Meniscal root tears are an increasingly recognized injury leading to notable functional limitations, potential rapid cartilage deterioration of the affected compartment, and subsequent risk of total knee arthroplasty if left untreated. Repair of these tears is advised when articular cartilage remains intact because both medial and lateral meniscus root repairs have demonstrated favorable results. Recent literature demonstrates decreased rates of osteoarthritis and arthroplasty after medial meniscus root repair compared with partial meniscectomy and nonsurgical management. The transtibial pull-out repair technique is most commonly used and provides a biomechanically strong suture construct with standard and familiar knee arthroscopy portals. Furthermore, repair has recently been shown to be economically effective by decreasing overall societal healthcare costs when compared with more conservative management strategies. This review outlines the evaluation, treatment, and documented outcomes of meniscal root repair, which is imperative to the preservation of knee function and maintaining quality of life.

Background: Femoroacetabular impingement (FAI) is a well-known cause of hip pain in adolescents and young adults. However, the incidence in the general population has not been clearly defined. Purpose: To (1) define the population-based incidence of diagnosis of FAI in patients with hip pain, (2) report the trends in diagnosis of FAI over time, and (3) determine the changes in the rate and type of surgical management over time. Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database was used to identify patients who were 14 to 50 years old with hip pain between the years 2000 and 2016. Chart and radiographic review was performed to determine which patients had FAI. To be included, patients had to have a triad of clinical symptoms, physical examination signs, and imaging findings consistent with FAI. Medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Statistical analysis determined the overall age- and sex-adjusted annual incidence of FAI diagnosis and trends over time. Results: There were 1893 patients evaluated with hip pain, and 716 (38%; 813 hips) had diagnosed FAI. The mean ± SD age was 27.2 ± 8.4 years, and 67% were female. The incidence of FAI diagnosis was 54.4 per 100,000 person-years. Female patients had a higher incidence than male patients (73.2 vs 36.1 per 100,000 person-years; P < .01). Incidence of FAI diagnosis were higher from 2010 to 2016 (72.6 per 100,000 person-years; P < .01) as compared with 2005 to 2009 (45.3) and 2000 to 2004 (40.3). Hip arthroscopy, surgical hip dislocation, and periacetabular osteotomy utilization increased from the 2000-2004 to 2010-2016 periods, respectively: 1 (1%) to 160 (20%; P = .04), 2 (1%) to 37 (5%; P = .01), and 1 (1%) to 22 (3%; P = .58). Conclusion: The overall incidence of FAI diagnosis was 54.4 per 100,000 person-years, and it consistently increased between 2000 and 2016. Female patients had a higher incidence than male patients. The utilization of joint preservation operations, including hip arthroscopy, surgical hip dislocation, and anteverting periacetabular osteotomy, increased over time.

Background: Meniscal root tears and ramp lesions have been rigorously characterized in recent literature. However, one of the most common lateral meniscal injuries identified with an acute anterior cruciate ligament (ACL) disruption, a posterior horn lateral meniscal oblique radial tear (LMORT), has not been thoroughly described. Purpose: To determine the incidence of all meniscal tears and, more specifically, the incidence of posterior horn LMORTs in a multicenter cohort of consecutive, acute ACL reconstructions. Additionally, the authors aimed to develop a new classification system to help guide treatment of posterior horn LMORTs. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A multicenter retrospective cohort design was used to analyze 200 consecutive cases of acute ACL reconstruction from each of 3 different surgeons, for a total of 600 patients. The operative notes and intraoperative photos were analyzed to determine the incidence and laterality of all meniscal tears. A classification system based on tear characterization was then used to categorize tear patterns into similar groups. Results: A total of 396 (66%) of the 600 patients with acute ACL disruption had concomitant meniscal tears. Specifically, 187 (31%) had a lateral meniscal injury, 89 (15%) had a medial meniscal injury, and 122 (20%) had both medial and lateral meniscal injuries. The most common lateral meniscal tear was an LMORT; 71 (18%) patients with meniscal tears had a posterior horn LMORT. Overall, the incidence of ACL injury with a concomitant posterior horn LMORT was 12%. A classification was developed, which included type 1 tear (partial thickness <10 mm from the root attachment), type 2 tear (complete radial oblique tear that extended <10 mm from root), type 3 tear (incomplete LMORT that extended >10 mm from root), and type 4 tear (complete LMORT >10 mm from root). Conclusion: In 600 consecutive acute ACL reconstructions, the incidence of concomitant ACL injury with meniscal injury was 66%, and posterior horn LMORTs represented a large proportion of all meniscal tears (12%). A classification scheme was developed for posterior horn LMORTs to aid reporting and clinical decision making for these common tears.

Background: As the incidence of ulnar collateral ligament (UCL) surgery continues to rise rapidly, an update on the current prevalence and demographics in professional baseball players is warranted. Hypothesis: The prevalence of UCL reconstruction in Major League Baseball (MLB) and Minor League Baseball (MiLB) players will be higher than that previously reported, and the increase in prevalence will be most notable in MiLB pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: During the 2018 baseball season, an online questionnaire regarding a history of UCL surgery was distributed to the certified athletic trainers of all 30 MLB organizations. These trainers then administered the survey to all players within their organizations, including MLB, MiLB (AAA, AA, High A, Low A, High Rookie, Low Rookie), and Dominican Summer League (DSL) players. Demographics were compared between MLB, MiLB, and DSL players. Results of this 2018 survey were compared with previously published data from the 2012 season to assess the change over time. Results: There were 6135 professional baseball players who completed the survey (66% response rate). The prevalence of UCL reconstruction in all MLB and MiLB players was 13% (637/4928), while the prevalence in DSL players was 2% (20/1207) ( P < .001). The prevalence in all MLB and MiLB players (13%) and pitchers (20%) both increased significantly from 2012 ( P < .001). MLB pitchers reported a higher prevalence of UCL reconstruction than did MiLB pitchers (26% vs 19%, respectively; P < .001). In 2018, the prevalence of UCL reconstruction has increased significantly in MiLB pitchers (19% vs 15%, respectively; P < .001) and pitchers aged 21 to 30 years (22% vs 17%, respectively; P < .001) compared with 2012. Additionally, United States–born pitchers were more likely to have undergone UCL reconstruction compared with Latin America–born pitchers (23% vs 13%, respectively; P < .001). Conclusion: The prevalence of UCL reconstruction has increased significantly in professional baseball players over the past 6 years from 10% to 13%. Ultimately, the prevalence of UCL reconstruction has increased most significantly since 2012 in MiLB pitchers, pitchers aged 21 to 30 years, and pitchers born in the United States.