Patellofemoral instability is a common condition in children, with an annual incidence of approximately 50 cases per 100,000 children. Instability of the patella involves a number of structures, such as the medial patellofemoral ligament and the vastus medialis obliquus, which can be used for patellar realignment in soft tissue, physeal-sparing procedures. In this rapid review, we aim to review the surgical interventions, post-operative outcomes, and associated surgical complications of global soft tissue procedures in the management of patellofemoral instability. A search of the Medline database was conducted to identify studies evaluating the treatment and outcomes of global treatment of pediatric patellofemoral instability. The included studies analyzed the surgical management of patellofemoral instability in pediatric patients, utilizing soft tissue global procedures and reported functional outcomes, return to sport or play, and post-operative complications. A total of eight studies were included, comprising a cohort of 270 pediatric and adolescent patients and 334 knees. The average patient age was 10.6 years, with 60.4% (163/270) patients being female, and the mean follow-up duration was 58.4 months. Of the eight studies, two examined the three-in-one procedure, three examined the four-in-one procedure, one examined a combination of medial and lateral release, and two examined the Galeazzi procedure. This review underscores the variety of global physeal-sparing surgical procedures available for treating patellofemoral instability. While outcomes are generally favorable, with high rates of return to sport, recurrent residual instability and recurrent dislocation remain significant challenges, with residual instability affecting nearly half of patients. Future research should focus on exploring long-term outcomes, optimizing patient selection, and identifying the causes of recurrent instability to further enhance patient outcomes and reduce complication rates.

Surgical reconstruction via hemiarthroplasty, anatomic total shoulder arthroplasty (aTSA), or reverse total shoulder arthroplasty (rTSA) is a common approach for treatment of various shoulder pathologies. Little is known about variations in negotiated payor rates for these procedures. The objective of this study was to examine hospital, regional, and policy-level factors associated with variations in negotiated rates for total shoulder arthroplasty (TSA) and hemiarthroplasty across the United States. A cross-sectional analysis was performed with 2024 payor rate data from the Turquoise Health Database, using current procedural terminology codes for hemiarthroplasty (23470) and rTSA/aTSA (23472). Variables of interest were downloaded from publicly available sources, including hospital size, payor class, metropolitan/nonmetropolitan classification, regional household income, and Area Deprivation Index. State-level policies included Medicaid expansion status, certificate-of-need (CON) status, nurse practitioner scope-of-practice regulations, and participation in the All-Payer Claims Database (APCD). Multivariable linear regressions were used to assess associations between payor rates and variables of interest. In total, 516,904 total rates were evaluated (256,422 hemiarthroplasty; 260,480 rTSA/aTSA). The unadjusted mean negotiated rate was $9,082 (standard deviation: $1,182) for hemiarthroplasty and $10,840 (standard deviation: $1,405) for TSA. In a separate multivariable analysis, the mean rate difference was $68 (95% CI: $35-$102). Hospital bed capacity was tied to variations in both cohorts. Metropolitan hospitals reported higher payor rates for both hemiarthroplasty (+$2,151.46) and rTSA/aTSA (+$879.73) in comparison to nonmetropolitan hospitals. Medicaid expansion was associated with higher rates for both cohorts, while increased nurse practitioner scope of practice, CON status, and APCD database participation were associated with lower rates (P < .001). Shoulder arthroplasty negotiated payor rates show large variations and are associated with several factors, including hospital size, payor class, and regional factors. Mean TSA rates were $68 higher, a clinically insignificant amount. States with CON laws and APCD database participation have lower payor rates while states with Medicaid expansion have higher rates. These findings underscore significant variations in how hospitals and payors negotiate rates for shoulder arthroplasty, emphasizing the many factors that play a role in shaping surgical costs.