Editorial Commentary: Femoral Notch Volume: Too Much Information?

Femoral intercondylar notch size and volume are some of the many morphometric knee measures that have been associated with increased risk of anterior cruciate ligament (ACL) injury. The merits of relatively simple measures such as notch width versus more complex 3-dimensional notch volume have been debated, and there is some evidence suggesting that volumetric measures may have a stronger association with injury risk. The application for this information is, however, unclear. Notch volume appears to be just one of many nonmodifiable risk factors that contribute in a small way to the complex puzzle that is ACL injury risk. Although studying notch morphology may be an interesting academic exercise, it is difficult to see how notch measurements would be useful for injury prevention or to improve care after ACL injury.     

Editorial Commentary: Knee Arthroscopy: How Fast Is Too Fast? How Slow Is Too Slow?

Although the quality of knee arthroscopy is not determined with a stopwatch, in general, an operation should not take significantly longer than average for a routine and uncomplicated procedure. On the other hand, rushing through an operation is never acceptable. Hurrying to complete an operation to meet a given time standard is not only undesirable, but also unsafe for the patient.     

Editorial Commentary: My Harvested Hamstring Autograft Is Too Small. Now What?

A harvested hamstring autograft that is too small is a technical challenge for an effective anterior cruciate ligament reconstruction. One potential solution is to assemble the graft differently to maximize the diameter and length of the graft. Compared with the traditional, all-inside, 4-strand graft preparation, alternative graft constructs could be further explored and evaluated.     

Body Composition and Skeletal Health: Too Heavy? Too Thin?

The relationship between body composition and skeletal metabolism has received growing recognition. Low body weight is an established risk factor for fracture. The effect of obesity on skeletal health is less well defined. Extensive studies in patients with anorexia nervosa and obesity have illuminated many of the underlying biologic mechanisms by which body composition modulates bone mass. This review examines the relationship between body composition and bone mass through data from recent research studies throughout the weight spectrum ranging from anorexia nervosa to obesity.     

Editorial Commentary: When Is Too Small,Too Small? Allograft Augmentation of Autologous Hamstring Grafts During Anterior Cruciate Ligament Reconstruction

Soft tissue allograft augmentation of small hamstring autografts, so-called hybrid grafts, has been proposed as an option during anterior cruciate ligament reconstruction (ACL-R). However, notable concerns exist with both small autograft use and allograft use during ACL-R, particularly in young, active patients. We currently choose to augment hamstring autografts with diameters <8.0 mm, adding only enough allograft to create a hybrid graft with an overall diameter no larger than 8.5 mm. Based on the available evidence, surgeons continue to seek the tipping point where the benefit of additional allograft tissue exceeds the consequence of its use.     

Editorial Commentary: Hip Cam Overresection May Result in Inferior Outcomes: The Goldilocks Paradox of Too Little,Too Much,or Just Right?

Femoroacetabular impingement is a recognized source of hip pain and cause of labral and articular cartilage injury. Persistent femoroacetabular impingement has been recognized as a source of inferior patient-reported outcomes, and attempts to define a “normal” α-angle has resulted in more aggressive resection of cam lesions. An overzealous femoroplasty may result in iatrogenic hip instability. A dynamic intraoperative examination may be the best way to truly recognize this problem, in particular, by visualizing the loss of the suction seal, as the cam resection engages the acetabulum, resulting in subluxation. A soft tissue “remplissage” salvage procedure may offer an option to correct cam overresection and improve patient outcomes during revision arthroscopy, as we continue to search for the “right” amount of cam correction to perform.