001). During the same period, the incidence of aSAD combined with RCR remained relatively stable, from 51.7 to 45.8 per 100,000 (11.5% decrease) (P= .27). The overall incidence of oSAD declined from 7.1 to 2.2 per 100,000 (68.1% decrease) (P < .001).
 
  The overall rate of aSAD has declined in recent years, primarily due to a large decrease in the incidence of aSAD without RCR as an isolated treatment for rotator cuff disorders.
 
  Prior studies have demonstrated a rising incidence of SAD; however, high-level clinical evidence and clinical practice guidelines have challenged its efficacy.  https://www.selleckchem.com/products/phorbol-12-myristate-13-acetate.html  It is important for orthopaedic surgeons to understand evolving national trends in management among their peers.
 Prior studies have demonstrated a rising incidence of SAD; however, high-level clinical evidence and clinical practice guidelines have challenged its efficacy. It is important for orthopaedic surgeons to understand evolving national trends in management among their peers.
  To systematically review the literature to (1) describe arthroscopic subscapularis repair constructs and outcomes in patients with isolated and combined subscapularis tears and (2) compare outcomes after single- and double-row subscapularis repair in both of these settings.
 
  A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for Level I-IV evidence studies that investigated outcomes after arthroscopic subscapularis repair for the treatment of isolated subscapularis tears or subscapularis tears combined with posterosuperior rotator cuff tears in adult human patients. Data recorded included study demographics, repair construct, shoulder-specific outcome measures, and subscapularis retears. Study methodological quality was analyzed using the MINORS score. Heterogeneity and low levels of evidence precluded meta-analysis.
 
  The initial search yielded 811 articles (318 duplicates, 493 screened, 67 full-text review). Forty-thher tears were isolated or combined or if repairs were single or double row.
 
  Level IV, systematic review of Level II-IV studies.
 Level IV, systematic review of Level II-IV studies.
  The goal of the present study was to evaluate a potential tunnel convergence in combined anterior cruciate ligament (ACL) reconstruction using the anteromedial portal technique and lateral extra-articular tenodesis (LET).
 
  Ten fresh frozen femora were dissected and a K-wires were inserted into the middle of the ACL stump, according to an ACL reconstruction at 110° and 140° knee flexion. ACL reconstruction at 120° and 130° was simulated. Seven K-wires with different femoral insertion sites and angulations were drilled into the lateral femoral condyle relative to the lateral epicondyle (E3 8 mm proximal and 4 mm posterior; E1 5 mm proximal and 5 mm anterior and E2 over-the-top position). Tunnel conflict rate was evaluated using a measuring arm and a metrology software.
 
  Drilling the femoral ACL tunnel in low knee flexion (110°-120°) significantly (P < .001) reduced the tunnel conflict rate compared to the ACL drilled in high knee flexion (130°-140°). Changing the insertion point from proximal and posterid reliably avoid a tunnel conflict when the ACL was drilled between 110 and 130° using a low anteromedial portal.
  The purpose of this study was to evaluate the short-term patient-reported outcomes of superior capsular reconstruction (SCR) and identify factors contributing to the success or failure of the procedure at 2 years.
 
  A retrospective review was performed on data prospectively collected from the Surgical Outcomes System database. Patient-reported outcomes (PROMs) including American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) were evaluated at a minimum of 2 years postoperatively and reported using a minimal clinically important difference (MCID) and the percent of maximal possible improvement (MPI). In addition, preoperative and intraoperative variables were evaluated in patients with and without a postoperative improvement in ASES and SANE scores meeting the threshold of MCID.
 
  Two-year follow-up data were available for 350 patients. Statistically significant improvements were noted in all PROMs at 2-year follow-up. In total, 240 patients (68.8%) achieved an MCID improvement of >17.5 in ASES score, and 185 patients (52.9%) achieved an MCID of >29.8 improvement in the SANE score. Primary SCRs were associated with a higher MPI in the ASES score (60.1% ± 39.8% vs 40.4% ± 47.9%; P= .025) and VR-12 physical score (14.0% ± 13.8% vs 8.0% ± 14.7%; P= .028) compared to revision repairs. Only diabetes was identified as a predictor of SANE score improvement (64.5% vs 62.2%; P= .041).
 
  SCR is associated with improvement in patient-reported outcomes at short-term follow-up, with 53% to 69% of patients achieving an improvement considered to meet the MCID. Greater improvement is expected when SCR is performed as a primary procedure rather than as a revision procedure for failed rotator cuff repair.
 
  Level III, retrospective comparative study.
 Level III, retrospective comparative study.
  To evaluate the effect of the Nonoperative Instability Severity Index Score (NISIS) criteria on an established US-geographic population-based cohort of patients with anterior shoulder instability.
 
  An established geographically based medical record system was used to identify patients <40 years of age with anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient demographics and instability characteristics. Patient-specific risk factors were individually incorporated into the 10-point NISIS criteria age (>15 years), bone loss, type of instability (dislocation vs subluxation), type of sport (collision vs noncollision), male sex, and dominant arm involvement. High risk was considered a score of ≥7 points and low risk as <7 points. Failure was defined as either progression to surgery or recurrent instability diagnosed by a consulting physician at any point after initial consultation.
 
  The study population consisted of 405 patients with a mean follow-up time of 9.