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Purpose To determine the biomechanical effect of limited lateral retinacular and capsular release on lateral patellar translation as a function of constant force at various knee flexion angles. Methods Six pairs of bilateral cadaveric knee specimens (12 knees) were obtained from a tissue bank, dissected, and potted in a perfect lateral position based on fluoroscopy. A direct lateral force was applied to the patella through an eye screw in the midpoint of the lateral patella, and each knee underwent testing in the intact state and after lateral retinacular and capsular release. All knees were tested at 0°, 10°, 20°, 30°, 45°, 60°, and 90° of flexion using a custom-machined jig on a materials testing system with a 20-N lateral force applied to the patella. Patellar displacement was recorded and compared for each specimen. Results Lateral displacement was significantly greater at all degrees of flexion for the lateral-release specimens than for an intact lateral retinaculum (P less then .05). Compared with intact specimens, lateral-release specimens experienced 30% more translation at 0° of flexion and between 6% and 9% more lateral translation at 10° to 90° of flexion. Conclusions Lateral retinacular and capsular release results in significantly increased lateral patellar translation at all flexion angles compared with intact specimens. This finding suggests that the lateral retinaculum may function as a significant restraint to lateral translation even with intact medial soft-tissue restraints. Clinical Relevance Arthroscopic and open limited lateral retinacular releases should be performed with extreme caution when treating lateral patellar instability given the lateral retinaculum's apparent role as a secondary restraint. © 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America.Purpose To determine whether debris from a silicone core suture has an observable intra-articular or extra-articular impact or can be shown to migrate into the lymphatic system. Methods Using a porcine stifle joint model, 2 study groups were created 1 group used silicone-suture particles created by rupturing hand-tied knots of a nonabsorbable suture with an outer sheath of ultrahigh molecular-weight polyethylene, an inner polyester sheath and a medical-grade silicone/sodium chloride-filled core. The second group used a mixture of 3 vitreous carbon particles sizes. Twelve Yorkshire pigs were randomly assigned to each group. Only 1 type of study particle was used in a single animal to avoid cross-contamination. Half of the study materials were placed by arthrotomy into the joint and, after capsular closure, the remaining half were placed on the joint capsule before skin closure. Six weeks postimplantation, the stifle joints and regional lymph nodes were examined macroscopically and microscopically. The extracap Carbon particles in the porcine knee migrated into the lymph nodes (iliac 100%; inguinal 50%, popliteal 0); gross discoloration was observed in 8 of 12 specimens. Silicone-suture particles could not be found in the lymph nodes, and no macroscopic joint damage was observed. Clinical Relevance The clinical use of a suture containing a silicone/salt central core is common, and the porcine lymphatic model suggests that this type of suture material does not result in clinically significant silicone particulates. © 2019 by the Arthroscopy Association of North America. Published by Elsevier Inc.Purpose To determine the cost-effectiveness of knotted (KT) versus knotless (KL) methods for rotator cuff surgical repair and to assess differences in patients' outcomes. Methods We retrospectively identified all patients who underwent arthroscopic rotator cuff repair at 1 institution by 1 surgeon over 2 6-month periods of time (KT technique from August 1, 2013, through January 31, 2014; and KL technique from December 1, 2014, through May 31, 2015) to calculate the direct and indirect costs associated with arthroscopic KT or KL suture bridge rotator cuff repair. Patient demographics, number of anchors used, tendons repaired, procedure time, operative time, and clinical results were also evaluated. We used univariate generalized linear models with a Gaussian distribution for assessment scores and total and implant cost data. Results We identified 87 patients for inclusion during the 2 time frames (35 KT, 54 KL). After excluding patients for tear size 0.05 for all). Conclusions Despite using more anchors and incurring higher implant costs, the KL technique for rotator cuff repair required less surgical procedure time and cost less overall than the KT technique and resulted in equivalent clinical results. Level of Evidence Level IV Economic and Decision Analyses. © 2019 by the Arthroscopy Association of North America. Published by Elsevier Inc.Purpose The purpose of this study was (1) to determine the prevalence of burnout in orthopaedic surgeons and (2) to determine whether there is an association or correlation between subject-specific variables (age, attending physician, resident, postgraduate year level, gender, number of calls, total hours worked, and total hours of sleep) and burnout. Methods Surgeons were prospectively enrolled and provided with a validated wearable device. Subject-specific variables were recorded. Participants completed the Maslach Burnout Inventory and Patient-Reported Outcomes Measurement Information System (PROMIS-29) weekly. Burnout and burnout risk were defined. Multivariate analysis and bivariate correlations were used to determine the association and correlation between subject-specific variables and burnout. Residents were compared to attending surgeons. Results Of the 26 enrolled subjects, 21 (15 males, 6 females; mean age 37.2 ± 10.9) completed the 4-week study. Residents worked significantly more hours per week t surgeons' health and patients' outcomes. Identifying the predictors of burnout would allow surgeons to address these risk factors and reduce burnout. © 2019 by the Arthroscopy Association of North America. Published by Elsevier Inc.Purpose The purpose of this study was to evaluate the reliability and educational content of YouTube videos concerning injuries to the posterior cruciate ligament (PCL) of the knee. Methods The first 50 videos specific to the PCL identified through the YouTube query posterior cruciate ligament were evaluated by a method of video selection demonstrated to be feasible in prior YouTube studies. Videos were classified by content and upload source. Video reliability was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (score range 0-5). Video educational content was assessed using the Global Quality Score (GQS) (range 0-4) and the PCL Score (PCLS) (score range 0-18). Analysis of variance was used to determine differences in video reliability and educational content quality based on video content and upload source. click here Multivariate linear regressions were used to identify predictors of video reliability and educational content quality. Results The mean number of views per video was 50,477.