable coronal alignment, symmetric varus, and patient preference for arthroplasty.

  View details for DOI 10.2106/JBJS.RVW.22.00127

  View details for PubMedID 36930742

• Aragonite-Based Scaffold Versus Microfractures and Debridement for the Treatment of Knee Chondral and Osteochondral Lesions: Results of a Multicenter Randomized Controlled Trial. The American journal of sports medicine Altschuler, N., Zaslav, K. R., Di Matteo, B., Sherman, S. L., Gomoll, A. H., Hacker, S. A., Verdonk, P., Dulic, O., Patrascu, J. M., Levy, A. S., Robinson, D., Kon, E. 2023: 3635465231151252

  Abstract

  Lesions of the articular cartilage, with or without involvement of the subchondral bone, are a common cause of pain and dysfunction in the knee. Although several treatment options have been developed, the majority of previous clinical trials examined patients with isolated or focal midsized defects, which rarely represent the condition found in the general population. Rather, cartilage lesions are often associated with the presence of mild to moderate osteoarthritic changes.The present multicenter randomized controlled trial compared the clinical and radiographic outcomes of an aragonite-based osteochondral implant with a control group (arthroscopic debridement/microfractures) in patients affected by joint surface lesions of the knee, including those with concurrent mild to moderate osteoarthritis.Randomized controlled trial; Level of evidence, 1.A total of 251 patients were enrolled in 26 medical centers according to the following criteria: age 21 to 75 years, up to 3 cartilage defects of International Cartilage Regeneration & Joint Preservation Society grade 3a or above located on the femoral condyles and/or trochlea, total treatable area from 1 to 7 cm2, bony defect depth ≤8 mm, and knee osteoarthritis grade 0 to 3 according to Kellgren-Lawrence score. Patients were randomized to the aragonite-based implant or debridement/microfracture control arm in a 2:1 ratio. Evaluation was performed at 6, 12, 18, and 24 months based on overall Knee injury and Osteoarthritis Outcome Score (KOOS) as the primary endpoint, and the KOOS subscales (Pain, Quality of Life, Activities of Daily Living), percentage of responders, and International Knee Documentation Committee (IKDC) subjective score as the secondary endpoints. Patients also underwent magnetic resonance imaging evaluation at 12 and 24 months to assess defect fill grade. Failures (ie, need for any secondary treatment) and adverse events were also recorded.The implant group showed a statistically superior outcome in the primary endpoint and all secondary endpoints at each follow-up. The magnitude of improvement in the implant group was twice as large as that in the control group in terms of mean KOOS improvement at 2 years. Responder rate (defined as at least a 30-point improvement in overall KOOS) was 77.8% in the implant group as opposed to 33.6% in the control (P < .0001). Statistically superior results were seen in the IKDC score as well. At 24 months, 88.5% of the implanted group had at least 75% defect fill on magnetic resonance imaging as compared with 30.9% of controls (P < .0001). The failure rate was 7.2% for the implant group versus 21.4% for control.This aragonite-based scaffold was safe and effective in the treatment of chondral and osteochondral lesions in the knee, including patients with mild to moderate osteoarthritis, and provided superior outcomes as compared with the control group.NCT03299959 (ClinicalTrials.gov identifier).

  View details for DOI 10.1177/03635465231151252

  View details for PubMedID 36779614

• Orthobiologic Techniques for Surgical Augmentation. Physical medicine and rehabilitation clinics of North America Lin, K. M., Frey, C. S., Atzmon, R., Pierre, K., Vel, M. S., Sherman, S. L. 2023; 34 (1): 265-274

  Abstract

  General awareness and clinical utilization of orthobiologic therapy has increased sharply in the recent years. Orthobiologics can be defined as "biological materials and substrates that promote bone, ligament, muscle, and tendon healing." There are 3 major strategies by which orthobiologics are thought to augment tissue repair or native biologic potential: factor-based, cell-based, and biomechanical augmentation. The purpose of this review is to synthesize the recent literature on orthobiologic techniques for surgical augmentation, with focus on several key areas including meniscus repair, osteochondral grafting, and rotator cuff repair.

  View details for DOI 10.1016/j.pmr.2022.08.015

  View details for PubMedID 36410886

• Medial Patellofemoral Ligament Reconstruction in Obese Patients Results in Low Complication Rates and Improved Subjective Outcomes. Arthroscopy, sports medicine, and rehabilitation Sherman, S. L., Rund, J. M., Welsh, J. W., Ray, T., Worley, J. R., Oladeji, L. O., Gray, A. D., Hinckel, B. B. 2023; 5 (1): e257-e262

  Abstract

  Purpose: To compare outcomes, activity scores, and complication rates of obese and non-obese patients undergoing medial patellofemoral ligament (MPFL) reconstruction.Methods: A retrospective review identified patients undergoing MPFL reconstruction for recurrent patellofemoral instability. Patients were included if they had undergone MPFL reconstruction and had follow-up for a minimum of 6 months. Patients were excluded if they underwent surgery less than 6 months earlier, had no outcome data recorded, or underwent concomitant bony procedures. Patients were divided into 2 groups based on body mass index (BMI): BMI of 30 or greater and BMI less than 30. Presurgical and postsurgical patient-reported outcomes including Knee Injury and Osteoarthritis Outcome Score (KOOS) domains and the Tegner score were collected. Complications requiring reoperation were recorded. P < .05 was defined as a statistically significant difference.Results: A total of 55 patients (57 knees) were included. There were 26 knees with a BMI of 30 or greater and 31 knees with a BMI less than 30. There were no differences in patient demographic characteristics between the 2 groups. Preoperatively, no significant differences were found in KOOS subscores or Tegner scores (P= .21) between groups. At minimum 6-month follow-up (range, 6.1-70.5 months), patients with a BMI of 30 or greater showed statistically significant improvements in the KOOS Pain, Activities of Daily Living, Symptoms, and Sport/Recreation subscores. Patients with a BMI less than 30 showed a statistically significant improvement in the KOOS Quality of Life subscore. The group with a BMI of 30 or greater had significantly lower KOOS Quality of Life (33.34 ± 19.10 vs 54.47 ± 28.00, P= .03) and Tegner (2.56 ± 1.59 vs 4.78 ± 2.68, P= .05) scores. Complication rates were low, with 2 knees (7.69%) requiring reoperation in the cohort with a BMI of 30 or greater and 4 knees (12.90%) requiring reoperation in the cohort with a BMI less than 30, including 1 reoperation for recurrent patellofemoral instability (P= .68).Conclusions: In this study, MPFL reconstruction in obese patients was safe and effective, with low complication rates and improvements in most patient-reported outcomes. Compared with patients with a BMI less than 30, obese patients had lower quality-of-life and activity scores at final follow-up.Level of Evidence: Level III, retrospective cohort study.

  View details for DOI 10.1016/j.asmr.2022.11.023

  View details for PubMedID 36866317

• Transtibial Repair of Lateral Meniscus Posterior Root Tears Improves Contact Biomechanics in Pediatric Cadavers. Arthroscopy, sports medicine, and rehabilitation Gupta, A., Sanchez, M., Storaci, H. W., Rohde, M. S., Sherman, S. L., Shea, K. G. 2022; 4 (6): e2011-e2018

  Abstract

  A paucity of data exists on the treatment of pediatric lateral meniscus root tears (LMPRTs). This study aims to characterize the biomechanics of the lateral knee joint in pediatric cadavers following LMPRT and root repair. Our hypotheses were: (1) compared with the intact state, LMPRT would be associated with decreased contact area; (2) compared with the intact state, LMPRT would be associated with increased contact pressures; and (3) compared with LMPRT, root repair would restore contact area and pressures toward intact meniscus values.Eight cadaver knees (ages 8-12 years) underwent contact area and pressure testing of the lateral compartment. Tekscan pressure mapping sensors covering the tibial plateau were inserted underneath the lateral meniscus. Appropriate pressure load equivalents were applied by a robot at degrees of flexion: 0, 30, 60. Three meniscus conditions were tested: (1) intact, (2) complete root tear, and (3) repaired root tear. Root repairs were performed with transtibial pullout sutures. Statistical analysis was performed.Root tear significantly decreased mean contact area at 30° (P = .0279) and 60° (P = .0397). Root repair increased mean contact area and did not significantly differ from intact states. Differences in contact pressures between meniscus states were not statistically significant. Relative to the intact state. the greatest increase in contact pressures occurred between 0° and 30°. Root repair decreased mean contact pressures at 0° and 30°. At 60°, mean contact pressures of the repair state were closer in magnitude to the tear state than the intact state. Conclusions: LMPRT decreases contact area and increases contact pressures in the lateral knee compartment. Repair of LMPRT improves tibiofemoral contact area at high (>30°) degrees of flexion and contact pressures at low (<30°) degrees of flexion.Transosseous pullout repair is a clinically validated treatment for LMPRT. This study provides baseline biomechanics data of transtibial pullout repair of pediatric LMPRTs.

  View details for DOI 10.1016/j.asmr.2022.08.010

  View details for PubMedID 36579044

  View details for PubMedCentralID PMC9791837

• Decreased Upward Vertical Movement for Fastballs After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers. Arthroscopy, sports medicine, and rehabilitation Gray, A. D., Platt, B., R Worley, J., Sherman, S. L., Leary, E. 2022; 4 (5): e1693-e1701

  Abstract

  Purpose: To analyze the velocity and movement of the 4-seam fastball, curve, and slider thrown before and after ulnar collateral ligament reconstruction (UCLR) in Major League Baseball pitchers using PITCHf/x data.Methods: Velocity and movement data of the 4-seam fastball, curve, and slider were collected for 3 time frames (12-24 months before the date of UCLR as an uninjured baseline, 12-24 months after the date of UCLR, and 24-36 months after the date of UCLR). Pitchers were separated into 3 age groups (<26, 26 to 31, and >31 years). A paired t-test for means was used to assess mean differences between 2 time periods and a generalized linear model, with time-dependent covariance structure and age group as a covariate, was used to determine differences across time. All analyses were performed using SAS, version 9.4.Results: Vertical movement of the 4-seam fastball decreased in the 24 to 36 months' postoperative time frame, compared with 12 to 24 months' preoperatively (9.46 to 9.14 inches, P= .032). Movement decreases in the 4-seam fastball were not age-related. Velocity did not significantly change for any pitch and movement did not change for the slider or curve pitches.Conclusions: Following UCLR, Major League Baseball pitchers experienced no changes in horizontal or vertical movement or velocity of the curve or slider in either time frame. Decreased upward vertical movement of the fastball occurred after UCLR at final follow-up, but no change was observed in velocity. Similar trends in pitch movement and velocity effects were observed regardless of age.Level of Evidence: IV, case series.

  View details for DOI 10.1016/j.asmr.2022.06.016

  View details for PubMedID 36312711

• Quadriceps Tendon Lengthening for Obligatory (Habitual) Patellar Dislocation in Flexion. Arthroscopy techniques Hinckel, B. B., Baumann, C. A., Arendt, E. A., Gobbi, R. G., Garrone, A. J., Voss, E., Fithian, D., Khan, N., Sherman, S. L. 2022; 11 (9): e1589-e1595

  Abstract

  Obligatory patella dislocation in flexion is an uncommon form of patellar instability, where the patella is located in extension and dislocates with every episode of knee flexion. This results in dramatically altered patellofemoral kinematics and can be extremely debilitating due to extensor strength deficits and lack of knee confidence in flexion. Concomitant pathology, which is often seen, includes a tight lateral retinaculum and a shortened extensor mechanism. Lengthening the extensor mechanism is a critical part of successful patellar stabilization, and has not been well-reported. Herein, we present a technique of quadriceps lengthening for the treatment of obligatory patellar dislocation.

  View details for DOI 10.1016/j.eats.2022.05.003

  View details for PubMedID 36185121

• Return to Sport Soccer after Anterior Cruciate Ligament Reconstruction: ISAKOS Consensus. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Figueroa, D., Arce, G., Joao Espregueira, M., Maestu, R., Mosquera, M., Williams, A., Parker, D., Cohen, M., Karahan, M., Ochoa Perea, G. A., Zaffagnini, S., Neyret, P., Karlsson, J., Musahl, V., Radice, F., van der Merwe, W. M., Landreau, P., Imhoff, A., Menetrey, J., Ayeni, O. R., Arliani, G. G., Sherman, S. L., Monllau, J. C., D'Hooghe, P., Pinczewski, L., Feller, J., Patnaik, S. 2022

  Abstract

  INTRODUCTION: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects, plays an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer - one of the most demanding level I pivoting sports after ACL reconstruction.METHODS: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree, and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement.RESULTS: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the ROM deficit, the previous high level of participation in sports, and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus.During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness, and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus.CONCLUSIONS: - The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.

  View details for DOI 10.1016/j.jisako.2022.08.004

  View details for PubMedID 35998884

• Distance to the Neurovascular Bundle for Iliotibial Band Graft Passage During Anterior Cruciate Ligament Reconstruction: A Pediatric Cadaveric Study. Orthopaedic journal of sports medicine Thomas, N. D., Ayala, S., Rohde, M., Gupta, A., Sanchez, M., Ellis, H., Tompkins, M., Wilson, P., Sherman, S., Green, D., Ganley, T. J., VandenBerg, C., Yen, Y., Shea, K. G. 2022; 10 (8): 23259671221113832

  Abstract

  Background: The Micheli technique for anterior cruciate ligament (ACL) reconstruction (ACLR) has proven to be a reliable method with a minimal risk for growth disturbance among skeletally immature patients.Purposes: To evaluate the Micheli technique of iliotibial band (ITB) graft passage for ACLR using cadaveric knee models and to measure the distance between the surgical instrument tip and the neurovascular bundle in the posterior knee joint: specifically, the peroneal nerve, tibial nerve, and popliteal artery.Study Design: Descriptive laboratory study.Methods: Gross dissection was performed on 17 pediatric cadaveric knees (12 male and 5 female) aged between 4 and 12 years. To simulate ITB graft passage, we passed a curved-tip hemostat clamp through the posterior capsule, with the knee flexed from 90° to 100°. Next, clinical photographs were taken, and digital imaging software was used to measure the distance in centimeters from the clamp tip to each respective neurovascular structure.Results: The mean distances from the clamp tip to the tibial nerve, popliteal artery, and peroneal nerve were 0.875 cm (range, 0.468-1.737 cm), 0.968 cm (range, 0.312-1.819 cm), and 1.149 cm (range, 0.202-2.409 cm), respectively. Mean values were further calculated for age groups of ≤8, 9-10, and 11-12 years. The mean distance from the clamp tip to the peroneal nerve was 1.400 cm larger for 11- to 12-year-old specimens than for ≤8-year-old specimens (95% CI, 0.6-2.2 cm; P = .005).Conclusion: The neurovascular structures in the posterior knee were in close proximity to the path of graft passage, with distances <1 cm in many specimens in this study. When passing the graft through the knee for an over-the-top position, surgeons should consider these small distances between the path of graft passage and critical neurovascular structures.Clinical Relevance: As the incidence of ACL tears is continuously increasing within the pediatric population, there are a larger number of ACLR procedures being performed. Although neurovascular injuries during ACLR are rare, this study clarifies the close proximity of neurovascular structures during ITB graft passage using the Micheli technique of ACLR.

  View details for DOI 10.1177/23259671221113832

  View details for PubMedID 35990874

• Increased Risk of ACL Injury for Female but Not Male Soccer Players on Artificial Turf Versus Natural Grass: A Systematic Review and Meta-Analysis. Orthopaedic journal of sports medicine Xiao, M., Lemos, J. L., Hwang, C. E., Sherman, S. L., Safran, M. R., Abrams, G. D. 2022; 10 (8): 23259671221114353

  Abstract

  Background: Both natural grass (NG) and artificial turf (AT) are popular playing surfaces for soccer. Biomechanical studies have found increased frictional forces on AT that may lead to anterior cruciate ligament (ACL) injury. The increased risk of ACL injury during soccer in female participants may amplify this effect.Purpose: To systematically review the literature for studies comparing ACL injury risk in soccer players on AT versus NG and to specifically determine whether there were differences in injury risk in male versus female players when considering the playing surface.Study Design: Systematic review; Level of evidence, 3.Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases were searched for studies with evidence level 1 to 3 that compared the incidence of ACL injuries on AT versus NG in soccer players. Data recorded included study characteristics, sex, competition level, exposure setting (games or practices), turf type, and ACL injury information. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS) score, and incidence rate ratios (IRRs) were calculated.Results: Included were 7 articles (3 studying professional soccer, 3 collegiate soccer, 1 youth-level soccer; 4 male cohorts, 2 female cohorts, and 1 male and female cohort; mean MINORS score, 20 ± 0.8). Pooled ACL injury IRRs demonstrated no significant differences in overall ACL injury risk when playing soccer on AT compared with NG (IRR = 0.57 [95% CI, 0.21-1.53]; P = .31). A significantly increased risk of ACL injury in games played on AT compared with NG was detected for female (IRR = 1.18 [95% CI, 1.05-1.31]; P = .004) but not for male players (IRR = 1.18 [95% CI, 0.97-1.42]; P = .09). Subgroup analyses showed no significant differences in injury risk for games (IRR = 1.07 [95% CI, 0.97-1.18]; P = .20) or practices (IRR = 0.21 [95% CI, 0.04-1.23]; P = .09).Conclusion: Findings indicated that female soccer players had a significantly higher risk of ACL injury when playing games on AT versus NG, whereas no significant difference was seen in male players. No differences were found for the combined male/female cohort or for soccer games or training sessions played on AT compared with NG.

  View details for DOI 10.1177/23259671221114353

  View details for PubMedID 35990873

• An Initial Injection and a Crossover Injection of Amniotic Suspension Allograft Following Failed Treatment with Hyaluronic Acid or Saline Are Equally Effective in the Treatment of Moderate Symptomatic Knee Osteoarthritis Over 12 Months. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Gomoll, A. H., Mandelbaum, B. R., Farr, J., Archambault, W. T., Sherman, S. L., Tabet, S. K., Kimmerling, K. A., Mowry, K. C. 2022

  Abstract

  PURPOSE: The purpose of this crossover study was to determine the efficacy of amniotic suspension allograft (ASA) for moderate symptomatic knee OA following failed treatment with hyaluronic acid (HA) or saline through 12 months post crossover injection using patient-reported and safety outcomes.METHODS: In this multicenter study, 95 patients from a 200-patient single-blind randomized controlled trial were eligible to crossover and receive a single injection of ASA 3 months after failed treatment with HA or saline. Patient-reported outcomes, including Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analog Scale (VAS), were collected out to 12 months post-crossover to determine pain and function. Radiographs and blood were collected for assessment of changes. Statistical analyses were performed using Mixed Effects Model for Repeated Measures (MMRM).RESULTS: Treatment with ASA following failed treatment with HA or saline resulted in significant improvements in KOOS and VAS scores compared to crossover baseline. There were no differences in radiographic measures or anti-human leukocyte antigen (anti-HLA) serum levels compared to baseline and no severe adverse events reported. Additionally, over 55% of patients were responders at months 3, 6, and 12 as measured by the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) simplified responder criteria. There were no significant differences between the original ASA randomized group and crossover cohorts at any of the time points evaluated, suggesting that prior failed treatment with HA or saline did not significantly impact outcomes following treatment with ASA.CONCLUSIONS: This study showed that patients who previously failed treatment with HA or saline had statistically significant improvements in pain and function scores following a crossover injection of ASA that was sustained for 12 months, as measured by KOOS and VAS. There were no serious adverse events reported, and the injection was safe.

  View details for DOI 10.1016/j.arthro.2022.06.036

  View details for PubMedID 35840067

• Prospective Randomized Controlled Clinical Trial Comparing Hyperosmolar Saline to Standard Isotonic Irrigation Fluid for Arthroscopic Knee Surgery: Initial Clinical Outcomes. The journal of knee surgery Oladeji, L. O., Stannard, J. P., Smith, M. J., Ma, R., Skelley, N. W., Sherman, S. L., Cook, J. L. 2022

  Abstract

  Numerous in vitro studies suggest higher osmolarity irrigation fluids potentiate a chondroprotective environment, and a recent clinical study using hyperosmolar saline for shoulder arthroscopy reported potential clinical advantages. This prospective randomized double-blind controlled clinical trial was designed to assess initial clinical outcomes associated with use of a hyperosmolar irrigation solution in patients undergoing arthroscopic knee surgery. With institutional review board approval and informed consent, patients scheduled for arthroscopic knee surgery were randomized to surgery with either isotonic lactated Ringer's (273 mOsm/L) or hyperosmolar saline (593 mOsm/L) irrigation solution. Outcomes included perioperative blood pressure, knee girth, visual analogue scale (VAS) pain scores, and narcotic pain medication consumption. Forty-six patients underwent arthroscopic knee surgery with isotonic (n=23) or hyperosmolar (n=23) irrigation fluids. There were 11 males and 12 females (mean age=44.0 years) in the isotonic cohort and 8 males and 15 females (mean age=40.2 years) in the hyperosmolar cohort. There were no significant differences with respect to surgical duration (pump time) or amount of irrigation fluid used between the two cohorts. There were no significant differences with respect to change in knee girth, blood pressure, or VAS pain scores. However, patients treated with hyperosmolar saline consumed less narcotic medication on postoperative day 3 (4.0±7.6 vs. 15.5±17.4mg, p=0.01). The results of this randomized clinical trial suggest that a hyperosmolar irrigation solution is safe and relatively inexpensive for use in patients undergoing arthroscopic knee surgery and contributes to a reduction in initial postoperative narcotic pain medication consumption. A hyperosmolar saline irrigation fluid was not associated with any detrimental effects on the execution of the surgical procedure, postoperative pain, or periarticular fluid extravasation. Taken together with previous basic science, translational, and clinical studies, hyperosmolar saline irrigation fluid is promising alternative to traditional isotonic irrigation fluids for knee arthroscopy. This study is a prospective trial and reflects level of evidence I.

  View details for DOI 10.1055/s-0042-1749655

  View details for PubMedID 35688444

• Author Reply to "Regarding 'No Difference in Complication Rates or Patient-Reported Outcomes Between Bone-Patellar Tendon-Bone and Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction"'. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Hogan, D. W., Burch, M. B., Rund, J. M., Geeslin, D. W., Ma, R., Gray, A. F., Chu, C. R., Ray, T. E., Pullen, W. M., Sherman, S. L. 2022; 38 (6): 1761-1763

  View details for DOI 10.1016/j.arthro.2022.03.036

  View details for PubMedID 35660173

• Limited Biomechanical Evidence Behind Single Row Versus Double Row Repair of Subscapularis Tears: ASystematic Review. Arthroscopy, sports medicine, and rehabilitation Xiao, M., Cohen, S. A., Cheung, E. V., Sherman, S. L., Abrams, G. D., Freehill, M. T. 2022; 4 (3): e1193-e1201

  Abstract

  Purpose: To systematically review the literature for studies investigating the biomechanical properties of constructs used to repair isolated subscapularis tears in time zero human cadaveric studies.Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three electronic databases were searched for studies that reported on the construct technique and biomechanical outcomes for the repair of isolated subscapularis tears in human cadaveric specimens. Ultimate load, gap formation, stiffness, and failure mode were documented. Methodological quality was assessed using the Quality Appraisal for Cadaveric Studies (QUACS) scale.Results: Six articles qualified (104 shoulders [72 single-row, 26 double-row, 6 transosseous]; mean QUACS score 10.5 ± 1) and were analyzed. Studies varied in the number and type of anchors and construct technique (1-2 anchors single-row; 3-4 anchors double-row; bioabsorbable or titanium anchors) and suture(s) used (no. 2 FiberWire or FiberTape), subscapularis tear type (25%, 33%, 50%, or 100% tear), and whether a knotless or knotted fixation was used. In studies that created full-thickness, upper subscapularis tears (Fox-Romeo II/III or Lafosse II), no significant differences were seen in ultimate load, gap formation, and stiffness for knotted versus knotless single-row repair (2 studies) and single-row versus double-row repair (1 study). Double-row repair of complete subscapularis tears demonstrated higher ultimate load, stiffness, and lower gap formation in 1 study. Ultimate load differed between the studies and constructs (single-row: range, 244 N to 678 N; double-row: range 332 N to 508 N, transosseous: 453 N). Suture cutout was the most common mode of failure (59%).Conclusion: Because of the limited number of studies and varying study designs in examining the biomechanical properties of repair constructs used for subscapularis tears, there is inconclusive evidence to determine which construct type is superior for repairing subscapularis tears.Clinical Relevance: Results from biomechanical studies of clinically relevant subscapularis repair constructs are important to guide decision-making for choosing the optimal construct for patients with subscapularis tears.

  View details for DOI 10.1016/j.asmr.2022.01.009

  View details for PubMedID 35747639

• Ulnar Collateral Ligament Reconstruction Does Not Decrease Spin Rate or Performance in Major League Pitchers. The American journal of sports medicine Cinque, M. E., LaPrade, C. M., Abrams, G. D., Sherman, S. L., Safran, M. R., Freehill, M. T. 2022: 3635465221097421

  Abstract

  Ulnar collateral ligament reconstruction (UCLR) is commonly performed in Major League Baseball (MLB) pitchers, with variable reported effects on velocity and traditional rate statistics. Currently, no studies have evaluated spin rate in the context of return to play (RTP) after injury. Greater spin rate has become increasingly sought after in the baseball community, as it is believed to be a vital aspect of pitch effectiveness.The purpose was to evaluate the effect of primary UCLR on fastballs (FB) and sliders (SL) of MLB pitchers in terms of spin rate, velocity, hard-hit rate, and whiff rate. It hypothesized that the post-UCLR FB and SL spin rates, velocity, and whiff rate would be significantly decreased versus their pre-UCLR levels, while the FB and SL hard-hit rates would be higher in comparison with pre-UCLR levels.Case series; Level of evidence, 4.In total, 42 pitchers who underwent UCLR and returned to MLB play were identified from public records from 2016 to 2019. The Statcast system was used to collect spin rate, velocity, hard-hit rate, and whiff rate for 4-seam FB (4FB), 2-seam FB (2FB), and SL for pitchers in the preinjury year as well as the 2 years after return from UCLR. Data were analyzed using the appropriate statistical tests.A total of 36 pitchers met the inclusion criteria, and 31 of the eligible 36 players (86.1%) were able to return to MLB pitching (RTP). There were no significant decreases for 4FB, 2FB, or SL in spin rate, measured in revolutions per minute (rpm), when comparing preinjury levels with the first and second seasons after return. There was a significant decrease in velocity for the 2FB in the first season (92.9 vs 93.7 miles per hour [mph]; P = .045) but not the second season (93 mph; P = .629) after RTP in comparison with pre-UCLR levels. For the 2FB, there was a significant increase in spin rate between preinjury and RTP season 2 (2173.5 vs 2253 rpm; P = .022). For the SL, there was a significant increase in spin rate between preinjury and RTP season 2 (2245.1 vs 2406 rpm; P = .016).A cohort of MLB pitchers who underwent UCLR and returned to the MLB level demonstrated no significant decreases in the spin rate, velocity, whiff rate, or hard-hit rate of 4FB, 2FB, or SL at 2 years after UCLR.

  View details for DOI 10.1177/03635465221097421

  View details for PubMedID 35616521

• Many Radiographic and Magnetic Resonance Imaging Assessments for Surgical Decision Making in Pediatric Patellofemoral Instability Patients Demonstrate Poor Interrater Reliability. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Fabricant, P. D., Heath, M. R., Mintz, D. N., Emery, K., Veerkamp, M., Gruber, S., Green, D. W., Strickland, S. M., Wall, E. J., JUPITER Study Group, Shubin Stein, B. E., Parikh, S. N., Brady, J. M., Chambers, C. C., Ellis, H. B., Farr, J., Heyworth, B. E., Koh, J. L., Kramer, D. E., Magnussen, R. A., Redler, L. H., Sherman, S. L., Tompkins, M. A., Wilson, P. L. 2022

  Abstract

  PURPOSE: The purpose of this study was to evaluate the interrater reliability of several common radiologic parameters used for patellofemoral instability, and to attempt to improve reliability for measurements demonstrating unacceptable interrater reliability through consensus training.METHODS: Fifty patients with patellar instability between the ages of 10 and 19 were selected from a prospectively enrolled cohort. For measurements demonstrating unacceptable interrater reliability (ICC<0.6), raters discussed consensus methods to improve reliability and reexamined a subset of 20 images from the previous set of images. If reliability was still low after the second round of assessment, the measure was considered unreliable.RESULTS: Of the 50 included subjects, 22 (44%) were male and the mean age at the time of imaging was 14±2 years. With one or fewer consensus training sessions, the interrater reliability of the following xray indices were found to be reliable: trochlea crossing sign (ICC:0.625), congruence angle (ICC:0.768), Caton-Deshamps index (ICC:0.644), lateral patellofemoral angle (ICC:0.768), and mechanical axis deviation on hip-to-ankle alignment radiographs (ICC:0.665-0.777). Reliable MRI indices were: trochlear depth (ICC:0.743), trochlear bump (ICC:0.861), sulcus angle (ICC:0.684), patellar tilt (ICC:0.841), TT-TG (ICC:0.706), effusion (ICC:0.866), and bone marrow edema (ICC:0.961).CONCLUSIONS: With one or fewer consensus training sessions, the interrater reliability of the following patellofemoral indices were found to be reliable for trochlear morphology: trochlea crossing sign and congruence angle on XR and trochlear depth, trochlear bump, and sulcus angle on MRI. Reliable patellar position measurements included: Caton-Deshamps index and lateral patellofemoral angle on XR and patellar tilt and TT-TG on MRI. Additional global measurements and MRI assessments demonstrated acceptable reliability.LEVEL OF EVIDENCE: 2, Prospective Diagnostic Study.

  View details for DOI 10.1016/j.arthro.2022.03.033

  View details for PubMedID 35398485

• Patient-Specific Risk Factors Exist for Hip Fractures After Arthroscopic Femoroacetabular Impingement Surgery, But Not for Dislocation-An Analysis of More Than 25,000 Hip Arthroscopies. Arthroscopy, sports medicine, and rehabilitation Varshneya, K., Abrams, G. D., Sherman, S. L., Safran, M. R. 2022; 4 (2): e519-e525

  Abstract

  To identify postoperative complications and risk factors associated with hip fracture and dislocation following primary arthroscopic surgical management of femoroacetabular impingement (FAI) syndrome.MarketScan was queried to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: acetabuloplasty only or femoroplasty only. A subanalysis of combined acetabuloplasty and femoroplasty also was undertaken. Surgical outcomes were followed postoperatively for 180 days. Multivariate logistic regression was used to control for with an alpha value of 0.05 set as significant.This study identified 13,809 patients (mean age, 36.3 years) who underwent primary acetabuloplasty or femoroplasty. We also identified 10,026 patients who underwent both procedures. Postoperative complication rates were similar between the cohorts (acetabuloplasty 17.1%, femoroplasty 19.9%, P = .0622). Rates of hip fracture (femoroplasty: 2.4% vs acetabuloplasty: 2.0%, P = .0302) and heterotopic ossification (femoroplasty: 11.3% vs acetabuloplasty: 8.8%, P < .0001) were greater in the femoroplasty-only cohort. Combined acetabuloplasty and femoroplasty was associated with the greatest complication burden of 21.6% (P < .0001). After multivariate regression, differences in age, sex, comorbid status, or procedure type did not influence odds in risk for postoperative hip dislocation. Adjusted data showed that neither femoroplasty nor acetabuloplasty influenced odds of hip fracture (P > .05). Patients who were aged younger than 20 years old were significantly less likely to fracture their hips postoperatively than patients aged 60+ years (odds ratio 0.3, 95% confidence interval 0.1-0.8). Hypertension was independently associated with increased odds of hip fracture (odds ratio 1.7, 95% confidence interval 1.2-3.5).Older age, male sex, and hypertension all carry increased risk for a hip fracture following acetabuloplasty or femoroplasty. Patient- and procedure-specific factors that could be assessed with this database did not influence risk for hip dislocation.Level III; retrospective comparative observation trial.

  View details for DOI 10.1016/j.asmr.2021.11.011

  View details for PubMedID 35494300

  View details for PubMedCentralID PMC9042775

• No Difference in Complication Rates or Patient-Reported Outcomes Between Bone-Patella Tendon-Bone and Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction. Arthroscopy, sports medicine, and rehabilitation Hogan, D. W., Burch, M. B., Rund, J. M., Geeslin, D. W., Ma, R., Gray, A. F., Chu, C. R., Ray, T. E., Pullen, W. M., Sherman, S. L. 2022; 4 (2): e417-e424

  Abstract

  Purpose: To compare subjective outcomes and complications of anterior cruciate ligament reconstruction (ACLR) using either bone-patellar tendon-bone (BPTB) or quadriceps tendon (QT) autograft.Methods: A retrospective analysis of prospectively collected data identified consecutive cohorts of patients undergoing ACLR with either BPTB or QT autograft. Patients with less than 12-month follow-up and those undergoing concomitant osteotomies, cartilage restoration, and/or other ligament reconstruction procedures were excluded. Pre- and postsurgical patient-reported outcomes including International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, Tegner, and Marx were compared between groups. Complications requiring reoperation were recorded.Results: One hundred nineteen patients met inclusion criteria, including 39 QT autografts and 80 BPTB autografts. Demographic information was comparable between groups. Mean follow-up was comparable between groups (QT 22.4 ± 10.6 months vs BPTB 28.5 ± 18.5 months, P= .06). At minimum 12-month follow-up (range 12.0-100.8 months), patients in both groups demonstrated statistically significant improvements in International Knee Documentation Committee (QT 60.0%, P < .0001; BPTB 57.7%, P < .0001), all Knee Injury and Osteoarthritis Outcome Score domains, PROMIS Mobility T-Score (QT 27.2%, P= .0001; BPTB 23.2%, P < .0001), PROMIS Global Physical Health (QT 14.4%, P= .002; BPTB 13.4%, P= .001), PROMIS Physical Function (QT 29.6%, P < .0001; BPTB 37.1%, P < .0001), PROMIS Pain Interference (QT -16.5%, P < .0001; BPTB -20.8%, P < .0001), Single Assessment Numeric Evaluation, (QT 76.9%, P<.0001; BPTB 73.3%, P < .0001), Tegner (QT 92.9%, P= .0002; BPTB 101.4%, P < .0001), and Marx (QT -26.6%, P= .02; BPTB -32.0%, P= .0002) with no statistically significant differences between the 2 groups. Overall postoperative reoperation rate did not differ between groups (QT 12.8% vs BPTB 23.8%, P= .2). Revision ACL reconstruction rate did not differ between groups (QT 5.1% vs BPTB 7.5%, P= .6).Conclusions: Patients undergoing autograft ACLR with either BPTB or QT demonstrated significant subjective improvements in patient-reported outcomes from preoperative values and no statistically significant differences in outcomes between the groups. Complication and revision ACLR rates were similar between the 2 groups.Level of Evidence: III, retrospective cohort study.

  View details for DOI 10.1016/j.asmr.2021.10.019

  View details for PubMedID 35494262

• Revision Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers: Effects of Fastball Velocity and Usage. Journal of shoulder and elbow surgery LaPrade, C. M., Cinque, M. E., Chona, D. V., Sciascia, A. D., Abrams, G. D., Sherman, S. L., Safran, M. R., Freehill, M. T. 2022

  Abstract

  Ulnar collateral ligament (UCL) tears are prevalent in Major League Baseball (MLB) pitchers and can cause significant loss of time with varying reports of impact on performance. Revision UCL reconstruction (UCLR) is becoming increasingly common, with little known about the effects on fastball velocity (FB) and usage (FB%) in this setting.The purpose was to evaluate the effect of revision UCLR on MLB pitchers with respect to post-operative FB velocity and FB% usage at one and two years after return-to-play. The hypothesis was post-operative FB velocity and FB% usage would significantly decrease versus pre-revision levels, and that revision UCLRs would result in significantly decreased FB velocity and FB% usage in comparison to a matched group of MLB pitchers after primary UCLR.Twenty-one pitchers who underwent revision UCLR and returned to MLB play were identified from public records from 2008-2021. The PITCHf(x) system collected FB velocity for four-seam (4FB) and two-seam (2FB) fastballs and total FB% for pitchers in the pre-revision year as well as the two years after return. A matched control group of pitchers who underwent primary UCLR was used for comparison.There were no significant differences in FB velocity between pre-revision levels (4FB 92.9 mph, 2FB 91.4 mph) and years one (4FB 92.5 mph) (2FB 91.2 mph) and two (4FB 93.4 mph) (2FB 91.1 mph) after revision UCLR. FB% decreased from the pre-revision season (60.1) and the first (56.2, p=0.036) and second years (52.5, p=0.002) after return. There were no significant differences between FB velocity or FB% or between the revision and primary UCLR groups.Pitchers returning to the MLB level after revision UCLR can expect similar FB velocity pre-revision FB velocity and to pitchers undergoing primary UCLR; however, they do demonstrate a decrease in FB% usage, which may suggest less confidence in their FB after RTP.

  View details for DOI 10.1016/j.jse.2022.02.026

  View details for PubMedID 35351655

• Innovation in Orthopaedics: Part 2-How to Translate Ideas and Research into Clinical Practice. Current reviews in musculoskeletal medicine Fernandes, T. L., de Faria, R. R., Gonzales, M. A., Sherman, S. L., Goldchmit, S., Fleury, A. 2022

  Abstract

  PURPOSE OF REVIEW: This paper presents some approaches and techniques for translating an idea or research into clinical practice, considering the innovation development process.RECENT FINDINGS: Innovative tools have been a key solution for healthcare problems, such as musculoskeletal disorders, which represent a great economic burden and are among the leading causes of disability. There has been an increase in publications on this topic, but there has been no analysis of the process of innovation development. This review describes the innovation phases for translating an idea or research into clinical practice, considering the stages of discovering the opportunity, innovation creation, project specification, technology development, and innovation launch. An analysis of the innovation development process to translate an idea or research into clinical practice, including concepts, approaches, and techniques that shows the "why", "how", and "what" of innovation.

  View details for DOI 10.1007/s12178-022-09749-4

  View details for PubMedID 35244892

• Treatment Options for Patellofemoral Arthritis. Current reviews in musculoskeletal medicine Kuwabara, A., Cinque, M., Ray, T., Sherman, S. L. 1800

  Abstract

  PURPOSE OF REVIEW: To present a synthesis of recent literature regarding the treatment of patellofemoral arthritis RECENT FINDINGS: Risk factors of PFJ OA include patella malalignment or maltracking, injury to supportive structures including the MPFL, dysfunction of hamstring and quadriceps coordination, lower limb alignment, trochlear dysplasia, patellar trauma, or ACL surgery. Special physical exam maneuvers include patellar grind test, apprehension test, and lateral patellar tilt angle. Radiographs that should be obtained first-line include weight bearing bilateral AP, lateral, and Merchant views. CT and MRI are used to assess trochlear dysplasia, excessive patellar height, and TT-TG distance. Non-operative management options discussed include non-pharmacologic treatment (patient education, self-management, physical therapy, weight loss), ESWT, cold therapy, taping, bracing, and orthotics. Pharmacologic management options discussed include NSAIDs, acetaminophen, oral narcotics, and duloxetine. Injection therapies include glucocorticoids, hyaluronic acid, PRP, and other regenerative therapies (BMAC, adipose, or mesenchymal stem cells). Other treatment options include radiofrequency ablation and botulinum toxin. The algorithm for the surgical treatment of PFJ OA can begin with arthroscopic assessment of the PF articular cartilage to address mechanical symptoms and to evaluate/treat lateral soft tissue with or without overhanging lateral osteophytes. If patients fail to have symptomatic improvement, a TTO can be considered in those patients less than 50 years of age or active patients >50 years old. In patients with severe PFJ OA, refractory to the above treatments, PFA should be considered. While early PFA design and technique were less than encouraging, more recent implant design and surgical technique have demonstrated robust results in the literature. Patellofemoral osteoarthritis is a challenging orthopedic problem to treat, in that it can often affect younger patients, with otherwise well-functioning knees. It is a unique entity compared to TF OA with distinct epidemiology, biomechanics and risk factors and treatment options.

  View details for DOI 10.1007/s12178-022-09740-z

  View details for PubMedID 35118631

• Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon. Sports medicine and arthroscopy review Pullen, W. M., Money, A. J., Ray, T. E., Freehill, M. T., Sherman, S. L. 2022; 30 (1): 17-23

  Abstract

  Postoperative infection remains a potentially devastating complication facing the sports medicine surgeon. Infection prevention begins with a thorough history and physical examination to identify patient specific risk factors and aid in risk stratification. Perioperative steroid injections should be used cautiously, with increased time prior to or following surgery being associated with lower infection risk. Sterile preparation with an alcohol containing solution is typically preferred, though there is limited evidence to identify which product is superior. Diagnosis can be challenging with a high index of suspicion needed to identify and appropriately manage patients. Treatment involves prompt irrigation and debridement with deep cultures. Antibiotic coverage should begin with empiric broad treatment and be tailored based on culture results. Early consultation with an infectious disease specialist is recommended to ensure appropriate antibiotic coverage and duration of treatment.

  View details for DOI 10.1097/JSA.0000000000000335

  View details for PubMedID 35113838

• Medial Patellofemoral Ligament Repair or Medial Advancement: Is There a Role? Clinics in sports medicine Murray, I. R., LaPrade, C. M., Pullen, W. M., Sherman, S. L. 2022; 41 (1): 157-169

  Abstract

  Patellar instability is one of the most prevalent knee disorders, with dislocations occurring in 5 to 43 cases per 10,000 annually. Traumatic patellar dislocation can result in significant morbidity and is associated with patellofemoral chondral injuries and fractures, medial soft tissue disruption, pain, and reduced function, and can lead to patellofemoral osteoarthritis. Chronic and recurrent instability can lead to deformation and incompetence of the medial soft tissue stabilizers. Despite recent gains in understanding the pathoanatomy of this disorder, the management of patients with this condition is complex and remains enigmatic.

  View details for DOI 10.1016/j.csm.2021.07.006

  View details for PubMedID 34782072

• Patients Who Return to Sport After Primary Anterior Cruciate Ligament Reconstruction Have Significantly Higher Psychological Readiness: A Systematic Review and Meta-analysis of 3744 Patients Am J Sports Med Xiao, M., van Niekerk, M., Trivedi, N., Hwang, C., Sherman, S., Safran, M., Abrams, G. 2022

  View details for DOI 10.1177/03635465221102420

• Return-to-play and performance after operative treatment of Achilles tendon rupture in elite male athletes: a scoping review. British journal of sports medicine LaPrade, C. M., Chona, D. V., Cinque, M. E., Freehill, M. T., McAdams, T. R., Abrams, G. D., Sherman, S. L., Safran, M. R. 2022

  Abstract

  To examine the current evidence regarding return-to-play (RTP) and performance after Achilles tendon rupture in elite athletes treated with operative intervention.Scoping review.Published sources identified through a PubMed search of elite athletes, defined as professional or division one collegiate athletes in baseball, basketball, American football or soccer.Our search yielded a total of 2402 studies, with 13 studies fulfilling the study criteria of reporting elite athletes with objective measures of their athletic performance. A total of 709 elite athletes were included from the NBA, NFL, Major League Baseball (MLB), National Collegiate Athletic Association (NCAA) football and professional soccer.Overall, 61%-100% of elite male athletes RTP after Achilles tendon rupture and operative repair. NBA players had inferior performance compared with their preoperative status as well as controls of non-injured players. Studies did not show significantly different performance after Achilles injury for MLB players. Professional soccer, NFL and NCAA football studies reported varying performance after injury.Evidence suggests that sports with explosive plantarflexion demands, such as basketball, may be associated with a greater decrease in performance despite operative intervention after Achilles rupture.

  View details for DOI 10.1136/bjsports-2021-104835

  View details for PubMedID 35144918

• An Injectable Containing Morphine, Ropivacaine, Epinephrine, and Ketorolac is Not Cytotoxic to Articular Cartilage Explants from Degenerative Knees. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Baumann, J. R., Stoker, A. M., Bozynski, C. C., Sherman, S. L., Cook, J. L. 1800

  Abstract

  PURPOSE: The purpose of this study was to determine the effects of a multi-drug injectate containing morphine, ropivacaine, epinephrine, and ketorolac, commonly referred to as the "Orthococktail", on cartilage tissue viability and metabolic responses using an established in vitro model.METHODS: With IRB approval and informed patient consent, tissues normally discarded after total knee arthroplasty (TKA) were recovered. Full-thickness cartilage explants (n = 72, Outerbridge grade 1-3) were created and bisected. Paired explant halves were treated with either 1 mL of the Orthococktail or 1 mL of saline and cultured for eight hours at 37°C with 0.5 mL of the treatment being removed and replaced with tissue culture media every hour. Explants were cultured for 6 days and media were changed and collected on days 3 and 6. After day 6, tissues were processed for cell viability, weighed, and processed for histologic grading. Outcomes measures were compared for significant differences between treated and untreated samples using paired t-Tests.RESULTS: There were no significant differences in cartilage viability between control and Orthococktail-treated samples across a spectrum of cartilage pathologies. Orthococktail treatment consistently resulted in a significant decrease in the release of PGE2, MCP-1, MMP-7, and MMP-8 on day 3 of culture, and PGE2, MMP-3, MMP-7, and MMP-8 on day 6 of culture, compared to saline controls.CONCLUSION: The results of the present study indicate that an "Orthococktail" injection composed of morphine, ropivacaine, epinephrine, and ketorolac is associated with a transient decrease in degradative and inflammatory mediators produced by more severely affected articular cartilage that may mitigate peri-operative joint pain such that post-operative narcotic drug use could be reduced.CLINICAL RELEVANCE: The Orthococktail solution used in this study may be a safe intra-operative intra-articular injection option for patients undergoing joint arthroplasty and other joint preservation surgical procedures.

  View details for DOI 10.1016/j.arthro.2021.12.019

  View details for PubMedID 34952188

• Biologic Augmentation for the Operative Treatment of Osteochondral Defects of the Knee: A Systematic Review ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Chona, D., Kha, S. T., Minetos, P. D., LaPrade, C. M., Chu, C. R., Abrams, G. D., Safran, M. R., Sherman, S. L. 2021; 9 (11)

  View details for DOI 10.1177/23259671211049756

  View details for Web of Science ID 000715843200001

• Cement augmentation of suture anchors in the proximal humerus during rotator cuff repair improves pullout strength: a systematic review. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Kimball, J. S., Gowd, A. K., Waterman, B. R., Sherman, S. L., Chahla, J., Amin, N. H., Liu, J. 2021; 6 (6): 349-355

  Abstract

  IMPORTANCE: Rotator cuff pathology is a growing concern in the ageing population. If cement augmentation of suture anchors improves pullout strength, its application can potentially be applied in cases of poor bone quality to prevent anchor failure.OBJECTIVE: To evaluate the biomechanical benefits and fixation strength of cement-augmented versus non-augmented suture anchors in the proximal humerus during rotator cuff repair (RCR).EVIDENCE REVIEW: A systematic review of PubMed, Embase and Cochrane Library was performed to identify all published articles reporting on biomechanical analysis of suture anchors in the shoulder in a cadaveric model. Inclusion criteria required fresh-frozen specimens, placement in the footprint of the proximal humerus, and comparative assessment of fixation constructs with or without polymethylmethacrylate (PMMA) or bioabsorbable composite cement augmentation. Biomechanical testing procedure, cement augmentation method and pullout force were assessed.FINDINGS: After review of 105 abstracts, seven full manuscripts met inclusion criteria. Six of seven studies reported statistically significant differences in mean pullout force between augmented (three PMMAs, three composites, one PMMA vs composite) and non-augmented anchors. Of two studies evaluating cycles to failure, both found a significant increase in the augmented versus non-augmented anchors. Of two studies stratifying by anchor position, both investigations identified significant differences in mean pullout strength between augmented and non-augmented anchors at the posteromedial and anterolateral anchor positions.CONCLUSIONS AND RELEVANCE: Cement augmentation of suture anchors in cadaveric humeri for RCR improves pullout strength regardless of cement type used or anchor position. Cement augmentation may provide a viable option for future clinical application.LEVEL OF EVIDENCE: IV, systematic review.

  View details for DOI 10.1136/jisakos-2020-000603

  View details for PubMedID 34794964

• Biologic Augmentation for the Operative Treatment of Osteochondral Defects of the Knee: A Systematic Review. Orthopaedic journal of sports medicine Chona, D. V., Kha, S. T., Minetos, P. D., LaPrade, C. M., Chu, C. R., Abrams, G. D., Safran, M. R., Sherman, S. L. 2021; 9 (11): 23259671211049756

  Abstract

  Various surgical treatment options exist for repairing, replacing, or regenerating tissue to fill osteochondral defects. Biologic augmentation has been increasingly studied as an adjunct in the surgical treatment of osteochondral defects of the knee in animal and human models.The purpose of the study was to systematically review use of platelet-rich plasma (PRP) and bone marrow concentrate (BMC) augmentation in the surgical treatment of osteochondral knee defects and to describe the outcomes. It was hypothesized that both PRP and BMC augmentation will result in improved outcomes in osteochondral knee surgery in both animal and human models.Systematic review.PubMed, MEDLINE, and Embase were searched for studies relating to PRP or BMC and treatment of osteochondral defects of the knee, from database inception to February 1, 2020. Included were articles that (1) studied PRP or BMC augmentation; (2) used osteochondral autograft, allograft, or biologic scaffold; and (3) treated osteochondral defects in the knee. Data on use of PRP or BMC, outcomes assessed, and results were recorded for each publication.Of the 541 articles identified initially, 17 were included in the final review. Five articles studied osteochondral grafts in animals, 5 studied biologic scaffolds in animals, and 7 studied scaffolds or allografts in humans; the combined sample size was 202 patients. Of 4 histologic scaffold studies, 3 PRP-augmented scaffold studies identified histologic improvements in regenerated cartilage in animal models, while 1 BMC study demonstrated similar improvement in histologic scores of BMC-augmented scaffolds compared with controls. Three studies associated greater collagen type 2 and glycosaminoglycan content with PRP treatment. Comparative studies found that both augments increase osteogenic proteins, including bone morphogenetic protein-2 and osteoprotegerin. Two of 3 studies on BMC-augmented osteochondral allografts reported no difference in radiographic features postoperatively. Long-term improvement in clinical and radiographic outcomes of PRP-augmented scaffolds was demonstrated in 1 human study.Animal studies suggest that biologics possess potential as adjuncts to surgical treatment of osteochondral knee defects; however, clinical data remain limited.

  View details for DOI 10.1177/23259671211049756

  View details for PubMedID 34778474

  View details for PubMedCentralID PMC8573505

• Evaluation of Commercially Available Knee Cartilage Restoration Techniques Stratified by FDA Approval Pathway. The American journal of sports medicine Gudeman, A. S., Hinckel, B. B., Oladeji, L., Ray, T. E., Gersoff, W., Farr, J., Sherman, S. L. 2021: 3635465211037233

  Abstract

  BACKGROUND: Commercially available products used in knee cartilage reconstructive and restorative surgical practices fall under unique US Food and Drug Administration (FDA) regulatory pathways that determine the level of evidence required to market each product.PURPOSE: To evaluate the levels of evidence in the literature supporting commercially available cartilage repair procedures stratified by FDA regulatory pathway (section 351 vs section 361 of "Human Cells, Tissues, and Cellular and Tissue-Based Products" [HCT/P] in the Code of Federal Regulation) with the hypothesis that products requiring approval under a stringent regulatory pathway (351 HCT/P) have higher levels of evidence in the literature supporting use and that products with a less stringent regulatory pathway (361 HCT/P) have a higher number of products available for use in the United States.STUDY DESIGN: Systematic review; Level of evidence, 4.METHODS: A search of the PubMed database was performed to identify all peer-reviewed articles pertaining to either allograft or autologous cartilage repair technologies. Predefined inclusion and exclusion criteria were used to find clinical, preclinical, and laboratory studies while excluding duplicates, systematic reviews, and products not available in the United States. Articles were categorized by regulatory pathway (351 and 361 HCT/P), and variables including publication year, type of publication, level of evidence, and number of publications were analyzed.RESULTS: After application of predefined criteria, 470 of 1924 articles were included in this study. The 351 HCT/P group was composed entirely of autologous chondrocyte implantation (ACI) technology; 94% of the 361 HCT/P group was composed of osteochondral allografts (OCA). The articles regarding 351 HCT/P were more likely to be clinical in nature than the articles on 361 HCT/P (80% vs 48%, respectively; P = .0001) and entailed significantly more level 1 studies (25 vs 0, respectively; P < .0001). Twice as many articles in the 351 HCT/P group were published in the American Journal of Sports Medicine compared with the 361 HCT/P group (71 vs 38, respectively; P = .18).CONCLUSION: Both ACI and OCA have robust evidence supporting their use, whereas the remaining regulated products have little or no supporting evidence. Technologies regulated by 351 HCT/P were more likely to be level 1 clinical studies and published in the highest impact journal. The 361 HCT/P pathway regulated many more products, with fewer articles supporting their use.

  View details for DOI 10.1177/03635465211037233

  View details for PubMedID 34524032

• Risk of Severe Acute Localized Reactions for Different Intraarticular Hyaluronic Acid Knee Injections in a Real-World Setting. Cartilage Ong, K. L., Farr, J., Gudeman, A. S., Murray, I. R., McIntyre, L. F., Hummer, C. D., Ngai, W., Lau, E., Altman, R. D., Sherman, S. L. 2021: 19476035211025815

  Abstract

  OBJECTIVE: Case reports of severe acute localized reactions (SALR) following intraarticular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA) have been described. We compared surrogate SALR measures between patients using hylan G-F 20 and specific non-hylan G-F 20 HA products.DESIGN: Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users, matched by single or multiple injection products. Occurrences of surrogate SALR measures including inflammation/infection, intraarticular corticosteroid (CS) injections, arthrocentesis/aspiration, arthrotomy/incision and drainage, and arthroscopy were evaluated within 3 days post-HA.RESULTS: Based on 694,404 HA injections, inflammation/infection rate was rare within 3 days of HA (up to 0.03%), with no statistical differences between hylan G-F 20 and non-hylan G-F 20 groups (matched by single or multiple injection products). The risk of knee arthrotomy/incision and drainage, arthroscopy, or arthrocentesis for hylan G-F 20 (2 mL) 3 weekly injection patients was lower than Hyalgan/Supartz and Orthovisc patients, but greater than Euflexxa patients. Overall, we found that Hylan G-F 20 (2 mL) 3 weekly injection had lower SALR rates compared to Hyalgan/Supartz and Orthovisc. However, Hylan G-F 20 (2 mL) 3 weekly injection had slightly higher rates of SALR when compared to Euflexxa. Among the single injection products, Hylan G-F 20 (6 mL) single injection had lower rates of SALR than Monovisc and Gel-One.CONCLUSIONS: This study shows no clear correlation between avian-derived or cross-linked products and SALR and provides evidence against avian-derived products or crosslinking as a source for these reactions.

  View details for DOI 10.1177/19476035211025815

  View details for PubMedID 34515539

• The Impact of COVID-19 on the Orthopaedic Sports Medicine Fellowship Application Process. Arthroscopy, sports medicine, and rehabilitation Peebles, L. A., Kraeutler, M. J., Waterman, B. R., Sherman, S. L., Mulcahey, M. K. 2021; 3 (4): e1237-e1241

  Abstract

  Over the last year, coronavirus disease 2019 (COVID-19) has spread across the world as a global pandemic, bringing unprecedented changes to the healthcare landscape for patients and physicians. Medical trainees have been similarly affected, as medical schools throughout the United States have implemented remote learning-based curriculums and withdrawn third- and fourth-year students from in-hospital clerkships. Of particular importance is the impact of COVID-19 on current orthopaedic surgery residents applying to subspecialty fellowship programs. Because of the highly transmissible nature of the virus and current social distancing restrictions, orthopaedic sports medicine fellowship interviews are being held virtually during the 2020-2021 application cycle. This transition to videoconference interviewing may de-emphasize an applicant's unique personality or interpersonal interactions that are traditionally captured in a variety of settings during the interview day. In turn, this may lead to increased prioritization of various aspects of the application, such as the applicant's residency program, letters of recommendation, and research productivity. Matching to a sports medicine fellowship program is an inherently competitive process and the COVID-19 pandemic presents novel challenges to orthopaedic residents in their efforts to successfully match. The purpose of this review is to describe the changes made to the orthopaedic sports medicine fellowship interview process resulting from COVID-19 during the 2020-2021 application cycle and discuss how these changes may impact the future fellowship application process. This review discusses the changes made to the orthopaedic sports medicine fellowship interview process caused by COVID-19 during the 2020-2021 application cycle. This review also assesses how such changes may impact the future application process and proposes potential adaptations to the current virtual interview format if it should become the new standard moving forward.

  View details for DOI 10.1016/j.asmr.2021.04.002

  View details for PubMedID 34430904

• Single-cell transcriptomic profiling reveals distinct mechanical responses between normal and diseased tendon progenitor cells. Cell reports. Medicine Still, C. 2., Chang, W., Sherman, S. L., Sochacki, K. R., Dragoo, J. L., Qi, L. S. 2021; 2 (7): 100343

  Abstract

  Regenerative medicine approaches utilizing stem cells offer a promising strategy to address tendinopathy, a class of common tendon disorders associated with pain and impaired function. Tendon progenitor cells (TPCs) are important in healing and maintaining tendon tissues. Here we provide a comprehensive single cell transcriptomic profiling of TPCs from three normal and three clinically classified tendinopathy samples in response to mechanical stimuli. Analysis reveals seven distinct TPC subpopulations including subsets that are responsive to the mechanical stress, highly clonogenic, and specialized in cytokine or growth factor expression. The single cell transcriptomic profiling of TPCs and their subsets serves as a foundation for further investigation into the pathology and molecular hallmarks of tendinopathy in mechanical stimulation conditions.

  View details for DOI 10.1016/j.xcrm.2021.100343

  View details for PubMedID 34337559

• ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Sherman, S. L., Calcei, J., Ray, T., Magnussen, R. A., Musahl, V., Kaeding, C. C., Clatworthy, M., Bergfeld, J. A., Arnold, M. P. 2021

  Abstract

  OBJECTIVES: The primary objective of this survey was to gauge the current global trends in anterior cruciate ligament reconstruction (ACLR) as reported by the members of the Anterior Cruciate Ligament (ACL) Study Group (SG).METHODS: A survey was created and distributed among the members of the ACL SG consisting of 87 questions and 16 categories related to ACLR, including member demographics, preoperative management, primary ACLR techniques and graft choice, use of concomitant procedures and biological augmentation, postoperative rehabilitation, and more.RESULTS: The survey was completed by the 140 members of the ACL SG. Fifty per cent of members are from Europe, 29% from the USA, 15% from the Asia-Pacific and the remaining 6% are from Latin America, the Middle East, New Zealand and Africa. Most (92%) do not believe there is a role for non-operative management of ACL tears in higher level athletes; conversely, most agree there is a role for non-operative management in lower impact athletes (92%). A single-bundle (90%) technique with hamstring autograft (53%) were most common for primary ACLR. Tunnel position varied among respondents. Sixty-one per cent do not use allograft for primary ACLR. Fifty per cent of respondents use cortical suspensory fixation on the femur, with variable responses on the tibia. Most (79%) do not use biologics in primary ACLR, while 83% think there is a selective role for extra-articular augmentation in primary ACLR. Fifty per cent prefer bone-tendon-bone autograft for revision ACLR and extra-articular augmentation is more commonly used (13% always, 26% often) than in primary ACLR (0% always, 15% often). A majority (53%) use a brace after primary ACLR. The most common responses for minimal time to return to play after primary ACLR were 6-8 months (44%) and 8-12 months (41%).CONCLUSION: We presented the thoughts and preferences of the ACL SG on the management of ACL injuries. This survey will help to facilitate an ongoing discussion with regard to ACLR by providing global insights into the current surgical trends in ACLR.LEVEL OF EVIDENCE: Level V, Expert Opinion.

  View details for DOI 10.1136/jisakos-2020-000567

  View details for PubMedID 34272329

• Biologics in professional and Olympic sport: a scoping review. The bone & joint journal Murray, I. R., Makaram, N. S., Rodeo, S. A., Safran, M. R., Sherman, S. L., McAdams, T. R., Murray, A. D., Haddad, F. S., Abrams, G. D. 2021; 103-B (7): 1189-1196

  Abstract

  AIMS: The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes.METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O'Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary.RESULTS: A total of 202 studies were initially identified, and 35 met criteria for the scoping review; 33 (94.3%) were published within the last eight years, and 18 (51.4%) originated from the USA. Platelet rich plasma was the most studied biologic therapy, being evaluated in 33 (94.3%) studies. Ulnar collateral ligament and hamstring injuries were the conditions most studied (nine (25.7%) studies and seven (20.0%) studies, respectively). Athletes most frequently participated in baseball, soccer, and American football. Only two (5.7%) studies were level 1 evidence, with interpretation and comparison between studies limited by the variations in the injury profile, biologic preparations, and rehabilitation protocols.CONCLUSION: There is diverse use of biologic therapies in the management of musculoskeletal injuries in professional and Olympic athletes. There is currently insufficient high-level evidence to support the widespread use of biologic therapies in athletes. Further research priorities include the development of condition/pathology-specific preparations of biologic therapies, and of outcome measures and imaging modalities sufficiently sensitive to detect differences in outcomes, should they exist. Cite this article: Bone Joint J2021;103-B(7):1189-1196.

  View details for DOI 10.1302/0301-620X.103B7.BJJ-2020-2282.R1

  View details for PubMedID 34192936

• Biologics in professional and Olympic sport: a scoping review BONE & JOINT JOURNAL Murray, I. R., Makaram, N. S., Rodeo, S. A., Safran, M. R., Sherman, S. L., McAdams, T. R., Murray, A. D., Haddad, F. S., Abrams, G. D. 2021; 103B (7): 1189-1196

  View details for DOI 10.1302/0301-620X.103B7.BJJ-2020-2282

  View details for Web of Science ID 000669369900004

• Infographic: Biologics in professional and Olympic sport: a scoping review. The bone & joint journal Murray, I. R., Makaram, N. S., Rodeo, S. A., Safran, M. R., Sherman, S. L., McAdams, T. R., Murray, A. D., Haddad, F. S., Abrams, G. D. 2021; 103-B (7): 1187-1188

  View details for DOI 10.1302/0301-620X.103B7.BJJ-2021-0864

  View details for PubMedID 34192930

• Return to sport following anterior cruciate ligament reconstruction: the argument for a multimodal approach to optimise decision-making: current concepts. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Chona, D., Eriksson, K., Young, S. W., Denti, M., Sancheti, P. K., Safran, M., Sherman, S. 2021

  Abstract

  Existing literature is varied in the methods used to make this determination in the treatment of athletes who have undergone recent anterior cruciate ligament (ACL) reconstruction. Some authors report using primarily time-based criteria, while others advocate for physical measures and kinematic testing to inform decision-making. The goal of this paper is to elucidate the most current medical evidence regarding identification of the earliest point at which a patient may safely return to sport. The present review therefore seeks to examine the evidence from a critical perspective-breaking down the biology of graft maturation, effect of graft choice, potential for image-guided monitoring of progression and results associated with time-based versus functional criteria-based return to play-to justify a multifactorial approach to effectively advance athletes to return to sport. The findings of the present study reaffirm that time is a prerequisite for the biological progression that must occur for a reconstructed ligament to withstand loads demanded by athletes during sport. Modifications of surgical techniques and graft selection may positively impact the rate of graft maturation, and evidence suggests that imaging studies may offer informative data to enhance monitoring of this process. Aspects of both functional and cognitive testing have also demonstrated utility in prior studies and consequently have been factored into modern proposed methods of determining the athlete's readiness for sport. Further work is needed to definitively determine the optimal method of clearing an athlete to return to sport after ACL reconstruction. Evidence to date strongly suggests a role of a multimodal algorithmic approach that factors in time, graft biology and functional testing in return-to-play decision-making after ACL reconstruction.Level of evidence: level V.

  View details for DOI 10.1136/jisakos-2020-000597

  View details for PubMedID 34088854

• Biologic Association Annual Summit: 2020 Report. Orthopaedic journal of sports medicine Frank, R. M., Sherman, S. L., Chahla, J., Dragoo, J. L., Mandelbaum, B., Members of the Biologic Association, Anz, A. W., Bradley, J. P., Chu, C. R., Cole, B. J., Farr, J., Flanigan, D. C., Gomoll, A. H., Halbrecht, J., Horsch, K., Lattermann, C., Leucht, P., Maloney, W. J., McIntyre, L. F., Murray, I., Muschler, G. F., Nakamura, N., Piuzzi, N. S., Rodeo, S. A., Saris, D. B., Shaffer, W. O., Shapiro, S. A., Spindler, K. P., Steinwachs, M., Tokish, J. M., Vangsness, C. T., Watson, J. T., Yanke, A. B., Zaslav, K. R. 2021; 9 (6): 23259671211015667

  Abstract

  Interest and research in biologic approaches for tissue healing are exponentially growing for a variety of musculoskeletal conditions. The recent hype concerning musculoskeletal biological therapies (including viscosupplementation, platelet-rich plasma, and cellular therapies, or "stem cells") is driven by several factors, including demand by patients promising regenerative evidence supported by substantial basic and translational work, as well as commercial endeavors that complicate the scientific and lay understanding of biological therapy outcomes. While significant improvements have been made in the field, further basic and preclinical research and well-designed randomized clinical trials are needed to better elucidate the optimal indications, processing techniques, delivery, and outcome assessment. Furthermore, biologic treatments may have potential devastating complications when proper methods or techniques are ignored. For these reasons, an association comprising several scientific societies, named the Biologic Association (BA), was created to foster coordinated efforts and speak with a unified voice, advocating for the responsible use of biologics in the musculoskeletal environment in clinical practice, spearheading the development of standards for treatment and outcomes assessment, and reporting on the safety and efficacy of biologic interventions. This article will introduce the BA and its purpose, provide a summary of the 2020 first annual Biologic Association Summit, and outline the future strategic plan for the BA.

  View details for DOI 10.1177/23259671211015667

  View details for PubMedID 34164559

• Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis. Cartilage Calcei, J. G., Varshneya, K., Sochacki, K. R., Safran, M. R., Abrams, G. D., Sherman, S. L. 2021: 19476035211011515

  Abstract

  OBJECTIVE: The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy.STUDY DESIGN: Retrospective cohort study, level III.DESIGN: Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated.RESULTS: A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively.CONCLUSIONS: Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.

  View details for DOI 10.1177/19476035211011515

  View details for PubMedID 33969740

• Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Meredith, S. J., Rauer, T., Chmielewski, T. L., Fink, C., Diermeier, T., Rothrauff, B. B., Svantesson, E., Hamrin Senorski, E., Hewett, T. E., Sherman, S. L., Lesniak, B. P., Symposium, P. 2021; 6 (3): 138-146

  Abstract

  OBJECTIVES: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making.METHODS: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.RESULTS: Key points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.CONCLUSION: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.

  View details for DOI 10.1136/jisakos-2020-000495

  View details for PubMedID 34006577

• High Specialization among Female Youth Soccer Players Is Associated with an Increased Likelihood of Serious Injury. Medicine and science in sports and exercise Xiao, M., Lemos, J. L., Hwang, C. E., Sherman, S. L., Safran, M. R., Abrams, G. D. 2021

  Abstract

  PURPOSE: To assess the associations between serious injury (> 3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes.METHODS: Youth, college, and professional female soccer players in the United States playing in the top league at each level were recruited to complete an anonymous online survey. The survey collected information about player demographics, soccer specialization and training patterns, history of serious injuries from soccer, and perceptions surrounding soccer specialization. Comparisons between groups were performed using 2-sample t-tests, chi-squared analyses, and multiple logistic regression models controlling for differences in age. A p-value of less than 0.05 was set as significant.RESULTS: A total of 1,018 (767 youth, 251 college/professional) athletes completed the survey. Serious injuries affected 23.6% of youth and 51.4% of college/professional athletes. Anterior cruciate ligament (ACL) tears were more prevalent in college/professional players compared to youth athletes (18.3% vs 4.0%; p < 0.001). Highly specialized youth athletes (66.5%) were more likely to have sustained a serious injury from soccer compared to athletes with low specialization (Odds Ratio (OR) = 2.28 [1.38-3.92]; p=0.008) but not moderate specialization (OR = 1.37 [0.83-2.27]; p=0.43). A higher proportion of youth athletes specialized at a young age (< 10 years) compared to college/professional players (44.2% vs 25.9%; p < 0.001).CONCLUSION: High specialization in female youth soccer players is associated with an increased likelihood of sustaining a serious injury. Current youth soccer players are specializing earlier and committing to play college soccer at a younger age compared to when current college and professional players did.

  View details for DOI 10.1249/MSS.0000000000002693

  View details for PubMedID 33927169

• Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Fabricant, P. D., Heath, M. R., Veerkamp, M., Gruber, S., Green, D. W., Strickland, S. M., Wall, E. J., Mintz, D. N., Emery, K. H., Shubin Stein, B. E., Parikh, S. N., Brady, J. M., Ellis, H. B., Farr, J., Heyworth, B. E., Koh, J. L., Kramer, D., Magnussen, R. A., Redler, L. H., Sherman, S. L., Tompkins, M., Wilson, P. L., JUPITER Study Grp 2021; 9 (4): 2325967121991110

  Abstract

  Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient's skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy.The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability.Cohort study (diagnosis); Level of evidence, 3.Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss' kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability.Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements).Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.

  View details for DOI 10.1177/2325967121991110

  View details for Web of Science ID 000640374300001

  View details for PubMedID 33912616

  View details for PubMedCentralID PMC8047867

• Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures. Cartilage Hinckel, B. B., Thomas, D., Vellios, E. E., Hancock, K. J., Calcei, J. G., Sherman, S. L., Eliasberg, C. D., Fernandes, T. L., Farr, J., Lattermann, C., Gomoll, A. H. 2021: 1947603521993219

  Abstract

  OBJECTIVE: To create a treatment algorithm for focal grade 3 or 4 cartilage defects of the knee using both classic and novel cartilage restoration techniques.DESIGN: A comprehensive review of the literature was performed highlighting classic as well as novel cartilage restoration techniques supported by clinical and/or basic science research and currently being employed by orthopedic surgeons.RESULTS: There is a high level of evidence to support the treatment of small to medium size lesions (<2-4 cm2) without subchondral bone involvement with traditional techniques such as marrow stimulation, osteochondral autograft transplant (OAT), or osteochondral allograft transplant (OCA). Newer techniques such as autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate implantation have also been shown to be effective in select studies. If subchondral bone loss is present OAT or OCA should be performed. For large lesions (>4 cm2), OCA or matrix autologous chondrocyte implantation (MACI) may be performed. OCA is preferred over MACI in the setting of subchondral bone involvement while cell-based modalities such as MACI or particulated juvenile allograft cartilage are preferred in the patellofemoral joint.CONCLUSIONS: Numerous techniques exist for the orthopedic surgeon treating focal cartilage defects of the knee. Treatment strategies should be based on lesion size, lesion location, subchondral bone involvement, and the level of evidence supporting each technique in the literature.

  View details for DOI 10.1177/1947603521993219

  View details for PubMedID 33745340

• Non-operative Management of Anterior Knee Pain: Patient Education. Current reviews in musculoskeletal medicine Bosshardt, L., Ray, T., Sherman, S. 2021

  Abstract

  PURPOSE OF REVIEW: Anterior knee pain is a multifactorial, often chronic condition, which can lead to long-term pain and disability. The purpose of this review is to examine the latest research on patient education for anterior knee pain. We will focus on how we might use patient education to increase the adoption of other efficacious treatment modalities and offer some suggestions for content and form of effective patient education.RECENT FINDINGS: New research suggests that patient education, alone, or in combination with targeted exercise therapy, can be effective in reducing pain and improving function in patients with patellofemoral pain. Addressing non-physical or psychological factors may also be an important component of patient education in many patients with chronic pain. Incorporation of new technologies into patient education, such as those available online, or through phone- or tablet-based apps, is likely to be helpful in the future, as we move more towards connecting with patients virtually. Patient education has been shown to be effective in decreasing pain and improving activity in patients with patellofemoral pain. Patient education should be individualized to the patient, focus on the latest effective treatments, and emphasize those treatments that can be self-managed by the patient. Emphasis should also be placed on patient understanding of risk factors and patterns of movement that may lead to, or exacerbate, anterior knee pain. Future research should continue to further characterize the elements of patient education that offer the most efficient treatment benefit.

  View details for DOI 10.1007/s12178-020-09682-4

  View details for PubMedID 33523412

• Acute Patellofemoral Dislocation: Controversial Decision-Making. Current reviews in musculoskeletal medicine Rund, J. M., Hinckel, B. B., Sherman, S. L. 2021

  Abstract

  PURPOSE OF REVIEW: The topic of acute patella dislocations is controversial. Discussions revolve around which individuals need early surgery, identification of risk factors, and rehabilitation protocol. The purpose of this review is to discuss the current recommendations for non-operative and/or operative management of first-time dislocators.RECENT FINDINGS: Recent studies have made it clear that not all patellar dislocations are the same, not all patients do well with conservative treatment, and risk stratification can identify individuals at high risk of recurrence who would benefit from early surgical intervention. Risk factors that have been identified include younger age, skeletally immature, contralateral instability, trochlear dysplasia, patella alta, increased tibial tubercle-trochlear groove distance, and increased patella tilt. The PAPI (Pediatric and Adolescent Patellar Instability) RCT study and JUPITER (Justifying Patellar Instability Treatment by Early Results) prospective cohort study have been carefully developed, are under way, and will provide further guidance. In summary, the management of acute patellar dislocations is evolving. Surgery for patients with osteochondral loose bodies should include fixation as well as soft tissue stabilization. The standard of care for patients with an acute patellar dislocation without osteochondral loose bodies or fracture is non-operative treatment. However, imaging for all first-time dislocators is indicated to stratify risks and determine risk profile. If an individual is at high risk, soft tissue stabilization may be considered. Still, most patients will be treated non-operatively.

  View details for DOI 10.1007/s12178-020-09687-z

  View details for PubMedID 33523411

• ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Arnold, M. P., Calcei, J. G., Vogel, N., Magnussen, R. A., Clatworthy, M., Spalding, T., Campbell, J. D., Bergfeld, J. A., Sherman, S. L., ACL Study Group 2021

  Abstract

  PURPOSE: Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG).METHODS: Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period.RESULTS: In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014.CONCLUSION: Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case.LEVEL OF EVIDENCE: Level V, Expert Opinion.

  View details for DOI 10.1007/s00167-021-06443-9

  View details for PubMedID 33486558

• Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability. Orthopaedic journal of sports medicine Agarwalla, A. n., Yao, K. n., Darden, C. n., Gowd, A. K., Sherman, S. L., Farr, J. n., Shubin Stein, B. E., Amin, N. H., Liu, J. N. 2021; 9 (1): 2325967120972016

  Abstract

  Studies with a low level of evidence (LOE) have dominated the top cited research in many areas of orthopaedics. The wide range of treatment options for patellar instability necessitates an investigation to determine the types of studies that drive clinical practice.To determine (1) the top 50 most cited articles on patellar instability and (2) the correlation between the number of citations and LOE or methodological quality.Cross-sectional study.The Scopus and Web of Science databases were assessed to determine the top 50 most cited articles on patellar instability between 1985 and 2019. Bibliographic information, number of citations, and LOE were collected. Methodological quality was calculated using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS). Mean citations and mean citation density (citations per year) were correlated with LOE, MCMS, and MINORS scores.Most studies were cadaveric (n = 10; 20.0%), published in the American Journal of Sports Medicine (n = 13; 26.0%), published between 2000 and 2009 (n = 41; 82.0%), and conducted in the United States (n = 17; 34.0%). The mean number of citations and the citation density were 158.61 ± 59.53 (range, 95.5-400.5) and 12.74 ± 5.12, respectively. The mean MCMS and MINORS scores were 59.62 ± 12.58 and 16.24 ± 3.72, respectively. No correlation was seen between mean number of citations or citation density versus LOE. A significant difference was found in the mean LOE of articles published between 1990 and 1999 (5.0 ± 0) versus those published between 2000 and 2009 (3.12 ± 1.38; P = .03) and between 2010 and 2019 (3.00 ± 1.10; P = .01).There was a shift in research from anatomy toward outcomes in patellar instability; however, these articles demonstrated low LOE and methodological quality. Higher quality studies are necessary to establish informed standards of management of patellar instability.

  View details for DOI 10.1177/2325967120972016

  View details for PubMedID 33614793

  View details for PubMedCentralID PMC7869164

• Hip Dislocation and Subluxation in Athletes: A Systematic Review. The American journal of sports medicine Chona, D. V., Minetos, P. D., LaPrade, C. M., Cinque, M. E., Abrams, G. D., Sherman, S. L., Safran, M. R. 2021: 3635465211036104

  Abstract

  Hip dislocation is a rare occurrence during sports but carries serious implications for athletes.To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury.Systematic review; Level of evidence, 4.PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets.A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion (P = .015 and .068, respectively), increased prevalence of a cam deformity (P < .0035), higher alpha angles (P≤ .0213), and decreased posterior acetabular coverage (P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies).Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

  View details for DOI 10.1177/03635465211036104

  View details for PubMedID 34623933

• Clinical Outcomes of Meniscal Allograft Transplantation With Respect to the Minimal Clinically Important Difference. The American journal of sports medicine Su, L., Garcia-Mansilla, I., Kelley, B., Arshi, A., Fabricant, P., Sherman, S. L., Jones, K. J. 2021: 3635465211036116

  Abstract

  Arthroscopic-assisted meniscal allograft transplantation (MAT) has become a viable and effective treatment option for young active patients with postmeniscectomy pain. The minimal clinically important difference (MCID) of patient-reported outcome measures (PROMs) is imperative to evaluate the clinical significance of surgical interventions and inform clinical practice guidelines in orthopaedic surgery.To perform a systematic review of clinical outcome studies of patients undergoing MAT and compare postoperative improvement with established MCID thresholds.Systematic review and meta-analysis; Level of evidence, 4.A systematic review was performed using the PubMed, Web of Science, and Cochrane Library databases. A meta-analysis was performed using data obtained from studies reporting patient-reported outcomes. Subgroup analysis was performed on patients undergoing isolated lateral MAT using fresh-frozen grafts. Weighted mean postoperative improvements in the International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale for pain (VAS pain) were calculated and compared with MCID values to determine if they met the MCID threshold.A total of 35 studies were identified, including 1658 unique patients. Weighted mean postoperative score improvements exceeded MCID thresholds for the VAS pain, IKDC, and Lysholm. Subgroup analysis of patients undergoing isolated lateral fresh-frozen MAT demonstrated postoperative improvements exceeding the MCID for the Lysholm and VAS pain.Evaluating postoperative PROMs with respect to the MCID is crucial to evaluate the effect of MAT on functional improvement. The results of the present meta-analysis suggest that postoperative improvements after MAT are clinically meaningful as reflected by PROMs exceeding the MCID threshold for the IKDC, Lysholm, and VAS pain.

  View details for DOI 10.1177/03635465211036116

  View details for PubMedID 34495780

• Force-Time Waveform Shape Reveals Countermovement Jump Strategies of Collegiate Athletes. Sports (Basel, Switzerland) Guess, T. M., Gray, A. D., Willis, B. W., Guess, M. M., Sherman, S. L., Chapman, D. W., Mann, J. B. 2020; 8 (12)

  Abstract

  The purpose of this study was to relate the shape of countermovement jump (CMJ) vertical ground reaction force waveforms to discrete parameters and determine if waveform shape could enhance CMJ analysis. Vertical ground reaction forces during CMJs were collected for 394 male and female collegiate athletes competing at the National Collegiate Athletic Association (NCAA) Division 1 and National Association of Intercollegiate Athletics (NAIA) levels. Jump parameters were calculated for each athlete and principal component analysis (PCA) was performed on normalized force-time waveforms consisting of the eccentric braking and concentric phases. A K-means clustering of PCA scores placed athletes into three groups based on their waveform shape. The overall average waveforms of all athletes in each cluster produced three distinct vertical ground reaction force waveform patterns. There were significant differences across clusters for all calculated jump parameters. Athletes with a rounded single hump shape jumped highest and quickest. Athletes with a plateau at the transition between the eccentric braking and concentric phase (amortization) followed by a peak in force near the end of the concentric phase had the lowest jump height and slowest jump time. Analysis of force-time waveform shape can identify differences in CMJ strategies in collegiate athletes.

  View details for DOI 10.3390/sports8120159

  View details for PubMedID 33276573

• Autologous Bone Grafting OPERATIVE TECHNIQUES IN SPORTS MEDICINE Robinson, P. G., Abrams, G. D., Sherman, S. L., Safran, M. R., Murray, I. R. 2020; 28 (4)

  View details for DOI 10.1016/j.otsm.2020.150780

  View details for Web of Science ID 000604313300004

• Superior Capsular Reconstruction: A Systematic Review of Surgical Techniques and Clinical Outcomes. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Gao, I., Sochacki, K. R., Freehill, M. T., Sherman, S. L., Abrams, G. D. 2020

  Abstract

  PURPOSE: To evaluate surgical techniques and clinical outcomes for arthroscopic superior capsular reconstruction (SCR) for treatment of massive irreparable rotator cuff tears.METHODS: A systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane databases were searched. Studies investigating SCR with reported surgical technique were included. Animal studies, cadaveric studies, review studies, and letters to the editor were excluded. Technical aspects of surgical technique for SCR were analyzed in each article, which included: graft type, glenoid fixation method, greater tuberosity fixation method, graft passage technique, suture management, margin convergence, concomitant procedures, and post-operative rehabilitation protocol. Clinical outcomes, when available, were also analyzed.RESULTS: Three hundred sixty-five articles were screened with 29 found that described surgical technique for SCR. According to the Modified Coleman Methodology Score, 24 articles were poor (scores <55), 4 were fair (scores between 55 and 69), and 1 was good (scores between 70 and 84) with an average score of 25.8 ± 20.9. The most commonly used technique for SCR utilized: acellular dermal allograft, two biocomposite suture anchors for glenoid fixation, transosseus equivalent double-row suture anchor fixation for greater tuberosity fixation with two biocomposite medial row anchors and two biocomposite lateral row anchors, double-pulley technique combined with an arthroscopic grasper and/or pull suture to pass the graft into the shoulder, performance of both anterior and posterior margin convergence, and native rotator cuff repair when possible. Only 8 of the studies reported clinical outcomes, and they showed that SCR provides significant improvement in patient-reported outcomes, significant improvement in shoulder ROM, variable graft failure rates, low complication rates, and variable reoperation rates. There were no studies comparing outcomes between the various surgical techniques.CONCLUSIONS: Many surgical techniques exist for arthroscopic SCR. However, no superior technique was demonstrated, as there were no studies comparing clinical outcomes among these various techniques.

  View details for DOI 10.1016/j.arthro.2020.09.016

  View details for PubMedID 33227320

• The use of biologics in professional and Olympic sport: a scoping review protocol. Bone & joint open Makaram, N. S., Murray, I. R., Rodeo, S. A., Sherman, S. L., Murray, A. D., Haddad, F. S., McAdams, T. R., Abrams, G. D. 2020; 1 (11): 715–19

  Abstract

  Aims: The use of biologics in the treatment of musculoskeletal injuries in Olympic and professional athletes appears to be increasing. There are no studies which currently map the extent, range, and nature of existing literature concerning the use and efficacy of such therapies in this arena. The objective of this scoping review is to map the available evidence regarding the use of biologics in the treatment of musculoskeletal injuries in Olympic and professional sport.Methods: Best-practice methodological frameworks suggested by Arksey and O'Malley, Levac et al, and the Joanna Briggs Institute will be used. This scoping review will aim to firstly map the current extent, range, and nature of evidence for biologic strategies to treat injuries in professional and Olympic sport; secondly, to summarize and disseminate existing research findings; and thirdly, to identify gaps in existing literature. A three-step search strategy will identify peer reviewed and non-peer reviewed literature, including reviews, original research, and both published and unpublished ('grey') literature. An initial limited search will identify suitable search terms, followed by a search of five electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, and Google Scholar) using keyword and index terms. Studies will be screened independently by two reviewers for final inclusion.Dissemination: We will chart key concepts and evidence, and disseminate existing research findings to practitioners and clinicians, through both peer reviewed and non-peer reviewed literature, online platforms (including social media), conference, and in-person communications. We will identify gaps in current literature and priorities for further study.

  View details for DOI 10.1302/2633-1462.111.BJO-2020-0159

  View details for PubMedID 33241221

• Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies. Orthopaedic journal of sports medicine Sochacki, K. R., Safran, M. R., Abrams, G. D., Donahue, J., Chu, C., Sherman, S. L. 2020; 8 (11): 2325967120964534

  Abstract

  Background: Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing.Purpose: To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without PRP.Study Design: Systematic review; Level of evidence, 3.Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Multiple databases were searched for studies that compared outcomes of isolated arthroscopic meniscal repair augmented with PRP versus without PRP in human patients. Failures and patient-reported outcome scores were reported for each study and compared between groups. Study heterogeneity was assessed using I 2 for each outcome measure before meta-analysis. Study methodological quality was analyzed. Continuous variable data were reported as mean and standard deviation from the mean. Categorical variable data were reported as frequency with percentage. All P values were reported with significance set at P < .05.Results: Five articles were analyzed (274 patients [110 with PRP and 164 without PRP]; 65.8% male; mean age, 29.1 ± 4.6 years; mean follow-up, 29.2 ± 22.1 months). The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP. Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP (odds ratio, 0.32; 95% CI, 0.12-0.90; P = .03). One of the 5 studies reported significantly higher outcomes in the PRP-augmented group versus the no-PRP group for the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) (P < .05 for all). The remaining 4 studies reported no significant difference between groups with regard to outcomes for the IKDC, Lysholm knee scale, visual analog scale for pain, or Tegner activity level.Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%; odds ratio, 0.32; P = .03) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes.

  View details for DOI 10.1177/2325967120964534

  View details for PubMedID 33283008

• Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis. Cartilage Sochacki, K. R., Varshneya, K., Calcei, J. G., Safran, M. R., Abrams, G. D., Donahue, J., Chu, C., Sherman, S. L. 2020: 1947603520967065

  Abstract

  OBJECTIVE: To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database.DESIGN: Subjects who underwent knee ACI (Current Procedural Terminology [CPT] code 27412) or OCA (CPT code 27415) with minimum 2-year follow-up were queried from a national insurance database. Reoperation was defined by ipsilateral knee procedure after index surgery. Multivariate logistic regression models were built to determine the effect of independent variables (age, sex, tobacco use, obesity, diabetes, and concomitant osteotomy) on reoperation rates. The 30-day complication rates were assessed using ICD-9-CM codes. The cost of the procedures per patient was calculated. Statistical comparisons were made. All P values were reported with significance set at P < 0.05.RESULTS: A total of 909 subjects (315 ACI and 594 OCA) were included (mean follow-up 39.2 months). There was a significantly higher reoperation rate after index ACI compared with OCA (67.6% vs. 40.4%, P < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, P < 0.0001 and OR 0.2, P = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups (P = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA (P = 0.013).CONCLUSIONS: Autologous chondrocyte implantation had significantly higher reoperation rates and cost with similar complication rates compared with OCA. Concomitant osteotomy significantly reduced the risk for reoperation in both groups.

  View details for DOI 10.1177/1947603520967065

  View details for PubMedID 33106002

• Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS Hinckel, B. B., Baumann, C. A., Ejnisman, L., Cavinatto, L. M., Martusiewicz, A., Tanaka, M. J., Tompkins, M., Sherman, S. L., Chahla, J. A., Frank, R., Yamamoto, G. L., Bicos, J., Arendt, L., Fithian, D., Farr, J. 2020; 4 (10)

  View details for DOI 10.5435/JAAOSGlobal-D-20-00083

  View details for Web of Science ID 000618910800004

• Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews Hinckel, B. B., Baumann, C. A., Ejnisman, L., Cavinatto, L. M., Martusiewicz, A., Tanaka, M. J., Tompkins, M., Sherman, S. L., Chahla, J. A., Frank, R., Yamamoto, G. L., Bicos, J., Arendt, L., Fithian, D., Farr, J. 2020; 4 (10): e20.00083

  Abstract

  Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.

  View details for DOI 10.5435/JAAOSGlobal-D-20-00083

  View details for PubMedID 33986224

• Microfracture for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Survey of International Cartilage Regeneration & Joint Preservation Society. Cartilage Medina, J., Garcia-Mansilla, I., Fabricant, P. D., Kremen, T. J., Sherman, S. L., Jones, K. 2020: 1947603520954503

  Abstract

  OBJECTIVE: The purpose of this study was to describe the current practice trends for managing symptomatic cartilage lesions of the knee with microfracture among ICRS (International Cartilage Regeneration & Joint Repair Society) members.DESIGN: A 42-item electronic questionnaire was sent to all ICRS members, which explored indications, surgical technique, postoperative management, and outcomes of the microfracture procedure for the treatment of symptomatic, full thickness chondral and osteochondral defects of the knee. Responses were compared between surgeons from different regions and years of practice.RESULTS: A total of 385 surgeons answered the questionnaire. There was a significant difference noted in the use of microfracture among surgeons by region (P < 0.001). There was no association between the number of years in practice and the self-reported proportion of microfracture cases performed (P = 0.37). Fifty-eight subjects (15%) indicated that they do not perform microfracture at all. Regarding indication for surgery, 56% of surgeons would limit their indication of microfracture to lesions measuring 2 cm2 or less. Half of the surgeons reported no upper age or body mass index limit. Regarding surgical technique, 90% of surgeons would recommend a formal debridement of the calcified layer and 91% believe it is important to create stable vertical walls. Overall, 47% of surgeons use biologic augmentation, with no significant difference between regions (P = 0.35) or years of practice (P = 0.67). Rehabilitation protocols varied widely among surgeons.CONCLUSIONS: Indications, operative technique, and rehabilitation protocols utilized for patients undergoing microfracture procedures vary widely among ICRS members. Regional differences and resources likely contribute to these practice pattern variations.

  View details for DOI 10.1177/1947603520954503

  View details for PubMedID 32911974

• Surgeon practice patterns for pre-soaking ACL tendon grafts in vancomycin: a survey of the ACL study group. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Xiao, M., Sherman, S. L., Safran, M. R., Abrams, G. D. 2020

  Abstract

  PURPOSE: To survey members of The ACL study group to determine the current practice patterns surrounding the technique of pre-soaking ACL grafts in vancomycin.METHODS: A web-based questionnaire was distributed to members of the ACL Study Group. Questions included the use of vancomycin solution for graft soaking during ACL reconstruction, their protocol for soaking the graft, vancomycin concentration utilized, graft choices, and concerns with the technique.RESULTS: Sixty-six (57%) ACL surgeons completed the survey. Approximately one-third (37.9%) of respondents currently pre-soak their ACL grafts in vancomycin prior to implantation, with 60% of these surgeons being from Europe. Seventy-six percent have adopted this practice within the past 5years. The majority of surgeons wrap the graft in a vancomycin-soaked gauze prior to implantation (56%), soak for a variable amount of time before implantation (56%), use a concentration of 5mg/mL (68%), and soak hamstring grafts (92%). Concerns included the mechanical properties of the graft (35%), cost of vancomycin (23%), availability (12%), and antibiotic resistance (9%).CONCLUSION: This survey demonstrates that 37.9% of ACL study group members currently utilize vancomycin to pre-soak ACL tendon grafts as a means to decrease post-operative infection risk, with the majority of surgeons having implemented this practice within the past 5years. The biggest concern towards using vancomycin was the mechanical properties of the graft after soaking.LEVEL OF EVIDENCE: IV.

  View details for DOI 10.1007/s00167-020-06265-1

  View details for PubMedID 32902684

• Rationale for the Use of Orthobiologics in Sports Medicine OPERATIVE TECHNIQUES IN SPORTS MEDICINE Makaram, N. S., Safran, M. R., Abrams, G. D., Sherman, S. L., Murray, I. R. 2020; 28 (3)

  View details for DOI 10.1016/j.otsm.2020.150753

  View details for Web of Science ID 000571432600008

• Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis. Arthroscopy, sports medicine, and rehabilitation Varshneya, K., Safran, M. R., Sherman, S. L., Abrams, G. D. 2020; 2 (4): e369–e376

  Abstract

  Purpose: To evaluate the reoperations, complications, and costs up to 5 years following arthroscopic rotator cuff repair (RCR) alone, with acromioplasty (acro), with biceps tenodesis (BT), or with both acro and BT.Methods: We queried the MarketScan database to identify patients who underwent RCR from 2007 to 2016. Patients were stratified into groups based on concomitant procedures (acro and/or BT) performed on the same day as index RCR. Reoperations, complications, and costs were followed for 5 years post-index procedure. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for confounding factors.Results: This study identified 147,838 patients (mean age, 53.1 years; standard deviation, 8.3 years) who underwent primary RCR. Patients were stratified into 4 groups: (1) RCR only, (2) RCR+ acro, (3) RCR+ BT, and (4) RCR+ acro+ BT. Patients in the RCR only group experienced the highest rate of unadjusted overall postoperative complications (17.2%) versus the other groups (RCR+ acro 16.4%, RCR+ BT 15.1%, RCR+ acro+ BT 16.2%, P < .0161). The RCR only group also experienced a significantly greater number of reoperations on the ipsilateral shoulder (P < .0001), whereas the RCR+ acro+ BT had the highest costs at all timepoints. In the regression analysis, there was no significant differences between complications and reoperations between any groups. After adjusting for covariates, the performance of a BT with an RCR and acromioplasty led to increased costs (odds ratio, 1.47, 1.37-1.59, P < .001).Conclusions: Concomitant biceps tenodesis does lead to higher total healthcare costs, both in the shorter and longer terms. When adjusting for confounding factors, the performance of concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery.Level of Evidence: Level IV, economic analysis.

  View details for DOI 10.1016/j.asmr.2020.05.010

  View details for PubMedID 32875302

• Hop test does not correlate with neuromuscular control during drop vertical jump test: A prognostic comparative study utilizing healthy subjects CURRENT ORTHOPAEDIC PRACTICE Gulbrandsen, T. R., Willis, B. W., Guess, T. M., Gray, A. D., Sherman, S. L. 2020; 31 (4): 358–65

  View details for DOI 10.1097/BCO.0000000000000890

  View details for Web of Science ID 000546991400007

• Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes. Orthopaedic journal of sports medicine Endo, A., Hoogervorst, P., Safranek, C., Sochacki, K. R., Safran, M. R., Sherman, S. L., Donahue, J. 2020; 8 (7): 2325967120938311

  Abstract

  Background: Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs.Purpose: To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates after linked double-row equivalent rotator cuff repair for full-thickness rotator cuff tears.Study Design: Case series; Level of evidence, 4.Methods: Consecutive patients who underwent linked double-row equivalent arthroscopic rotator cuff repair with minimum 2-year follow-up were included. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at final follow-up. Secondary outcomes included the Simple Shoulder Test (SST), shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, visual analog scale (VAS), reoperations, and complications. Clinical relevance was defined by the minimally clinically important difference (MCID). Comparisons on an individual level that exceeded MCID (individual-level scores) were deemed clinically relevant. Comparisons between preoperative and postoperative scores were completed using the Student t test. All P values were reported with significance set at P < .05.Results: A total of 42 shoulders in 41 consecutive patients were included in this study (21 male patients [51.2%]; mean age, 64.5 ± 11.9 years; mean follow-up, 29.7 ± 4.5 months). All patients (100%) completed the minimum 2-year follow-up. The rotator cuff tear measured on average 15.2 ± 8.9 mm in the coronal plane and 14.6 ± 9.8 mm in the sagittal plane. The ASES score improved significantly from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively (P < .001). The QuickDASH (P < .001), SST (P < .001), and VAS (P < .001) scores also significantly improved after surgery. All patients (42/42 shoulders; 100%) achieved clinically relevant improvement (met or exceeded MCID) on ASES and SST scores postoperatively. There were no postoperative complications (0.0%) or reoperations (0.0%) at final follow-up.Conclusion: Arthroscopic repair of full-thickness rotator cuff tears with the linked double-row equivalent construct results in statistically significant and clinically relevant improvements in PRO scores with low complication rates (0.0%) and reoperation rates (0.0%) at short-term follow-up.

  View details for DOI 10.1177/2325967120938311

  View details for PubMedID 32728593

• Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Meredith, S. J., Rauer, T., Chmielewski, T. L., Fink, C., Diermeier, T., Rothrauff, B. B., Svantesson, E., Hamrin Senorski, E., Hewett, T. E., Sherman, S. L., Lesniak, B. P., Panther Symposium ACL Injury Return to Sport Consensus Group 2020

  Abstract

  PURPOSE: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making.METHODS: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.RESULTS: Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.CONCLUSION: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery.LEVEL OF EVIDENCE: IV.

  View details for DOI 10.1007/s00167-020-06009-1

  View details for PubMedID 32347344

• Failures of Realignment Osteotomy OPERATIVE TECHNIQUES IN SPORTS MEDICINE Schubert, M. F., Sidhu, R., Getgood, A. M., Sherman, S. L. 2020; 28 (1)

  View details for DOI 10.1016/j.otsm.2019.150714

  View details for Web of Science ID 000522139700008

• Patellofemoral Cartilage Restoration: A Systematic Review and Meta-analysis of Clinical Outcomes. The American journal of sports medicine Hinckel, B. B., Pratte, E. L., Baumann, C. A., Gowd, A. K., Farr, J. n., Liu, J. N., Yanke, A. B., Chahla, J. n., Sherman, S. L. 2020: 363546519886853

  Abstract

  Many surgical options for treating patellofemoral (PF) cartilage lesions are available but with limited evidence comparing their results.To determine and compare outcomes of PF cartilage restoration techniques.Systematic review and meta-analysis.PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were followed by utilizing the PubMed, EMBASE, and Cochrane Library databases. Inclusion criteria were clinical studies in the English language, patient-reported outcomes after PF cartilage restoration surgery, and >12 months' follow-up. Quality assessment was performed with the Coleman Methodology Score. Techniques were grouped as osteochondral allograft transplantation (OCA), osteochondral autograft transfer (OAT), chondrocyte cell-based therapy, bone marrow-based therapy, and scaffolds.A total of 59 articles were included. The mean Coleman Methodology Score was 71.8. There were 1937 lesions (1077 patellar, 390 trochlear, and 172 bipolar; 298 unspecified). The frequency of the procedures was as follows, in descending order: chondrocyte cell-based therapy (65.7%), bone marrow-based therapy (17.2%), OAT (8%), OCA (6.6%), and scaffolds (2.2%). When compared with the overall pooled lesion size (3.9 cm2; 95% CI, 3.5-4.3 cm2), scaffold (2.2 cm2; 95% CI, 1.8-2.5 cm2) and OAT (1.5 cm2; 95% CI, 1.1-1.9 cm2) lesions were smaller (P < .001), while chondrocyte cell-based therapy lesions were larger (4.7 cm2; 95% CI, 4.1-5.3 cm2; P = .039). Overall, the instability pool was 11.9%, and the anatomic risk factors pool was 32.1%. Statistically significant improvement was observed on at least 1 patient-reported outcome in chondrocyte cell-based therapy (83%), OAT (78%), OCA (71%), bone marrow-based therapy (64%), and scaffolds (50%). There were no significant differences between any group and the overall pooled change in International Knee Documentation Committee score (30.2; 95% CI, 27.4-32.9) and Lysholm score (25.2; 95% CI, 16.9-33.5). There were no significant differences between any group and the overall pooled rate in minor complication rate (7.6%; 95% CI, 4.7%-11.9%) and major complication rate (8.3%; 95% CI, 5.7%-12.0%); however, OCA had a significantly greater failure rate (22.7%; 95% CI, 14.6%-33.4%) as compared with the overall rate (6.8%; 95% CI, 4.7%-9.5%).PF cartilage restoration leads to improved clinical outcomes, with low rates of minor and major complications. There was no difference among techniques; however, failures were higher with OCA.

  View details for DOI 10.1177/0363546519886853

  View details for PubMedID 31899868

• Risk of Subsequent Knee Arthroplasty After Sports Medicine Procedures. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews Enweze, L. C., Varshneya, K. n., Sherman, S. L., Safran, M. R., Abrams, G. D. 2020; 4 (8): e2000125

  Abstract

  Approximately 10% of men and 13% of women older than the age of 60 are affected by symptomatic osteoarthritis of the knee. Anatomic repair or reconstruction after knee injury has been a central tenet of surgical treatment to reduce the risk of osteoarthritis. The purpose of this study was to examine common sports medicine procedures of the knee and determine the proportion of patients who subsequently undergo total knee arthroplasty (TKA).The MarketScan database was queried from the period of January 2007 through December 2016. Patients were identified, who underwent a procedure of the knee, as defined by Current Procedural Terminology codes relating to nonarthroplasty procedures of the knee. Patients in whom laterality could not be confirmed or underwent another ipsilateral knee procedure before TKA were excluded from this study. The primary outcome of this study was the overall rate of TKA after index knee surgery. Time from index procedure to TKA was a secondary outcome. A multivariate regression analysis was used to control for covariates such as age, sex, and comorbidity status.A total of 843,749 patients underwent one of the 13 common sports medicine procedures of the knee. The procedure with the highest unadjusted rate of subsequent TKA was arthroscopic osteochondral allograft (5.81%), whereas anterior cruciate ligament (ACL) reconstruction with meniscus repair demonstrated the lowest rate of subsequent TKA (0.01%). When adjusting for confounding factors, the regression analysis identified meniscal transplantation (odds ratio [OR] = 3.06, P < 0.0001) as having the highest risk of subsequent TKA, followed by osteochondral autograft (OR = 1.74, P = 0.0424) and arthroscopic osteochondral allograft (OR = 1.49, P < 0.0001). ACL reconstruction with meniscus repair (OR = 0.02, P < 0.0001), ACL reconstruction alone (OR = 0.17, P < 0.0001), ACL with meniscectomy (OR = 0.20, P < 0.0001), and meniscal repair (OR = 0.65, P < 0.0001) had the lowest rate of subsequent TKA. ACL reconstruction with meniscus repair had the longest period from index procedure to TKA at 2827 days.ACL reconstruction and meniscus preservation demonstrated an extremely low rate of conversion to TKA when compared with patients who needed salvage interventions such as meniscus and cartilage transplantation. None of the salvage interventions delayed the need for a TKA. Meniscal transplantation had the highest risk of all procedures of going on to a TKA.

  View details for DOI 10.5435/JAAOSGlobal-D-20-00125

  View details for PubMedID 32852917

• The effect of silicone ankle sleeves and lace-up ankle braces on neuromuscular control, joint torque, and cutting agility. Journal of orthopaedics Cinque, M. E., Bodendorfer, B. M., Shu, H. T., Arnold, N. A., Gray, A. D., Summerhays, B. J., Guess, T. M., Sherman, S. L. 2020; 20: 359–66

  Abstract

  To evaluate the effects of silicone ankle sleeves (SASs) and lace-up ankle braces (LABs) on neuromuscular control, net joint torques, and cutting agility in healthy, active individuals.Markerless motion-capture technology tracked subjects fitted with SASs, LABs, or no brace while they performed the movements: Y-excursion, left cutting, right cutting, single-leg drop vertical jump (SLDVJ), 45-degree bound, and single-leg squat (SLS).University Laboratory.Ten healthy, active individuals (5 males and 5 females, mean ± SD 23.60 ± 1.43 years of age).Degrees of joint range of motion (ROM), Newton-meters of joint torque, time to perform a cutting maneuver.SASs and LABs resulted in significantly different knee and ankle ROM and hip internal rotation in the SLDVJ, SLS, Y-excursion, cutting maneuver, and 45-degree bound when compared to control (p < .05). Both ankle and knee torque were significantly reduced in the 45-degree bound and cutting movements with both types of PABs (p < .05). There were minimal differences between the SASs and LABs for all conditions. There were no statistically significant differences in cutting times for any of the 3 conditions.Both SAS and LAB positively impacted neuromuscular control, reduced net joint torque, and neither impaired cutting agility when compared to control.

  View details for DOI 10.1016/j.jor.2020.05.019

  View details for PubMedID 32684673

  View details for PubMedCentralID PMC7355724

• Management of Large Focal Chondral and Osteochondral Defects in the Knee. The journal of knee surgery Calcei, J. G., Ray, T. n., Sherman, S. L., Farr, J. n. 2020; 33 (12): 1187–1200

  Abstract

  Large, focal articular cartilage defects of the knee (> 4 cm2) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.

  View details for DOI 10.1055/s-0040-1721053

  View details for PubMedID 33260221

• Relationship of the Medial Patellofemoral Ligament Origin on the Distal Femur to the Distal Femoral Physis: A Systematic Review. The American journal of sports medicine Sochacki, K. R., Shea, K. G., Varshneya, K. n., Safran, M. R., Abrams, G. D., Donahue, J. n., Sherman, S. L. 2020: 363546520904685

  Abstract

  The relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis has been reported in multiple studies.To determine the distance from the MPFL central origin on the distal femur to the medial distal femoral physis in skeletally immature participants.Systematic review.A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched for studies investigating the anatomic origin of the MPFL on the distal femur and its relationship to the medial distal femoral physis in skeletally immature participants. Study methodological quality was analyzed with the Anatomical Quality Assessment tool, with studies categorized as low risk, high risk, or unclear risk of bias. Continuous variable data were reported as mean ± SD. Categorical variable data were reported as frequency with percentage.Seven articles were analyzed (298 femurs, 53.7% male patients; mean age, 11.7 ± 3.4 years). There was low risk of bias based on the Anatomical Quality Assessment tool. The distance from the MPFL origin to the distal femoral physis ranged from 3.7 mm proximal to the physis to 10.0 mm distal to the physis in individual studies. Six of 7 studies reported that the MPFL origin on the distal femur lies distal to the medial distal femoral physis in the majority of specimens. The MPFL originated distal to the medial distal femoral physis in 92.8% of participants at a mean distance of 6.9 ± 2.4 mm.The medial patellofemoral ligament originates distal to the medial distal femoral physis in the majority of cases at a mean proximal-to-distal distance of 7 mm distal to the physis. However, this is variable in the literature owing to study design and patient age and sex.

  View details for DOI 10.1177/0363546520904685

  View details for PubMedID 32109145

• Consensus on Rehabilitation Guidelines among Orthopedic Surgeons in the United States following Use of Third-Generation Articular Cartilage Repair (MACI) for Treatment of Knee Cartilage Lesions. Cartilage Flanigan, D. C., Sherman, S. L., Chilelli, B. n., Gersoff, W. n., Jones, D. n., Lee, C. A., Toth, A. n., Cramer, C. n., Zaporojan, V. n., Carey, J. n. 2020: 1947603520968876

  Abstract

  The aim of this study was to evaluate levels of consensus in rehabilitation practices following MACI (autologous cultured chondrocytes on porcine collagen membrane) treatment based on the experience of an expert panel of U.S. orthopedic surgeons.A list of 24 questions was devised based on the current MACI rehabilitation protocol, literature review, and discussion with orthopedic surgeons. Known areas of variability were used to establish 4 consensus domains, stratified on lesion location (tibiofemoral [TF] or patellofemoral [PF]), including weightbearing (WB), range of motion (ROM), return to work/daily activities of living, and return to sports. A 3-step Delphi technique was used to establish consensus.Consensus (>75% agreement) was achieved on all 4 consensus domains. Time to full WB was agreed as immediate (with bracing) for PF patients (dependent on concomitant procedures), and 7 to 9 weeks in TF patients. A progression for ROM was agreed that allowed patients to reach 90° by week 4, with subsequent progression as tolerated. The panel estimated that the time to full ROM would be 7 to 9 weeks on average. A range of time was established for release to activities of daily living, work, and sports, dependent on lesion and patient characteristics.Good consensus was established among a panel of U.S. surgeons for rehabilitation practices following MACI treatment of knee cartilage lesions. The consensus of experts can aid surgeons and patients in the expectations and rehabilitation process as MACI surgery becomes more prevalent in the United States.

  View details for DOI 10.1177/1947603520968876

  View details for PubMedID 33124432

• Soaking of Autologous Tendon Grafts in Vancomycin Before Implantation Does Not Lead to Tenocyte Cytotoxicity. The American journal of sports medicine Xiao, M. n., Leonardi, E. A., Sharpe, O. n., Sherman, S. L., Safran, M. R., Robinson, W. H., Abrams, G. D. 2020: 363546520951815

  Abstract

  Surgical site infections (SSIs) after anterior cruciate ligament (ACL) reconstruction procedures are an unfortunate complication. Soaking grafts in vancomycin before implantation has been reported to reduce the incidence of postoperative SSI after ACL reconstruction. There is potential for vancomycin to compromise graft integrity because of tenocyte toxicity.To examine the in vitro toxicity of varying doses of vancomycin on human tenocytes.Controlled laboratory study.Human patellar tenocytes were isolated and expanded in vitro. Tenocytes in culture were exposed to vancomycin at 5 different concentrations (400, 1600, 3200, 6400, and 12,800 μg/mL) and 3 time intervals (2, 6, and 24 hours). The control for all series was tenocyte exposure to only culture medium for each time interval. After treatment, a 10% Cell Counting Kit-8 solution in cellular growth medium was applied to the cells to examine cytotoxicity. A live/dead assay was used to assess tenocyte viability through fluorescence microscopy and flow cytometry. Results were analyzed statistically using multivariable logistic regression models with Tukey honest significant difference post hoc tests.Vancomycin did not cause significant changes in tenocyte viability after 2 and 6 hours of incubation at any concentration between 0 and 12,800 µg/mL. Incubation with vancomycin for 24 hours led to a significant decrease in cell viability at higher concentrations.Tenocytes derived from human patellar tendons exposed to relatively high concentrations of vancomycin for short periods of time do not demonstrate significant cell death and toxicity.Exposing tendons to vancomycin for a short period of time, such as before ACL reconstruction, is not likely to cause tenocyte toxicity because of vancomycin administration.

  View details for DOI 10.1177/0363546520951815

  View details for PubMedID 32898431

• Significantly Lower Infection Risk For ACL Grafts Pre-Soaked in Vancomycin Compared to Un-Soaked Grafts: A Systematic Review and Meta-analysis. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Xiao, M. n., Sherman, S. L., Safran, M. R., Abrams, G. D. 2020

  Abstract

  To compare post-operative infection rates following ACL reconstruction performed with grafts pre-soaked in vancomycin versus those without vancomycin.A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for therapeutic level I-III studies that compared outcomes of pre-soaking ACL grafts with vancomycin versus without vancomycin in human patients. Included graft types were tendon autografts or allografts, and studies documenting infection with a minimum follow-up of 30 days were included. Postoperative infection rates and knee-specific patient reported outcome scores were extracted from each study and compared between groups. Study methodological quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) and Modified Coleman Methodology Score (MCMS). Infection rates and re-tear rates were pooled and weighted for meta-analysis using a random-effects model. All P values were reported with an alpha level of 0.05 set as significant.The initial search yielded 144 articles (44 duplicates, 100 screened, 29 full-text review). Ten articles (21,368 subjects [7,507 vancomycin and 13,861 no vancomycin], 67% males, mean age 29.5 + 1.5 years old) were included and analyzed. Eight of the 10 studies included only autografts, with 94.5% of grafts being hamstring autografts. Soaking grafts in vancomycin resulted in significantly fewer infections (0.013% vs 0.77%; OR 0.07 [0.03, 0.18], p < 0.001). Only two studies included patient reported outcomes, and both demonstrated no difference in International Knee Documentation Committee (IKDC) scores one year after surgery for patients with grafts pre-soaked in vancomycin compared to without vancomycin.Soaking ACL tendon grafts with vancomycin prior to implantation is associated with a nearly 15 times decrease in odds of infection compared to grafts not soaked in vancomycin. There were few studies that investigated patient reported outcomes and re-tear rates after soaking ACL grafts in vancomycin.

  View details for DOI 10.1016/j.arthro.2020.12.212

  View details for PubMedID 33359822

• Administrative Databases Utilized for Sports Medicine Research Demonstrate Significant Differences in Underlying Patient Demographics and Resulting Surgical Trends. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Xiao, M. n., Donahue, J. n., Safran, M. R., Sherman, S. L., Abrams, G. D. 2020

  Abstract

  To discern differences between the PearlDiver and MarketScan databases with regards to patient demographics, costs, re-operations, and complication rates for isolated meniscectomy.We queried the PearlDiver Humana Patient Records Database and the IBM® MarketScan® Commercial Claims and Encounters database for all patients who had record of meniscectomy denoted by CPT-29880 or CPT-29881 codes between January 1, 2007 and December 31, 2016. Those that had any other knee procedure at the same time as the meniscectomy were excluded, and the first instance of isolated meniscectomy was recorded. Patient demographics, Charlson Comorbidity Index (CCI), reoperations, 30- and 90-day complication rates, and costs were collected from both databases. Pearson's χ2 test with Yate's continuity correction and the student t-test were used to compare the two databases, and an alpha value of 0.05 was set as significant.We identified 441,147 patients with isolated meniscectomy from the MarketScan database (0.36% of total database), approximately 10 times the number of patients (n = 49,924; 0.20% of total database) identified from PearlDiver. The PearlDiver population was significantly older (median age: 65-69) than the MarketScan cohort, where all patients were younger than 65 (median age: 52; p < 0.001). Average CCI was significantly lower for MarketScan (0.172, SD: 0.546) compared to PearlDiver (1.43, SD: 2.05; p < 0.001), even when restricting the PearlDiver cohort to patients under 65 (1.02, SD: 1.74; p < 0.001). The PearlDiver < 65 sub-cohort also had increased 30- (RR: 1.53 (1.40-1.67)) and 90-day (RR: 1.56 (1.47-1.66)) post-operative complications compared to MarketScan. Overall, laterality coding was more prevalent in the PearlDiver database.For those undergoing isolated meniscectomy, the MarketScan database comprised an overall larger and younger cohort of patients with fewer comorbidities, even when examining only subjects under 65 years of age.Level III, retrospective comparative study.

  View details for DOI 10.1016/j.arthro.2020.09.013

  View details for PubMedID 32966865

• Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database. The American journal of sports medicine Sochacki, K. R., Varshneya, K. n., Calcei, J. G., Safran, M. R., Abrams, G. D., Donahue, J. n., Sherman, S. L. 2020: 363546520935453

  Abstract

  Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series.To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database.Cohort study; Level of evidence, 3.A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All P values were reported with significance set at P < .05.A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery (P < .001), meniscal transplantation (P = .005), or total knee arthroplasty (P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001).Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.

  View details for DOI 10.1177/0363546520935453

  View details for PubMedID 32667826

• Reoperation Rates following Meniscus Transplantation using the Truven Database. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Sochacki, K. R., Varshneya, K. n., Safran, M. R., Abrams, G. D., Donahue, J. n., Wang, T. n., Sherman, S. L. 2020

  Abstract

  The purpose of this study was to determine the (1) reoperation rate and (2) 30-day complication rate in a large insurance database.The Truven Database was queried for subjects that underwent meniscus allograft transplantation (CPT code 29868) in the outpatient setting with minimal two year follow up. Patients without confirmed laterality and patients that underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes.284 patients (mean age of 26.2 ± 10.4 years old and 49.6% females) were included in this study with mean follow up of 43.2 ± 19.2 months. One hundred and sixty seven subjects (58.8%) undergoing meniscus allograft transplantation underwent reoperation at an average of 11.9 ± 12.2 months postoperatively. There was a low number of subjects that required ipsilateral unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) postoperatively (0.7% and 1.1%, respectively). The overall 30-day complication rate following meniscus allograft transplantation was 1.4%.Patients undergoing meniscus allograft transplantation have a 58.8% reoperation rate at final follow up with low (1.4%) 30-day complication rates in a large insurance database.

  View details for DOI 10.1016/j.arthro.2020.06.031

  View details for PubMedID 32645340

• Meniscus Injuries: A Review of Rehabilitation and Return to Play. Clinics in sports medicine Sherman, S. L., DiPaolo, Z. J., Ray, T. E., Sachs, B. M., Oladeji, L. O. 2020; 39 (1): 165–83

  Abstract

  Meniscal injury potentiates a sequence of events that leads to degenerative changes and early osteoarthritis. It is therefore imperative to preserve the meniscus whenever possible. Given the expanding indications for meniscus repair, it is important to continually analyze and advance the understanding of rehabilitation and return to play following meniscal surgery. This article presents evidence-based rehabilitation and return-to-play guidelines as well as a brief review of return-to-play outcomes following isolated meniscus repair.

  View details for DOI 10.1016/j.csm.2019.08.004

  View details for PubMedID 31767104

• Patellofemoral Imaging and Analysis OPERATIVE TECHNIQUES IN SPORTS MEDICINE Sherman, S. L., Todd Raines, B., Benjamin Burch, M., Ray, T., Stein, B. 2019; 27 (4)

  View details for DOI 10.1016/j.otsm.2019.150684

  View details for Web of Science ID 000502884400003

• Enhanced subchondroplasty treatment for post-traumatic cartilage and subchondral bone marrow lesions in a canine model. Journal of orthopaedic research : official publication of the Orthopaedic Research Society Oliver, H. A., Bozynski, C. C., Cook, C. R., Kuroki, K., Sherman, S. L., Stoker, A. M., Cook, J. L. 2019

  Abstract

  This study characterizes outcomes associated with subchondroplasty (SCP) versus SCP enhanced with platelet rich plasma (PRP) or bone marrow aspirate concentrate (BMC) treatment of impact-induced subchondral bone marrow lesions (BML) using a validated pre-clinical canine model. With IACUC approval, purpose-bred research hounds (n=24) underwent arthroscopic impact injury (40N) to both medial femoral condyles. At 3 months, functional assessments, arthroscopy, and MRI were performed. One knee in each dog (n=24; n=12 per endpoint) was randomly assigned to SCP with the other knee randomly assigned to SCP+PRP, SCP+BMC or sham injection (Control) (n=8 per group; n=4 per endpoint). Dogs were evaluated at 6 and 12 months after treatment using functional assessments, radiography, arthroscopy, and MRI and humanely euthanatized at 6 or 12 months after treatment for histologic assessments. At 6 months post-treatment, comfortable range-of-motion (CROM) was higher (p<0.04) in SCP+PRP and SCP+BMC knees compared to Controls. At 1 year post-treatment, %-Total Pressure Index was higher (p=0.036) in SCP+BMC compared to Controls, pain was lower (p<0.05) in SCP+BMC and SCP+PRP compared to SCP and Controls, and CROM was higher (p<0.05) in SCP+BMC and SCP+PRP compared to SCP and Controls. Knees treated with SCP+PRP and SCP+BMC had better (p<0.05) MRI grades than SCP and Controls. No statistically significant differences in arthroscopic or histologic pathology were noted. Clinical significance: Biologics added to SCP treatment may further enhance its beneficial effects by improving range-of-motion, pain severity, and limb loading through 1 year after treatment. However, these benefits must be considered alongside cost, logistics, and treatment availability. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/jor.24508

  View details for PubMedID 31692048

• Optimizing Patellofemoral Cartilage Restoration and Instability With Tibial Tubercle Osteotomy ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Sherman, S. L., Humpherys, J., Farr, J. 2019; 35 (8): 2255–56

  Abstract

  Tibial tubercle osteotomy (TTO) is a procedure that may be used to address a wide array of patellofemoral joint pathology. The most common indications for TTO include (1) patellar instability, including either a lateralized force vector or abnormal patellar alta, and (2) patellar focal cartilage defects or chondromalacia. Customization of the TTO can effectively address the patellofemoral joint pathology by modifying patellar tracking in the trochlear groove and/or altering the contact pressures experienced by the patellofemoral cartilage. TTO may be most successful when performed in conjunction with soft-tissue stabilization and/or biological augmentation of chondral injuries. Specifically, isolated anteromedialization is recommended for focal, distal lateral patellar lesions; combined anteromedialization and cartilage restoration are recommended for medial, central, and/or panpatellar cartilage pathology; medialization with soft-tissue stabilization is recommended for a lateralized tubercle position (elevated tibial tubercle-trochlear groove distance); and distalization with soft-tissue stabilization is recommended for patella alta. Clinical studies have shown good to excellent results at long-term follow-up when a TTO is performed for patellar instability, whereas TTO performed for chondral defects has shown good to excellent outcomes that correlate strongly with the size and location of the chondral defect. With appropriate patient selection, TTO is a valuable tool for the treatment of patellofemoral joint pathology.

  View details for DOI 10.1016/j.arthro.2019.05.013

  View details for Web of Science ID 000478807600002

  View details for PubMedID 31395155

• Biomechanical Evaluation of Suture Anchor versus Transosseous Tunnel Patellar Tendon Repair Techniques. The journal of knee surgery Sherman, S. L., Black, B., Mooberry, M. A., Freeman, K. L., Gulbrandsen, T. R., Milles, J. L., Evans, L., Flood, D., Pfeiffer, F. 2019; 32 (8): 825–32

  Abstract

  The objective of this study is to compare the cyclic loading strength and ultimate failure load in suture anchor repair versus transosseous tunnel repair of patellar tendons using a cadaver model. Twelve cadaveric patella specimens were used (six matched pairs). Dual-energy X-ray absorptiometry (DXA) measurements were performed to ensure equal bone quality among groups. All right knees were assigned to the suture anchor repair group (n=6), whereas all left knees were assigned to the transosseous bone tunnel group (n=6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 1Hz between magnitudes of 50 and 150N, 50 and 200N, 50 and 250N, and tensile load at a rate of 0.1 mm/s until failure. Failure was defined as a sharp deviation in the linear load versus displacement curve, and failure mode was recorded. DXA measurements demonstrated equivalence of bone quality between the two groups (p>0.05). During cyclic load testing, there was only a statistically significant difference between the groups with regard to cyclic loading at the 50 to 200N loading cycle (p=0.010). There was no statistically significant difference between the groups with regard to ultimate load to failure (p=0.43). Failure mode within the suture anchor cohort occurred through anchor pullout except for one, which failed through the tendon. All specimens within the transosseous cohort failed through the midsubstance of the tendon except for one, which failed through suture breakage. Suture anchor repair demonstrated a similar biomechanical profile regarding cyclic loading and ultimate load to failure when compared with "gold standard" transosseous tunnel patellar tendon repair with a trend toward less gapping in the suture anchor group. Using suture anchors for repair of the patella tendon has similar biomechanical properties to transpatellar tunnels but may provide other clinical advantages.

  View details for DOI 10.1055/s-0038-1669790

  View details for PubMedID 30189438

• Articular Cartilage Lesion Characteristic Reporting Is Highly Variable in Clinical Outcomes Studies of the Knee CARTILAGE Jones, K. J., Sheppard, W. L., Arshi, A., Hinckel, B. B., Sherman, S. L. 2019; 10 (3): 299–304

  Abstract

  The purpose of this study was to investigate the degree of standardized evaluation and reporting of cartilage lesion characteristics in high-impact clinical studies for symptomatic lesions of the knee. We hypothesized that there are significant inconsistencies in reporting these metrics across orthopedic literature.A total of 113 clinical studies on articular cartilage restoration of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2016. Full-text review was used to evaluate sources for details on study methodology and reporting on the following variables: primary procedure, location, size, grade, and morphology of cartilage lesions.All studies reported on the type of primary cartilage procedure and precise lesion location(s). Approximately 99.1% reported lesion morphology (chondral, osteochondral, mixed). For lesion size, 32.7% of articles did not report how size was measured and 11.5% did not report units. The lesion sizing method was variable, as 27.4% used preoperative magnetic resonance imaging to measure/report lesion size, 31.0% used arthroscopy, and 8.8% used both. The majority of studies (83.2%) used area to report size, and 5.3% used diameter. Formal grading was not reported in 17.7% of studies. Only 54.8% of studies reported depth when sizing osteochondral defects.Recent literature on cartilage restoration provides adequate information on surgical technique, lesion location, and morphology. However, there is wide variation and incomplete reporting on lesion size, depth, and grading. Future clinical studies should include these important data in a consistent manner to facilitate comparison among surgical techniques.

  View details for DOI 10.1177/1947603518756464

  View details for Web of Science ID 000472034600004

  View details for PubMedID 29405742

  View details for PubMedCentralID PMC6585291

• Do neoprene sleeves and prophylactic knee braces affect neuromuscular control and cutting agility? Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine Bodendorfer, B. M., Arnold, N. R., Shu, H. T., Leary, E. V., Cook, J. L., Gray, A. D., Guess, T. M., Sherman, S. L. 2019; 39: 23–31

  Abstract

  OBJECTIVES: To evaluate the effects of neoprene sleeves (NSs) and prophylactic knee braces (PKBs) on neuromuscular control and cutting agility.DESIGN: Markerless motion-capture technology tracked subjects (1) without a brace as a control (2) with NSs and (3) with PKBs during single-leg drop vertical jump (SLDVJ), single-leg squat (SLS), Y-excursion, and cutting movements. Movements were recorded five times per bracing condition in three different sessions.SETTING: University laboratory.PARTICIPANTS: Ten healthy, active subjects (5 male, 5 female; age range, 22-26 years).MAIN OUTCOME MEASURES: Degrees of motion and time to completion.RESULTS: Use of NSs and PKBs reduced subjects' hip internal rotation in the loading phase of SLDVJ (p = 0.026, 0.02) and SLS (p = 0.005, <0.001), reduced knee flexion in the loading phase of SLDVJ (p = 0.038, <0.001), and reduced knee frontal plane abduction (FPA) with SLS (p = 0.015, 0.024) and Y-excursion (p = 0.002, 0.005) compared to control. Use of PKBs decreased subjects' hip internal rotation in the Y-excursion (p = 0.024) and reduced knee FPA in the SLDVJ loading phase (p = 0.014) compared to control. There was no difference in cutting agility for either group (p = 0.145, 0.347).CONCLUSION: Both NSs and PKBs positively impacted neuromuscular control without impacting cutting agility.

  View details for DOI 10.1016/j.ptsp.2019.05.007

  View details for PubMedID 31203143

• Accurate Reporting of Concomitant Procedures Is Highly Variable in Studies Investigating Knee Cartilage Restoration. Cartilage Sheppard, W. L., Hinckel, B. B., Arshi, A., Sherman, S. L., Jones, K. J. 2019: 1947603519841673

  Abstract

  OBJECTIVE: Successful clinical outcomes following cartilage restoration procedures are highly dependent on addressing concomitant pathology. The purpose of this study was to document methods for evaluating concomitant procedures of the knee when performed with articular cartilage restoration techniques, and to review their reported findings in high-impact clinical orthopedic studies. We hypothesized that there are substantial inconsistencies in reporting clinical outcomes associated with concomitant procedures relative to outcomes related to isolated cartilage repair.DESIGN: A total of 133 clinical studies on articular cartilage repair of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2017. Studies were included if they were primary research articles reporting clinical outcomes data following surgical treatment of articular cartilage lesions with a minimum sample size of 5 patients. Studies were excluded if they were review articles, meta-analyses, and articles reporting only nonclinical outcomes (e.g., imaging, histology). A full-text review was then used to evaluate details regarding study methodology and reporting on the following variables: primary cartilage repair procedure, and the utilization of concomitant procedures to address additional patient comorbidities, including malalignment, meniscus pathology, and ligamentous instability. Each study was additionally reviewed to document variation in clinical outcomes reporting in patients that had these comorbidities addressed at the time of surgery.RESULTS: All studies reported on the type of primary cartilage repair procedure, with autologous chondrocyte implantation (ACI) noted in 43% of studies, microfracture (MF) reported in 16.5%, osteochondral allograft (OCA) in 15%, and osteochondral autograft transplant (OAT) in 8.2%. Regarding concomitant pathology, anterior cruciate ligament (ACL) reconstruction (24.8%) and meniscus repair (23.3%) were the most commonly addressed patient comorbidities. A total of 56 studies (42.1%) excluded patients with malalignment, meniscus injury, and ligamentous instability. For studies that addressed concomitant pathology, 72.7% reported clinical outcomes separately from the cohort treated with only cartilage repair. A total of 16.5% of studies neither excluded nor addressed concomitant pathologies. There was a significant amount of variation in the patient reported outcome scores used among the studies, with the majority of studies reporting International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) in 47.2% and 43.6% of articles, respectively.CONCLUSIONS: In this study on knee cartilage restoration, recognition and management of concomitant pathology is inadequately reported in approximately 28% of studies. Only 30% of articles reported adequate treatment of concomitant ailments while scoring their outcomes using one of a potential 18 different scoring systems. These findings highlight the need for more standardized methods to be applied in future research with regard to inclusion, exclusion, and scoring concomitant pathologies with regard to treatment of cartilage defects in the knee.

  View details for DOI 10.1177/1947603519841673

  View details for PubMedID 30971096

• Isolated Complete Rupture of the Biceps Femoris Insertion: A Surgical Repair Technique Manuscript ARTHROSCOPY TECHNIQUES Todd Raines, B., Pomajzl, R. J., Ray, T. E., Bley, J. A., Sherman, S. L. 2019; 8 (4): E407–E411

  Abstract

  Isolated rupture of the distal biceps femoris insertion is rare. Current literature offers limited case reports and outcome measures after surgical management. We describe a knotless suture anchor fixation technique for this tear pattern. At surgery, the retracted biceps tendon and insertion site is debrided to healthy tissue, FiberTape suture (Arthrex) is passed in a Kracków fashion through the tendon, and the 2 ends of the suture are brought down to a SwiveLock anchor (Arthrex) at the anatomic insertion. FiberWire sutures (Arthrex) from the anchor are brought over the remnant stump, completing the repair.

  View details for DOI 10.1016/j.eats.2018.11.020

  View details for Web of Science ID 000466921200009

  View details for PubMedID 31080724

  View details for PubMedCentralID PMC6506860

• Relationship Between 2-Dimensional Frontal Plane Measures and the Knee Abduction Angle During the Drop Vertical Jump JOURNAL OF SPORT REHABILITATION Willis, B. W., Hocker, K., Razu, S., Gray, A. D., Skubic, M., Sherman, S. L., Kurkowski, S., Guess, T. M. 2019; 28 (4): 399–402

  Abstract

  Context: Knee abduction angle (KAA), as measured by 3-dimensional marker-based motion capture systems during jump-landing tasks, has been correlated with an elevated risk of anterior cruciate ligament injury in females. Due to the high cost and inefficiency of KAA measurement with marker-based motion capture, surrogate 2-dimensional frontal plane measures have gained attention for injury risk screening. The knee-to-ankle separation ratio (KASR) and medial knee position (MKP) have been suggested as potential frontal plane surrogate measures to the KAA, but investigations into their relationship to the KAA during a bilateral drop vertical jump task are limited. Objective: To investigate the relationship between KASR and MKP to the KAA during initial contact of the bilateral drop vertical jump. Design: Descriptive. Setting: Biomechanics laboratory. Participants: A total of 18 healthy female participants (mean age: 24.1 [3.88] y, mass: 65.18 [10.34] kg, and height: 1.63 [0.06] m). Intervention: Participants completed 5 successful drop vertical jump trials measured by a Vicon marker-based motion capture system and 2 AMTI force plates. Main Outcome Measure: For each jump, KAA of the tibia relative to the femur was measured at initial contact along with the KASR and MKP calculated from planar joint center data. The coefficient of determination (r2) was used to examine the relationship between the KASR and MKP to KAA. Results: A strong linear relationship was observed between MKP and KAA (r2 = .71), as well as between KASR and KAA (r2 = .72). Conclusions: Two-dimensional frontal plane measures show strong relationships to the KAA during the bilateral drop vertical jump.

  View details for DOI 10.1123/jsr.2018-0017

  View details for Web of Science ID 000470203900001

  View details for PubMedID 30422040

• The 50 Most-Cited Articles in Meniscal Allograft Transplantation Research: A Bibliometric Analysis CARTILAGE Chaudhry, Z. S., Fram, B., Henn, R., Sherman, S. L., Hammoud, S. 2019; 10 (2): 196–204

  Abstract

  To identify the 50 most-cited articles in meniscal allograft transplantation (MAT) research and analyze their characteristics.In September 2017, the Scopus database was queried to identify the 50 most-cited articles in MAT research. Variables analyzed include number of citations, publication year, journal, institution, country of origin, article type, study design, and level of evidence. Citation density was calculated for each article. The correlation between citation density and publication year and the correlation between level of evidence and number of citations, citation density, and publication year were computed.The 50 most-cited articles were published in 12 journals between 1986 and 2011. The number of citations ranged from 59 to 290 (109.3 ± 48.6). Citation density ranged from 2.7 to 17.6 citations per year (7.0 ± 3.3). There was a positive correlation between citation density and publication year ( r = +0.489, P < 0.001). Overall, 56% of the articles were clinical and 44% were basic science. Of the 28 clinical articles, 61% were level IV or V evidence. Level of evidence was not significantly correlated with number of citations ( r = -0.059, P = 0.766), citation density ( r = +0.030, P = 0.880), or publication year ( r = -0.0009, P = 0.996).This analysis provides the orthopedic community with a readily accessible list of the classic citations in MAT research and provides insight into the historical development of this procedure. Although there was a moderate positive correlation between citation density and publication year, articles with stronger levels of evidence were not more frequently cited despite the increasing trend toward evidence-based practice.

  View details for DOI 10.1177/1947603517749922

  View details for Web of Science ID 000461640700006

  View details for PubMedID 29291274

  View details for PubMedCentralID PMC6425545

• Management of patellofemoral instability in the setting of multiligament knee injury ANNALS OF JOINT Sherman, S. L., Oladeji, L. O., Welsh, J., DiPaolo, Z. J. 2018; 3 (11)

  View details for DOI 10.21037/aoj.2018.11.10

  View details for Web of Science ID 000452891200014

• Subchondroplasty for the treatment of post-traumatic bone marrow lesions of the medial femoral condyle in a pre-clinical canine model JOURNAL OF ORTHOPAEDIC RESEARCH Brimmo, O. A., Bozynski, C. C., Cook, C. R., Kuroki, K., Sherman, S. L., Pfeiffer, F. M., Stoker, A. M., Cook, J. L. 2018; 36 (10): 2709–17

  Abstract

  This study characterizes long-term outcomes associated with subchondroplasty (SCP) treatment for impact-induced subchondral bone marrow lesions (BML) using a validated pre-clinical canine model. With IACUC approval, purpose-bred research hounds (n = 16) underwent arthroscopic impact injury (40N) to both medial femoral condyles. At 3 months, functional assessments, arthroscopy, and MRI were performed and knees (n = 32) were randomly assigned to SCP (3 ml fluoroscopically guided percutaneous injection of AccuFill BSM into BML bone defects) or sham injection (Control). Dogs were assessed at 3, 6, 12, and 24 months after treatment using functional assessments, radiographic evaluation, arthroscopy, and MRI. Dogs were humanely euthanatized at 3, 6, 12, or 24 months after treatment for gross, microCT, and histologic assessments. All knees had focal articular cartilage defects with associated subchondral BMLs, as well as clinical dysfunction, 3 months after injury. At the 3 and 6 months, SCP knees showed more functional impairment than Control knees, however, these differences were not statistically significant. At 1- and 2-year post-treatment, function in SCP knees was better than in Control knees with range of motion being significantly (p < 0.05) better for SCP. Radiographic, arthroscopic, MRI, gross, microCT, and histologic findings matched the functional assessments well with Control being associated with better results at the two early time points and SCP being associated with better results at 1 and 2 years. Clinical significance: SCP treatment using calcium phosphate bone void filler was associated with an initial increase in pain and dysfunction followed by symptomatic benefits for up to 2 years after treatment for post-traumatic femoral condyle BMLs in a preclinical canine model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2709-2717, 2018.

  View details for DOI 10.1002/jor.24046

  View details for Web of Science ID 000449527800016

  View details for PubMedID 29748965

• Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY Baumann, C. A., Pratte, E. L., Sherman, S. L., Arendt, E. A., Hinckel, B. B. 2018; 26 (10): 2920–33

  Abstract

  The medial patellotibial ligament (MPTL), the medial patellofemoral ligament (MPFL), and the medial patellomeniscal ligament (MPML) support the stability of the patellofemoral joint. The purpose of this systematic review was to report the surgical techniques and clinical outcomes of the repair or reconstruction of the MPTL in isolation or concomitant with the MPFL and/or other procedures.A systematic review of the literature was conducted. Inclusion criteria were articles in the English language that reported clinical outcomes of the reconstruction of the MPTL in isolation or in combination with the MPFL and/or other procedures. Included articles were then cross-referenced to find additional journal articles not found in the initial search. The methodological quality of the articles was determined using the Coleman Methodology Score.Nineteen articles were included detailing the clinical outcomes of 403 knees. The surgical procedures described included hamstrings tenodesis with or without other major procedures, medial transfer of the medial patellar tendon with or without other major procedures and the reconstruction of the MPTL in association with the MPFL. Overall, good and excellent outcomes were achieved in > 75% of cohorts in most studies and redislocations were < 10%, with or without the association of the MPFL. An exception was one study that reported a high failure rate of 82%. Results were consistent across different techniques. The median CMS for the articles was 66 out of 100 (range 30-85).Across different techniques, the outcomes are good with low rates of recurrence, with one article reporting a high rate of recurrence. Quality of the articles is variable, from low to high. Randomized control trials are needed for a better understanding of the indications, surgical techniques, and clinical outcomes. This systematic review suggests that the reconstruction of the MPTL leads to favorable clinical outcomes and supports the role of the procedure as a valid surgical patellar stabilization procedure.IV: systematic review of level I-IV studies.

  View details for DOI 10.1007/s00167-018-4833-6

  View details for Web of Science ID 000444832000008

  View details for PubMedID 29344696

• Meniscus Allograft Transplantation OPERATIVE TECHNIQUES IN SPORTS MEDICINE Sherman, S. L., Thomas, D. M., Gulbrandsen, T. R., Farr, J. 2018; 26 (3): 189–204

  View details for DOI 10.1053/j.otsm.2018.06.010

  View details for Web of Science ID 000447244200007

• Evaluation of Novel Cartilage Treatment Options for Clinical Use OPERATIVE TECHNIQUES IN SPORTS MEDICINE Farr, J., Sherman, S. L. 2018; 26 (3): 218–26

  View details for DOI 10.1053/j.otsm.2018.06.001

  View details for Web of Science ID 000447244200010

• Chondral and osteochondral lesions in the patellofemoral joint: when and how to manage ANNALS OF JOINT Sherman, S. L., Thomas, D. M., Farr, J. 2018; 3 (6)

  View details for DOI 10.21037/aoj.2018.04.12

  View details for Web of Science ID 000452887300006

• Return to Play after Patellar Stabilization CURRENT REVIEWS IN MUSCULOSKELETAL MEDICINE Sherman, S. L., Deasis, D. P., Garrone, A. J., Voss, E. E., Oliver, H. A. 2018; 11 (2): 280–84

  Abstract

  The purpose of this review is to evaluate the existing literature regarding return to play (RTP) and return to prior performance (RPP) following patellar stabilization surgery. It will also discuss suggested guidelines regarding RTP, and finally, to encourage future patellofemoral instability research to report and publish results of RTP rates using standardized RTP guidelines.There is a lack of validation and universal adoption of standardized RTP guidelines. This has led to a dearth of high-quality studies on RTP and RPP after patellar stabilization. The best available studies to date would suggest high RTP rates (84%-100%), average RPP rates (33%-77%), and a highly variable timeframe for return (3-12 months). Patellofemoral instability can be a persistent and challenging problem, particularly in the young and active population for which it most often occurs. Much of the previous studies on patellofemoral instability evaluated success and failure as prevention of recurrent dislocation. However, prevention of recurrence alone may not be enough for many patients. The best available data on RTP and RPP following patellofemoral instability is based on lower quality of evidence studies, expert opinion, and published societal guidelines. Future research on this topic should include clinical validation of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) RTP guidelines and reporting of outcomes based on these guidelines in patellofemoral instability publications.

  View details for DOI 10.1007/s12178-018-9484-1

  View details for Web of Science ID 000433204500014

  View details for PubMedID 29750318

  View details for PubMedCentralID PMC5970119

• Radiologic and Histologic Evaluation of Proximal Bicep Pathology in Patients With Chronic Biceps Tendinopathy Undergoing Open Subpectoral Biceps Tenodesis ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Nuelle, C. W., Stokes, D. C., Kuroki, K., Crim, J. R., Sherman, S. L. 2018; 34 (6): 1790–96

  Abstract

  To correlate preoperative magnetic resonance imaging (MRI) and intraoperative anatomic findings within the proximal long head biceps tendon to histologic evaluation of 3 separate zones of the tendon in patients with chronic biceps tendinopathy.Sixteen patients with chronic biceps tendinopathy were treated with open subpectoral biceps tenodesis. Preoperative MRI tendon grading was as follows: normal tendon, increased signal, tendon splitting, incomplete/complete tear. The removed portion of the biceps tendon was split into 3 segments: zone 1, 0-3.5 cm from the labral insertion; zone 2, 3.5-6.5 cm; and zone 3, 6.5-9 cm, and was histologically evaluated using the Bonar score. Tenosynovium adjacent to the tendon was assessed histologically using the Osteoarthritis Research Society International score. CD31, CD3, and CD79a immunohistochemistries were conducted to determine vascularization, T-cell infiltrates, and B-cell infiltrates, respectively. Analysis of variance and Pearson correlations were performed for statistical analysis.Preoperative MRI showed no significant differences in tendon appearance between zones 1-3. Intraoperative findings included nonspecific degenerative SLAP tears or mild/moderate biceps tenosynovitis in all cases. Significantly (P < .001) higher Bonar scores were noted for tendon in zones 1 (7.9 ± 1.8) and 2 (7.3 ± 1.5) compared with zone 3 (5.0 ± 1.1). Cell morphology scores in zone 1 (1.9 ± 0.4) and zone 2 (1.5 ± 0.6) were significantly higher than that in zone 3 (0.8 ± 0.3) (P < .05). Inflammatory tenosynovium showed weak correlation with tendon changes in zone 1 (r = 0.08), zone 2 (r = 0.03), or zone 3 (r = 0.1).In patients with chronic long head biceps tendinopathy who underwent open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes. Severity of tendon histopathology was more pronounced in the proximal and mid-portions of the tendon.Proximal versus distal biceps tenodesis is a subject of frequent debate. This study contributes to the ongoing evaluation of the characteristics of the proximal biceps in this type of pathologic condition.

  View details for DOI 10.1016/j.arthro.2018.01.021

  View details for Web of Science ID 000433213900013

  View details for PubMedID 29573932

• Anterior Cruciate Ligament Injuries in Missouri High School Male and Female Soccer Athletes Gray, A. D., Miller, S., Sherman, S. L., Leary, E., Willis, B. W. LIPPINCOTT WILLIAMS & WILKINS. 2018: 575

  View details for Web of Science ID 000456870502404

• Distal Femoral Varus Osteotomy for the Management of Valgus Deformity of the Knee JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Sherman, S. L., Thompson, S. F., Clohisy, J. F. 2018; 26 (9): 313–24

  Abstract

  Distal femoral varus osteotomy is a well-described treatment option for patients with valgus malalignment associated with a variety of underlying conditions. This procedure may be the definitive treatment option in active patients with isolated lateral compartment osteoarthritis or posttraumatic arthritis. It may be a useful concomitant procedure in young patients with lateral meniscus deficiency, focal chondral defects, chronic medial collateral ligament insufficiency, and/or patellofemoral instability. Distal femoral varus osteotomy can be performed with medial closing wedge or lateral opening wedge techniques. Variable outcomes and complication rates have been reported. A framework for the use of distal femoral varus osteotomy can aid the orthopaedic surgeon in the evaluation and treatment of patients with symptomatic valgus malalignment.

  View details for DOI 10.5435/JAAOS-D-16-00179

  View details for Web of Science ID 000441215400006

  View details for PubMedID 29629916

• Youth Baseball Pitching Mechanics: A Systematic Review SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH Thompson, S. F., Guess, T. M., Plackis, A. C., Sherman, S. L., Gray, A. D. 2018; 10 (2): 133–40

  Abstract

  Pitching injuries in youth baseball are increasing in incidence. Poor pitching mechanics in young throwers have not been sufficiently evaluated due to the lack of a basic biomechanical understanding of the "normal" youth pitching motion.To provide a greater understanding of the kinetics and kinematics of the youth baseball pitching motion.PubMed, MEDLINE, and SPORTDiscus databases were searched from database inception through February 2017.A total of 10 biomechanical studies describing youth pitching mechanics were included.Systematic review.Level 3.Manual extraction and compilation of demographic, methodology, kinetic, and kinematic variables from the included studies were completed.In studies of healthy youth baseball pitchers, progressive external rotation of the shoulder occurs throughout the start of the pitching motion, reaching a maximum of 166° to 178.2°, before internally rotating throughout the remainder of the cycle, reaching a minimum of 13.2° to 17°. Elbow valgus torque reaches the highest level (18 ± 4 N·m) just prior to maximum shoulder external rotation and decreases throughout the remainder of the pitch cycle. Stride length is 66% to 85% of pitcher height. In comparison with a fastball, a curveball demonstrates less elbow varus torque (31.6 ± 15.3 vs 34.8 ± 15.4 N·m).Multiple studies show that maximum elbow valgus torque occurs just prior to maximum shoulder external rotation. Forces on the elbow and shoulder are greater for the fastball than the curveball.

  View details for DOI 10.1177/1941738117738189

  View details for Web of Science ID 000429947700006

  View details for PubMedID 29090988

  View details for PubMedCentralID PMC5857730

• Patellofemoral Cartilage Restoration: Indications, Techniques, and Outcomes Foreword JOURNAL OF KNEE SURGERY Sherman, S. L. 2018; 31 (3): 205

  View details for DOI 10.1055/s-0037-1608642

  View details for Web of Science ID 000425403200001

  View details for PubMedID 29165743

• Overuse of Magnetic Resonance Imaging in the Diagnosis and Treatment of Moderate to Severe Osteoarthritis. The Iowa orthopaedic journal Sherman, S. L., Gulbrandsen, T. R., Lewis, H. A., Gregory, M. H., Capito, N. M., Gray, A. D., Bal, B. S. 2018; 38: 33–37

  Abstract

  Background: MRI in the evaluation of end-stage knee joint osteoarthritis (OA) is usually unnecessary when radiographic and clinical evidence of gonarthrosis is clear. The purpose of this study was to assess the prevalence of MRI scans ordered in patients with radiographically obvious gonarthrosis and to examine the characteristics of health care providers who ordered these imaging studies.Methods: We retrospectively identified 164 patients diagnosed with moderate to severe OA who were referred for total knee replacement (TKA) over a one-year period. The percentage of patients who had an MRI scan with or without X-ray, within the preceding 3 months prior to referral, were calculated. Subgroups were analyzed to identify characteristics that may influence the decision to order an MRI, including K-L grade, provider type, level of training, and practice location.Results: Of 145 patients, 19 (13.1%) presented with an MRI scan. Between the number of MRI scans ordered, there was a significant difference when comparing physicians versus non-physicians, with physicians ordering less MRI scans (p=0.018). There was a significant difference when comparing non-academic versus academic, with academic providers ordering less MRI scans (p=0.044). There was no significant difference with fellowship training or provider proximity to our academic institution.Conclusions: In this study, 13.1% of patients with radiographically obvious knee OA obtained an MRI prior to referral for TKA. Non-physicians and non-academic physicians were more likely to order MRI scans. Improved education for referring providers may be necessary to decrease overuse of MRI in the diagnosis of moderate to severe arthritis.Level of Evidence: Level II.

  View details for PubMedID 30104922

• A Novel Depth Image Analysis Method to Calculate the Anterior Reach of the Modified Star Excursion Balance Test Mishra, A. K., Skubic, M., Willis, B. W., Guess, T., Gray, A. D., Sherman, S. L., ACM ASSOC COMPUTING MACHINERY. 2018: 11-14

  View details for DOI 10.1145/3240925.3240971

  View details for Web of Science ID 000614057600002

• In Vivo Toxicity of Local Anesthetics and Corticosteroids on Supraspinatus Tenocyte Cell Viability and Metabolism. The Iowa orthopaedic journal Nuelle, C. W., Cook, C. R., Stoker, A. M., Cook, J. L., Sherman, S. L. 2018; 38: 107–12

  Abstract

  Background: This study was conducted to evaluate the effects of commonly used injection medication combinations on supraspinatus tenocyte cell viability and tissue metabolism.Methods: Twenty adult dogs underwent ultrasound guided injection of the canine equivalent of the subacromial space, based on random assignment to one of four treatment groups (n=5/group): normal saline, 1.0% lidocaine/methylprednisolone, 1.0% lidocaine/triamcinolone or 0.0625% bupivacaine/triamcinolone. Full-thickness sections of supraspinatus tendon were harvested under aseptic conditions and evaluated on days 1 and 7 post-harvest for cell viability and tissue metabolism. Data were analyzed for significant differences among groups.Results: Tendons exposed to 1% lidocaine/ methylprednisolone had significantly lower cell viability at day 1 as compared to all other groups and control. All local anesthetic/ corticosteroid combination groups had decreased cell viability at day 7 when compared to the control group.Conclusions: This study demonstrated significant in vivo supraspinatus tenotoxicity following a single injection of combination local anesthetic/ corticosteroid when compared to saline controls.Level of Evidence: Level II.

  View details for PubMedID 30104932

• Development and Validation of a Portable and Inexpensive Tool to Measure the Drop Vertical Jump Using the Microsoft Kinect V2 SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH Gray, A. D., Willis, B. W., Skubic, M., Huo, Z., Razu, S., Sherman, S. L., Guess, T. M. 2017; 9 (6): 537–44

  Abstract

  Noncontact anterior cruciate ligament (ACL) injury in adolescent female athletes is an increasing problem. The knee-ankle separation ratio (KASR), calculated at initial contact (IC) and peak flexion (PF) during the drop vertical jump (DVJ), is a measure of dynamic knee valgus. The Microsoft Kinect V2 has shown promise as a reliable and valid marker-less motion capture device.The Kinect V2 will demonstrate good to excellent correlation between KASR results at IC and PF during the DVJ, as compared with a "gold standard" Vicon motion analysis system.Descriptive laboratory study.Level 2.Thirty-eight healthy volunteer subjects (20 male, 18 female) performed 5 DVJ trials, simultaneously measured by a Vicon MX-T40S system, 2 AMTI force platforms, and a Kinect V2 with customized software. A total of 190 jumps were completed. The KASR was calculated at IC and PF during the DVJ. The intraclass correlation coefficient (ICC) assessed the degree of KASR agreement between the Kinect and Vicon systems.The ICCs of the Kinect V2 and Vicon KASR at IC and PF were 0.84 and 0.95, respectively, showing excellent agreement between the 2 measures. The Kinect V2 successfully identified the KASR at PF and IC frames in 182 of 190 trials, demonstrating 95.8% reliability.The Kinect V2 demonstrated excellent ICC of the KASR at IC and PF during the DVJ when compared with the Vicon system. A customized Kinect V2 software program demonstrated good reliability in identifying the KASR at IC and PF during the DVJ.Reliable, valid, inexpensive, and efficient screening tools may improve the accessibility of motion analysis assessment of adolescent female athletes.

  View details for DOI 10.1177/1941738117726323

  View details for Web of Science ID 000418307700007

  View details for PubMedID 28846505

  View details for PubMedCentralID PMC5665114

• Management of Anterior Cruciate Ligament Injury? What's In and What's Out? INDIAN JOURNAL OF ORTHOPAEDICS Raines, B., Naclerio, E., Sherman, S. L. 2017; 51 (5): 563–75

  Abstract

  Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.

  View details for DOI 10.4103/ortho.IJOrtho_245_17

  View details for Web of Science ID 000410233800011

  View details for PubMedID 28966380

  View details for PubMedCentralID PMC5609378

• Osteochondral Autologous Transplantation CLINICS IN SPORTS MEDICINE Sherman, S. L., Thyssen, E., Nuelle, C. W. 2017; 36 (3): 489-+

  Abstract

  Osteochondral autologous transplantation (OAT) is a treatment strategy for small and medium sized focal articular cartilage defects in the knee. This article reviews the indications, surgical techniques, outcomes, and limitations of OAT for the management of symptomatic chondral and osteochondral lesions in the knee joint.

  View details for DOI 10.1016/j.csm.2017.02.006

  View details for Web of Science ID 000404499200008

  View details for PubMedID 28577708

• Safety and efficacy of hyperosmolar irrigation solution in shoulder arthroscopy JOURNAL OF SHOULDER AND ELBOW SURGERY Capito, N. M., Cook, J. L., Yahuaca, B., Capito, M. D., Sherman, S. L., Smith, M. J. 2017; 26 (5): 745–51

  Abstract

  A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during shoulder arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for shoulder arthroscopy.A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation shoulder scores RESULTS: Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in shoulder girth (P < .05), and a significantly lower immediate postoperative visual analog scale pain score (P = .036). At 1 year postoperatively, the differences between groups for American Shoulder and Elbow Surgeons, visual analog scale pain, and Single Assessment Numeric Evaluation were not significant (P > .2).A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for shoulder arthroscopy has potential clinical benefits to surgeons and patients.

  View details for DOI 10.1016/j.jse.2017.02.021

  View details for Web of Science ID 000402464300010

  View details for PubMedID 28318850

• In vivo bone tunnel evaluation of nanoparticle-grafts using an ACL reconstruction rabbit model JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART A Grant, S. A., Smith, S. E., Schmidt, H., Pfeiffer, F., Kuroki, K., Sherman, S., White, R., Grant, D. A. 2017; 105 (4): 1071–82

  Abstract

  Acellular human gracilis tendons conjugated with gold nanoparticles (AuNP) and hydroxyapatite nanoparticles (nano-HAp) were used as a graft in an anterior cruciate ligament (ACL) reconstruction rabbit model. The ACLs of 11 New Zealand rabbits were reconstructed using grafts conjugated without nanoparticles, with AuNP only, and with both AuNP and nano-HAp. Semi-quantitative histological scoring of bone tunnel portion of grafts was performed after 14 weeks. Bone tunnels were scored for graft degeneration, graft remodeling, percentage of new host fibrous connective, collateral connection, head-to-head connection, graft collagen fiber organization, new host fibrous connective tissue organization, and graft and interface vascularity. All grafts were intact at 14 weeks. Results of bone tunnel scoring indicate remodeling in all graft types with new organized host fibrous connective tissue, head-to-head connection to bone and mild inflammation associated with remodeling. Components of the 20 nm AuNP grafts have significantly more graft degeneration, more new host fibrous connective tissue, and more vascularity compared to crosslinked grafts. Comparison between femoral and tibial tunnel scores indicate more degeneration in femoral tunnels compared to tibial tunnels. Overall results indicated potentially enhanced remodeling from the use of 20 nm AuNP grafts. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1071-1082, 2017.

  View details for DOI 10.1002/jbm.a.36000

  View details for Web of Science ID 000395008300012

  View details for PubMedID 28076887

• In vitro toxicity of local anaesthetics and corticosteroids on supraspinatus tenocyte viability and metabolism JOURNAL OF ORTHOPAEDIC TRANSLATION Nuelle, C. W., Cook, C. R., Stoker, A. M., Cook, J. L., Sherman, S. L. 2017; 8: 20–24

  Abstract

  The purpose of this study was to evaluate supraspinatus tenocyte viability and metabolism in explants exposed to various local anaesthetics and corticosteroids. Our hypothesis was that the tendons exposed to these common injectates would have significantly decreased cell viability and metabolism compared with controls.Supraspinatus tendon explants were obtained from dogs, placed in a culture media, and randomly assigned to one of the following groups: culture media only (control), 1% lidocaine, 0.5% lidocaine, 0.25% bupivacaine, 0.125% bupivacaine, 0.0625% bupivacaine, betamethasone acetate (5 mg), methylprednisolone acetate (40 mg), or triamcinolone acetonide (40 mg). Cell viability was determined on Days 1 and 7 after culture treatment using calcein AM (live cell) and Sytox Blue (dead cell) stains. Tissue metabolism was assessed on Days 1 and 7 using the resazurin blue metabolic assay. Significant differences were evaluated using a one-way analysis of variance with Tukey post hoc analysis.Compared with the controls, there were significant decreases in cell viability noted at Days 1 and 7 in tenocytes exposed to 1% lidocaine, betamethasone, and methylprednisolone. Significant decreases in cell metabolism were also noted at Days 1 and 7 in those groups. Treatment with 0.125% bupivacaine, 0.0625% bupivacaine, and triamcinolone demonstrated no decrease in cell viability or metabolism when compared with controls at any time point.This data confirms that peritendinous injection of commonly used local anaesthetics and corticosteroids results in significant supraspinatus tenotoxicity in vitro. Further in vivo studies are required before making definitive clinical recommendations.

  View details for DOI 10.1016/j.jot.2016.08.002

  View details for Web of Science ID 000391086500004

  View details for PubMedID 30035090

  View details for PubMedCentralID PMC5987053

• Development of a Micronized Meniscus Extracellular Matrix Scaffold for Potential Augmentation of Meniscal Repair and Regeneration TISSUE ENGINEERING PART C-METHODS Monibi, F. A., Bozynski, C. C., Kuroki, K., Stoker, A. M., Pfeiffer, F. M., Sherman, S. L., Cook, J. L. 2016; 22 (12): 1059–70

  Abstract

  Decellularized scaffolds composed of extracellular matrix (ECM) hold promise for repair and regeneration of the meniscus, given the potential for ECM-based biomaterials to aid in stem cell recruitment, infiltration, and differentiation. The objectives of this study were to decellularize canine menisci to fabricate a micronized, ECM-derived scaffold and to determine the cytocompatibility and repair potential of the scaffold ex vivo. Menisci were decellularized with a combination of physical agitation and chemical treatments. For scaffold fabrication, decellularized menisci were cryoground into a powder and the size and morphology of the ECM particles were evaluated using scanning electron microscopy. Histologic and biochemical analyses of the scaffold confirmed effective decellularization with loss of proteoglycan from the tissue but no significant reduction in collagen content. When washed effectively, the decellularized scaffold was cytocompatible to meniscal fibrochondrocytes, synoviocytes, and whole meniscal tissue based on the resazurin reduction assay and histologic evaluation. In an ex vivo model for meniscal repair, radial tears were augmented with the scaffold delivered with platelet-rich plasma as a carrier, and compared to nonaugmented (standard-of-care) suture techniques. Histologically, there was no evidence of cellular migration or proliferation noted in any of the untreated or standard-of-care treatment groups after 40 days of culture. Conversely, cellular infiltration and proliferation were noted in scaffold-augmented repairs. These data suggest the potential for the scaffold to promote cellular survival, migration, and proliferation ex vivo. Further investigations are necessary to examine the potential for the scaffold to induce cellular differentiation and functional meniscal fibrochondrogenesis.

  View details for DOI 10.1089/ten.tec.2016.0276

  View details for Web of Science ID 000391500100001

  View details for PubMedID 27824291

• OSTEOCHONDRAL ALLOGRAFTS IN SHOULDER SURGICAL PROCEDURES JBJS REVIEWS Capito, N. M., Owens, B. D., Sherman, S. L., Smith, M. J. 2016; 4 (11)

  Abstract

  The use of fresh osteochondral allografts has become popular in many joint-preserving orthopaedic procedures and shows early promising results within the shoulder. Distal tibial allograft contains a stout cartilaginous layer that appears to have highly congruent curvature and concavity to the glenoid, which makes for an optimal allograft option for instability. In the setting of large Hill-Sachs lesions, the use of a humeral-head osteochondral allograft is essential to restore geometry, stability, and mechanics of the native glenohumeral joint. One must be cautious with the treatment of glenoid chondral lesions with osteoarticular grafting procedures because of the depth of the glenoid compared with the depth of subchondral bone on the graft necessary to achieve a press fit, and advanced imaging is recommended when planning an operative intervention. Optimizing joint-preservation treatment with osteochondral allografts will rely on the long-term results of these procedures, and careful patient selection, preoperative discussion, and realistic expectations are necessary.

  View details for DOI 10.2106/JBJS.RVW.16.00001

  View details for Web of Science ID 000391034100003

  View details for PubMedID 27922984

• The 50 Most Cited Articles in Orthopedic Cartilage Surgery CARTILAGE Arshi, A., Siesener, N. J., McAllister, D. R., Williams, R. J., Sherman, S. L., Jones, K. J. 2016; 7 (3): 238–47

  Abstract

  To determine the 50 most cited articles in orthopedic cartilage surgery and their characteristics.A systematic review of the Science Citation Index Expanded was performed for articles related to cartilage surgery published in the 66 journals under the category "Orthopedics." The 50 most cited articles were determined, and the following characteristics were analyzed for each article: authors, journal and year of publication, number of citations, geographic origin, article type (basic science or clinical), article subtype by study design, and level of evidence. Citation density (total number of citations/years since publication) was also computed.The 50 most cited articles ranged from 989 to 172 citations, with citation density ranging from 71.5 to 4.1. The publication years spanned from 1968 to 2008, with the 2000s accounting for half (25) of the articles and the highest mean citation density (14.6). The 50 most cited articles were published in 11 journals. The majority of the articles (29) were clinical, with level IV representing the most common level of evidence (10). The remaining basic science articles were most commonly animal in vivo studies (14). Stronger level of evidence was correlated with overall number of citations (P = 0.044), citation density (P < 0.001), and year of publication (P = 0.003).Articles with stronger levels of evidence are more highly cited, with an increasing trend as evidence-based practice has been emphasized. This article list provides clinicians, researchers, and trainees with a group of "citation classics" in orthopedic cartilage surgery.

  View details for DOI 10.1177/1947603515621997

  View details for Web of Science ID 000384334800004

  View details for PubMedID 27375839

  View details for PubMedCentralID PMC4918068

• Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Sherman, S. L., Copeland, M. E., Milles, J. L., Flood, D. A., Pfeiffer, F. M. 2016; 32 (6): 1117–24

  Abstract

  To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model.Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading.The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel.Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques.Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to transosseous repair of the quadriceps tendon.

  View details for DOI 10.1016/j.arthro.2015.11.038

  View details for Web of Science ID 000377563900026

  View details for PubMedID 26895785

• Two-Stage Revision Anterior Cruciate Ligament Reconstruction ORTHOPEDICS Erickson, B. J., Cvetanovich, G., Waliullah, K., Khair, M., Smith, P., Bach, B., Sherman, S. 2016; 39 (3): E456–E464

  Abstract

  The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.].

  View details for DOI 10.3928/01477447-20160324-01

  View details for Web of Science ID 000377519200010

  View details for PubMedID 27045480

• Development of a Novel Canine Model for Posttraumatic Osteoarthritis of the Knee JOURNAL OF KNEE SURGERY Brimmo, O. A., Pfeiffer, F., Bozynski, C. C., Kuroki, K., Cook, C., Stoker, A., Sherman, S. L., Monibi, F., Cook, J. L. 2016; 29 (3): 235–41

  Abstract

  Translational models of posttraumatic osteoarthritis (PTOA) that accurately represent clinical pathology need to be developed. This study assessed a novel canine model for PTOA using impact injury. Impacts were delivered to the medial femoral condyle of dogs using a custom-designed impactor at 20, 40, or 60 MPa. Functional assessments and magnetic resonance imaging (MRI) were performed at 2 and 12 weeks, and arthroscopic and histologic assessments were performed at 12 weeks after injury. At 2 and 12 weeks, dogs had observable lameness, knee pain, effusion, loss in range of motion (ROM) and dysfunction in both hindlimbs with severity correlated strongly (r > 0.77) to impact level. At 12 weeks, function, pain, effusion, and ROM were significantly (p < 0.049) worse in knees impacted at 40 and 60 MPa compared with 20 MPa. MRI showed consistent cartilage and subchondral bone marrow lesions, and arthroscopy revealed synovitis and cartilage destruction in impacted knees, with increased severity for 40 and 60 MPa impacts. Histopathology was significantly (p = 0.049) more severe in 40 and 60 MPa and strongly correlated (r = 0.93) to impact level. This novel translational model appears to be valid for investigation of PTOA, including determination of temporal mechanisms of disease and preclinical testing for preventative and therapeutic strategies.

  View details for DOI 10.1055/s-0035-1549026

  View details for Web of Science ID 000373292400009

  View details for PubMedID 25892003

• Rethinking the Standard of Care in Treating Professional Athletes CLINICS IN SPORTS MEDICINE Poma, C., Sherman, S. L., Spence, B., Brenner, L. H., Bal, B. 2016; 35 (2): 269-+

  Abstract

  There is public discussion and debate about the role of the team physician in professional sports. There is uncertainty over whether a separate legal standard of care should apply when treating professional athletes. This article advocates a single standard of care for all patients. This article also proposes that it would be useful for team physicians to develop a consensus that there should be a health policy for professional athletes. This health policy should aspire that professional athletes can complete their career, while minimizing the risk of cognitive or physical injuries that affect later quality of life.

  View details for DOI 10.1016/j.csm.2015.10.001

  View details for Web of Science ID 000372375700009

  View details for PubMedID 26832976

• Nonligamentous Soft Tissue Pathology About the Knee: A Review ORTHOPEDICS Erickson, B. J., Campbell, K., Cvetanovich, G. L., Harris, J. D., Bach, B. R., Sherman, S. L. 2016; 39 (1): 32–42

  Abstract

  Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.

  View details for DOI 10.3928/01477447-20151218-06

  View details for Web of Science ID 000377409200041

  View details for PubMedID 26709560

• In Vitro Toxicity of Local Anesthetics and Corticosteroids on Chondrocyte and Synoviocyte Viability and Metabolism CARTILAGE Sherman, S. L., Khazai, R. S., James, C. H., Stoker, A. M., Flood, D. L., Cook, J. L. 2015; 6 (4): 233–40

  Abstract

  There is growing concern that intra-articular injection of local anesthetic and/or corticosteroids may cause significant morbidity, including potential toxicity to chondrocytes and synoviocytes, after even a single exposure. We demonstrate that full thickness canine chondral and synovial samples exposed to various local anesthetics and corticosteroids exhibit decreased loss of cell viability compared with prior in vitro studies using monolayer culture, due to the protective effects of intact extracellular matrix and cell heterogeneity.Full-thickness cartilage and synovial explants were obtained from canine cadavers and exposed in culture media to the following for 24 hours: 1% lidocaine, 0.5% lidocaine, 0.25% bupivacaine, 0.125% bupvacaine, 0.0625% bupivacaine, betamethasone acetate, methylprednisolone acetate, triamcinolone acetonide, or culture media only (control). Cell viability was determined on days 1 and 7 of culture using a microscopic live-dead and alamar blue metabolic assays.Complete loss of chondrocyte and synoviocyte viability was noted in the 1% and 0.5% lidocaine group, 0.25% and 0.125% bupivacaine group, betamethasone group, and methylprednisolone groups after 1 and 7 days of culture. Treatment with 0.0625% bupivacaine and triamcinolone demonstrated no decrease in cell viability or metabolism when compared to negative control.In this canine explant model, 1% and 0.5% lidocaine, 0.25% and 0.125% bupivacaine, betamethasone acetate, and methylpresdnisolone acetate were severely chondrotoxic and synoviotoxic after a single exposure, despite intact extracellular matrix. In contrast, chondrocytes and synoviocytes exposed to 0.0625% bupivacaine and triamcinolone remained viable after treatment. Further in vivo study is needed before definitive recommendations can be made.

  View details for DOI 10.1177/1947603515594453

  View details for Web of Science ID 000361156100005

  View details for PubMedID 26425261

  View details for PubMedCentralID PMC4568732

• Return to Play Following Anterior Cruciate Ligament Reconstruction JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Ellman, M. B., Sherman, S. L., Forsythe, B., LaPrade, R. F., Cole, B. J., Bach, B. R. 2015; 23 (5): 283–96

  Abstract

  In athletes, significant advances in anterior cruciate ligament reconstruction techniques and rehabilitation have led to improved surgical outcomes and increased expectations for return to play. Although an expeditious return to sport has become an achievable and often realistic goal, the factors that most influence safe, timely, and successful return to play remain unknown. The literature offers mainly anecdotal evidence to guide the team physician in the decision-making process, with a paucity of criteria and consensus guidelines available to help determine return to sport. Attempts have been made to introduce criteria-based progression in the rehabilitation process, but validation of subjective and objective criteria has been difficult. Nevertheless, several pertinent factors in the preoperative, intraoperative, and postoperative periods may affect return to play following anterior cruciate ligament reconstruction. Further research is warranted to validate reliable, consensus guidelines with objective criteria to facilitate the return to play process.

  View details for DOI 10.5435/JAAOS-D-13-00183

  View details for Web of Science ID 000353467800005

  View details for PubMedID 25911661

• In Vivo Toxicity of Local Anesthetics and Corticosteroids on Chondrocyte and Synoviocyte Viability and Metabolism CARTILAGE Sherman, S. L., James, C., Stoker, A. M., Cook, C. R., Khazai, R. S., Flood, D. L., Cook, J. L. 2015; 6 (2): 106–12

  Abstract

  Intra-articular injection of local anesthetic and/or corticosteroid is an adjunct treatment for arthritic and inflammatory orthopedic conditions. Despite potential benefits, there is growing concern that these medications may cause significant morbidity, including potential toxicity to intra-articular chondrocytes and synoviocytes.Twenty dogs underwent intra-articular injection of the shoulder joint using ultrasound guidance, with the following injectates (n = 5 each): negative control (saline), methylprednisolone/1.0% lidocaine, triamcinolone/1.0% lidocaine, and triamcinolone/0.0625% bupivacaine. The dogs were euthanized 24 hours postinjection for reasons unrelated to this study. Synovium/cartilage explants were harvested under sterile conditions and assessed immediately or cultured for 7 days. Synoviocyte and chondrocyte viability was determined on day 1 and day 7 using Calcien AM and Sytox Blue live/dead fluorescent stains, and cell metabolism determined on day 2 using the alamar blue additive test. Results were compared statistically.On day 1 synovium exposed to 1%L/M demonstrated a significant decrease in cell metabolism (P = 0.0107) and subjective synoviocyte viability scores (P = 0.013) compared with the negative control. Cartilage exposed to 1%L/M demonstrated decreased chondrocyte viability and cell metabolism versus all other groups, although not significantly. After 7 days of culture, cartilage viable cell density in the 1%L/M group was significantly (P ≤ 0.001) lower than the negative control. Subjective synoviocyte viability scores was significantly lower in the 1%L/M (P = 0.013), 1%L/T (P ≤ 0.001), and 0.0625%B/T groups (P = 0.006) compared with the negative control.This study suggests potential negative effects of combination local anesthetic/corticosteroid on intra-articular cell viability and cell metabolism. Further study is needed before determining definitive clinical recommendations.

  View details for DOI 10.1177/1947603515571001

  View details for Web of Science ID 000356631400005

  View details for PubMedID 26069713

  View details for PubMedCentralID PMC4462250

• Quantifying the Economic Impact of Provider Volume Through Adverse Events The Case of Sports Medicine ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Scott, D. J., Sherman, S., Dhawan, A., Cole, B. J., Bach, B. R., Mather, R. C. 2015; 3 (3): 2325967115574476

  Abstract

  Procedures performed by surgeons with higher provider volumes offer advantages both to the individual patient and the health system, with studies documenting fewer adverse events, shorter surgical times, and decreased reoperation rates. With workforce requirements for surgeons growing, it is increasingly necessary to establish the most efficient structure of this workforce.Substantial economic savings are realized when procedures are performed by high-volume providers as compared with low-volume providers in the areas of readmission, prolonged admission, and subsequent surgery.Economic and decision analysis; Level of evidence, 2.This study utilized decision modeling to estimate the cost savings to high-volume providers in sports medicine. Simple decision models were constructed for 3 common procedures: anterior cruciate ligament (ACL) reconstruction, rotator cuff repair, and total shoulder arthroplasty. Outcome probabilities for adverse events (readmission, prolonged admission, and subsequent surgery) and costs were taken from the literature. A Monte Carlo simulation reflecting the incidence of these procedures in the United States was performed to estimate the total nationwide cost of these procedures, and the impact of both negative and positive policies on this cost were examined using sensitivity analysis.The costs per case attributable to adverse outcomes for ACL reconstruction (in 2010 US$) were $496, $781, and $868 for high-, medium-, and low-volume providers, respectively. For rotator cuff repair, these numbers were $523, $640, and $872, and for total shoulder arthroplasty, $1692, $1876, and $2021, respectively. Sensitivity analysis revealed that a 50% increase in the number of these 3 procedures performed by high-volume surgeons could save the health system $23.1 million. If all procedures were performed by high-volume surgeons, the health system could save $72 million.The hypothesis was accepted; higher provider volumes for surgeons do convey substantial societal economic benefits. Policies to incentivize and facilitate a greater portion of procedures being performed by high-volume surgeons may increase the efficiency of resource utilization in health care delivery.

  View details for DOI 10.1177/2325967115574476

  View details for Web of Science ID 000367979000008

  View details for PubMedID 26665030

  View details for PubMedCentralID PMC4622357

• Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction CURRENT REVIEWS IN MUSCULOSKELETAL MEDICINE Ma, R., Smith, P. A., Smith, M. J., Sherman, S. L., Flood, D., Li, X. 2015; 8 (1): 75–82

  Abstract

  Complications of the acromioclavicular joint injuries can occur as a result of the injury itself, conservative management, or surgical treatment. Fortunately, the majority of acromioclavicular surgeries utilizing modern techniques and instrumentation result in successful outcomes. However, clinical failures do occur with frequency. The ability to identify the causative factor of failures makes revision surgery more likely to be successful. The purposes of this review are to highlight common problems that can occur following acromioclavicular joint surgery and discuss techniques that can be utilized in revision surgery.

  View details for DOI 10.1007/s12178-014-9255-6

  View details for Web of Science ID 000219599300009

  View details for PubMedID 25663435

  View details for PubMedCentralID PMC4596186

• Anterior Ankle Arthroscopy Indications, Pitfalls, and Complications FOOT AND ANKLE CLINICS Epstein, D. M., Black, B. S., Sherman, S. L. 2015; 20 (1): 41–57

  Abstract

  Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preoperative planning and meticulous surgical technique.

  View details for DOI 10.1016/j.fcl.2014.10.001

  View details for Web of Science ID 000351810000005

  View details for PubMedID 25726482

• Effects on Exposed Articular Cartilage During Open Surgical Procedures: A Comparison of Various Fluids in an Animal Model ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Farr, J., Mathew, L. M., Stoker, A. M., Sherman, S. L., Cook, J. L. 2015; 31 (1): 113–17

  Abstract

  The aim of this study was to assess the potential detrimental effects of the operating room environment on exposed healthy articular cartilage and to evaluate tissue hydration treatment strategies for preserving chondrocyte viability and extracellular matrix composition in this environment.With institutional Animal Care and Use Committee approval, femoral and tibial condyles (n = 36; 6 per specimen) were harvested from canine cadavers (n = 6) immediately after euthanasia and placed on a draped operating table under standard surgical lighting for a timed 2-hour period. Each condyle was randomly assigned to one of 6 groups (n = 6 per group): no-treatment control, hyaluronic acid (HA), saline sponge, saline drip, culture media (Dulbecco's modified Eagle's medium [DMEM]) sponge, or culture media drip. Full-thickness cartilage sections were collected from each specimen immediately after harvest (time 0) and immediately after 2-hour exposure (time 2H), and processed to determine chondrocyte viability, tissue water content, and extracellular matrix composition (glycosaminoglycan [GAG] and collagen content).Chondrocyte viability was significantly lower (P = .03) after the 2-hour exposure in the control group. HA, saline sponge, and saline drip treatment groups all had significantly higher (P < .043) chondrocyte viability compared with controls at time 2H. Water content was significantly lower (P < .01) after the 2-hour exposure in the control group. Further, the water content in the control group was significantly lower than all treatment groups at time 2H (P < .001). No significant differences in tissue collagen or GAG content were observed within groups between time points or among groups at either time point.Canine articular cartilage did not demonstrate any reduction in chondrocyte viability or tissue water content at 2 hours when treated with hyaluronic acid, saline drip, saline-soaked sponge, or DMEM-soaked sponge compared with untreated exposed cartilage.Surgeons should consider the use of a hydrating solution for the treatment of exposed articular cartilage during open joint surgery of 2 hours or longer duration.

  View details for DOI 10.1016/j.arthro.2014.07.027

  View details for Web of Science ID 000347032400024

  View details for PubMedID 25260748

• Does a Syrinx Matter for Return to Play in Contact Sports? A Case Report and Evidence-Based Review of Return-to-Play Criteria After Transient Quadriplegia SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH Milles, J. L., Gallizzi, M. A., Sherman, S. L., Smith, P. A., Choma, T. J. 2014; 6 (5): 440–45

  Abstract

  Transient quadriplegia is a rare injury that can change the course of an athlete's career if misdiagnosed or managed inappropriately. The clinician should be well versed in the return-to-play criteria for this type of injury. Unfortunately, when an unknown preexisting syrinx is present in the athlete, there is less guidance on their ability to return to play. This case report and review of the current literature illustrates a National Collegiate Athletic Association (NCAA) Division I football player who suffered a transient quadriplegic event during a kickoff return that subsequently was found to have an incidental cervical syrinx on magnetic resonance imaging. The player was able to have a full neurologic recovery, but ultimately he was withheld from football.

  View details for DOI 10.1177/1941738114544674

  View details for Web of Science ID 000214873300011

  View details for PubMedID 25177422

  View details for PubMedCentralID PMC4137682

• Tibial Tuberosity Osteotomy Indications, Techniques, and Outcomes AMERICAN JOURNAL OF SPORTS MEDICINE Sherman, S. L., Erickson, B. J., Cvetanovich, G. L., Chalmers, P. N., Farr, J., Bach, B. R., Cole, B. J. 2014; 42 (8): 2006–17

  Abstract

  Tibial tuberosity osteotomy (TTO) is a well-described treatment option for a broad range of patellofemoral joint disorders, including patellofemoral instability, patellar and trochlear focal chondral lesions, and patellofemoral arthritis. The purpose of this article is to review the evolution of the TTO procedure, from the original Hauser procedure to the current anteromedialization procedure, as well as discuss the pertinent anatomy and radiographs that accompany this procedure. The article highlights the surgical techniques for some of the more commonly performed TTO procedures and discusses the outcomes of the various TTO techniques. Complications, as well as clinical pearls to avoid these complications, are also included.

  View details for DOI 10.1177/0363546513507423

  View details for Web of Science ID 000341634900033

  View details for PubMedID 24197613

• Patellofemoral Anatomy and Biomechanics CLINICS IN SPORTS MEDICINE Sherman, S. L., Plackis, A. C., Nuelle, C. W. 2014; 33 (3): 389-+

  Abstract

  Patellofemoral disorders are common. There is a broad spectrum of disease, ranging from patellofemoral pain and instability to focal cartilage disease and arthritis. Regardless of the specific condition, abnormal anatomy and biomechanics are often the root cause of patellofemoral dysfunction. A thorough understanding of normal patellofemoral anatomy and biomechanics is critical for the treating physician. Recognizing and addressing abnormal anatomy will optimize patellofemoral biomechanics and may ultimately translate into clinical success.

  View details for DOI 10.1016/j.csm.2014.03.008

  View details for Web of Science ID 000339463400003

  View details for PubMedID 24993406

• Evidence-Based Approach of Treatment Options for Postoperative Knee Pain PHYSICIAN AND SPORTSMEDICINE Farr, J., Jaggers, R., Lewis, H., Plackis, A., Sim, S. B., Sherman, S. L. 2014; 42 (2): 58–70

  Abstract

  Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. Preoperative assessment includes management of patient expectations, recognition of conditions and early counseling for high-risk patients (ie, opioid dependence, psychiatric comorbidities), and use of preemptive analgesia techniques (ie, preoperative IV medications, peripheral nerve blocks, incisional field blocks). Intraoperative strategies include meticulous surgical technique, limiting the use of tourniquets (ie, duration and pressure), and using preventive analgesia methods (ie, postoperative field block, continuous nerve catheters, intra-articular injection). Postoperative analgesia may be facilitated by cryotherapy, early mobilization, bracing, and rehabilitation. Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.

  View details for DOI 10.3810/psm.2014.05.2058

  View details for Web of Science ID 000343399000006

  View details for PubMedID 24875973

• Does ACL Reconstruction Alter Natural History? A Systematic Literature Review of Long-Term Outcomes JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Chalmers, P. N., Mall, N. A., Moric, M., Sherman, S. L., Paletta, G. P., Cole, B. J., Bach, B. R. 2014; 96A (4): 292–300

  Abstract

  Anterior cruciate ligament (ACL) injury can lead to tibiofemoral instability, decreased functional outcomes, and degenerative joint disease. It is unknown whether ACL reconstruction alters this progression at long-term follow-up.A systematic literature review of the long-term results (minimum follow-up, more than ten years) after operative intra-articular reconstruction of ACL injuries and after nonoperative management was performed to compare (1) knee stability on physical examination, (2) functional and patient-based outcomes, (3) the need for further surgical intervention, and (4) radiographic outcomes. After application of selection criteria, forty patient cohorts with a mean of 13.9 ± 3.1 years of postoperative follow-up were identified. Twenty-seven cohorts containing 1585 patients had undergone reconstruction, and thirteen containing 685 patients had been treated nonoperatively.Comparison of operative and nonoperative cohorts revealed no significant differences in age, sex, body mass index, or rate of initial meniscal injury (p > 0.05 for all). Operative cohorts had significantly less need for further surgery (12.4% compared with 24.9% for nonoperative, p = 0.0176), less need for subsequent meniscal surgery (13.9% compared with 29.4%, p = 0.0017), and less decline in the Tegner score (-1.9 compared with -3.1, p = 0.0215). A difference in pivot-shift test results was observed (25.5% pivot-positive compared with 46.6% for nonoperative) but did not reach significance (p = 0.09). No significant differences were seen in outcome scores (Lysholm, International Knee Documentation Committee [IKDC], or final Tegner scores) or the rate of radiographically evident degenerative joint disease (p > 0.05 for all).At a mean of 13.9 ± 3.1 years after injury, the patients who underwent ACL reconstruction had fewer subsequent meniscal injuries, less need for further surgery, and significantly greater improvement in activity level as measured with the Tegner score. There were no significant differences in the Lysholm score, IKDC score, or development of radiographically evident osteoarthritis.

  View details for DOI 10.2106/JBJS.L.01713

  View details for Web of Science ID 000331431300005

  View details for PubMedID 24553885

• Fresh Osteochondral Allograft Transplantation for the Knee: Current Concepts JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Sherman, S. L., Garrity, J., Bauer, K., Cook, J., Stannard, J., Bugbee, W. 2014; 22 (2): 121–33

  Abstract

  Fresh osteochondral allograft (OCA) transplantation has been used to manage a wide spectrum of chondral and osteochondral knee disorders. Basic science and clinical studies support the safety and efficacy of the procedure. Transplantation of viable, mature hyaline cartilage into the affected area is an advantage of the procedure, which can be used to restore bone stock in complex or salvage scenarios. Indications for OCA transplantation in the knee include primary management of large chondral or osteochondral defects and salvage of previously failed cartilage repair. The procedure also can be used for complex biologic knee reconstruction in the setting of osteonecrosis, fracture malunion, or posttraumatic arthritis. Challenges associated with OCA transplantation include allograft storage and size matching, tissue availability, chondrocyte viability, the possibility of immunologic graft response, and a demanding surgical technique. Future research should focus on optimizing allograft viability and healing and refining current surgical indications and techniques.

  View details for DOI 10.5435/JAAOS-22-02-121

  View details for Web of Science ID 000349452200007

  View details for PubMedID 24486758

• Evaluation and Management of an Irreducible Posterolateral Knee Dislocation JOURNAL OF KNEE SURGERY Capito, N., Gregory, M. H., Volgas, D., Sherman, S. L. 2013; 26: S136–S141

  Abstract

  Irreducible posterolateral knee dislocations are rare and complex injuries that are often difficult to treat. Prompt recognition and appropriate early management are vital to the successful long-term outcome for the patient. In this case report, we highlight a single patient presenting with an irreducible posterolateral knee dislocation following a high-energy trauma. Evaluation and management included careful history and physical examination, appropriate imaging studies, and formulation of an early operative plan, leading to a safe and successful knee reduction for this patient. We review the best available evidence to guide orthopedic surgeons in their evaluation and management of the irreducible knee dislocation.

  View details for DOI 10.1055/s-0033-1341577

  View details for Web of Science ID 000346581400030

  View details for PubMedID 23512541

• Return to High-Level Sport After Meniscal Allograft Transplantation ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Chalmers, P. N., Karas, V., Sherman, S. L., Cole, B. J. 2013; 29 (3): 539–44

  Abstract

  Our purpose was to determine the results of meniscal allograft transplantation (MAT) in high school and higher-level athletes, specifically with respect to return to their preinjury level of play.This is a retrospective case series of prospectively collected data from a single surgeon, evaluating athletes who underwent MAT. Each patient participated in either high school, collegiate, or professional athletics before injury, with a mean preinjury Tegner score of 8. In addition, patients were only included if one of their stated preoperative goals was to return to their previous level of activity. Patients completed preoperative and postoperative validated knee surveys (Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lysholm score, and Tegner score) and underwent physical examinations.The mean age of the 13 included patients was 19.8 years, with a mean follow-up of 3.3 years (range, 1.9 to 5.7 years). After MAT, 10 of 13 patients (77%) returned to sporting activity. The mean Knee Injury and Osteoarthritis Outcome Score for the sport subset was 76 (SD, 18), the mean International Knee Documentation Committee score was 77 (SD, 14), and the mean Lysholm score was 81 (SD, 13). Of the 13 patients, 3 (23%) required further surgery, comprising one revision MAT, one partial meniscectomy, and one meniscal repair.In this small retrospective series, 77% of high school and higher-level athletes with meniscal deficiency and symptomatic "post-meniscectomy syndrome" returned to their desired level of play after MAT. These athletes also had significant improvements in most outcome measures.Level IV, therapeutic case series.

  View details for DOI 10.1016/j.arthro.2012.10.027

  View details for Web of Science ID 000315584200023

  View details for PubMedID 23375179

• An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Mall, N. A., Lee, A. S., Chahal, J., Sherman, S. L., Romeo, A. A., Verma, N. N., Cole, B. J. 2013; 29 (2): 366–76

  Abstract

  The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears.An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data.Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84% of tears, and infraspinatus was torn in 39% of shoulders. Subscapularis tears were present in 78% of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and >5 cm in 42%. Average active forward elevation improved from 81° to 150° postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77.Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the subscapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair.Level IV, systematic review Levels III and IV studies.

  View details for DOI 10.1016/j.arthro.2012.06.024

  View details for Web of Science ID 000314127100027

  View details for PubMedID 23290186

• Biomechanical Evaluation of Transosseous Rotator Cuff Repair Do Anchors Really Matter? Salata, M. J., Sherman, S. L., Lin, E. C., Sershon, R. A., Gupta, A., Shewman, E., Wang, V. M., Cole, B. J., Romeo, A. A., Verma, N. N. SAGE PUBLICATIONS INC. 2013: 283–90

  Abstract

  Suture anchor fixation has become the preferred method for arthroscopic repairs of rotator cuff tears. Recently, newer arthroscopic repair techniques including transosseous-equivalent repairs with anchors or arthroscopic transosseous suture passage have been developed.To compare the initial biomechanical performance including ultimate load to failure and localized cyclic elongation between transosseous-equivalent repair with anchors (TOE), traditional transosseous repair with a curved bone tunnel (TO), and an arthroscopic transosseous repair technique utilizing a simple (AT) or X-box suture configuration (ATX).Controlled laboratory study.Twenty-eight human cadaveric shoulders were dissected to create an isolated supraspinatus tear and randomized into 1 of 4 repair groups (TOE, TO, AT, ATX). Tensile testing was conducted to simulate the anatomic position of the supraspinatus with the arm in 60° of abduction and involved an initial preload, cyclic loading, and pull to failure. Localized elongation during testing was measured using optical tracking. Data were statistically assessed using analysis of variance with a Tukey post hoc test for multiple comparisons.The TOE repair demonstrated a significantly higher mean ± SD failure load (558.4 ± 122.9 N) compared with the TO (325.3 ± 79.9 N), AT (291.7 ± 57.9 N), and ATX (388.5 ± 92.6 N) repairs (P < .05). There was also a significantly larger amount of first-cycle excursion in the AT group (8.19 ± 1.85 mm) compared with the TOE group (5.10 ± 0.89 mm). There was no significant difference between repair groups in stiffness during maximum load to failure or in normalized cyclic elongation. Failure modes were as follows: TOE, tendon (n = 4) and bone (n = 3); TO, suture (n = 6) and bone (n = 1); AT, tendon (n = 2) and bone (n = 3) and suture (n = 1); ATX, tendon (n = 7).This study demonstrates that anchorless repair techniques using transosseous sutures result in significantly lower failure loads than a repair model utilizing anchors in a TOE construct.Suture anchor repair appears to offer superior biomechanical properties to transosseous repairs regardless of tunnel or suture configuration.

  View details for DOI 10.1177/0363546512469092

  View details for Web of Science ID 000314307500009

  View details for PubMedID 23239668

• Recutting the distal femur to increase maximal knee extension during TKA causes coronal plane laxity in mid-flexion KNEE Cross, M. B., Nam, D., Plaskos, C., Sherman, S. L., Lyman, S., Pearle, A. D., Mayman, D. J. 2012; 19 (6): 875–79

  Abstract

  The aim of this study was to quantify the effects of distal femoral cut height on maximal knee extension and coronal plane knee laxity.Seven fresh-frozen cadaver legs from hip-to-toe underwent a posterior stabilized TKA using a measured resection technique with a computer navigation system equipped with a robotic cutting guide. After the initial femoral resections were performed, the posterior joint capsule was sutured until a 10° flexion contracture was obtained with the trial components in place. Two distal femoral recuts of +2mm each were then subsequently made and the trials were reinserted. The navigation system was used to measure the maximum extension angle achieved and overall coronal plane laxity [in degrees] at maximum extension, 30°, 60° and 90° of flexion, when applying a standardized varus/valgus load of 9.8 [Nm] across the knee.For a 10 degree flexion contracture, performing the first distal recut of +2mm increased overall coronal plane laxity by approximately 4.0° at 30° of flexion (p=0.002) and 1.9° at 60° of flexion (p=0.126). Performing the second +2mm recut of the distal femur increased mid-flexion laxity by 6.4° (p<0.0001) at 30° and 4.0° at 60° of flexion (p=0.01), compared to the 9 mm baseline resection (control). Maximum knee extension increased from 10° of flexion to 6.4° (± 2.5° SD, p<0.005) and to 1.4° (± 1.8° SD, p<0.001) of flexion with each 2mm recut of the distal femur.Recutting the distal femur not only increases the maximum knee extension achieved but also increases coronal plane laxity in midflexion.

  View details for DOI 10.1016/j.knee.2012.05.007

  View details for Web of Science ID 000311329300027

  View details for PubMedID 22727760

• Long-term survivorship of a unicondylar knee replacement - A case report KNEE Egidy, C. C., Sherman, S. L., Macdessi, S. J., Cross, M. B., Windsor, R. E. 2012; 19 (6): 944–47

  Abstract

  Unicondylar knee arthroplasty (UKA) was introduced in the 1970s as a treatment option for isolated knee compartment gonarthrosis. Early results were discouraging secondary to poor patient selection, suboptimal surgical technique, and inferior prosthetic design. In recent years, there has been resurgence in the use of the UKA. Improvements in implant design, surgical technique, and patient selection have led to multiple studies demonstrating 94-98% survivorship of the implants at a 10 year follow-up. However, there still remains a paucity of evidence with regard to this treatment option for young, active patients. This case report presents the longest recorded follow-up (31 years) of a UKA in a young, active patient and it highlights that with appropriate patient selection and meticulous surgical technique, UKA may have a role as a long term treatment option in patients with isolated unicompartmental disease.

  View details for DOI 10.1016/j.knee.2012.03.015

  View details for Web of Science ID 000311329300040

  View details for PubMedID 22533962

• Graft Tensioning During Knee Ligament Reconstruction: Principles and Practice JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Sherman, S. L., Chalmers, P. N., Yanke, A. B., Bush-Joseph, C. A., Verma, N. N., Cole, B. J., Bach, B. R. 2012; 20 (10): 633–45

  Abstract

  Failure to correctly tension grafts may overconstrain or underconstrain the knee, potentially predisposing the patient to deteriorating clinical and/or radiographic results over time. Knee ligament reconstruction requires a fundamental understanding of native anatomy, ligament biomechanics, and principles of graft tensioning. A successful strategy for graft tensioning takes into account the specific biomechanics of the ligament or ligaments in question, the mechanical properties of the graft selected, the chosen fixation method, the selected tensioning method (ie, manual or mechanical), and the overall goal of the reconstruction (ie, isometry versus anisometry).

  View details for DOI 10.5435/JAAOS-20-10-633

  View details for Web of Science ID 000309489400003

  View details for PubMedID 23027693

• Biomechanical Analysis of the Pectoralis Major Tendon and Comparison of Techniques for Tendo-osseous Repair AMERICAN JOURNAL OF SPORTS MEDICINE Sherman, S. L., Lin, E. C., Verma, N. N., Mather, R. C., Gregory, J. M., Dishkin, J., Harwood, D. P., Wang, V. M., Shewman, E. F., Cole, B. J., Romeo, A. A. 2012; 40 (8): 1887–94

  Abstract

  Various described surgical techniques exist for the repair of pectoralis major ruptures at the tendo-osseous junction. It is unclear how these techniques restore the native properties of the pectoralis major tendon because its biomechanical properties have not been described.All repairs will have lower initial biomechanical profiles than the native attachment, and transosseous sutures will demonstrate improved initial biomechanical performance compared with anchors or buttons.Controlled laboratory study.Twenty-four fresh-frozen cadaveric shoulders were randomized to 4 equal groups, including 3 experimental repair groups and 1 control group of intact pectoralis major tendons. The characteristics of the native anatomic footprint were recorded, and the experimental groups underwent pectoralis detachment, followed by subsequent repair. The restoration of the anatomic footprint was recorded. All specimens were tested with cyclic loading and load-to-failure protocols with load, displacement, and optical marker data simultaneously collected.Under cyclic loading, the intact specimens demonstrated a significantly higher secant stiffness (74.8 ± 1.6 N/mm) than the repair groups (endosteal Pec Button [PB], 46.2 ± 6.4 N/mm; suture anchor [SA], 45.9 ± 8.7 N/mm; transosseous [TO], 44.2 ± 5.5 N/mm). Measured as a percentage change, the PB and SA groups showed a significantly higher initial excursion than the intact group (PB, 24.0% ± 11.7%; SA, 17.5% ± 6.9%; intact, 2.2% ± 1.0%), and the PB group demonstrated a significantly higher cyclic elongation than the intact group (PB, 7.5% ± 2.9%; intact, 1.5% ± 1.5%). Under load-to-failure testing, the intact group showed a significantly greater maximum load (1454.8 ± 795.7 N) and linear stiffness (221.0 ± 111.7 N/mm) than the 3 repair groups (PB, 353.5 ± 88.3 N and 63.5 ± 6.9 N/mm; SA, 292.0 ± 73.3 N and 77.0 ± 7.8 N/mm; TO, 359.2 ± 110.4 N and 64.5 ± 14.1 N/mm, respectively). All repair constructs failed via suture pulling through the tendon.The biomechanical characteristics of the transosseous repair, suture anchors, or Pec Button repair were inferior to those of the native pectoralis tendon. There was no significant difference in any of the biomechanical outcomes among the repair groups. Further refinement and evaluation of suture technique and configuration in pectoralis major repair should be considered.Transosseous repair, suture anchors, and endosteal Pec Buttons appear to confer similar biomechanical integrity for pectoralis major repair. Restricting early activities to thresholds below the identified failure loads seems prudent until soft tissue healing to bone is reliably achieved.

  View details for DOI 10.1177/0363546512452849

  View details for Web of Science ID 000307175700026

  View details for PubMedID 22781500

• A Review of Translational Animal Models for Knee Osteoarthritis ARTHRITIS Gregory, M. H., Capito, N., Kuroki, K., Stoker, A., Cook, J. L., Sherman, S. L. 2012: 764621

  Abstract

  Knee osteoarthritis remains a tremendous public health concern, both in terms of health-related quality of life and financial burden of disease. Translational research is a critical step towards understanding and mitigating the long-term effects of this disease process. Animal models provide practical and clinically relevant ways to study both the natural history and response to treatment of knee osteoarthritis. Many factors including size, cost, and method of inducing osteoarthritis are important considerations for choosing an appropriate animal model. Smaller animals are useful because of their ease of use and cost, while larger animals are advantageous because of their anatomical similarity to humans. This evidence-based review will compare and contrast several different animal models for knee osteoarthritis. Our goal is to inform the clinician about current research models, in order to facilitate the transfer of knowledge from the "bench" to the "bedside."

  View details for DOI 10.1155/2012/764621

  View details for Web of Science ID 000215117300023

  View details for PubMedID 23326663

  View details for PubMedCentralID PMC3541554

• Humeral Head Osteochondral Allograft Reconstruction with Arthroscopic Anterior Shoulder Stabilization at a Long-Term Follow-Up: A Case Report. JBJS case connector Sochacki, K. R., Dillingham, M. F., Abrams, G. D., Sherman, S. L., Donahue, J. n. ; 10 (2): e0555

  Abstract

  The authors report a case of recurrent anterior shoulder instability in a 19-year-old man. Intraoperative arthroscopic examination identified Bankart and engaging Hill-Sachs lesions. The patient was treated with humeral head osteochondral allograft reconstruction and concomitant arthroscopic anterior stabilization. At the 14-year follow-up, there was no recurrent instability.Humeral head osteochondral allograft reconstruction combined with an arthroscopic anterior stabilization procedure can be successful for recurrent shoulder instability and engaging Hill-Sachs lesion.

  View details for DOI 10.2106/JBJS.CC.19.00555

  View details for PubMedID 32649125