Eric Cleveland McCarty

Case: We report a unique case of a 14-year-old girl with juvenile osteochondritis dissecans (JOCD) lesions of the talus and humeral head. She presented with painful motion of the ankle and shoulder that failed conservative treatment and was treated with surgical intervention. Four-year follow-up was achieved. Conclusion: A paucity of literature exists regarding the incidence and treatment of JOCD lesions occurring in multiple joint areas of a single patient. Our case highlights a unique presentation of contralateral, multijoint JOCD lesions and describes the treatment modalities subsequently used to address symptoms and assist in return to sport.

Background: Before the rise of arthroscopic rotator cuff repair (RCR), mini-open RCR was the preferred method of repairing a torn rotator cuff. However, in the recent fluid shortage that limited the viability of performing arthroscopic procedures, we felt that mini-open RCR could be a viable method to achieve satisfactory patient outcomes while limiting arthroscopic fluid utilization. Little information, particularly in video form, exists describing how to perform a mini-open RCR. Indications: Our patient presented with a symptomatic chronic rotator cuff tear that was affecting her ability to work. She wanted to undergo surgical intervention at a specific time to minimize the impact of the recovery time on her work. At that time, we were experiencing a fluid shortage, which limited our ability to perform arthroscopic procedures; thus, we elected to perform a mini-open RCR. Technique Description: We utilized a small 4-cm incision on the lateral aspect of the shoulder and performed a deltoid split to expose the rotator cuff tear. In a similar fashion to an arthroscopic procedure, we debrided the rotator cuff footprint. We then performed a double-row transosseous equivalent repair through the open incision, as would be performed arthroscopically. Results: Previous literature suggests that mini-open RCR leads to similar functional and patient-reported outcomes as arthroscopic RCR. The open procedure may have a shorter operative time. Some evidence indicates that mini-open RCR may lead to an early increase in pain compared with arthroscopic repair, which tends to normalize within 1 week. We were able to limit the amount of arthroscopic fluid utilized to ≤3 L per case. Discussion/Conclusion: While mini-open RCR may be an older technique, there are instances when either arthroscopic equipment or fluid may not be available, and mini-open RCR may be the most viable technique for repair. Mini-open RCR can achieve satisfactory outcomes comparable to arthroscopic RCR. Patient Consent Disclosure Statement: 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.

Background: Medicaid coverage is associated with longer appointment wait times, poorer health outcomes, and decreased access to care compared with private insurance across multiple medical specialties. Currently, there is a paucity of data assessing the effect of Medicaid coverage on new patient access to care and appointment wait times for orthopaedic sports medicine surgeons. Purpose: To assess the effect of insurance status on patient access to care and appointment wait times for sports medicine–trained orthopaedic surgeons specializing in hip, knee, and shoulder arthroscopy. Study Design: Cross-sectional study. Methods: Sports medicine–trained orthopaedic surgeons were identified using the American Academy of Orthopaedic Surgeons patient-facing database, and physicians were categorized by joint specialization (hip, knee, or shoulder). Mystery callers posing as either Medicaid or Blue Cross/Blue Shield (BCBS) insured patients with a textbook presentation of a nonurgent hip, knee, or shoulder injury contacted physicians to request the next available new patient appointment. The number of business days until the first available new patient appointment was recorded and analyzed using a linear mixed model of Poisson regression. Results: A total of 1046 telephone calls were made to 523 unique orthopaedic sports medicine clinics in 48 states. Of the 385 included physicians, 129 (34%) did not accept Medicaid. Patients with Medicaid experienced a 20% longer wait time for a new patient appointment compared with patients with BCBS (incidence rate ratio [IRR], 1.20 [95% CI, 1.14-1.26]; P < .001), with median wait times of 13 days (IQR, 7-23 days) and 12 days (IQR, 6-20 days), respectively. Additionally, patients with Medicaid experienced increased wait times in specific geographic locations ( P < .05) and a greater increase in wait times at academic institutions compared with private practices (IRR, 1.36 [95% CI, 1.13-1.62]; P = .001), with median wait times of 19 days (IQR, 15-22 days) and 14 days (IQR, 12-15 days), respectively. No significant difference in access to care or wait time was identified between hip, knee, and shoulder arthroscopic surgeons ( P = .68). Our model achieved an R ² value of 0.93, demonstrating strong explanatory power. Conclusion: Patients with Medicaid experienced decreased access to care, with 34% of sports medicine–trained orthopaedic surgeons declining to accept Medicaid insurance. Among surgeons who accepted Medicaid, patients with Medicaid experienced slightly longer wait times for a new patient appointment compared with patients with private (BCBS) insurance. Additionally, patients with Medicaid experienced significantly longer wait times at academic institutions and in specific geographic locations. The present findings highlight a critical disparity in care, further underscoring the need for additional research to identify the cause and implement solutions.

Background: Orthopaedic sports medicine fellowships are highly competitive, yet objective data defining characteristics of successful applicants remain limited. Hypothesis: It was hypothesized that greater academic productivity, top-tier residency training, and certain demographic factors would be associated with matching into a top-ranked orthopaedic sports medicine fellowship. Study Design: Cross-sectional study. Methods: We retrospectively reviewed applicants who matched into one of the top 10 orthopaedic sports medicine fellowships from 2020 to 2025, as identified by previous applicant preference rankings. Applicant data were obtained from publicly available sources and verified by 2 independent reviewers. Variables included sex, degree type, residency program ranking, geographic region, and research productivity (total publications, primary publication count, H-index, and sports-related publications). Multivariate logistic regression assessed predictors of matching into top 5 versus 6th- to 10th-ranked programs. Results: Among 226 matched applicants, 87.7% were male and 99.1% held a doctorate in medicine degree. The mean total publication count was 12.4, mean H-index was 8.2, and 30.5% trained at a top 20 orthopaedic residency. Applicants matching into top 5 programs had significantly higher research metrics than those in the 6th- to 10th-ranked programs: total publications (20.1 vs 4.7), primary publication count (6.2 vs 1.6), and sports-related publications (11.4 vs 1.9). On regression analysis, total publications, H-index, and residency ranking were independent predictors of matching into a top 5 program. Conclusion: Matching into a top orthopaedic sports medicine fellowship is associated with higher academic productivity and training at a top-tier residency program.

Background: Glenohumeral instability can be addressed surgically with repair of the capsulolabral complex, the “Bankart” repair, or bone augmentation with coracoid autograft, the “Latarjet” procedure. Superior return-to-sport (RTS) rates with either Bankart repair or Latarjet have yet to be delineated, and it remains unclear which surgical procedure is optimal. Purpose: To review the current literature and report on RTS data for patients who received Bankart repair or Latarjet to address glenohumeral instability. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review and meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines by an individual researcher screening through 3 databases (PubMed, Cochrane Library, Embase) for articles including RTS rates after Bankart repair and Latarjet. Eight studies that met inclusion and exclusion criteria were included for review. Results: Meta-analysis included 874 athletes who underwent shoulder stabilization: 479 Bankart repair and 395 Latarjet. An overall 94.4% of athletes returned to sport with no statistically significant difference between the surgical groups. Of 665 athletes, 68.1% returned to sport at the same level or higher with no statistically significant difference between the groups. RTS time among the 665 athletes averaged 6 months with no statistically significant difference between the groups. A total of 56 athletes did not RTS: 33 (7.4%) Bankart repair and 23 (6.3%) Latarjet. There was a statistically significant difference ( P < .0001) in recurrent instability rates. Bankart repair (14.8%) was 4 times more likely to result in recurrent instability as compared with Latarjet (3.5%). A total of 85 athletes, 71 Bankart repair and 14 Latarjet, had recurrent instability with 53.5% (7.9% overall) and 100% (3.5% overall) requiring a revision procedure, respectively. Conclusion: Bankart repair and Latarjet have a high RTS rate with no significant difference in rate, rate of return to previous level of play, or time. One of 4 athletes will not return to the level played before surgery, independent of stabilization technique. Bankart repair is 4 times more likely to result in recurrent instability as compared with Latarjet.

Background: Meniscal tears are a common knee injury in athletes, necessitating effective repair techniques. Despite the prevalence of meniscal tears, there is limited literature comparing the efficacy of the 2 primary suture methods—all-inside and inside-out—in the athletic population. Purpose: To evaluate the postoperative outcomes and failure rates of the all-inside versus inside-out suture techniques in meniscal repairs among athletes. Study Design: Systematic review; Level of evidence, 4. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted across the PubMed, Cochrane, and Embase databases on July 26, 2023, yielding 245 studies, of which 7 were included in this review. Studies reporting postoperative outcomes and failure rates of both suture techniques were included. Failure was defined as the need for subsequent surgery due to a persistent meniscal tear. Outcome measures included the Tegner, Lysholm, and International Knee Documentation Committee scores. Differences between groups and subgroups were assessed using the Welch t test and the odds ratio. Wilcoxon tests were used as a sensitivity analysis to confirm the results of the Welch t tests. Heterogeneity was assessed with the I ² statistic and the Bartlett test. All statistical analyses were done using R. Results: Seven studies—published between 2009 and 2023—met the inclusion criteria, including 469 operations in 458 patients. A total of 199 operations used the all-inside technique, and 270 operations used the inside-out technique. Of the 469 operations, 377 had documentation on laterality (medial meniscal repair versus lateral meniscal repair), with 167 patients undergoing medial meniscal repair and 210 patients undergoing lateral meniscal repair. Each all-inside repair was done with the Fast-Fix device. The all-inside technique showed a statistically significant increase in failure rate compared with the inside-out technique (23.1% vs 12.2%; P = .003). This trend was exaggerated in all-inside repairs for the medial meniscus versus the lateral meniscus (58.1% vs 11.8%; P = 2.6 × 10 ⁻⁵ ). When excluding all radial tears, the all-inside technique again had an increased rate of failure compared with the inside-out repairs (20.7% vs 8.3%; P = .01). No significant difference was found in postoperative Tegner scores between all-inside and inside-out repairs (5.9 vs 6.5; P = 0.45). Conclusion: Our review demonstrated that medial meniscal repairs with the all-inside technique using the Fast-Fix device had a higher failure rate compared with those with the inside-out technique; this trend is not seen for lateral meniscal repairs. Based on the findings of this study, surgeons should consider the inside-out technique first for athletic patients presenting with medial meniscal tears who want to return to their sport. Given the limited scope of existing studies combined with more recent utilization of novel all-inside meniscal repair devices that may not be captured in the present study, additional high-quality, prospective studies in this area are needed to validate these findings.

Background: Platelet-rich plasma (PRP) and patch augmentation (PA) are 2 adjuncts that are used in the context of rotator cuff repair (RCR) to strengthen the repair construct and promote healing. Purpose: To systematically review the literature to compare the clinical efficacy of RCR with PA versus RCR with PRP. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify Level 1 and 2 studies that compared the clinical efficacy of RCR alone with RCR with PRP or RCR with PA. The search phrase used was as follows: rotator cuff repair AND (patch OR augmentation OR bioinductive OR implant OR PRP OR platelet-rich plasma OR platelet-rich plasma). Patients were assessed based on the visual analog scale for pain, the Constant-Murley score, the American Shoulder and Elbow score, the University of California Los Angeles shoulder score, range of motion (ROM), and retear rates. Results: A total of 27 studies (Level 1 or 2) met the inclusion criteria, including 342 patients undergoing RCR with PA (mean age, 60 years) and 547 patients undergoing RCR with PRP (mean age, 58.1 years). The mean follow-up was 20.6 months in the PA group and 22.2 months in the PRP group. Among all patient-reported outcomes and ROM measures, there were no significant differences in weighted improvements between the 2 groups from pre- to postoperatively. However, patients undergoing RCR with PRP (13.1%) demonstrated significantly lower retear rates at the latest follow-up when compared with patients undergoing RCR with PA (18.4%) ( P = .04). Conclusion: Patients undergoing RCR with PRP may experience lower retear rates when compared with patients undergoing RCR with PA. Patients in both groups can be expected to experience similar improvements in both patient-reported and functional outcomes, although further randomized studies are needed to directly compare these 2 groups.

Background: Medial meniscal repair performed at the time of primary anterior cruciate ligament reconstruction (ACLR) has been shown to be significantly associated with subsequent surgery, and subsequent surgery has been associated with increased Knee injury and Osteoarthritis Outcome Score (KOOS) pain score and decreased patient satisfaction. Hypothesis/Purpose: The purpose was to determine if medial meniscal repair decreases KOOS pain 10 years after ACLR and to assess the consequences of subsequent surgery on the development of KOOS pain. The authors hypothesized that medial meniscal repair performed at the time of primary ACLR decreases the likelihood of developing KOOS pain. It was further hypothesized that surgery performed subsequent to medial meniscal repair and primary ACLR increases KOOS pain 10 years after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Our inclusion criteria were all patients undergoing unilateral primary ACLR from 2002 to 2008 who were enrolled in the Multicenter Orthopaedic Outcomes Network without a history of medial or lateral meniscal surgery and contralateral ACLR. Causal mediation analysis using R software (Version 4.2.3) was employed to compare 2 effects on the development of significant knee pain, as represented by a KOOS pain score 10 mm in medial-to-lateral length and (2) medial meniscal excision at baseline of ACLR. A directed acyclic graph was constructed to provide a qualitative representation of the influence of known confounders that have been shown to affect the outcome of interest. Missing data were multiply imputed using multivariate imputation by chained equations. All tests were 2-sided, assuming a type I error rate of .05. Results: In total, 2387 participants (1074 female [45%]; 1313 male [55%]) were included in the final analysis. In 1502 (62.9%) cases, there was no medial meniscal tear reported. Of the 885 cases with medial meniscal tears, no treatment was performed in 109 (12.4%), meniscal excision was performed in 396 (44.7%), and meniscal repair was performed in 380 (42.9%). An overall 1825 of 2387 (76.5%) patients reported KOOS pain at 10-year follow-up: 252 (13.8%) had KOOS pain 2 = 28.9; P < .001) and subsequent surgery significantly increased the likelihood of KOOS pain 2 = 17.3; P < .001). However, the direct effect of a successful medial meniscal repair without subsequent surgery decreased the likelihood of KOOS pain P = .024). When subsequent surgery was performed after medial meniscal repair and ACLR, the likelihood of KOOS pain P < .001.) Conclusion: Successful medial meniscal repair performed at the time of primary ACLR decreased clinically significant knee pain 10 years postoperatively. However, the mediating effect of subsequent surgery was significant and diminished the overall contribution of medial meniscal repair in decreasing the likelihood of KOOS pain. Continued efforts should be made to decrease the likelihood of subsequent surgery after medial meniscal repair performed at the time of primary ACLR.