OBJECTIVE: The purpose of this systematic review was to evaluate the use of shoulder arthroscopic simulation in Orthopaedic surgery trainees.
METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were experimental studies reporting pre- and post-test results of shoulder arthroscopic simulation in orthopaedic trainees (studies reporting results of comparison between groups not within the groups were excluded). Participant demographics, type of simulator training, simulator tasks assessed and performance outcome measures were systematically reviewed. Each performance outcome measure was graphically represented in a Forest plot with point estimates of the incidence of performance outcomes with corresponding 95% confidence intervals and I2.
RESULTS: Fifteen studies met inclusion criteria with a total of 353 participants. The most common procedures simulated were diagnostic shoulder arthroscopy (n=9 [60%]), arthroscopic Bankart repairs (n=3 [20%]), and rotator cuff repairs (n =2 [13%]). Simulations primarily utilized virtual reality (60%) and bench top models (40%). The primary outcomes measured were time to task completion and Arthroscopic Surgical Skill Evaluation Tool (ASSET) scores. Time to task completion improved significantly with training (range 13-439 seconds pre-test to 8-253.29 seconds post-test), with substantial heterogeneity across studies (I2=87%). ASSET scores improved in 60% of the studies (ranging from 14-20.9 pre-test to 17.9-28.5 post-test), with low heterogeneity (I2=20%). Additionally, both camera and probe distances decreased after simulation use, while the 14-point anatomic checklist showed no pre to post-test differences.
CONCLUSIONS: Arthroscopic simulation training benefits technical skills in shoulder arthroscopy, but the quality, assessment, and validity of these protocols vary. The translation of simulation training into the operating room has yet to be conclusively demonstrated.

OBJECTIVE: To evaluate the efficacy and outcomes of arthroscopic Bankart repair using a single anterior working portal and determine whether they are comparable to the standard two-portal technique.
METHODS: A search following PRISMA guidelines was performed in July 2024 in the PubMed, Embase, Scopus, and Cochrane Library databases. Studies evaluating outcomes of patients undergoing arthroscopic Bankart repair using a single anterior portal technique were included. A meta-analysis comparing outcomes was performed using a random-effects model. A P-value < 0.05 was considered statistically significant.
RESULTS: Seven studies in patients undergoing Bankart repair with a single anterior portal were included (311 patients, 84.6% male, mean age 27.8 years, mean follow-up 37.4 months). Five of seven studies compared outcomes of a single anterior portal versus the standard two-portal technique. The duration of surgery was significantly shorter in the single anterior portal group (P < 0.00001). The postoperative Oxford Instability Score (P = 0.84), Rowe score (P = 0.26), American Shoulder and Elbow Surgeons score (P = 0.73), Constant-Murley score (P = 0.92), and Visual Analog Scale Pain score (P = 0.07) were similar between both groups. The postoperative degree of shoulder abduction (P = 0.84) and external rotation (P = 0.64) were similar between both groups. The risk of redislocation (P = 0.98) was similar between both groups.
CONCLUSIONS: Patients undergoing arthroscopic Bankart repair with a single anterior portal had significantly lower operative times and comparable PROs, ROM, and risk of redislocation relative to patients undergoing repair with a standard two-portal technique.

UNASSIGNED: Shoulder instability in pediatric and adolescent patients can be treated operatively via arthroscopic or open procedures, but there a paucity of evidence to support the incidence of these treatment modalities over time. It is hypothesized that the overall rate of arthroscopic shoulder stabilization procedures will increase over time. Given advances in open stabilization techniques, we also hypothesized that the rate of open procedures may be increasing.
UNASSIGNED: The Pediatric Health Information System database was queried for patients 19 years or younger who underwent arthroscopic or open surgery for shoulder instability and pediatric orthopedic surgeries between 2009 and 2019. Data from 37 of the 52 pediatric hospitals with Pediatric Health Information System data was included in the analysis. Annual and overall incidence rates were estimated for arthroscopic and open procedures, along with 95% confidence intervals. The yearly incidence for secondary (homolateral revisions) or primary contralateral arthroscopic and open procedures was also examined.
UNASSIGNED: 4747 patients underwent primary arthroscopic procedures and 384 patients had primary open procedures. There were 8.2 primary open shoulder stabilization procedures per 10,000 orthopedic surgical patients in 2009, which decreased by 19% to 6.7 per 10,000 orthopedic surgical patients in 2019. There was an increase seen in both arthroscopic and open secondary stabilization procedures. In 2009, there were 0.97 secondary arthroscopic procedures per 10,000 orthopedic surgical patients. This increased by 672% to 7.5 per 10,000 orthopedic surgical patients in 2019. No secondary open procedures were recorded in 2009; however, an increase to 2.6 secondary open procedures per 10,000 orthopedic surgical patients was seen by 2019.
UNASSIGNED: This study shows a rise in primary arthroscopic pediatric shoulder stabilization surgeries across the U.S. over the last decade. There was a slight decrease in the rate of primary open shoulder stabilization surgeries and an increase in both arthroscopic and open secondary (homolateral revisions or primary contralateral) shoulder stabilization surgeries, implying an increasing revision burden in this population.

Biceps tenodesis is an accepted treatment option for various pathologies of the long head of the biceps tendon and labrum. Many techniques have been published, both arthroscopic and open, that utilize various fixation techniques and locations of the tenodesis, yet none has been proven to be superior. We introduce a novel method, the SALSA (subacromial locking stitch anchor), an all-arthroscopic suprapectoral biceps tenodesis utilizing a running locking stitch from a double-loaded biocomposite anchor. This technique provides a reliable method of multipoint fixation including the transverse humeral ligament that avoids many of the potential complications encountered with other techniques.

BACKGROUND: Though Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (P-UE) has been validated in upper extremity orthopedics, it\'s ability to capture a patient\'s functional recovery after arthroscopic rotator cuff repair (aRCR), as measured by its responsiveness, is minimal in the early postoperative period. The primary purpose of this study is to determine if addition of PROMIS Pain Intensity (P-Intensity) or Pain Interference (P-Interference) scores to PROMIS UE improves the responsiveness throughout the one-year postoperative period after aRCR.
METHODS: This prospective, longitudinal study included 100 patients who underwent aRCR. Patients completed P-UE, P-Interference, P-Intensity, American Shoulder and Elbow Surgeons (ASES), and Western Ontario Rotator Cuff Index (WORC) scores preoperatively and at 2-weeks, 6-weeks, 3 months, 6-months and 12-months after surgery. Responsiveness at each time-point relative to preoperative baseline and one-way analysis of variance with post-hoc analysis was conducted for each PROM. Responsiveness of the outcome score was determined using the effect size (ES), graded as small (0.2), medium (0.5), or large (0.8). The Pearson correlation coefficient (r) was determined between these instruments at each time-point.
RESULTS: In isolation, P-UE, P-Interference, and P-Intensity showed a medium-large ability to detect change (positive and negative) throughout the one-year postoperative period. The addition of PROMIS pain scores to P-UE improved the responsiveness of the instrument (from medium to a large effect size) starting at 3 months and continued throughout the 12 month follow-up period. Though the addition of pain scores increases the response burden for PROMIS, this was still lower when compared to the response burden for the legacy outcome scores (p<0.05).
CONCLUSIONS: The addition of PROMIS pain instruments improves the responsiveness of the P-UE function score in patients undergoing aRCR.

BACKGROUND: Tibial avulsion fractures of the posterior cruciate ligament (PCL) are challenging to treat and compromise knee stability and function. Traditional open surgery often requires extensive soft tissue dissection, which may increase the risk of morbidity. In response to these concerns, arthroscopic techniques have been evolving. The aim of this study was to introduce a modified arthroscopic technique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.
OBJECTIVE: To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.
METHODS: We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL. This case series included 18 patients who underwent the procedure between January 2021 and December 2022. The patients were assessed for range of motion (ROM), Lysholm score and International knee documentation committee (IKDC) score. Postoperative complications were also recorded.
RESULTS: The patients were followed for a mean of 13.83 ± 2.33 months. All patients showed radiographic union. At the final follow-up, all patients had full ROM and a negative posterior drawer test. The mean Lysholm score significantly improved from 45.28 ± 8.92 preoperatively to 91.83 ± 4.18 at the final follow-up (P < 0.001), and the mean IKDC score improved from 41.98 ± 6.06 preoperatively to 90.89 ± 5.32 at the final follow-up (P < 0.001).
CONCLUSIONS: The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL, with excellent fracture healing and functional recovery.

BACKGROUND: Several studies have reported a strength deficit in internal rotation (IR) following a Latarjet procedure, which can persist for months or even years. The arthroscopic Trillat procedure does not require splitting the subscapularis muscle, potentially making it less damaging.
OBJECTIVE: The arthroscopic Trillat procedure does not cause any atrophy or strength deficit in the subscapularis muscle.
METHODS: This was a single center, retrospective study of patients treated between 2013 and 2021. Included were patients who had chronic anterior shoulder instability with an indication for surgical stabilization using an arthroscopic Trillat procedure and who underwent a CT scan before surgery and a second one at 6 months postoperative. The following morphological parameters were measured on all the rotator cuff muscles: cross-sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery.
RESULTS: One hundred seventeen patients underwent arthroscopic Trillat surgery between 2013 and 2021; 58 were included, 30 were analyzed and 17 patients underwent isokinetic testing. The CSA of the subscapularis was significantly smaller by 5.3% (17.0 vs. 16.1; p = 0.03). None of the other rotator cuff muscles had a smaller CSA. The MMA of the subscapularis increased significantly while the MMA of the external rotators decreased postoperatively. No strength deficit was found at 1 year postoperative in the internal and external rotators.
CONCLUSIONS: The arthroscopic Trillat procedure produces minor atrophy of the subscapularis muscle at 6 months, with no strength deficit at 1 year postoperative. Several studies have reported a deficit in internal rotation strength after a Latarjet procedure, ranging from 6% to 19% depending on the study.
METHODS: IV.

BACKGROUND: Subtalar osteoarthritis in the context of flatfoot (recently renamed Progressive Collapsing Foot Deformity (PCFD)) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA).
METHODS: In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2 A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1 C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes.
RESULTS: Thirtythree PCFD (33 patients, median age 62) were included in the study. Preoperative medial facet subluxation was 28.3 % (IQR, 15.1 to 49.3 %). Overall PCFD 3D deformity improved with a reduction of the foot and ankle offset from 9.3 points (IQR, 7.8 to 12) to 4 (IQR, 0.9 to 7) (p < 0.001). Class A-hindfoot valgus (median tibiocalcaneal angle and median calcaneal moment arm improved by 9.4 degrees (p < 0.001) and 11 mm (p < 0.001), respectively), class B-midfoot abduction (median talonavicular coverage angle improved by 20.5 degrees, p < 0.001) and class C-forefoot varus (median sagittal talo-first metatarsal angle improved by 10.2 degrees (p < 0.001)) were significantly corrected after surgery. Class D was difficult to assess due to the fusion procedure. No patient had a pre-operative valgus deformity at the ankle (no class E), and no significant change of the talar tilt was observed (p = 0.12).
CONCLUSIONS: In this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus.
METHODS: Level IV, case series.

OBJECTIVE: The aim of this study was to evaluate the postoperative radiological and functional results of patients treated with arthroscopy-assisted (AA) and percutaneous (P) procedures using endo-button for type III acromioclavicular joint dislocations with a minimum 1-year follow-up. The study hypothesis was that the AA technique would provide more favourable coracoid tunnels.
METHODS: This retrospective study included patients who underwent surgery between 2017 and 2022. Computed tomography images taken immediately postoperatively of all the patients were analysed to group coracoid tunnels as optimal or suboptimal based on orientation and placement within the coracoid base. Residual horizontal instability was assessed using the bilateral Alexander view at the final follow-up. Shoulder functions were evaluated at the final follow-up examination.
RESULTS: Of the 63 patients, 39 underwent surgery using the percutaneous procedure and 24 with the AA procedure. Surgical duration was significantly longer in the AA group (AA: 61.1 ± 5.9 min; P: 34.7 ± 5.6 min) (p = 0.001; 95% confidence interval [CI]: 23.3-29.3), whereas fluoroscopy time was longer in the percutaneous group (AA: 2.0 ± 0.8 s; P: 15.7 ± 3.9 s) (p = 0.001; 95% CI: -14.9 to 12.3). Optimal coracoid tunnels were more frequently observed in the AA group (p = 0.001; 95% CI: 7.4-137.8). There was no significant difference in functional scores between the groups (n.s.). Postoperative horizontal instability was more common in the percutaneous procedure (p = 0.013; 95% CI: 8.3-39.2).
CONCLUSIONS: Although no difference was detected between the methods in terms of complications and functional results, the higher frequency of residual horizontal instability, the high risk of suboptimal tunnel creation and greater radiation exposure were seen to be the most important disadvantages of the percutaneous technique. During surgery, such technical problems related to the percutaneous method should be kept in mind and care should be taken about the orientation of the coracoid tunnel.
METHODS: Level III.

BACKGROUND: Hip replacement surgery is highly effective in relieving pain and improving mobility in patients with various hip conditions. However, some patients develop groin pain after surgery, often due to iliopsoas impingement (IPI), which can be challenging to diagnose. Conservative treatments are initially recommended, but when these are not effective, surgical options may be considered. This study aims to evaluate the clinical outcomes, success and failure rates, revision rates, and complications associated with arthroscopic and endoscopic surgery for IPI, thereby providing a comprehensive understanding of the effectiveness and risks of these surgical interventions.
METHODS: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a thorough search of five main databases: PubMed, Scopus, Embase, Medline, and Cochrane. Eligible articles were meticulously evaluated according to predefined criteria for levels of evidence (LoE), with retrospective studies assessed using the Coleman Methodology Score (mCMS). This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO).
RESULTS: Among the 16 included studies, 431 patients with 434 hips underwent either endoscopic or arthroscopic tenotomy. Both techniques showed favorable outcomes, with arthroscopic tenotomy demonstrating slightly higher success rates than endoscopic tenotomy. Common complications included mild pain and occasional infections, with recurrence observed in some cases. Both techniques offer direct visualization of prosthetic components and potential preservation of psoas function.
CONCLUSIONS: Arthroscopic and endoscopic iliopsoas tenotomy are effective treatments for alleviating symptoms and improving hip function in patients with IPI post-total hip arthroplasty (THA).
METHODS: IV.