Editorial Commentary: The Everted Acetabular Labrum. It Is Not Just a Small Labrum

Everted, hypoplastic acetabular labra represent a variant of acetabular rim development. It is important to be able to recognize this pathology on magnetic resonance imaging and at the time of hip arthroscopy. Proper intraoperative identification of this variant that does not make contact with the femoral head is critical to being able to successfully restore this contact, often through labral advancement, acetabuloplasty of the abnormal rim development, and occasionally labral augmentation. A broad awareness among hip arthroscopy surgeons of this topic will lead to improved clinical outcomes after hip arthroscopy for a challenging cohort.     

Editorial Commentary: Just Getting Warmed Up: Risks,Benefits, and Economics of Active Warming Devices

Efforts to maintain normothermia should be a part of every patient’s perioperative care. Risks, benefits, and economic implications should be considered when deciding how to use active warming devices for orthopaedic surgery. The Centers for Medicare & Medicaid Services has implemented economic incentives and penalties driving hospitals to invest in active warming devices, including forced-air warmers and resistive heating devices. Even though forced-air warmers and resistive heating blankets are likely to statistically improve patient temperatures, they may not be worth the additional cost for shorter, less invasive, elective arthroscopic surgeries. In addition, recent research demonstrates minimal clinically significant differences between these 2 types of devices. Concern regarding possible increased risk of surgical-site contamination with forced-air warmers warrants further study but, again, is unlikely clinically relevant to arthroscopic cases, and proper staff training and warming equipment routine maintenance could minimize patient risk.     

Editorial Commentary: If the Massive Rotator Cuff Tear is Irreparable,Just Fix the Rotator Cable

Large and massive rotator cuff tears are not always reparable and present a difficult clinical problem. If surgery is warranted surgical options range from arthroscopic debridement, partial repairs, degradable spacers, tendon transfers, and more superior capsular reconstruction. The rotator cable is formed by the deep layer of the coracohumeral ligament and the crescent structure running from the anterior insertion site of the supraspinatus to the inferior border of the infraspinatus. The role of the rotator cable is not clear but seems to play a role in reducing tendon stress and influence glenohumeral kinematics. In this laboratory-based cadaver study the anterior cable was reconstructed with semitendinosus allograft treating large “irreparable” rotator cuff defects. Reconstruction resulted in reduced superior migration and subacromial contact forces without inhibiting range of motion.     

Editorial Commentary: Timing of Anterior Cruciate Ligament Reconstruction Is Just as Important as a Correct Surgical Procedure

The timing between anterior cruciate ligament (ACL) injury and surgical treatment may determine secondary injuries and abnormal laxity. Specifically, a knee without a functioning ACL is more at risk of a future episode of instability and the development of injuries to other joint structures. Ultimately, this may result in degenerative joint disease. Associated medial or lateral meniscus, cartilage or multiligamentous lesions indicate earlier ACL reconstruction. In particular, the possibility of an effective meniscus repair is a key indicator for early surgery. Patient selection is the key to success of ACL surgery, and it is deeply linked to surgical timing. Also, in the case of athletic patients, professional or otherwise, surgery must be as performed early to allow a rapid recovery of activity.     

Editorial Commentary: Machine Learning Is Just a Statistical Technique,Not a Mystical Methodology or Peer Review Panacea

Orthopaedic and sports medicine research surrounding artificial intelligence (AI) has dramatically risen over the last 4 years. Meaningful application and methodologic rigor in the scientific literature are critical to ensure appropriate use of AI. Common but critical errors for those engaging in AI-related research include failure to 1) ensure the question is important and previously unknown or unanswered; 2) establish that AI is necessary to answer the question; and 3) recognize model performance is more commonly a reflection of the data than the AI itself. We must take care to ensure we are not repackaging and internally validating registry data. Instead, we should be critically appraising our data—not the AI-based statistical technique. Without appropriate guardrails surrounding the use of artificial intelligence in Orthopaedic research, there is a risk of repackaging registry data and low-quality research in a recursive peer-reviewed loop.     

Editorial Commentary: Go Ahead and Repair That Shoulder Rotator Cuff Tear in Your Obese Patient: Just Be Prepared to Admit Them

Arthroscopic rotator cuff repair in the obese patient offers functional outcomes and rates of complications comparable to those seen in nonobese patients. Future prospective studies with better methodology, as well as including larger numbers of severely obese patients with a body mass index of 40 or greater, will help to further elucidate if obesity truly affects outcomes in rotator cuff repair. In the meantime, be sure to consider admission of your obese rotator cuff repair patients.     

Editorial Commentary: Age-Appropriate Expectations Are Critical When Analyzing Knee Anterior Cruciate Ligament Reconstruction Outcomes: Age Is More Than Just a Number

In patients undergoing anterior cruciate ligament (ACL) reconstruction, age affects treatment and postoperative recovery decisions, as well as failure rates and outcomes. However, how age affects postoperative patient-reported outcomes and the appropriateness of using the International Knee Documentation Committee patient acceptable symptoms state score in the >40-year-old patient population has received little attention. This study assesses commonly used patient-reported outcomes in older patients undergoing ACL reconstruction and aims to redefine a more suitable patient acceptable symptoms state score for this patient population. As our understanding of both the importance of ACL reconstruction on knee biomechanics and joint stability, as well as the increased rate of ACL reconstruction in older patients grows, having age-appropriate outcomes expectations is critical to both counseling patients and developing future research aims. Future application of outcomes scores in clinical practice and in the research, arena must take into account patient age and function after ACL reconstruction.     

Editorial Commentary: Biomechanical Analyses of the Hip Capture Are Way Too Simple! The Capsule Is Just One Piece of the Puzzle

The hip capsule is clearly a significant part of the hip and the considerations that we need to take into account when performing hip arthroscopy. Any study that adds some further clarity to this important structure is welcome and appreciated. The inherent problem with all of these articles is the lack of application to the reality of a living, breathing patient whose capsule changes following time zero of the capsular intervention and also whose negative intra-articular pressure is immediately violated and not recreated following any intervention that is undertaken. Hip capsular closure and perhaps even imbrication is indicated in some cases, but in many cases, it is a nonissue.     

Editorial Commentary: Tibial Attachment of the Anterior Cruciate Ligament: Just 1 Piece to the Complex Puzzle of Individualized,Anatomic Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is a complex, biologic structure that continues to be explored in the literature. Given the individual uniqueness of the ACL, variation exists, and studies continue to attempt to tease out what is truly important for ACL reconstruction. Although individual components of the ACL structure provide function, the ACL works as a dynamic structure, in unison with the surrounding bony morphology, to produce normal knee kinematics. Ultimately, in ACL reconstruction, the surgeon is tasked with restoring the native dimensions, collagen orientation, and insertion sites according to the individual anatomy.