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IONA may allow orthopaedic surgeons to deliver better services at a reduced cost for ankle arthroscopy.An excessively lateral tibial tubercle is a well-accepted risk factor for recurrent patellar dislocation. Generally, it is measured on magnetic resonance imaging as the TT-TG distance (tibial tubercle-trochlear groove distance), and recent meta-analyses have suggested that a value as low as 12.5 mm can be used as the threshold for deciding when to medialize the tibial tubercle. However, a problem with using the TT-TG distance is that it is influenced by the size of the knee. An individualized index helps overcomes this problem, and dividing the TT-TG distance by the trochlear width may be the most promising method. The suggested cut-off value of (TT-TG)/trochlear width is 0.572.Following anterior cruciate ligament injury and surgery, it is important that we prepare athletes to return to sport not only from a physical perspective but also a psychological one. Typically, we are concerned for an athlete who has low confidence or high anxiety. However, can being too psychologically ready to return to sport also be a bad thing? While the optimal psychological profile will vary from person to person, evidence is emerging that more extreme responses may have detrimental consequences and increase the risk of further injury.Various treatment options exist for patellar chondral lesions, including nonoperative management, marrow stimulation, cell-based strategies, and osteochondral transplantation, yet there is insufficient evidence to recommend one treatment over another. One frequently discussed downside of cell-based strategies, including particulated juvenile allograft cartilage and matrix-induced autologous chondrocyte implantation, is the associated cost. Markov modeling is a tool used for economic modeling of different treatments and may be a viable option to compare cell-based strategies for patellar chondral defects. Too many assumptions carry great risk of drawing a strong conclusion. Further high-quality studies and comparative outcome studies are needed before any definitive cost-effectiveness conclusion is made.Successful anterior cruciate ligament (ACL) reconstruction requires definition. Some focus on return to sport or early return to sport. Others focus on reproduction of normal ACL anatomy or biomechanics. Recent focus includes restoration of secondary stabilizers. However, each new focus can have positive, but also adverse, consequences. In general, positive results in 4 categories are equally important for the success of ACL reconstruction early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption, and clinical measures of knee function and structure. We are moving the needle to achieve the "best" ACL reconstruction, but we should never change treatment based on one parameter or "fashion."Return-to-sport rates following arthroscopic treatment of femoroacetabular impingement are high; however, the predictors of failure to return to sport must be elucidated. Recent data suggest that the postoperative alpha angle may be a significant predictor of return to sport in athletes, despite the fact that the role of radiographic measurements on postoperative outcomes is debated in the literature. Nonetheless, it is incumbent on surgeons to fully understand the unique biomechanics of the hip in each sport and consider each patient's unique anatomy when undertaking cam resection. Recreation of the motion at-risk during a careful intraoperative dynamic examination is imperative to ensure that all areas of impingement have been eradicated while attentively avoiding over-resection. While the postoperative alpha angle is an important metric for surgeons to keep in mind, it may only represent one piece of the puzzle.In recent years, femoroacetabular impingement syndrome (FAIS) has developed itself into a well-known pathology throughout the orthopaedic community worldwide. The more we learned, the more sophisticated it became In the beginning, we measured the femoral head-neck offset; then, the alpha angle was found to be a useful measurement in detecting FAIS. We learned to perform these measurements with, for example, the 45° Dunn view. The alpha angle, but not the femoral head-neck offset, measured as described, predicts not only the acetabular cartilage damage resulting from FAIS but also the correlation between the degree of the alpha angle and the severity of the cartilage damage within the acetabular labrum articular disruption and Outerbridge classifications. The femoral head-neck offset cannot provide us with this information, but it is the first sign we all look at before taking any measurements on radiographs or magnetic resonance imaging scans if a cam morphology could be present. It is paramount to understand the underlying problems of the individual hip and distinguish instability (dysplasia) from FAIS and also to evaluate femoral torsional abnormalities to perform the appropriate treatment using magnetic resonance imaging and computed tomography scans if necessary. The alpha angle quantifies the severity of the pathology and predicts the possible cartilage damage in FAIS patients, but in our opinion, we cannot neglect the femoral head-neck offset, because it is often the first radiologic sign of FAIS that most of us realize on a radiograph. Therefore, both signs have their place in detecting and treating FAIS.In the last 20 years, femoroacetabular impingement (FAI) has transitioned from a disputed disease to a well-established cause of hip pain and osteoarthritis (OA). Cam-type FAI, specifically, is supported by several studies as a risk factor for osteoarthritis. Elevated α-angle is also a mild-to-moderate risk factor for OA in patients with FAI. Other risk factors include age, sex, body mass index, activity level, range of motion, 3D acetabular and femoral morphology, and femoral version. To further complicate the picture, when we look at the contralateral hip (where many of these factors are held constant), only about 25% of patients appear to report symptoms over a 5-year period after their presentation with ipsilateral FAI. In the setting of an FAI bony morphology, some individuals end up with early symptoms and cartilage damage at a young age, while others go their whole life without hip pain. We still have a long way to go to understand the multitude of factors that drive the "perfect storm" that leads to symptomatic FAI and eventual OA in certain patients.The perfect femoroplasty varies with the individual patient's pathoanatomy and is a prime example of the art and science of surgery. Radiographs are two-dimensional representations of a three-dimensional reality and can miss detection of cam impingement. Cam impingement may occur without cam morphology as femoral retrotorsion and/or supraphysiological range of motion (e.g., dancers and martial artists) may cause cam impingement with normal α-angles and anterior offset. Acetabuloplasty or acetabular reorientation osteotomy may change the dynamic interaction between the proximal femur and acetabular rim and may alter the location and extent of cam decompression. Although much is discussed about the α-angle, restoration of anterior offset is also important. Incremental femoroplasty assessed in real time by arthroscopic dynamic examination is key, as the surgeon sculpts a nonimpinging proximal femur using a burr rather than a chisel in creating a customized surgical masterpiece.The literature to guide clinical-decision making for the treatment of symptomatic distal radioulnar joint instability in the setting of distal radius fracture is mixed, with some advocating for surgical treatment at the time of fracture fixation and others reporting acceptable clinical outcomes with conservative management. Given this, it can be challenging to determine which treatment strategy to employ for each individual patient. For injuries that are the result of high-energy trauma or when there is persistent instability lasting 6 months or longer after fracture fixation, surgical intervention may be needed. However, a period of conservative treatment does not appear to result in poorer outcomes.Youth baseball pitchers who also play catcher are at nearly 3-fold increased risk of developing a shoulder or elbow injury throughout the course of a season. The risk of injury has been largely attributed to the increased workload from a greater overall number of throws. In addition, throws performed by catchers are often performed in the squatting or kneeling position, which is radically different from all other positions. EZM0414 Fortunately, recent research shows no difference in medial elbow torque between squatting and standing throws a standard distance from home plate to the pitcher and also shows that greater passive internal rotation of the hip on the throwing side is protective against loads on the medial elbow when throwing from the squatting position. Improving passive hip range of motion through stretching exercises may prevent injury in young baseball catchers.Operative management of anterior glenohumeral dislocation can confer significant improvements in subjective shoulder function, pain, and overall stability. Although the coracoid-based Latarjet procedure has long been considered the ultimate treatment for complex anterior shoulder instability with glenoid or bipolar bone loss, few authors have considered the unimaginable question what do you do when a patient fails Latarjet? A modified arthroscopic technique of the Eden-Hybinette procedure allows for revision anterior glenoid augmentation of critical glenoid bone loss with autologous tricortical iliac crest, while suture button fixation may obviate hardware complications previously seen with bicortical screw fixation. Although distal tibial allograft provides excellent congruity, viable articular cartilage, and no harvest site morbidity, financial costs and graft availability must also be considered. With favorable patient-reported outcomes, excellent rates of radiographic union, and reliable return to sport, the Eden-Hybinette procedure with suture button-based construct offers a viable alternative for patients with advanced glenoid bone loss (>20%) or revision scenarios.Subacromial bursal tissue biopsied during arthroscopic surgery for full-thickness rotator cuff tears appears to possess mesenchymal progenitor cells. Although attempting to harvest mesenchymal progenitor cells from the subacromial bursa for therapeutic purposes may currently be premature, the presence of these cells in bursal tissue does call into question the routine practice of subacromial bursectomy. To maximize the chances of healing after rotator cuff repair, perhaps it would be best to avoid excising non-diseased-appearing bursal tissue any more than what is absolutely necessary to facilitate visualization.The technical nuances of arthroscopic Bankart repair cannot be overstated. Previous literature has identified a number of risk factors for failure of arthroscopic stabilization procedures, and the implications of glenoid bone loss is widely recognized as a critical driver of postoperative outcomes. However, other technical considerations (inadequate number of suture anchors, improper position of suture anchors) have been acknowledged as risk factors for the failure of arthroscopic stabilization procedures. More recently, concerns have been raised regarding the observed rates of glenoid bone resorption following arthroscopic Bankart repair, which theoretically may predispose higher rates of clinical failure. Furthermore, certain techniques for placing anchors on the glenoid during arthroscopic Bankart repair may accelerate these resorptive changes. Precise measures of poststabilization surgery glenoid resorption coupled with comprehensive assessments of clinical outcomes are required to determine the optimal technique for anchor insertion during arthroscopic Bankart repair.