Adult medial patellofemoral ligament (MPFL) reconstruction techniques are not appropriate for the skeletally immature patient given the proximity of the distal femoral physis. Biomechanical consequences of reconstructions aimed at avoiding the physis have not been adequately studied.

In conclusion, in this cadaveric simulation, the epiphyseal technique allowed for a more isometric ligament until midflexion, when the patella engaged within the trochlear groove. The adductor sling and adductor transfer grafts became tighter in flexion, resulting in potential loss of motion, pain, graft stretching, and failure. Marginal between-condition differences in patellofemoral contact mechanics and patellar kinematics were observed in late flexion.

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Five articles from the December 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis", "Functional Outcome of Sesamoid Excision in Athletes", "Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair", "Differences in Clinical Presentations and Surgical Outcomes of Gluteus Medius Tears Between Men and Women", and "90-Day Complication Rate After the Latarjet Procedure in a High-Volume Center".

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Blood flow restriction therapy (BFRT) has been increasingly applied to improve athletic performance and injury recovery. Validation of BFRT has lagged behind commercialization, and currently the mechanism by which this therapy acts is unknown. BFRT is one type of ischemic therapy, which involves exercising with blood flow restriction. Repetitive restriction of muscle blood flow (RRMBF) is another ischemic therapy type, which does not include exercise.

In conclusion, ischemic therapy did not induce gains in muscle mass, contractility strength, fiber cross-sectional area, or satellite cell density locally or systemically in this model, although the RRMBF group did have elevated GH levels on ELISA.

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Five articles from the November 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "The Incidence of Kaplan Fiber Injury Associated With Acute Anterior Cruciate Ligament Tear Based on Magnetic Resonance Imaging", "Characteristics of Soccer Players Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement: A Sex- and Competitive Level–Specific Analysis", "Bone Marrow Stimulation in Arthroscopic Repair for Large to Massive Rotator Cuff Tears With Incomplete Footprint Coverage", "Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players", and "Rate of Force Development Remains Reduced in the Knee Flexors 3 to 9 Months After Anterior Cruciate Ligament Reconstruction Using Medial Hamstring Autografts: A Cross-Sectional Study".

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Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development.

In conclusion, surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.

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Five articles from the October 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Steep Posterior Tibial Slope and Excessive Anterior Tibial Translation Are Predictive Risk Factors of Primary Anterior Cruciate Ligament Reconstruction Failure: A Case-Control Study With Prospectively Collected Data", "Optimal Treatment of Cam Morphology May Change the Natural History of Femoroacetabular Impingement", "Anchor-Based Femoral Fixation for Physeal-Sparing Medial Patellofemoral Ligament Reconstruction: A Time-Zero Biomechanical Comparison With Tenodesis Screw Fixation", "Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques", and "Performance and Return to Sport After Excision of the Fractured Hook of the Hamate in Professional Baseball Players".

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The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known.

In conclusion, smaller height (<6 mm) of the acetabular labrum was significantly associated with decreased distance to suction seal rupture and decreased peak negative pressure. A new strategy to increase the size of the labrum, such as labral augmentation, could be justified for patients with smaller labra in order to optimize the hip suction seal.

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The acetabular labrum contains free nerve endings, and an unstable labrum can result in increased femoral head movement during hip motion. This can be caused by chondrolabral junction (CLJ) separation, especially in association with pincer-type femoroacetabular impingement, and may contribute to hip pain.

In conclusion, rim trimming did not change the biomechanical properties of the labral suction seal. Labral refixation resulted in a shorter distance to break the labral suction seal. This indicates that labral mobility is reduced by the labral refixation procedure, which could be beneficial in postoperative pain relief and labral healing.

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Five articles from the September 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Human Rotator Cuff Tears Have an Endogenous, Inducible Stem Cell Source Capable of Improving Muscle Quality and Function After Rotator Cuff Repair", "An Iliopsoas Impingement Lesion in the Absence of Painful Internal Snapping May Not Require Iliopsoas Fractional Lengthening", "Location of the Suture Anchor in Hill-Sachs Lesion Could Influence Glenohumeral Cartilage Quality and Limit Range of Motion After Arthroscopic Bankart Repair and Remplissage", "Epidemiology, Treatment, and Performance-Based Outcomes of Symptomatic Spondylolysis and Isthmic Spondylolisthesis in American Professional Baseball Players", and "Medial Elbow Instability Resulting From Partial Tears of the Ulnar Collateral Ligament: Stress Ultrasound in a Cadaveric Model".

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The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. Expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, characterization of intraarticular inflammation away from cam deformity as well as the nature of the adjacent synovial tissue has also not been extensively characterized.

In conclusion, hip cartilage exhibits an osteoarthritic phenotype in patients with early FAI similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident in late-stage disease.

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Five articles from the August 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer 24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery", "Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex (ACLC) Reconstruction: A Comparative Biomechanical Analysis in Cadaver Specimens", "An In-Depth Analysis of Graft Rupture and Contralateral ACL Rupture Rates After Pediatric ACL Reconstruction", "Concussion Symptom Cut-offs for Identification and Prognosis of Sports related Concussion: The Role of Time Since Injury", and "Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study".

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Injuries to the hamstring complex most commonly involve the proximal musculotendinous junction of the long head
of the biceps femoris (MTJ-BFlh). Nonoperative management of these injuries is associated with prolonged rehabilitation and high
risk of recurrence. To our knowledge, the surgical management of acute MTJ-BFlh injuries has not been previously reported.

In conclusion, surgical repair of acute MTJ-BFlh injuries enables return to preinjury level of sporting function with low risk of recurrence at short-term follow-up.

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Five articles from the July 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Return to Sports After High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation", "Influence of Glenoid Labral Bumper Height and Capsular Volume on Clinical Outcomes After Arthroscopic Bankart Repair as Assessed With Serial CT Arthrogram: Can Anterior-Inferior Volume Fraction Be a Prognostic Factor?", "Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury", "Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study", and "The Use of Recombinant Human Growth Hormone to Protect Against Muscle Weakness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Pilot, Randomized Placebo-Controlled Trial".

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Arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a bone–patellar tendon–bone graft (BTB) is a reliable surgical option for the control of anterior knee laxity after ACL injury. The addition of a lateral extra-articular tenodesis (LET) may improve control of rotation knee laxity and improve short-term graft survival in high-risk patients.

In conclusion, there were no significant differences in long-term patient-reported outcomes after ACLR with or without an LET. LET may increase the risk of lateral compartment osteoarthritis at long-term follow-up. There was a trend toward decreased graft failure risk with the addition of LET but this study was underpowered to assess this outcome.

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Five articles from the June 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Predictive Modeling to Determine Functional Outcomes After Arthroscopic Rotator Cuff Repair", "A Multicenter Study of Radiographic Measures Predicting Failure of Arthroscopy in Borderline Hip Dysplasia: Beware of the Tönnis Angle", "Comparison of Tendon Lengthening With Traditional Versus Accelerated Rehabilitation After Achilles Tendon Repair: A Prospective Randomized Controlled Trial", "Does Age Itself Have an Adverse Effect on Survivorship of Meniscal allograft transplantation?: A Cartilage Status and Time From Previous Meniscectomy-Matched Cohort Study", and "The Role of Patient Characteristics on the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries".

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Preclinical studies suggest that for complete midsubstance anterior cruciate ligament (ACL) injuries, a suture repair of the ACL augmented with a protein implant placed in the gap between the torn ends (bridge-enhanced ACL repair [BEAR]) may be a viable alternative to ACL reconstruction (ACLR).

In conclusion, BEAR resulted in noninferior patient-reported outcomes and AP knee laxity and superior hamstring muscle strength when compared with autograft ACLR at 2-year follow-up in a young and active cohort. These promising results suggest that longer-term studies of this technique are justified.

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Five articles from the May 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Prospective Assessment of Outcomes After Primary Unipolar, Multisurface, and Bipolar Osteochondral Allograft Transplantations in the Knee", "Five-Year Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome in Elite Athletes", "Effect of Sex and Ankle Brace Design on Knee Biomechanics During a Single-Leg Cut", "Influence of Varus Alignment on Survivorship After Lateral Meniscal Allograft Transplantation", and "Investigating the Range of Symptom Endorsement at Initiation of a Graduated Return to Play Protocol after Concussion and Duration of the Protocol: A study from the NCAA-DoD Concussion, Assessment, Research, and Education (CARE) Consortium."

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Safe return to play (RTP) after anterior cruciate ligament (ACL) reconstruction is critical to patient satisfaction. Enhanced rehabilitation after ACL reconstruction with appropriate objective criteria for RTP may reduce the risk of subsequent injury. The cost-effectiveness of an enhanced RTP (eRTP) strategy relative to standard post-ACL reconstruction rehabilitation has not been investigated.

In conclusion, the eRTP strategy in this study adds additional neuromuscular retraining and additional physician follow-up—as well as advanced testing goals upon which RTP is contingent—to traditional physical therapy. Our data suggest that these additions are cost-effective, even assuming only modest associated decreases in ACL graft failure. This study also determined that the only variable that had the potential to change the cost-effectiveness conclusion based on predetermined ranges was the additional cost of rehabilitation based on 1-way sensitivity analysis.

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Five articles from the April 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Outcomes of Arthroscopic All-Inside Repair versus Observation in Older Patients with Meniscus Root Tears", "What Can a Jump Tell Us About Elbow Injuries in Professional Baseball Pitchers?", "Incidence and Prognostic Significance of the Segond Fracture in Patients Undergoing Anterior Cruciate Ligament Reconstruction", "Video Confirmation of Head Impact Sensor Data From High School Soccer Players", and "Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability".

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Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized.

In conclusion, women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.

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Five articles from the March 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear", "Minimum 5-Year Outcomes and Return to Sports After Resection Arthroplasty for the Treatment of Sternoclavicular
Osteoarthritis", "Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients
From the SANTI Study Group Database", "Bilateral Hip Arthroscopy in High-Level Athletes: Results of a Shorter Interval Between Staged Bilateral Hip Arthroscopies", and "The Prevalence of Radiographic Findings of Structural Hip Deformities for Femoroacetabular Impingement in Patients With Hip Pain".

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*This podcast features Drs. Frances T. Sheehan and Camila Grant, and Cameron N. Fick from the NIH Clinical Center Rehabilitation Medicine.

Developing bone is highly adaptable and, as such, is susceptible to pathological shape deformation. Thus, it is imperative to quantify if changes in patellofemoral morphology are associated with adolescent-onset patellofemoral pain, as a pathway to improve our understanding of this pain’s etiology.

In conclusion, this study provides direct evidence that patellofemoral morphology is altered and influences maltracking in adolescents with patellofemoral pain, highlighting the multifactorial etiology of this pain. Neither morphology nor kinematics (measured during active flexion-extension) correlated with pain. Both increases and decreases in these parameters likely lead to pain, negating a direct linear correlation.

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Five articles from the February 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Shoe Cushioning Influences the Running Injury Risk According to Body Mass: A Randomized Controlled Trial Involving 848 Recreational Runners", "More Than a 2-Fold Risk of Contralateral Anterior Cruciate Ligament Injuries Compared With Ipsilateral Graft Failure 10 Years After Primary Reconstruction", "Prospective Randomized Comparison of Capsular Management Techniques During Hip Arthroscopy", "Accuracy and Reliability of the Visual Assessment of Patellar Tracking", "Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial".

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Women are 2 to 9 times more likely to experience an anterior cruciate ligament (ACL) injury than men. Various hormones including relaxin, progesterone, and estrogen influence ACL strength. Oral contraceptives (OCs) alter these hormone levels; however, studies have yet to comprehensively compare different OCs’ effects on the ACL.

In conclusion, OC formulations with higher progestin-to-estrogen ratios may be more protective for the ACL than formulations with lower ratios.

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Five articles from the January 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full.

The featured articles for this month are, "Peripheral-Track and Central-Track Hill-Sachs Lesions: A New Concept of Assessing an On-Track Lesion", "Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up", "Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction", "Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome", and "High Prevalence of Connective Tissue Gene Variants in Professional Ballet".

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