Steadman Clinic

There is a paucity of literature evaluating (1) changes in lateral compartment tibiofemoral contact mechanics and lateral meniscal function and (2) the effect of varying repair constructs in treating partial-thickness (type 3) lateral meniscal oblique radial tears (LMORTs). (1) Type 3 LMORTs would significantly alter lateral compartment contact mechanics and meniscal function when compared with the intact state, and (2) tibia-based suture anchor repair would more effectively restore these metrics to native levels when compared with capsular-based side-to-side repair or debridement. Controlled laboratory study. Eight nonpaired fresh-frozen human cadaveric knees were utilized for this study. Each specimen was tested across 5 states in the following order: intact lateral meniscus, LMORT type 3 (partial thickness) tear created 12 mm lateral to the root attachment, tibia-based suture anchor fixation, capsular-based side-to-side repair, and debridement. For each state, 4 knee flexion angles were tested in random order: 0°, 30°, 60°, and 90° with 500 N of axial load. The following were recorded for each state: contact area, mean contact pressure, peak contact pressure of the lateral compartment, lateral meniscal extrusion, and 3-dimensional lateral meniscal anterior root forces (via use of a novel 3-axis sensor). Differences in means of outcomes were compared by 2-way repeated measures analysis of variance. Type 3 LMORTs were associated with significantly increased contact pressures and extrusion at all flexion angles and decreased contact area at high knee flexion angles as compared with the intact state. The tear state was also associated with significantly decreased forces experienced at the lateral meniscal anterior root attachment versus the intact state. Tibia-based suture anchor and capsular-based side-to-side repair restored contact mechanics, extrusion, and anterior root forces to the intact state, with no significant difference between the repair conditions. Debridement was associated with worse or no better outcomes than tear state alone. In a cadaveric model, type 3 LMORTs significantly alter tibiofemoral joint mechanics and lateral meniscal force transmission, and repair of these tears restores the native state, regardless of repair construct. Clinically, this study provides biomechanical support for the repair of type 3 LMORTs at the time of anterior cruciate ligament reconstruction. This study provides data regarding the effects of type 3 LMORTs and LMORT repair on tibiofemoral contact mechanics and meniscal function. The results of our study provide additional biomechanical justification for LMORT repair at the time of anterior cruciate ligament reconstruction.

AimsChronic proximal hamstring tendon injuries sometimes require surgical reconstruction using a certain type of tendon graft. Although a distal hamstring and an Achilles tendon are the previously reported allograft options for this procedure, it remains unclear which allograft has superior biomechanical properties. The objective is to biomechanically compare the failure load, elongation at failure, and stiffness of proximal hamstring reconstruction techniques, using a semitendinosus tendon allograft and an Achilles tendon allograft. We hypothesized that the reconstruction, using a semitendinosus tendon allograft, would result in superior biomechanical properties.MethodsEight pairs of fresh-frozen human cadaveric hemipelvises were obtained, along with Achilles tendon and semitendinosus allografts. Specimens first underwent non-destructive native-state testing to determine linear stiffness. Within each pair, specimens were randomly assigned to reconstruction with either an Achilles tendon or a semitendinosus allograft. Following repair, the specimens underwent uniaxial tension testing consisting of a preconditioning phase and pull-to-failure testing to determine failure load, elongation at failure, stiffness, and mode of failure.ResultsThe Achilles tendon allograft group failed at a significantly lower mean load than the semitendinosus group (213 N (SD 48) vs 366 N (SD 85); p = 0.005). Failure in the Achilles group occurred exclusively via suture pullout at the proximal end of the graft. Repairs with semitendinosus grafts most often failed by the same mechanism. Mean percent difference of native stiffness was significantly higher in the Achilles group compared to the semitendinosus group (34.4% (SD 14.1%) vs 13.1% (SD 6.4%); p = 0.003).ConclusionProximal hamstring reconstruction with a semitendinosus tendon allograft showed higher failure load and better preservation of native stiffness compared to an Achilles tendon allograft using the techniques described in this study. While construct differences may contribute to this result, these findings support semitendinosus as the strongest allograft option for proximal hamstring reconstruction.Cite this article: Bone Joint Res 2026;15(3):278–287.

Anterior cruciate ligament (ACL) graft tears and contralateral ACL tears are both relatively common after primary ACL reconstruction (ACLR). There is little prior work comparing the outcomes of reconstruction after these injuries. The authors hypothesize that patient-reported outcome measures (PROMs) and activity level are lower after revision ACLR than after primary contralateral ACLR. Cohort study; Level of evidence, 3. From a cohort of 2333 patients who underwent primary unilateral ACLR, 267 were identified who underwent subsequent revision ACLR or primary contralateral ACLR within 5 years of primary ACLR. After exclusion of 11 patients who had both injuries, 256 were eligible for the study, including 124 who underwent revision ACLR and 132 who underwent primary contralateral ACLR. Patients were contacted for follow-up at 6 years after the primary ACLR, and PROMs were collected, including subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and knee-related quality of life (KOOS-QOL), and Marx activity level. Patient demographics, surgical factors, and PROMs were compared between groups. Beta regression models with identity link were used to determine whether side of subsequent surgery (revision vs primary contralateral ACLR) was a significant predictor of outcome. Of 256 patients, 223 (87%) were contacted and completed PROMs at 6 years after the primary ACLR. At baseline, there were no significant differences between groups except that the subsequent revision group had a lower incidence of partial lateral meniscectomy and a higher incidence of lateral meniscal repair and was more likely to have received allograft for the primary ACLR than the subsequent contralateral reconstruction group. The median time from primary ACLR to second ACL surgery was lower in the revision group (1.3 years) than the contralateral group (2.0 years; P < .001). When controlling for demographics, surgical factors, and baseline PROMS, the revision ACL group demonstrated a 7.8-point lower International Knee Documentation Committee score (P < .001), a 3.2-point lower KOOS-Pain score (P = .012), a 10.4-point lower KOOS-QOL score (P < .001), and 2.0-point lower Marx score (P = .002) than the contralateral ACLR group. Patients who undergo revision ACLR within 5 years of primary ACLR demonstrate poorer PROMs and lower activity levels than those who undergo primary contralateral ACLR during this period. These 2 groups of patients should not be pooled to study outcomes of ACLR.

Authorship patterns in medical journals continue to evolve with expanding team science, academic incentives, and updated authorship guidance. Previous American Journal of Sports Medicine (AJSM) work (1994-2014) reported rising author counts and a growing share of international contributors. To update AJSM authorship trends (2014, 2019, 2020, and 2024) and test whether the past decade shows greater mean authors per article, more international and/or academic groups, and a higher proportion of nonphysician first authors. Cross-sectional bibliometric analysis. We reviewed AJSM articles in 2014, 2019, 2020, and 2024 via the journal archive; editorials, letters, society news, and corrigenda were excluded. For each article, we recorded the first/last author's highest degree and sex, the number of authors, country (United States vs international), and institution type (academic vs nonacademic). Articles with >20 authors were excluded. Differences across years were tested with a chi-square test (Bonferroni-adjusted α = .0083) and a 1-way analysis of variance with the Tukey honest significant difference post hoc test. A total of 1482 articles met the inclusion criteria (2014: n = 336; 2019: n = 383; 2020: n = 383; and 2024: n = 380). Article volume did not differ significantly across years (χ2[3] = 4.30; P = .23). From 2014 to 2024, article volume increased by 13.1%. Mean authors per article increased from 5.82 (2014) to 6.47 (2019), 6.55 (2020), and 7.02 (2024) (F[3,1470] = 15.69; P < .0001); all but the 2019 versus 2020 pairwise contrasts were significant. International groups increased from 42.6% (2014) to 51.3% (2024) (χ2[3] = 8.92; P = .03). No pairwise comparison met the Bonferroni threshold (α =.0083); the lowest P value was .0097 (2014 vs 2019). Bachelor of Arts/Bachelor of Science first authorship rose (χ2[3] = 13.78; P = .003), reaching 9% (2020) and 11% (2024). Sex distributions for first and last authors did not change (all P > .05). Twelve articles exceeded the >20-author cutoff and were excluded. From 2014 to 2024, AJSM authorship shows expanding team size, increased international participation, and a higher proportion of bachelor's-level first authors-largely medical trainees-while sex representation remained stable. These patterns underscore the need for transparent contributorship and mentorship to maintain rigor as collaboration intensifies.

Rotator cuff repair aims to optimize stability and healing. While double-row (DR) techniques have shown biomechanical advantages, retear rates remain high, especially in the anterior supraspinatus (SSP). This region experiences greater gap formation and strain than the posterior SSP, making it more prone to retears. To assess the biomechanical properties of a novel double-double-row (DDR) repair compared with a DR repair. The DDR repair will exhibit superior biomechanical outcomes than the standard DR repair. Controlled laboratory study. Twelve pairs of fresh-frozen human cadaveric shoulders were mounted to a 6-degree-of-freedom robot. With the humerus at 30° of abduction and external rotation, the SSP line of action was marked. The SSP muscle was dissected, and native tendon stiffness was measured. Each specimen was then repaired with either a DR or a DDR repair. The DR repair used a 6-strand, self-reinforcing construct with three medial and two lateral anchors. The DDR repair added an anterior row to the standard repair. A pressure sensor was placed beneath the repair. The tendon was then cyclically loaded from 25 to 100 N for 3000 cycles and pulled to failure. Repair footprint contacts and failure outcomes were compared. The DDR repair group exhibited a 54% increase in overall contact area (DR, 172 ± 27 mm2; DDR, 266 ± 42 mm2; P < .001), a 92% increase in mean contact pressure (DR, 0.08 ± 0.03 MPa; DDR, 0.16 ± 0.4 MPa; P = .015), a 57% improvement in gapping (DR, 0.7 ± 0.2 mm; DDR, 0.4 ± 0.1 mm; P = .001), and a 57% increase in failure load (DR, 332 ± 119 N; DDR, 520 ± 184 N; P = .025) compared with the DR repair group. Addressing the anterior portion of the SSP in a DDR repair versus a DR rotator cuff repair yields significant increases in contact area and mean contact pressure at the tendon-bone interface, stronger fixation, and reduced gap formation under cyclic loading. DDR repair may enhance healing potential and reduce retear risk, particularly in patients with anteriorly based tears or those at elevated risk due to tissue quality or tear morphology.

This case features the surgical reconstruction of the coracohumeral ligament (CHL) in conjunction with open capsulorrhaphy and capsular shift for the management of chronic, recurrent, multidirectional shoulder instability (MDI). While there is a paucity of existing literature examining the clinical outcomes of this technique, biomechanical studies have implied its potential to restore stability. This procedure may be of particular benefit to patients who have failed previous conservative management and/or attempts at surgical stabilization, as well as those with severe joint hyperlaxity or connective tissue disorders. This patient failed extensive physical therapy, as well as previous arthroscopic labral repair and capsulorrhaphy of the shoulder, necessitating further intervention to achieve the desired level of activity and function. After positioning the patient in a modified beach-chair position, a deltopectoral approach is utilized. Next, a subscapularis split is performed, followed by a T-capsulotomy. A capsular shift is performed. Then, the semitendinosus allograft is docked into the lateral and posterior aspect of the coracoid. After placing the arm into neutral forward flexion with 40° of external rotation and 30° of abduction, the graft is secured onto the humerus. Cadaveric biomechanical studies have demonstrated an increased resistance to translation after imbrication of the CHL. However, no clinical outcome studies have been reported to date using the technique described in this video. In our patient, stabilization of the shoulder joint was achieved. Reduction of the sulcus sign and decreased degree/frequency of subjective symptoms of instability were reported in the early postoperative period. This patient reported no pain, had negative apprehension and relocation tests, and a near-full range of motion at 7 months postoperatively, although external rotation was moderately decreased. In the setting of recurrent MDI refractory to conservative or previous surgical interventions, reconstruction of the CHL may be considered as an adjunct to other operative stabilization procedures. Further research is needed to determine clinical outcomes. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

PurposeThis study aims to introduce and assess the reliability of a novel intraoperative classification system for categorizing the severity of anteroinferior acetabular wall hypoplasia and assess the relationship between classification and hip instability diagnosis.MethodsThis multicenter, retrospective cohort study evaluated patients who underwent hip arthroscopy with labral repair from 2023-2024. Cases were excluded if visualization or image quality was inadequate, injury was traumatic, or previous rotational osteotomy was indicated. Four independent reviewers with varying levels of experience blindly classified arthroscopic images of the anterior acetabular wall. A numerical grade (1–3) was used to describe the medial-lateral area/shape of the anteroinferior acetabular wall using a novel “shoe” classification to fit each wall into one of three distinct categories: (1) rounded ‘clog’ (no narrowing); (2) bulbous ‘sneaker’ (mild narrowing); (3) sharp ‘stiletto’ (significant / severe narrowing). In addition, a letter grade (A/B) was used to describe anteroinferior distal chondral deficiency, with “A” representing cartilage coverage to or within 1 cm of the transverse acetabular ligament (TAL), and “B” indicating the chondral surface terminating >1cm proximal to the TAL, suggesting severe chondral deficiency. Patient demographics, classification prevalence, and reviewer agreement were assessed.ResultsFifty arthroscopic images from 50 patients met inclusion criteria. Mean age was 33.0±8.3 years, mean BMI was 26.1±6 kg/m2, 74% were female and 90% were white. Thirteen patients (26.0%) were diagnosed with instability, 16 (32.0%) with mild instability, and 21 (42.0%) with no instability. Complete agreement between reviewers on both the numeric grade and letter type classification was reached in 39 hips (78%). Agreement on the numeric grade alone was achieved in 44 hips (88%), with 13 (26%) classified as grade 1, 21 (42%) as grade 2, and 5 (10%) as grade 3. Agreement on the letter classification alone was achieved in 45 hips (90%), with 25 (64%) categorized as type A and 14 (36%) as type B.ConclusionAgreement between reviewers was high for both numeric grade (88%) and letter grade (90%). Future research will validate these findings with inter- and intra-reviewer assessments, larger sample size, and exploring associations with hip instability.

BackgroundThe use of hip arthroscopy in older patients is controversial as total hip arthroplasty (THA) has consistently demonstrated excellent results. Little is known regarding the efficacy of hip arthroscopy for the treatment of femoracetabular impingement (FAI) in patients over the age of 50. Long-term data assessing patient risk factors in older patients is sparse. The aim of this study is to assess patient reported outcomes (PROs) and risk factors associated with subsequent surgery in patients over the age of 50 who underwent hip arthroscopy for treatment of FAI.MethodsPatients over 50 who underwent primary hip arthroscopy before 2013 by the senior author were included. PROs were obtained preoperatively,- and at minimum 10 years postoperatively, including 12-Item Short Form Survey Physical Component Score (SF-12 PCS), 12-Item Short Form Survey Mental Component Score (SF-12 MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), Vail Hip Score (VHS), Hip Outcome Score – Activities of Daily Living (HOS-ADL), and Hip Outcome Score – Sport (HOS-Sport).ResultsA total of 326 patients over the age of 50 who underwent primary hip arthroscopy were identified, and 259 (79.4%) patients provided follow up at a mean of 11.88 ± 2.23 years. The mean age at the time of surgery was 56.5 ± 5.7 years. Thirty (14%) patients underwent a microfracture procedure, and 111 (50%) had an Outerbridge grade 3 or 4 cartilage defect. Of those with completed follow up, 95 patients had subsequent surgery including 80 (36%) who had THA and 15 (7%) who had a revision hip scope. Patients demonstrated a survival rate of 73%, 69%, and 64% at 5, 10, and 15 years respectively. The remaining 164 patients with completed follow-up reported improvement in mHHS, HOS-ADL, HOS-Sport, SF-12 MCS, SF-12 PCS, and WOMAC. Additionally, most patients achieved HOS-ADL, HOS-Sport, and mHHS MCID and PASS.ConclusionThe findings of the study suggest hip arthroscopy is an effective procedure for the treatment of FAI in patients over the age of 50, with most patients experiencing significant improvement in PROs and preserving their native hip at a minimum 10-year follow up.

IntroductionThe role of preoperative mental health on outcomes following hip arthroscopy has been a recent topic of interest. Current studies are limited in scope as they often focus on primary hip arthroscopy and rely on anxiety and depressive symptoms to assess patient mental health rather than a prior psychiatric diagnosis per the DSM-criteria (Diagnostic & Statistical Manual of Mental Disorders). As a result, the aim of this study was to report and compare the prevalence of DSM-criteria psychiatric disorders in patients undergoing primary and revision hip arthroscopy.MethodsAll primary and revision hip arthroscopy cases performed by the senior author between 2017 and 2024 were retrospectively reviewed. Patients were included if they underwent a complete history and physical with the on-site board-certified internal medicine physician prior to surgery. Pre-operative psychiatric diagnosis was documented via retrospective chart review while demographic details, and patient reported outcomes (PROs) were obtained from a prospectively and consecutively enrolled institutional database. Patients were deemed to have a psychiatric disorder if they presented to our institution with a prior psychiatric diagnosis per DSM-criteria and/or a current prescription for pharmacologic treatment of their psychiatric diagnosis.ResultsA total of 1642 patients, including 1318 primary and 324 revision hip arthroscopy cases, were included in the present study. Psychiatric diagnoses were more prevalent in the revision hip arthroscopy cohort (14%, 95% CI [12%-16%]) compared to the primary hip arthroscopy cohort (34%, 95% CI [29%-39%], p<0.001). Additionally, psychiatric diagnoses were more prevalent in females compared to males (p<0.001). Furthermore, anxiety and depression were the most common diagnoses with 33% of patients with a psychiatric disorder reporting a diagnosis of both depression and anxiety. Notably, patients with a psychiatric disorder reported significantly worse baseline WOMAC, HOS-ADL, HOS-Sport, SF-12 MCS, and SF-12 PCS compared to patients without psychiatric diagnoses.ConclusionPsychiatric diagnoses are highly prevalent in patients undergoing hip arthroscopy, with patients undergoing revision surgery demonstrating a higher prevalence of psychiatric diagnosis compared to patients undergoing primary surgery.