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.

This study examines the survival implications of operative versus nonoperative management of periprosthetic humerus fractures in a large, single-center cohort. Patients at a single tertiary care center with periprosthetic humerus fractures about a shoulder prosthesis between January 2013 and March 2024 were retrospectively identified. Patients were stratified according to operative versus nonoperative treatment. The primary outcome was all-cause mortality. Survival was compared using Kaplan–Meier curves and log-rank tests. Prespecified time horizons were 90 days, 1 year, 2 years, and 3 years. Ninety patients with periprosthetic fractures were identified (23 nonoperative, 67 operative). There were 13 total deaths (8/23 [35%] nonoperative, 5/67 [7.5%] operative). Baseline characteristics were largely similar aside from a higher body mass index in the operative group (32 vs. 29 kg/m², P = .046). Age (nonoperative: 74 vs. operative: 71 years, P = .30), sex (P = .40), hand dominance (P > .9), race (P = .07), smoking (P = .40), comorbidity burden (Elixhauser weighted and count P = .20 and P = .60, respectively), and Charlson distribution (P = .20) were all similar between groups. On Kaplan–Meier analysis, early mortality was rare: 90-day survival was 95.7% in the nonoperative group versus 100.0% in the operative group (P = .09). Survival differences widened over time, becoming significant at 3 years after the injury: 1 year (nonoperative: 95.7%; operative: 98.5%; P = .42), 2 years (nonoperative: 90%, operative: 98.5%; P = .09), and 3 years (nonoperative: 72.2%; operative: 96.5%; P = .004). Surgical fixation of periprosthetic humerus fractures is associated with lower mortality that becomes apparent in a delayed fashion and grows over time. By 3 years after the injury, the mortality difference approached 25% between operatively and nonoperatively treated patients. These findings should be validated in larger, multicenter studies.

The incidence of acute prosthetic joint infections (PJIs) that develop within one year following aseptic revision total shoulder arthroplasty (TSA) has been poorly described. The purpose of this study was to identify the rate of PJI following aseptic revision TSA. A retrospective cohort study was performed of patients who underwent aseptic revision TSA identified by Current Procedural Terminology codes 23473 and 23474 at a single academic institution between 2015 and 2022. Only patients with negative intraoperative cultures held for a minimum of 14 days were included. Patients were followed for one year postoperatively to identify acute periprosthetic joint infections, which were classified using the 2018 International Consensus Meeting shoulder-specific criteria. Demographic, perioperative, and clinical variables were compared between infected and noninfected cohorts. Overall, 140 patients met the inclusion criteria. Of these, 7 developed an acute PJI (5.0% infection rate). There was no statistical difference in patient age (64.9 vs. 69.0; P = .29), body mass index (30.4 vs. 31.0; P = .75), male sex (71% vs. 40%; P = .10), or smoking history (71% vs. 45%; P = .19) between the infected and noninfected cohorts. Aseptic revision TSA was found to have a 5.0% rate of acute PJIs within the first year postoperatively. There was no significant difference in age, body mass index, gender, history of tobacco use, underlying comorbidities, length of operative time, or length of hospitalization between patients who developed acute PJI and those who did not.