Matthew Joseph Salzler

Congratulations and commendations to the readers, authors, researchers, reviewers, and editors who intentionally made 2026 a year to remember for Arthroscopy and its Family of Journals. Our year in review highlights outstanding articles, editorial commentaries, editorials, and special issues in our journals that have resulted in high impact. International collaboration and effort have culminated in another increase in Arthroscopy 's Clarivate Impact Factor. We thank all our contributors for their intention, dedication, innovation, and ingenuity in making 2026 another successful year.

Editorial Commentaries on new articles serve many roles; they highlight key findings, provide contemporary clinical context, assist in understanding the key strengths and limitations, identify areas of controversy, and stimulate debate. The November 2026 issue of Arthroscopy has its usual compliment of outstanding articles, and we call attention to the 33 outstanding commentaries from Arthroscopy reviewers, editors, authors, and thought leaders. We celebrate and thank all authors who have contributed Editorial Commentaries since their inception in 2015. Their willingness to share their experience and knowledge enriches our journal and strengthens the scientific dialogue.

Purpose: To review current randomized controlled trials (RCTs) investigating the efficacy of orthobiologic augmentation for anterior cruciate ligament reconstruction (ACLR) for clinical or radiographic outcomes. Methods: PubMed, EMBASE, and the Web of Science databases were queried in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines to identify RCTs investigating the efficacy of orthobiologics for ACLR. Studies were included if they compared patient‐reported outcome measures or radiographic evaluation of graft maturation of ACLR with and without orthobiologics. Included forms of orthobiologics were platelet‐rich plasma, bone marrow aspirate concentrate, and mesenchymal stem cell. Studies were excluded if they applied the orthobiologic to the harvest or donor site, rather than the ACL graft itself, or if they did not report patient‐reported outcome measures or radiographic evaluation of graft maturation. For outcome measures with 3 or more studies that used the same orthobiologic, meta‐analyses were conducted using DerSimonian‐Laird random‐effects models, reported in standardized mean difference (SMD). Results: There were 9 RCTs with 543 total patients investigating platelet‐rich plasma (5 studies), bone marrow aspirate concentrate (3 studies), and mesenchymal stem cell (1 study) augmentation in ACLR. Meta‐analysis revealed no significant difference in Lysholm scores (SMD = 0.99 [0.72‐1.36], I ² = 0.58%, P = .95) with versus without platelet‐rich plasma augmentation for ACLR. Similar knee injury and osteoarthritis outcome scores were found for ACLR augmented by bone marrow aspirate concentrate versus ACLR alone (SMD = 0.78 [0.41‐1.49], I ² = 76.97%, P = .45). Orthobiologic augmentation was not found to decrease bone tunnel enlargement (SMD = 1.56 [0.61‐3.96], I ² = 87.46%, P = .35). All studies reported a radiographic evaluation of graft maturation, 6 of which reported no significant change with orthobiologic augmentation. No complications related to orthobiologics were reported. Conclusions: Orthobiologic augmentation for ACLR shows similar patient‐reported outcome measures and bone tunnel healing as compared with ACLR alone, although these results are limited by heterogeneity. This review suggests limited efficacy regarding orthobiologic augmentation for ACLR. Level of Evidence: Level II, systematic review and meta‐analysis of Level I and II randomized controlled trials.

Delphi Expert Consensus studies are increasingly common in orthopaedic literature and provide clinical guidance on many new and controversial topics. Although meta‐analyses and randomized controlled trials remain the gold standard of evidence, they are not always feasible, not always definitive, and not always needed. Delphi Consensus Statements currently play a unique role in our research armamentarium to add insight to the many unanswered questions in arthroscopic surgery and sports medicine that other higher levels of evidence studies have not yet fully answered. Arthroscopy has been intentional in the past decade with our published Delphi articles that have offered compelling guidance in the diagnosis, imaging, and management of multiple pathologies in the knee, shoulder, hip, and elbow and in many sports medicine topics.

Arthroscopy aims to be the primary home for musculoskeletal biologics research. To this end, we introduce our Fourth Annual Musculoskeletal Biologics Special Issue with Guest Editor Brian Cole, M.D., whose team selected the top publications from the past year in the Arthroscopy Family of Journals. We reiterate our Call for Papers of clinically relevant and high‐impact musculoskeletal biologics research. We further highlight our lead article and Expert Opinion from top authors outlining high‐yield topics identified by the 2026 Biologic Research Think Tank with eager anticipation to publish future literature of nascent biologic substances harnessed to augment musculoskeletal treatment.

Innovation. Insights. Impact. The 2026 Annual Meeting of the Arthroscopy Association of North America (AANA) in Phoenix, Arizona, delivered an inspirational, informative, and impressive series of lectures, meetings, and reunions of friends in the desert. We look forward to seeing you again next year for another bright and sunny Annual Meeting in Hollywood, Florida, May 13 to 15, 2027.

Background: An expanding body of literature is available on arthroscopy for femoroacetabular impingement syndrome (FAIS). Studies have attempted to relate Tonnis grade to postoperative outcomes but do not often provide a complete picture of the clinical, radiographic, and failure outcomes for a given Tonnis cohort. Purpose: To systematically review and meta-analyze the impact of preoperative arthritic changes, as measured by Tonnis grade, on clinical, radiographic, and survivorship outcomes in patients undergoing hip arthroscopy for FAIS. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, EMBASE, and Web of Science Core Collection databases were queried for investigations associating preoperative Tonnis grade with postoperative outcomes after hip arthroscopy for FAIS. Eligible articles compared patient-reported outcomes (PROs), radiographic arthritis progression, or rate of secondary surgical interventions between patients with various Tonnis arthritis grades. Continuous random-effects models were used to compare PROs between arthritic grades as represented by standardized mean difference (SMD), whereas restricted maximum likelihood random-effects models compared event rates of Tonnis grade progression and secondary surgical interventions, reported as odds ratio (OR). Results: A total 29 investigations were included in this systematic review, of which 16 studies provided sufficient quantitative data for meta-analysis. The 3972 hips included were followed for a mean of 68.4 months (range, 24.0-150.0 months); the mean age was 39.6 years (range, 20.3-63.3 years). Meta-analysis revealed similar results between Tonnis 0 and 1 cohorts for modified Harris Hip Score (SMD = 0.05, 95% CI [–0.33, 0.42]; I ² = 73.35%; P = .80), Hip Outcome Score (HOS)–Activities of Daily Living (SMD = −0.16, 95% CI [–0.36, 0.04]; I ² = 0.00%; P = .12), HOS–Sports Subscale (SMD = −0.36, 95% CI [–0.97, 0.25]; I ² = 89.14%; P = .25), and Tonnis progression (OR = 2.66, 95% CI [0.51-13.95]; I ² = 58.80%; P = .25). The Tonnis 2 cohort was found to have similar mHHS to Tonnis 0 (SMD = −0.22, 95% CI [–0.60, 0.17]; I ² = 52.52%; P = .27) and Tonnis 1 (SMD = −0.24, 95% CI [–0.48, 0.01]; I ² = 0.00%; P = .06). Tonnis 0, 1, and 2 cohorts were found to have similar rates of revision arthroscopy (OR = 1.65, 95% CI [0.63-4.28]; I ² = 0.00%; P = .31). Increasing Tonnis grade was found to have increased rates of conversion to total hip arthroplasty, except for Tonnis 2 and 3 having similar rates of conversion (OR = 5.27, 95% CI [0.91-30.51]; I ² = 0.00%; P = .06). Conclusion: A systematic review of 29 studies identified relevant data, and meta-analysis of 16 studies that provided sufficient quantitative data revealed that compared with Tonnis grade 0 and 1 hips, Tonnis grade 2 hips had similar symptomatic improvement, reflected by select PROs, but decreased joint survivorship, reflected by significantly higher rates of conversion to total hip arthroplasty.

Arthroscopy has undergone many changes in the past year that strengthen our journal and provide a sound foundation for the future. These changes have been intentional. In this past year, we have published a series of editorials designed to apply our high standards of study design and methodology to adapt to new research trends and current controversies in sports medicine research. These editorials have ranged in scope from a trilogy on best practices for addressing follow‐up in literature to sex disaggregation, hip surgery, and large databases. With these changes and the transition to Wiley, our new publisher, we have intentionally reaffirmed our mission to foster high‐quality, methodologically sound articles that will be both accurate and impactful.

An increasing number of orthopaedic and sports medicine research studies use large databases of electronic health records and claim data aggregated from multiple health systems and corporations. While these databases benefit from study populations far larger than any single institution, they create additional risks of bias that may not exist in traditional orthopaedic clinical research designs. Researchers need to consider how the health data is transformed (“harmonized”) into research data, how much data is missing, whether the length of follow‐up within the database is disclosed, and whether the quality of the data input is uniform across contributing institutions. In some cases, these data may not be disclosed, especially for databases maintained by private for‐profit entities. It remains unclear whether the perceived benefits of these databases truly outweigh concerns about transparency and bias, which need to be acknowledged and managed when presenting the data‐supported conclusions.

Purpose: To perform breakeven analysis to assess the cost‐effectiveness of performing lateral extra‐articular tenodesis (LET) at the time of hamstring autograft primary anterior cruciate ligament reconstruction (ACLR) in high‐risk patients. Methods: Baseline costs for ACLR, ACLR with LET (ACLR‐LET), revision ACLR, and initial failure rate were collected from the literature. Two initial failure rates following hamstring autograft ACLR without LET in high‐risk patients were used based on a previous study: the rate of revision surgery (11%) and the rate of clinical failure due to rotatory instability (40%). Breakeven economic analysis was used to assess the cost‐effectiveness of adding LET to primary ACLR. To account for the variability in cost, initial failure rates, and procedural differences across institutions, a wide range of values were used to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) to achieve cost‐effectiveness. Results: Assuming primary ACLR cost of $20,840, ACLR‐LET cost of $27,405, and revision ACLR cost of $35,205, primary LET is cost‐effective at initial failure rates exceeding 18.7% (ARR = 0.187, NNT = 5). Assuming a 40% failure rate, LET is cost‐effective when revision surgery costs are greater than $16,412 (ARR = 0.400, NNT = 3) or when primary ACLR‐LET costs less than $39,422 (ARR = 0.400, NNT = 3). When assuming a failure rate of 11%, LET is cost‐effective when revision surgery costs exceed $59,700 (ARR = 0.110, NNT = −9) or when primary ACLR‐LET is no greater than $24,712 (ARR = 0.110, NNT = 10). Conclusions: Primary LET is a cost‐effective intervention for a wide range of primary and revision surgery costs according to this breakeven economic analysis. Using surgical cost estimates from literature, LET is cost‐effective when the initial failure exceeds 18.7%, or when revision surgery exceeds $16,412, which is greater than reported in current literature, thus indicating the clinical and economic benefits of primary LET in high‐risk patients undergoing hamstring autograft ACLR. Level of Evidence: Level IV, economic analysis.