The emergence and spread of SARS-CoV-2 lineage B.1.1.7, first detected in the United Kingdom, has become a national public health concern in the United States because of its increased transmissibility. Over 500 COVID-19 cases associated with this variant have been detected since December 2020, but its local establishment and pathways of spread are relatively unknown. Using travel, genomic, and diagnostic testing data, we highlight the primary ports of entry for B.1.1.7 in the US and locations of possible underreporting of B.1.1.7 cases. New York, which receives the most international travel from the UK, is likely one of the key hubs for introductions and domestic spread. Finally, we provide evidence for increased community transmission in several states. Thus, genomic surveillance for B.1.1.7 and other variants urgently needs to be enhanced to better inform the public health response.

Sex Side Tear Management I 16 Male Left No Local excision 2 24 Male Left No Local excision 3 22 Male Left Yes Meniscectomy 4 42 Female Left No Local excision 5 36 Male Left No Local excision 6 22 Female Left Yes Meniscectomy 7 18 Female Left Yes Meniscectomy 8 27 Male Left No Local excision 9 24 Female Left Yes Meniscectomy 10 42 Male Left No Local excision I I 30 Male Left Yes Meniscectomy 12 51 Male Right Yes Meniscectomy 13 17 Female Right No Local excision 14 24 Female Left No Local excision 15 28 Female Right Yes Meniscectomy 16 29 Male Right Yes Meniscectomy I 7 29 Female Left No Local excision 18 27 Male Right No Local excision 19 48 Female Left Yes Meniscectomy 20 39 Female Right No Local excision 21 20 Female Left No Local excision 22 42 Male Right Yes Meniscectomy 88 THE JOURNAL OF BONE AND JOINT SURGERY

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