Editorial Commentary: Is Arthroscopic In Situ Repair Effective for Long-Term Functional Recovery and Pain Relief in Symptomatic Partial Rotator Cuff Tears?

Currently, although most evidence suggests that surgery is effective in treating symptomatic partial-thickness rotator cuff tears in patients with failure of nonoperative management and with a tear of more than 50% of the tendon thickness, there is little consensus on the best method of repair. Some surgeons would advocate completing the tear and repairing it, whereas others would advocate performing in situ repair. In our opinion, it is important to also consider treating the long head of the biceps tendon, which is frequently a source of pain at the time of or after surgery.     

Editorial Commentary: Is an Arthroscopic Single-Row Repair Effective for the Treatment of Chronically Retracted,Full-thickness Subscapularis Tears?

Retraction and scarring of subscapularis tears make arthroscopic fixation technically challenging. The ideal arthroscopic technique is still under debate, with new studies examining the importance of repairing the “leading edge.” Regardless of single- or double-row fixation, it is our opinion that restoring the native anatomy as well as any concomitant biceps pathology is essential for postoperative success.     

Editorial Commentary: Proximal Hamstring Injuries—Is the Hip to Blame?

There is a growing understanding of the relation between femoroacetabular impingement (FAI) and injury to adjacent structures. Patients with proximal hamstring pathology appear to have a high prevalence of underlying FAI. The kinetic chain phenomenon is a potential explanation of the high correlation between proximal hamstring injury and underlying FAI of the hip.     

Editorial Commentary: Biological Cartilage Repair Technique—An “Effective,Accessible, and Safe” Surgical Solution for an Old Difficult Biological Problem

Achieving good long-term outcomes while treating chondral defects has always been a challenge. Several surgical techniques for regeneration of the articular cartilage have been proposed. Among them, osteochondral autograft transplantation and 2-step procedures such as autologous chondrocyte implantation have provided good results, promoting formation of new hyaline-like cartilage tissue, whereas other techniques such as microfracture result in fibrous cartilage and a less durable repair. Single-stage cell-based procedures are an attractive treatment option given the potential for cost savings and avoiding a second-stage procedure. We believe that 1-stage cartilage repair in the knee with a hyaluronic acid–based scaffold embedded with mesenchymal stem cells sourced from bone marrow aspirate concentrate has a prominent role in treating chondral defects because this is a simple technique that could improve the care of patients and be cost-effective in the near future.     

Editorial Commentary: Repair of Horizontal Meniscal Tears—A Need for High-Quality Research!

A paucity of evidence exists by which to inform clinical decision-making in the management of repair of horizonal cleavage tears of the meniscus. Available data suggest reasonable outcomes and low failure rates; however, high-quality research is required to refine our understanding of optimal indications, techniques, and long-term outcomes with respect to function and joint preservation.     

Editorial Commentary: A-version to a Pain in the Butt—Structural and Dynamic Determinants of Posterior Hip Pain

Ischiofemoral impingement is becoming a more recognized source of buttock pain that occurs as the lesser trochanter of the femur approximates the lateral margin of the ischium. Abnormal bony structure and alignment of the hip joint and/or faulty dynamic movement patterns may decrease the ischiofemoral space and compress the structures that are found within the space, including the quadratus femoris, proximal hamstring tendons, and sciatic nerve. The ischiofemoral space is reduced by structural factors including an increase in femoral anteversion and femoral neck angle. Dynamic assessment of the hip region may include the Craig test and total rotational range of motion of the hip joint, as well as the ischiofemoral impingement test and the long-stride walking test. The combination of structural and dynamic assessment of the hip region may help determine the presence of ischiofemoral impingement and direct appropriate management of the condition.     

Editorial Commentary: Proximal Hamstring Tendon Injuries: Is the Research Hamstrung by the Use of Poor Outcome Measures?

Proximal hamstring tendon injuries are uncommon injuries, and there are few high-quality studies of surgical procedures in the literature. Increasing standardization of outcome measures with the use of validated, injury-specific, patient-reported outcome measures will improve research in this area. This will allow better assessment of novel surgical techniques.     

Editorial Commentary: Doc,Is It All in My Head? With Rotator Cuff Tears,It Partially Is!

Psychosocial factors including anxiety, depression, and poor mental health negatively influence the baseline clinical expression of rotator cuff tearing. The same factors may influence clinical outcomes after rotator cuff repair surgery. Counseling patients preoperatively about postoperative expectations of rotator cuff repair surgery has a substantial positive impact on postoperative functional outcomes. As surgeons, we need to take the time to not just be technicians but counsel our patients and consider the impact of distress, anxiety, and expectations on the success of our treatments for rotator cuff tears.     

Editorial Commentary: Is the Capsulodesis the Solution to Reduce Graft Extrusion in Meniscal Allograft Transplantation?

The causes of graft extrusion after lateral meniscus allograft transplantation seem to be a multifactorial problem. A recent study shows that the lateral capsulodesis technique could result in better results relative to the degree of meniscal extrusion compared with the bone-bridge fixation technique. Long-term comparative clinical studies are needed to confirm the efficacy of this procedure.     

Editorial Commentary: Subpectoral Biceps Tenodesis Is a Safe Alternative to Arthroscopic Repair for Unstable SLAP Tear in the Young Athlete: Should We Do the Last Operation First?

The clinical significance of structural pathology affecting the biceps-superior labrum complex may be highly variable. Among younger, physically active patients with symptomatic superior labrum anterior-posterior (SLAP) tears that have failed to respond to nonoperative treatment, we continue to lack clear high-level evidence to guide surgical decision making, including a decision between arthroscopic SLAP repair or primary biceps tenodesis for more unstable, type II lesions. Rates of patient satisfaction, return to play, return to prior level of activity, and secondary revision rate are widely reported, and we lack consensus for surgical best practice treatment. With the high rate of postoperative stiffness and revision reoperation and inconsistent functional outcomes after modern arthroscopic shoulder SLAP repair with knotless anchor technology, subpectoral biceps tenodesis may emerge as a primary alternative for treating the young athlete with unstable SLAP tears.     

Editorial Commentary: Arthroscopic Repair of Partial Thickness Rotator Cuff Tears: What Do We Know So Far and Where Should We Put the Focus of Our Future Research?

The available evidence shows that arthroscopic repair using either the transtendon in situ repair technique or the tear completion and subsequent repair technique are associated with favorable results in the short term. Likewise, the location of the lesions (articular or bursal) does not seem to significantly influence the clinical results, regardless of the technique used. Specifically with regard to the surgical technique of choice in the case of deciding to complete the tear and then repair it, it remains to be defined more clearly in future investigations whether it is better to repair with a single- or double-row technique, whether associated subacromial decompression has any advantage and what the results of this technique are in the subgroup of athletes, especially in competitive and overhead athletes in whom repair of rotator cuff tears has shown unfavorable outcomes mainly at the expense of a low return to the same level of sport.     

Editorial Commentary: Threshold Values for Treatment Success—Rotator Cuff Repair Success Lies in the Eye of the Beholder

Successful treatment is the shared goal of patients, surgeons, and clinicians. In the realm of rotator cuff repair, identifying threshold values provides insight into the relation between scores generated from commonly used outcome measures and patient-rated success. These thresholds are useful for separating clinical significance from statistical significance and can help direct future research that aims to examine the effects of different treatments in the context of success. It is important to note that threshold values are sensitive to the sample from which they were drawn. Given the inherent subjectivity of patient-rated success and the diverse nature of patients with rotator cuff tears, there is no single threshold for success but rather a spectrum of threshold values, all of which are dependent on the underlying characteristics of the patients from whom the values were generated.     

Editorial Commentary: Is the Biceps Tendon a Valid Option for Augmentation in Rotator Cuff Repair? Future Perspectives on Superior Capsule Reconstruction

Biceps autograft can be a viable option for biological augmentation of massive rotator cuff repair, albeit results of this procedure might depend on the surgical technique. In the present qualitative systematic review, 8 case series were analyzed, in which biceps autograft was used as a scaffold or tissue bridge. Indeed, leaving the proximal portion intact and fixing it onto the greater tuberosity can simulate a superior capsule reconstruction, with potentially high biologic and mechanical advantages.     

Editorial Commentary: Hip Arthroscopy in an Aging Patient Population—Is 50 the New 40?

As the field of hip arthroscopy expands, in combination with an aging population that remains active into its later years, more outcome studies will be needed to better understand the efficacy and applicability of hip preservation in this patient population.     

Editorial Commentary: Remplissage for All: Hammer and a Nail or the Necessary Adjunct to Arthroscopic Bankart Repair?

Despite advancement in arthroscopic techniques and greater characterization of bone loss, recurrence persists following isolated arthroscopic Bankart repair. Remplissage was developed to prevent engagement of a Hill-Sachs lesion and has decreased recurrence rates compared with isolated Bankart repair. However, the procedure may result in partial loss of external rotation, and long-term studies on the impact of this range of motion loss are needed.     

Editorial Commentary: The Gain in Pain After Hip Arthroscopic Surgery: What Is Clinically Relevant,and Is Pain Related to Function in Patients With Femoroacetabular Impingement Syndrome?

Hip arthroscopic surgery improves patient-reported outcomes in patients with femoroacetabular impingement syndrome and/or hip chondropathy. The minimal clinically important change on a pain visual analog scale has now been calculated in this patient group, and the pain level 1 year after surgery has been related to function. Next step: identifying what causes pain and decreased function 1 year after surgery.     

Editorial Commentary: Meta-analysis Shows That Platelet-Rich Plasma Is Safe and Effective for Knee Osteoarthritis: Future Randomized Controlled Trials Must Be of High Quality—Not High Quantity

The use of platelet-rich plasma in knee osteoarthritis is still controversial, and meta-analysis shows that platelet-rich plasma can be effective and safe for nonoperative management of knee osteoarthritis. Randomized controlled trials (RCTs) are essential tools for evaluating the effectiveness and safety of new therapeutic interventions. Meta-analysis of these RCTs is critical to try to approximate the truth but also reminds us that sometimes, “value does not necessarily derive from quantity but rather from quality.” Given the fact that approximately 92.8% of published abstracts of RCTs report at least 1 significant outcome (indicated as at least P < .05), there is a notion that significant outcomes are most likely to become published, suggesting a potential publication bias. Therefore, additional studies repeating the significant outcomes are sometimes necessary.     

Editorial Commentary: Arthroscopic Fixation of Tibial Eminence Fractures—Which Technique Is the Best Has Not Been Defined Yet!

The tibial eminence fractures are most frequently observed in children and adolescents increasingly. Their classification and management are mainly made by the displacement of the fracture fragment. The surgical management has evolved from open to arthroscopic techniques. Various fixation techniques have been defined. Mainly, there are 2 types of fixation: screw and suture-based methods. Although recent studies have demonstrated the biomechanical advantages of newer suture-based fixation methods, the best method of fixation has not been defined, yet. Currently, nondisplaced and reducible fractures are managed nonoperatively, and displaced and irreducible fractures are managed operatively. Until the best surgical method is defined by higher level of evidence studies clinically, functionally, radiologically, and biomechanically, the type of fixation will be chosen by considering the experience of the surgeon, the clinical status of the patient, the availability of the implants, and the morphology of these fractures.