A risk index based on age, sex, and distal endoscopic findings has limited ability to discriminate low from intermediate-risk white, black, and Hispanic patients for APN.

Background:Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with anterior or posterior shoulder instability but have not compared outcomes between groups.Purpose:To compare return-to-sport and other patient-reported outcomes in patients after primary arthroscopic anterior, posterior, and combined anterior and posterior shoulder stabilization.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent primary arthroscopic anterior, posterior, or combined anterior and posterior shoulder stabilization were contacted at a minimum 2-year follow-up. Patients completed a survey that consisted of return-to-sport outcomes as well as the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Sur’geons (ASES) score, and Shoulder Activity Scale.Results:A total of 151 patients were successfully contacted (anterior: n = 81; posterior: n = 22; combined: n = 48) at a mean follow-up of 3.6 years. No significant differences were found between the groups with regard to age at the time of surgery or time to follow-up. No significant differences were found between the groups in terms of WOSI (anterior: 76; posterior: 70; combined: 78; P = .28), SANE (anterior: 87; posterior: 85; combined: 87; P = .79), ASES (anterior: 88; posterior: 83; combined: 91; P = .083), or Shoulder Activity Scale (anterior: 12.0; posterior: 12.5; combined: 12.5; P = .74) scores. No significant difference was found between the groups in terms of the rate of return to sport (anterior: 73%; posterior: 68%; combined: 75%; P = .84).Conclusion:Athletes undergoing arthroscopic stabilization of anterior, posterior, or combined shoulder instability can be expected to share a similar prognosis. High patient-reported outcome scores and moderate to high rates of return to sport were achieved by all groups.

Few studies have compared outcomes between autografts versus hybrid grafts (combination of autograft and allograft) for anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare revision rate and patient-reported outcomes following primary ACLR with a hamstring autograft versus a preoperatively planned hybrid autograft-allograft. At a minimum 2-year follow-up, patients who had undergone primary ACLR with a double-stranded semitendinosus and gracilis hamstring autograft (A) or a planned hybrid (H) graft (single-strand semitendinosus with nonirradiated peroneus longus or tibialis posterior allograft) were contacted to fill out a survey containing the Knee Injury and Osteoarthritis Outcome Score (KOOS), Subjective International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE), 12-Item Short-Form Health Survey (SF-12), and visual analog scale (VAS) for activity level prior to injury and at follow-up. From this collection of patients, a matched-pair comparison was made between groups, with patients matched by gender, age at the time of surgery, and follow-up time. Revision rate at follow-up was 8.4 and 2.4% in the A and H groups, respectively ( = 0.073). A total of 148 surveys were completed (83 A, 65 H), from which 36 matched pairs were formed. Within the matched pairs, average age at surgery did not differ significantly between groups (A: 35.7 years, H: 36.0 years, = 0.23). Time to follow-up was 4.3 and 3.7 years in the A and H groups, respectively. Patients with a hybrid graft had significantly higher KOOS Quality of Life subscores (A 69.6, H 79.2, = 0.028), subjective IKDC scores (A 72.6, H 79.7, = 0.031), and SANE scores (A 83.2, H 91.4, = 0.015) at follow-up. Otherwise, no significant differences were found in patient-reported outcome scores between groups. A preoperatively planned hybrid graft, with use of a fresh-frozen, nonirradiated allograft, should be considered as a viable alternative for primary ACLR in older patients.

estimated area of physeal disruption (1.64 cm2 vs. 0.74 cm2, P<0.001), femoral (32.1 vs. 72.8 , P<0.001) and tibial (50.1 vs. 60.5 , P¼0.003) tunnel drill angles, medial/lateral location of the femoral tunnel (24.2 mm vs. 36.1 mm from lateral cortex, P¼0.001), and distance from the lateral aspect of the distal femoral physis and the femoral tunnel exit (4.7mm vs. 26.7mm from the perichondrial ring, P<0.001). All patients who underwent femoral tunnel drilling at an angle of greater than 25 from the transverse axis experienced a <6% disruption of physeal area. Conclusion: With femoral tunnel drilling techniques that create more oblique tunnels, the area of physeal damage is larger, more eccentric and closer to the perichondrial ring. Since most studies noting the safety of transphyseal ACL reconstruction have utilized a vertical femoral tunnel, surgeons should be aware that if an independent femoral tunnel drilling technique is utilized during transphyseal ACL reconstruction, the physis is at greater risk when drilling at more horizontal angles. Angles greater than 25 from the transverse axis may safely create <6% physeal area damage.