Background: Shoulder arthroscopy is increasingly common for treating various shoulder pathologies, but racial, ethnic, and geographic disparities in its use persist, especially as more procedures move to ambulatory surgery centers. Identifying and addressing these disparities is crucial for ensuring equitable orthopaedic care in the United States. Hypothesis/Purpose: It was hypothesized that racial and ethnic disparities exist in shoulder arthroscopy utilization. The purpose of this study was to assess these disparities and their contributing factors in greater detail. Study Design: Descriptive epidemiology study. Methods: This study used the 2019 National Ambulatory Surgery Sample (NASS) to evaluate utilization patterns for shoulder arthroscopy in the United States. Age-standardized utilization rates were calculated for racial and ethnic subgroups. Multivariate Poisson regression models were used to assess disparities, incorporating patient demographics, socioeconomic factors, and facility characteristics as covariates. Differences in total charges were also analyzed. Results: An estimated 340,892 shoulder arthroscopy surgeries were performed nationwide in 2019, with a mean charge of $32,910. The patient cohort was 57.34% male and 80.26% White, and 78.4% of the patients were older than 45 years. The most common indications for shoulder arthroscopy in this patient cohort were rotator cuff injury (59.96%), labral tear (8.17%), and impingement syndrome (8.32%). There were notable disparities in shoulder arthroscopy by race and ethnicity. White patients had higher utilization rates for shoulder arthroscopy (138.7/100,000) compared with Black (73.0), Hispanic (50.7), and Asian/Pacific Islander (36.5) patients, with an adjusted rate ratio (aRR) of 1.29. White patients were charged less on average for shoulder arthroscopy procedures ($32,183) compared with non-White patients ($35,474). Disparities persisted across all indications, with White patients showing higher utilization rates for rotator cuff repairs (aRR = 1.17) and shoulder instability (aRR = 1.22) and consistently lower charges ($34,438 vs $37,175 for rotator cuff repair; $32,568 vs $35,732 for instability). Geographic disparities were observed, with mean charges of $28,657 in the Northeast and Midwest and $36,309 in the South and West. Black (15.38%), Hispanic (13.15%), and Asian/Pacific Islander (11.24%) patients had higher Medicaid rates than White patients (7.3%). Black (42.9%) and Hispanic (28.97%) patients were more likely to live in low-income areas compared with White patients (20.52%). Conclusion: There are well-defined disparities in the use of orthopaedic surgery among different patient populations in the United States. Differences in utilization rates, costs incurred, and patient-reported outcomes of shoulder arthroscopy mirror those of hip and knee arthroscopy. These trends continue to worsen and may reflect the changing landscape of healthcare delivery. These trends must be closely analyzed to help define their effect on the disparities experienced by disadvantaged populations in the United States.

Purpose: To investigate the factors associated with charges of primary treatment options for patellar instability, analyze the financial impact of performing specific concomitant procedures, and identify critical social determinants of health care charges associated with patellar instability treatment. Methods: This retrospective study used the 2019 Nationwide Ambulatory Surgery Sample to analyze patients with primary patellar instability undergoing a single stabilization procedure, including relevant concomitant procedures. Cases with multiple primary stabilization procedures or cases with unrelated concomitant Current Procedural Terminology codes were excluded. Bivariate analyses identified significant covariates, which were included in a generalized linear model to compare charges across Current Procedural Terminology codes, adjusting for patient and hospital factors. Results: In total, 3,035 procedures were analyzed, including 54.79% arthroscopic lateral retinacular releases, 7.45% open lateral releases, 31.73% medial patellofemoral ligament (MPFL) reconstructions, and 6.03% tibial tubercle osteotomies. On average, tibial tubercle osteotomy ($47,401) had greater charges than MPFL reconstruction ($41,333), arthroscopic lateral release ($23,930), and open lateral release ($34,520). Charges varied by patient demographics and hospital characteristics. Non‐White patients faced greater charges compared with White patients ($36,051 vs $29,924, P < .001). Similarly, Hispanic patients faced greater charges than non‐Hispanic patients ($38,256 vs $30,861, P < .001). Male patients were charged more than female patients ( P < .001). Private hospitals charged $10,422 more than public hospitals ( P < .001). Urban hospitals charged $3,929 more than hospitals in rural locations. Osteochondral grafting increased charges by $35,816 ( P < .001). Conclusions: This study highlights significant variability in charges for patellar instability treatments, influenced by procedural complexity, concomitant interventions, and demographic factors. Tibial tubercle osteotomy was the most expensive treatment option, followed by MPFL reconstruction. Concomitant osteochondral grafting significantly increased charges. Disparities in charges were evident on the basis of patient demographics and hospital characteristics, with greater charges associated with non‐White race, Hispanic ethnicity, and procedures performed in private hospitals or urban hospitals. Clinical Relevance: Understanding cost drivers in patellar instability treatment can inform clinical decision‐making, resource allocation, and efforts to address health care disparities in orthopedic and sports medicine care.

Background: This study investigates revision surgery rates in patients with Ehlers-Danlos Syndrome (EDS) or hypermobility spectrum disorder (HSD) following ankle surgery for instability compared to matched controls. Methods: A retrospective cohort study was conducted using the PearlDiver Mariner 170 Database. Patients undergoing ankle ligament repair procedures were identified using Current Procedural Terminology ( CPT ) codes. The experimental cohort included patients with EDS or HSD with at least 2 years of follow-up data, excluding other connective tissue disorders and confounding conditions. Propensity score matching was used to create a matched control group. The primary outcome was the rate of revision ankle ligament repair within 2 and 5 years. The secondary outcome was the effect of patient risk factors associated with revision. Revision rates were compared between cohorts using multivariable logistic regression. Statistical significance was set at P < .05. Results: The 2-year cohort included 805 patients with EDS/HSD and 805 matched controls, whereas the 5-year cohort consisted of 480 patients in each group. Procedures primarily involved modified Brostrom repair, lateral ankle ligament reconstruction, and arthroscopic-assisted repairs. Patients with EDS/HSD had significantly higher revision rates at 2 years (13.8% vs 6.3%) and 5 years (19.4% vs 7.3%) ( P < .0001). Multivariate analysis identified EDS/HSD as an independent risk factor for revision surgery, with adjusted odds ratios of 2.41 (95% CI 1.71-3.45; P < .0001) at 2 years and 3.11 (95% CI 2.07-4.77; P < .0001) at 5 years. Conclusion: This study highlights the significant challenges in surgical management of ankle instability in patients with EDS and HSD. The risk of surgical failure increases over time, with a 3.1-fold increase in revision surgery rates at 5 years postoperatively compared with matched controls. These findings emphasize the need for specialized surgical approaches and comprehensive perioperative care to address the unique risks in this population. Future work should compare specific repair techniques and graft choices in this high-risk cohort.

Background/Objectives: Chlorhexidine and iodine-based preparations are both widely used, and the existing literature suggests a possible advantage of chlorhexidine in clean elective surgery. Whether this extends to instrumented degenerative spine surgery is unknown. We asked whether chlorhexidine-based skin preparation reduces 90-day postoperative infection compared with iodine-based preparation after instrumented degenerative cervical or lumbar spine surgery. Methods: A retrospective TriNetX cohort study was performed among adults undergoing instrumented degenerative cervical or lumbar spine surgery. Patients were stratified by anatomic region and by preoperative preparation exposure: chlorhexidine-based versus iodine-based. Moreover, 1:1 propensity-score matching was performed within each anatomic stratum on demographics, Charlson Comorbidity Index (CCI), diabetes, smoking, obesity and BMI, immunosuppression, methicillin-resistant Staphylococcus aureus (MRSA) carrier status, and index procedure codes. The primary outcome was 90-day postoperative infection. Secondary outcomes were superficial and deep surgical site infection, MRSA infection, incision and drainage, debridement, sepsis, urinary tract infection, and pneumonia. Results: After matching, the cervical cohort included 3528 patients per group and the lumbar cohort 4164 per group. Postoperative infection did not differ in the cervical cohort (1.76% vs. 1.59%; risk ratio [RR] 1.11, 95% confidence interval [CI] 0.77–1.58; p = 0.578) or the lumbar cohort (3.17% vs. 3.29%; RR 0.96, 95% CI 0.76–1.22; p = 0.757). Superficial and deep infection, MRSA infection, debridement, sepsis, urinary tract infection, and pneumonia did not differ significantly in either cohort. Conclusions: No statistically significant difference in 90-day postoperative infection was found between chlorhexidine-based and iodine-based skin preparation after instrumented degenerative cervical or lumbar spine surgery.

Lacrosse participation is increasing, with a corresponding rise in upper extremity injuries. This study aims to comprehensively analyze lacrosse-related upper extremity injuries among high school and college-aged athletes. Data from the National Electronic Injury Surveillance System (NEISS), a large-scale database providing nationally representative estimates, were analyzed for lacrosse-related upper extremity injuries from 2004 to 2023. Patients aged 14-23 years were included and categorized into high school (14-18) and college (19-23) age groups. Weighted analyses were conducted to estimate national injury rates and patterns. An estimated 50,042 upper extremity injuries were reported, with an overall incidence rate of 14.61 injuries per 1000 athlete exposures. Higher-acuity injuries were common overall; fractures were the most common injury type (IR: 5.61). Males experienced upper extremity injuries at more than four times the rate of females (IRR: 4.44). Athletes in the high school age group were more likely to sustain fractures, while athletes in the college age group had higher risks of dislocations and avulsions. The shoulder was the most commonly injured body part overall. This study provides a comprehensive analysis of upper extremity injuries in lacrosse among high school and college-aged players. The findings highlight significant patterns in injury distribution and reveal important differences based on sex and age group. These findings can help guide continued research, improved protective equipment, and tailored injury prevention strategies to ensure the long-term health and safety of lacrosse athletes at all levels of play.