Orthopaedics in the Real World: The Business and Legal Aspects of Employment in 2022.

As more physicians enter hospital employment on completion of their training, the details and complexity associated with these arrangements are increasing. To better position surgeons to succeed in any employment model, it is important to describe several key topics associated with these business models. First, financial modeling can be used to make smarter choices when evaluating employment opportunities. This tool, applied often in the business world, allows surgeons to truly understand the midterm and long-term financial implications of employment decisions and can help surgeons thrive financially as they progress through their careers. There are both positive and negative intricate points associated with different employment models, including hospital-employed positions. Although each model may have its minor unique differences, a thorough understanding of the basics is critical for success. Contracts and some of the common issues of concern that surgeons should be keenly aware of when negotiating their hospital employment contract are important topics for discussion, along with the concept of ancillary revenue, specifically its unique implications as it applies to hospital-employed physicians; these relationships can be very different from traditional private practice models of ancillary income. Orthopaedic surgeons should be knowledgeable about Stark Law, the Anti-Kickback Statute, and Certificate of Need laws and the potential effect of these and other regulations on physicians.

"Assessing the hemodynamic impact of various inotropes combination in patients with cardiogenic shock with Non-ST elevation myocardial infarction -the ANAPHOR study".

BACKGROUND: Various inotropic agents/vasopressors combinations are used in patients of cardiogenic shock. We performed this study to observe hemodynamic effects of various inotrope/vasopressor combinations in patients with NSTEMI cardiogenic shock (CS) at tertiary cardiac centre METHODS AND MATERIALS: Of 3832 NSTEMI, we studied 59 consecutive such patients with CS who hadn't undergone revascularization in the first 24 h in a prospective, open label, observational study. Group 1 comprised of background Dopamine with Noradrenaline titration(N = 38), Group 2 had background Dobutamine and Noradrenaline titration(N = 15) and Group 3 comprised of triple combination of Dopamine, Noradrenaline & Adrenaline(N = 6). RESULTS: The mean change in hemodynamic parameters between these groups from baseline to 24 h showed no statistical difference. Cardiac output(CO), mean arterial pressure(MAP), central venous pressure(CVP) and cardiac power output(CPO) in group 2 were favorable at 6 and 24 h compared to baseline but mean change was insignificant as compared to others. In group 3, the increase in MAP was significant. IABP use did not change CO, CPO or SVR in any group except lower dosages of Dobutamine (49%) in IABP group. Lower in-hospital mortality in group 2 compared to others (P = 0.004) may be reflective of sicker patients in group 1 and 3. CONCLUSION: The mean changes in hemodynamic parameters were not significant between all groups. All regimes of inotropes when selected as per clinical indication in CS with ACS resulted in similar hemodynamic effects. The mortality difference may not truly be reflective of regimes rather reflect sicker patients in the higher mortality group.

Technical Pearls for Arthroscopic Labral Augmentation of the Hip.

Our recent understanding of the importance of the acetabular labral suction seal has placed preserving labral integrity as a guiding principle in hip preservation surgery. In cases with a hypoplastic labrum and intact chondrolabral junction, labral augmentation presents as a viable alternative and an often preferred treatment option over labral reconstruction. At this time, there are few studies that have described the technical pearls of performing labral augmentation of the hip. In this technique guide, we describe, in detail, the kite technique for the introduction, control, and acetabular fixation of a hip labral augmentation graft. Comparable to flying a kite with 2 fly lines and to the previously described kite technique for hip labral reconstruction, the kite technique for labral augmentation is based on the principle that the use of 2 control sutures in a pulley system creates an efficient method to accurately and reproducibly facilitate graft passage and fixation during arthroscopic labral augmentation procedures.

Capsular Reconstruction of the Hip Using Modified Kite Technique: A Technical Guide for Efficient Graft Management and Fixation.

Preserving capsular integrity has become an important principle of hip preservation surgery given the increasingly recognized deleterious effects of instability in cases of capsular insufficiency. When capsular tissue is deficient, capsular reconstruction may be indicated to restore function of the iliofemoral ligament and improve hip biomechanics. To date, few studies have presented technical guidance on performing arthroscopic capsular reconstruction of the hip. In this Technical Note, we introduce a modified kite technique for arthroscopic entry, control, and fixation of a capsular reconstruction graft. Similar to flying a kite with multiple fly lines, and to the previously described kite technique for hip labral reconstruction, the principles of this method are founded on the belief that control sutures within a pulley system facilitate safe and efficient graft management during capsular reconstruction procedures.

Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence.

BACKGROUND: Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance. PURPOSE: To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. The study quality was evaluated according to the Modified Coleman Methodology Score. Studies in English evaluating SCR outcomes were included. RESULTS: Seven studies were reviewed, including 352 patients (358 shoulders) treated with arthroscopic SCR with the mean duration of follow-up ranging from 15 to 48 months (range, 12-88 months). Fourteen patients were lost to follow-up, leaving 338 patients (344 shoulders) with clinical outcome data. Graft types included dermal allografts (n = 3 studies), fascia lata autografts (n = 3), or both (n = 1). Most commonly, a double-row technique was utilized for humeral graft fixation. The most common complication included graft tears in 13% of patients, resulting in 15 SCR revisions and 7 reverse shoulder arthroplasties. Postoperatively, improvements in visual analog scale (2.5 to 5.9), American Shoulder and Elbow Surgeons (20 to 56), Japanese Orthopaedic Association (38.0), Subjective Shoulder Value (37.0 to 41.3), and Constant (11.6 to 47.4) scores were observed. Three studies reported respective satisfaction rates of 72.9%, 85.7% and 90%. Increases in external rotation, internal rotation, and abduction with improved strength in external rotation were observed postoperatively. Improvement of pseudoparalysis was also observed in 3 studies. One study reported return to sports in 100% of patients (2 competitively, 24 recreationally) with no adverse outcomes. CONCLUSION: SCR showed good to excellent short-term clinical outcomes with adequate pain relief and functional improvement. The current evidence suggests that the procedure is an alternative for symptomatic patients with irreparable MRCT; however, the included studies were fair to poor in quality, and there were some notable complications. Long-term follow-up will determine the longevity and ultimate role of this new method in the treatment of irreparable MRCT.

Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review.

BACKGROUND: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. PURPOSE: To systematically review the literature on the outcomes of RCR among patients ≥70 years old. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. RESULTS: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs (P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. CONCLUSION: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

Successful Hip Arthroscopy Using Postless Distraction in a Professional Basketball Player: A Case Report.

CASE: A 36-year-old 7'0' male professional basketball player presented with hip pain and radiographic imaging consistent with femoroacetabular impingement syndrome and a labral tear. Hip arthroscopy was performed with the patient positioned supine on a postless distraction table to negate the risk of pudendal nerve and perineal skin complications. Hip distraction was achieved with only 40 lbs (18.14 kg) of distraction force. Labral repair and cam osteochondroplasty were safely performed without complication. CONCLUSIONS: This case is the first to demonstrate that postless distraction may be considered for patients at end ranges of height that exceed the limitations of common hip arthroscopy tables.

Kite Measurement Technique for Enhanced Accuracy and Technical Proficiency of Graft Preparation in Segmental Labral Reconstruction of the Hip.

Preserving labral integrity has become a guiding principle in hip preservation surgery given the recent understanding of the importance of the acetabular labral suction seal. When labral tissue is deficient, a labral reconstruction may be indicated to re-create the suction seal and improve hip biomechanics. One of the main challenges of segmental labral reconstruction techniques is obtaining an accurate measurement of the defect because incorrect sizing of the graft could result in incomplete restoration of the labral seal or an oversized graft that requires amputation. In this report, we present a kite measurement technique that allows for easy, accurate measurement of the segmental defect during segmental labral reconstruction.

Postoperative alpha angle not associated with patient-centered midterm outcomes following hip arthroscopy for FAI.

PURPOSE: The most commonly used parameter for defining cam-type femoroacetabular impingement(FAI) has been the alpha angle. The purpose of this study was to determine if patient-reported outcomes 5 years following hip arthroscopy for FAI were associated with postoperative alpha angle. We hypothesized that patient-reported outcomes would not be influenced by postoperative alpha angle in patients with FAI. METHODS: 230 patients had primary hip arthroscopy for FAI and chondrolabral dysfunction. The median age was 40 years (range 18-69). All patients had preoperative and 1 day postoperative alpha angles recorded. At minimum 5 years following arthroscopy, all patients completed an online questionnaire that included the modified Harris Hip score(MHHS), WOMAC, HOS ADL, HOS Sport, SF12 and patient satisfaction. This study was IRB approved. Patients were grouped into two, based on their postoperative alpha angle: <55° (n = 158) and ≥ 55° (n = 56). RESULTS: The median preoperative alpha angle was 72° (range 50°-105°) and the median postoperative alpha angle was 45° (range 30°-100°). The postoperative alpha angle did not correlate with any outcome measure. The median preoperative alpha angle in the < 55° group was 71° and in ≥ 55° group the median was 74° (p = 0.044). The median follow-up was 5.1 years (range 5-7). The median mHHS was 85 (range 47-100) in the < 55° and 85 (range 54-100) in the ≥ 55° group (n.s); WOMAC was 5 (range 0-73) in the < 55° and 4.5 (range 1-57) in the ≥ 55° group(n.s); HOS ADL was 95 (range 31-100) in the < 55° and 96 (range 50-100) in the ≥ 55° group (n.s); HOS Sport was 88 (range 0-100) in the < 55° and 88 (range 13-100) in the ≥ 55° group (n.s) Median patient satisfaction was 9 (range 1-10) in both groups. CONCLUSION: This study shows no statistically significant differences between the investigated patient-reported outcome scores at a 5 years postoperatively in relation to a correction of the alpha angle to 55°. While alpha angle has been shown to be an excellent preoperative diagnostic tool, the postoperative angle does not correlate with midterm outcomes or the development of osteoarthritis based on patient symptoms. The amount of osteoplasty should be based on dynamic examination at arthroscopy, and not by alpha angle. LEVEL OF EVIDENCE: III Case-control, retrospective comparative study.

Intraoperative Neuromonitoring for Brachial Plexus Neurolysis During Delayed Fixation of a Clavicular Fracture Presenting as Thoracic Outlet Syndrome: A Case Report.

CASE: Brachial plexopathy is a rare complication of nonoperatively treated clavicular fractures. We describe a 68-year-old man who presented with fracture-callus-induced acute brachial plexopathy and dynamic thoracic outlet syndrome after 9 weeks of nonoperative management for a clavicular fracture. He underwent fracture fixation with brachial plexus decompression via callus excision; intraoperative neuromonitoring was used to evaluate brachial plexus function. Postsurgery, his neurologic function recovered completely. CONCLUSION: Intraoperative neuromonitoring is a useful tool for minimizing the risk of additional brachial plexus injury and determining the adequacy of neural decompression during delayed open reduction and internal fixation of clavicular fractures with fracture-callus-induced brachial plexus compression.

Femoroacetabular Impingement in Professional Football Players: Return to Play and Predictors of Career Length After Hip Arthroscopy.

BACKGROUND: Previous studies have shown hip arthroscopy to be a highly effective treatment for symptomatic femoroacetabular impingement (FAI) in a wide range of athletes; however, the rate of return to play and length of career after hip arthroscopy in professional football players are unknown. PURPOSE: To determine how many athletes returned to professional football and the number of seasons they played after surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-one professional football players (60 hips) underwent hip arthroscopy for FAI between 2000 and 2014 by a single surgeon. Return to play was defined as competing in a preseason or regular season professional football game after surgery. Data were retrospectively obtained for each player from NFL.com , ESPN.com , individual team websites, and/or CFL.ca . RESULTS: We found that 87% (52/60) of the arthroscopic procedures allowed professional football players to return to play in a preseason or regular season game. Athletes who returned played an average of 38 games during 3.2 seasons after arthroscopy, with an average total career length of 7.4 seasons. Ninety-two percent (48/52) of players who returned had a minimum total career length of 3 years. When participants were analyzed by position, linemen were less likely to return after hip arthroscopy compared with other players (odds ratio 5.6; 95% CI, 1.1-35; P = .04). All quarterbacks and tight ends returned to play after surgery. No significant difference in return to play rate was found between athletes who underwent microfracture and those who did not (25% vs 38%, P = .698). CONCLUSION: Hip arthroscopy for treatment of FAI and associated pathologic abnormalities in professional football players resulted in a high rate of return to play. The study's findings demonstrate that 87% of the arthroscopic procedures allowed professional football players to return to play, linemen were less likely to return compared with other positions, and the presence of microfracture did not significantly affect the return to play rate. These findings support hip arthroscopy as an effective procedure to treat FAI and related pathologic abnormalities in the professional football player, and this information is important for proper counseling of athletes with FAI.

Medial Meniscus Radial Tear: A Transtibial 2-Tunnel Technique.

Complete radial tears of the medial meniscus significantly decrease the meniscal tissue's ability to dissipate tibiofemoral loads and have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis. At present, no consensus exists regarding the optimal surgical treatment of a radial meniscal tear. Current repair techniques have led to a reportedly high rate of incomplete healing or healing of the meniscus in a nonanatomic, gapped position, which compromises its ability to withstand hoop stresses. Improvement regarding the ability to repair and heal medial meniscus radial tears has the potential to result in enhanced preservation of the articular cartilage in the medial compartment of the knee. This technical description details a method for repairing radial tears of the medial meniscus using a transtibial 2-tunnel technique.

Assessment and Evaluation of Glenoid Bone Loss.

The preoperative assessment of anterior glenoid bone loss is a critical step in surgical planning for patients with recurrent anterior glenohumeral instability. The structural integrity of the glenoid has been identified as one of the most important factors influencing the success of operative repair. The currently accepted gold standard for glenoid structural assessment among most orthopaedic surgeons is the use of 3-dimensional reconstructed computed tomography images with the humeral head digitally subtracted, yielding an en face sagittal oblique view of the glenoid. This view allows for evaluation of glenoid morphology and quantitative assessment of glenoid bone loss. In this article, we describe the practical application of ImageJ software (National Institutes of Health, Bethesda, MD) to quantify the amount of glenoid bone loss reported as a percentage of either total surface area or diameter. The following equations are used in this technical note for the diameter-based method and surface area method, respectively: Percent bone loss = (Defect width/Diameter of inferior glenoid circle) × 100% and Percent bone loss = (Defect surface area/Surface area of inferior glenoid circle) × 100%.

Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

Hip Labral Reconstruction: The "Kite Technique" for Improved Efficiency and Graft Control.

Although the merits of labral reconstruction have been well established, the technical difficulty of presently used reconstruction techniques-particularly with graft passage and fixation-limit its efficacy and potentiates the risk of iatrogenic damage within the hip joint. The unwieldy nature of a floating labral graft anchored on one end may impede accurate fixation of the other end, which is critical for restoration of the fluid hip seal and preservation of graft integrity. In this technique narrative, we present a "kite technique" for introduction, control, and efficient fixation of a labral reconstruction graft. The principles of this method are founded on the belief that a soft-tissue graft in an arthroscopic environment is much easier to guide into position with 2 control sutures using a pulley system similar to flying a kite with 2 fly lines. Although we herein detail the technique as it applies to labral reconstruction in the hip, the concept of the kite technique may also be employed in arthroscopic-assisted soft-tissue reconstructions of other joints.

Predictive Value of 3-T Magnetic Resonance Imaging in Diagnosing Grade 3 and 4 Chondral Lesions in the Hip.

PURPOSE: To assess the diagnostic capability and predictive value of 3-T magnetic resonance imaging (MRI) in detecting grade 3 and 4 cartilage lesions in the hip. METHODS: From August 2010 to April 2015, patients who underwent 3-T MRI and hip arthroscopy were included in the study. Data were prospectively collected and retrospectively reviewed. A radiologist prospectively documented MRI findings, and the surgeon documented cartilage damage at arthroscopy using the Outerbridge grading system. Arthroscopy was considered the diagnostic gold standard. This study was approved by the institutional review board. RESULTS: The study group comprised 606 patients, with 354 men (58%) and 252 women (42%). The mean patient age was 34 years (range, 18 to 71 years). For femoral head defects, the sensitivity was 61% (95% confidence interval [CI], 53% to 68%), specificity was 58% (95% CI, 55% to 62%), positive predictive value was 29% (95% CI, 25% to 33%), and negative predictive value was 84% (95% CI, 81% to 87%). For chondral defects of the acetabulum, the sensitivity was 80% (95% CI, 75% to 84%), specificity was 41% (95% CI, 38% to 44%), positive predictive value was 42% (95% CI, 39% to 45%), and negative predictive value was 79% (95% CI, 74% to 84%). CONCLUSIONS: The results of this study showed that 3-T MRI had sensitivity, as well as specificity, for identifying chondral defects that is similar to what has been previously reported. MRI showed increased sensitivity when identifying acetabular defects compared with femoral head defects. With a low positive predictive value, MRI may be most useful in ruling out cartilage lesions. LEVEL OF EVIDENCE: Level III, diagnostic study.

Surgical Techniques and Outcomes of Repairing Meniscal Radial Tears: A Systematic Review.

PURPOSE: To systematically review meniscal radial tear repair procedures and compare the techniques, outcomes, and complications. METHODS: Studies were identified through a systematic review of the literature using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2014), Medline (1980-2014), and Embase. Inclusion criteria included a minimum follow-up of 24 months, English language, and publications from 1980 or later. Exclusion criteria were surgical techniques not reporting follow-up, biomechanical studies, cadaver/anatomic studies, and non-radial tear meniscal repair procedures. Meniscal radial repair, meniscal radial tear, meniscal radial tear repair, radial repair and radial tear were used as search terms. RESULTS: A total of 6 studies (55 patients) met the inclusion criteria. The mean duration of follow-up ranged from 24 to 71 months. Of the 6 studies, 5 reported radial tears to the lateral meniscus and 1 study reported cases of both medial and lateral meniscal radial tears. Two studies reported different inside-out repair techniques, 2 studies reported the use of an all-inside anchor-based repair system, 1 study reported an all-inside repair technique with absorbable sutures, and 1 study reported an inside-out repair with fibrin clots. Average postoperative Lysholm scores were reported in all 6 studies and ranged from 86.9 to 95.6. Average postoperative Tegner activity scores were reported in 4 studies and ranged from 1 to 6.7. The majority of studies concluded that their techniques produced satisfactory healing of the radial tear, without serious subsequent complications. CONCLUSIONS: Radial repair techniques differed among studies; however, postoperative subjective outcomes revealed patient improvement with repairing radial tears. With the increasing concern of long-term osteoarthritis after meniscectomy, meniscal preservation with repair of radial tears results in improved short-term clinical outcomes; however, long-term outcomes remain unknown. LEVEL OF EVIDENCE: Level IV, systematic review of level IV studies.

Outerbridge Grade IV Cartilage Lesions in the Hip Identified at Arthroscopy.

PURPOSE: To determine factors associated with grade IV cartilage defects in the hip in patients undergoing hip arthroscopy with joint pain. METHODS: Data from consecutive patients who underwent hip arthroscopy performed by a single surgeon over a period of 4 years were included in this study. The study group included 1,097 patients (491 women and 606 men; mean age, 37 years) who underwent hip arthroscopy for pain, had no prior hip surgery, and were aged 18 years or older. Preoperative radiographs, patient demographic characteristics, and operative details were used to identify risk factors for cartilage defects. RESULTS: Grade IV chondral defects were present in 308 of 1,097 hips (28%). Isolated chondral lesions were more frequently observed on the acetabulum (76%) than on the femoral head (24%). Defects of the acetabulum were more commonly anterosuperior (94.7%) and less commonly posterolateral (5.3%). Patients with less than 2 mm of joint space on preoperative radiographs were 8 times more likely to have a grade IV lesion than those with more than 2 mm. Men were more likely than women to have grade IV lesions (35% v 19%, P = .0001); patients with grade IV lesions were older than those without (42 years v 34 years, P = .0001). Hips with grade IV lesions had significantly higher alpha angles than those without (74° v 70°, P = .0001). Patients with grade IV defects reported a longer duration of symptoms than those without (37 months v 27 months, P = .007). Independent risk factors for the presence of grade IV chondral defects were less than 2 mm of joint space, male gender, increasing age, larger alpha angle, and longer duration of symptoms. CONCLUSIONS: Grade IV chondral defects in patients undergoing hip arthroscopy were associated with decreased joint space, increased time from symptom onset to arthroscopy, male gender, and larger alpha angles associated with femoroacetabular impingement. LEVEL OF EVIDENCE: Level IV, prognostic case series.

A Novel Repair Method for Radial Tears of the Medial Meniscus: Biomechanical Comparison of Transtibial 2-Tunnel and Double Horizontal Mattress Suture Techniques Under Cyclic Loading.

BACKGROUND: Complete radial tears of the medial meniscus have been reported to be functionally similar to a total meniscectomy. At present, there is no consensus on an ideal technique for repair of radial midbody tears of the medial meniscus. Prior attempts at repair with double horizontal mattress suture techniques have led to a reportedly high rate of incomplete healing or healing in a nonanatomic (gapped) position, which compromises the ability of the meniscus to withstand hoop stresses. HYPOTHESIS: A newly proposed 2-tunnel radial meniscal repair method will result in decreased gapping and increased ultimate failure loads compared with the double horizontal mattress suture repair technique under cyclic loading. STUDY DESIGN: Controlled laboratory study. METHODS: Ten matched pairs of male human cadaveric knees (average age, 58.6 years; range, 48-66 years) were used. A complete radial medial meniscal tear was made at the junction of the posterior one-third and middle third of the meniscus. One knee underwent a horizontal mattress inside-out repair, while the contralateral knee underwent a radial meniscal repair entailing the same technique with a concurrent novel 2-tunnel repair. Specimens were potted and mounted on a universal testing machine. Each specimen was cyclically loaded 1000 times with loads between 5 and 20 N before experiencing a load to failure. Gap distances at the tear site and failure load were measured. RESULTS: The 2-tunnel repairs exhibited a significantly stronger ultimate failure load (median, 196 N; range, 163-212 N) than did the double horizontal mattress suture repairs (median, 106 N; range, 63-229 N) (P = .004). In addition, the 2-tunnel repairs demonstrated decreased gapping at all testing states (P < .05) with a final measured gapping of 1.7 mm and 4.1 mm after 1000 cycles for the 2-tunnel and double horizontal mattress suture repairs, respectively. CONCLUSION: The 2-tunnel repairs displayed significantly less gapping distance after cyclic loading and had significantly stronger ultimate failure loads compared with the double horizontal mattress suture repairs. CLINICAL RELEVANCE: Complete radial tears of the medial meniscus significantly decrease the ability of the meniscus to dissipate tibiofemoral loads, predisposing patients to early osteoarthritis. Improving the ability to repair medial meniscal radial tears in a way that withstands cyclic loads and heals in an anatomic position could significantly improve patient healing rates and result in improved preservation of the articular cartilage of the medial compartment of the knee. The 2-tunnel repair may be a more reliable and stronger repair option for midbody radial tears of the medial meniscus. Clinical studies are warranted to further evaluate these repairs.