This study set out to determine the incidence of avulsion of the posterior horn of the lateral meniscus in isolated Anterior cruciate ligament injuries. Anterior cruciate injuries are often associated with meniscal injuries and a number of different patterns of injuries are described. Although avulsion of the posterior horn of the lateral meniscus has been reported in combined ACL/MCL injuries this has not been reported in isolated ACL injuries. We examined 25 consecutive patients who had ACL ruptures and recorded the presence or absence of an avulsed posterior horn of the lateral meniscus. The mechanism of injury was also recorded. We found 6 patients (24%) with avulsion of the posterior horn of the lateral meniscus from its tibial attachment. All these patients had an external rotation injury rather than a valgus type injury. Avulsion of the posterior horn of the lateral meniscus is a relatively common finding in ACL injury. If this injury occurs the normal load sharing function of the meniscus may not be present and this may be part of the explanation for the development of degenerative change in the ACL injured knee

Purpose. The purpose of the present study was to compare functional outcomes of medial unicompartmental knee arthroplasty (UKA) in patients with lateral meniscal lesion (LM (+) group) in the preoperative MRI and those without lateral meniscal pathology (LM (−) group) and to evaluate the effect of lateral meniscus lesion in preoperative MR on functional outcomes after UKA. Methods. The outcomes of 66 knees (LM (+) group) were compared to the outcomes of 54knees(LM (−) group)with a median follow-up of 28 month(range 24–36 months). Clinical outcomes including KS object score, KS pain score, lateral side pain, physical exam for lateral meniscal lesion and squatting ability. Radiological parameters (mechanical axis and component position) were compared and their effects on functional outcomes were evaluated at the final follow-up visits. Result. At final follow-up visits, no significant intergroup difference was found about KS object score, presence of lateral side pain, positive physical examination for meniscal lesion and squatting ability. LM(+) group had a tendency of more varus postoperative mechanical axis and showed better KS pain score and more comfortable feeling during squatting activity. Furthermore, no correlation was found between postoperative mechanical axis and functional outcome variables. Conclusions. The result of UKA for medial unicompartmental knee osteoarthritis was excellent regardless of preoperative lateral meniscal pathology in the MRI, if patient had not symptoms related to lateral meniscus lesion. Mild varus alignment for those who had a lateral meniscal lesion provided satisfactory clinical outcome of medial UKA

Introduction: The purpose of our investigation was to determine if tibial lateral meniscus insertions (anterior and posterior horn) can precisely and reproducibly be determined on preoperative radiographs. Bony landmarks and their topographic relations to the meniscus insertions were described, measured and statistically evaluated. We concentrated on the lateral meniscus because there are many reasons to restrict the indications for meniscus replacement on the lateral compartment. Methods: We prepared the lateral meniscus insertions in 22 tibial plateaus from 11 body donors. Insertion site outline was performed on anterior and posterior horns with radio opaque 1.6 mm steal balls. Anteroposterior and lateral radiographs were performed. On these radiographs, different landmarks of the tibial head were defined and their distances measured (width, depth, distance from lateral tibia border to meniscus midpoint, distance from lateral tibia border to lateral tibial spine). These measures were statistically evaluated and percent values for meniscus insertion midpoint position were determined. Results: On anteroposterior radiographs, from lateral to medial, the anterior meniscus midpoint was located on 45.1 % ± 1.3 % of the tibial width, the posterior meniscus midpoint on 49.8 % ± 1.9 % of the tibial width. On lateral radiographs, from anterior to posterior, the anterior meniscus midpoint was located on 41.9 % ± 3.2 % of the tibial depth, the posterior meniscus midpoint on 72.1 % ± 2.3 % of the tibial depth. With linear regression analysis, we could show that the lateral meniscus insertions have constant relations, as well to the dimensions of the tibia plateau as to the lateral tibial spine. Conclusions: We think that it is possible to determine precisely and reproducibly on preoperative anteroposterior and lateral radiographs the insertions of the lateral meniscus. Our results and the method to determine preoperatively meniscus insertions might bring decisive advantages considering the optimal fixation of meniscus transplants, enhancing biomechanical conditions and possibly improving postoperative results

Background: After inside out suture for lateral meniscal tear, the popliteal hiatus is closed. So that procedure is not anatomical. From 2003 we have done all inside anatomical meniscal suture without any implants. This procedure preserves popliteal hiatus. Objective: To introduce the procedure of anatomical all inside lateral meniscal suture and evaluate post operative results. Material and Method: From 2003 till 2008, we have done all inside lateral meniscal suture in 43 cases. Twenty eight were male and 15 were female. The age at operation was 9 to 42 (mean: 22). Simple meniscal tear were 21 cases, meniscal tear with ACL injury 17 cases, discoid meniscal tear 4cases, and loose meniscus 1 case. Three portals (lateral infra-patellar, medial infra-patellar, and mid para-patellar) were needed. For suturing torn meniscus, we always use spinal needle that was curved by operative surgeon, and sometimes use Caspari suture punch. After rasping torn part, through medial portal the curved spinal needle within non-absorbable thread was pierced to free margin side of lateral meniscus to be passes through torn part toward tibial side of popliteal hiatus. From mid para-patellar view, tip of spinal needle and thread were seen in popliteal hiatus. And only thread was picked up by punch forceps through lateral portal. This end was passed over lateral meniscus. Finally sliding knot was done. Forty cases were followed. Mean follow up period was 1 year and 11 months. The second look arthroscopy was done in 27 cases, 3 months to29 months (mean: 11 months) after meniscal suture. Results: There were no complications during and after operation. The second look arthroscopy showed complete union in 16 cases, incomplete union in 7 cases and failure in 4 cases. Among the other cases, physical examination revealed failure in one case. Total success rate was 87.5%. This procedure is only the way for anatomical repair of torn lateral meniscus and post operative results are good

Injury to the anterolateral ligament (ALL) has been reported to contribute to high-grade anterolateral laxity following anterior cruciate ligament (ACL) injury. Failure to address ALL injury has been suggested as a cause of persistent rotational laxity following ACL reconstruction. However, lateral meniscus posterior root (LMPR) tears have also has been shown to cause increased internal rotation and anterior translation of the knee. Due to the anatomic relationship of the ALL and the lateral meniscus, we hypothesise that the ALL and lateral meniscus work synergistically, and that a tear to the LMPR will have the same effect on anterolateral laxity as an ALL tear in the ACL deficient knee. Sixteen fresh frozen cadaveric knee specimens were potted into a hip simulator(femur) and a six degree-of-freedom load cell (tibia). Two rigid optical trackers were inserted into the proximal femur and distal tibia, allowing for the motion of the tibia with respect to the femur to be tracked during biomechanical tests. A series of points on the femur and tibia were digitised to create bone coordinate systems that were used to calculate the kinematic variables. Biomechanical testing involved applying a 5Nm internal rotation moment to the tibia while the knee was in full extension and tested sequentially in the following three conditions: i) ACLintact; ii) Partial ACL injury (ACLam) – anteromedial bundle sectioned; iii) Full ACL injury (ACLfull). The specimens were then randomised to either have the ALL sectioned first (ALLsec) followed by the LMPRsec or vice versa. Internal rotation and anterior translation of the tibia with respect to the femur were calculated. A mixed two-way (serial sectioning by ALL section order) repeated measures ANOVA (alpha = 0.05). Compared to the ACLintact condition, internal rotation was found to be 1.78° (p=0.06), 3.74° (p=0.001), and 3.84° (p=0.001) greater following ACLfull, LMPRsec and ALLsec respectively. LMPRsec and the ALLsec resulted in approximately 20 of additional internal rotation (p=0.004 and p=0.01, respectively) compared with the ACL deficient knee (ACLfull). No difference was observed between the ALL and LMPR sectioned states, or whether the ALL was sectioned before or after the LMPR (p=0.160). A trend of increasing anterior translation was observed when the 5Nm internal rotation moment was applied up until the ACL was fully sectioned; however, these differences were not significant (p=0.070). The ALL and LMPR seem to have a synergistic relationship in aiding the ACL in controlling anterolateral rotational laxity. High-grade anterolateral laxity following ACL injury may be attributed to injuries of the ALL and/or the LMPR. We suggest that the lateral meniscus should be thought of as part of the anterolateral capsulomeniscal complex (i.e., LM, ITB, and ALL) that acts as a stabiliser of anterolateral rotation in conjunction with the ACL

Radial cleavage tears of the lateral meniscus are uncommon and may be associated with a meniscal cyst. There is a recognised association of these lesions with radiographically visible erosions of the lateral tibial plateau; however, this association is reported to be rare. We believe this radiographic feature is more common than previously reported and as most reports are limited to the radiology literature it is not widely appreciated by Orthopaedic Surgeons. The aim of this study was to determine the prevalence of this valuable radiographic sign in patients with a proven radial cleavage tear and draw attention to it among Orthopaedic Surgeons. We identified 20 patients from our prospectively collected database that had undergone an arthroscopic partial lateral meniscectomies for radial cleavage tears of the lateral menisci. A consultant radiologist (NS) independently assessed the pre-operative radiographs of these patients, specifically looking for the presence of erosions of the tibiae below the lateral joint line. Of 20 patients assessed 9(45%) had radiographically visible bone erosions. Our study confirms our clinical experience that patients with symptoms and signs suggestive of a radial cleavage tear of the lateral meniscus frequently have an associated plain radiographic sign to support the clinical diagnosis

Purpose of Study. A description of a procedure to stabilize symptomatic complete discoid menisci with medium term results. Methods and Results. Children with mechanical symptoms of lateral meniscal instability were assessed by MRI scan. In those with a lateral discoid meniscus an arthroscopic examination was performed to identify the presence of tears and confirm the radiological diagnosis. No incomplete or Wrisberg variant types were encountered. An antero-lateral arthrotomy was performed. The anterior horn of the meniscus was mobilized and traction sutures inserted. Flexion and extension of the knee whilst traction was applied led to delivery of the anterior horn into the wound. After confirmation of position with image intensifier a groove was fashioned in the anterior aspect of the cartilaginous portion of the proximal tibial epiphysis. Typically three titanium bone anchors with non absorbable sutures were placed in the base of the groove. The anterior horn of the meniscus was drawn into the groove and anchored with sutures. Active range of motion exercises were encouraged but a canvas knee immobilizer was employed whilst walking for the first six weeks. Four boys and three girls underwent meniscopexy performed at a mean age of 9.4 years (range 5.7 to 12.4 years). Follow up was at a mean of 4.9 years. At last follow up no patient reported symptoms of locking or pain. No patient has required revision surgery but one girl had a subsequent meniscopexy procedure on the opposite knee. Five of the children have had Lysholm scores performed at last follow up averaging 93.5 (80 to 100 points). Conclusion. Complete lateral discoid menisci in children can be rendered asymptomatic in the medium term by re-tensioning the anterior horn

Introduction. Anatomical reconstruction of the Anterior Cruciate Ligament (ACL) reconstruction has been shown to be desirable and improve patient outcome. The posterior border of the anterior horn of the lateral meniscus (AHLM) is an easily identifiable arthroscopic landmark, which could guide anatomic tibial tunnel position in the sagital plane. The aim of the study was to establish the relationship between the posterior border of AHLM and the centre of the ACL foot print to facilitate anatomical tibial tunnel placement. Materials/Methods. We analysed 100 knee MRI scans where there was no ACL or lateral meniscal injury. We measured the distance between the posterior border of the AHLM and the midpoint of the tibial ACL footprint in the sagital plane. The measurements were repeated 2 weeks later for intra-observer reliability. Results. The mean distance between the posterior border of the AHLM and the ACL midpoint was −0.1mm (i.e. 0.1mm posterior to the ACL midpoint). The range was 5mm to −4.6mm. The median value was 0.00mm. 95% confidence interval was from 0.3 mm to −0.5 mm. A normal, parametric distribution was observed and Intra-observer variability showed significant correlation (p=0.01) using Pearsons Correlation test. Conclusion. Using the posterior border of the AHLM is a reliable, reproducible and anatomic marker for the midpoint of the ACL footprint in the majority of cases. It can be used intra-operatively as a guide for tibial tunnel and graft placement allowing anatomical reconstruction. There will inevitably be some anatomical variation. Pre-operative MRI assessment of the relationship between AHLM and ACL footprint is advised to improve surgical planning

The absence of menisci in the knee leads to early degenerative changes. Complete radial tears of the meniscus are equivalent to total meniscectomy and repair should be performed if possible. The purpose of this study was to biomechanically compare the cross suture, hashtag and crosstag meniscal repairs using all-inside implants for radial tears. Radial tears were created at the mid-body of 36 fresh-frozen lateral human menisci and then repaired, in randomiSed order, with Fast-Fix™ 360s (Smith & Nephew, Andover, MA) using the cross suture, hashtag and crosstag techniques. The repaired menisci were tested using an Instron Electropuls E10000 (Instron, Norwood, MA). The tests consisted of cyclic loading from 5 to 30N at 1Hz for 500 cycles, then a load to failure test. Displacement following cyclic loading, load at 3mm of displacement, load to failure, and stiffness were recorded. Any differences between repairs were assessed using Kruskal-Wallis and Mann Whitney tests (p<0.05). Cross suture repairs displaced more following cyclic loading and resisted less load to failure than both the hashtag and crosstag repairs. However, these differences were not statistically significant. The average displacement following cyclic loading of cross suture, hashtag, and crosstag repairs was 4.34 mm (±2.02 mm), 3.46 mm (±2.12 mm), and 3.24 mm (±1.52 mm) respectively (p=0.33). Maximal load to failure was 64.83 N (±17.41 N), 74.52 N (±9.03 N), and 74.98N (±10.50N), respectively (p=0.419). All-inside cross suture, hashtag and crosstag repairs all displaced >3mm with cyclic loading, which is the threshold for meniscal insufficiency. This contrasts previous studies using inside-out sutures, where crosstag and hashtag repairs resisted cyclic loading (< 3mm). Inside-out suturing for radial tears of the lateral meniscus currently remains the gold standard

Purpose. Injuries of the meniscal attachments can lead to meniscal extrusion. We hypothesized that the extent of lateral meniscal extrusion (LME) was associated with the severity of the lateral meniscus posterior root tear (LMPRT). This study aimed to evaluate the relationship between preoperative LME and arthroscopic findings of LMPRT in knees with anterior cruciate ligament (ACL) injury. Methods. Thirty-four knees that had LMPRTs with concomitant ACL injuries on arthroscopy were evaluated. Patients were divided into two groups, partial and complete root tears, via arthroscopic findings at the time of ACL reconstruction. We retrospectively measured preoperative LMEs using magnetic resonance imaging (MRI). Statistical analysis was performed using the Mann-Whitney U-test and Chi-square test. Results. Twenty-three knees had partial LMPRTs (type 1). Complete LMPRTs were observed in 11 knees (type 2, 2 knees; type 3, 2 knees; and type 4, 7 knees). In the partial LMPRT group, the average LME was 0.43±0.78 mm. In the complete LMPRT group, the average extrusion was 1.99±0.62 mm. A significant difference between these groups was observed in the preoperative LMEs (P<0.01). The receiver operating curve analysis identified an optimal cutoff point of 1.05 mm for the preoperative LME. This LME cutoff had a sensitivity of 100% and specificity of 85% for complete LMPRT. Conclusion. This study demonstrated that preoperative LMEs were larger in complete LMPRTs associated with ACL injuries than in partial LMPRTs. Our results suggest that preoperative MRI-detected LME may be a useful indicator for estimating LMPRT severity in knees with ACL injury

Introduction. Anatomical reconstruction of the Anterior Cruciate Ligament (ACL) reconstruction has been shown to improve patient outcome. The posterior border of the anterior horn of the lateral meniscus (AHLM) is an easily identifiable landmark on MRI and arthroscopy, which could help plan tibial tunnel position in the sagittal plane and provide anatomical graft position intra-operatively. Method. Our method for anatomical tibial tunnel placement is to establish the relation of the posterior border of AHLM to the centre of the ACL footprint on a pre-operative sagittal MRI. Based on this relationship studied on preoperative MRI scan, posterior border of AHLM is used as an intra- operative arthroscopic landmark for anatomic tibial tunnel placement during ACL reconstruction. This relationship has been studied on 100 MRI scans where there was no ACL or LM injury (Bone and Joint Journal 2013 vol 95-B, SUPP 19). The aim of the study is to validate our method for anatomical tibial tunnel placement. Results. 25 patients with ACLR where there were both pre and post op MRI scan with good quality images of AHLM and tibial tunnel opening were included in this study. The preoperative relationship between posterior border of AHLM and centre of ACL footprint was compared with that between the posterior border of AHLM and centre of tibial tunnel on postop MRI scans. The measurements were done by two observers on two different occasions to establish intra and inter observer correlation. Discussion and Conclusion. There was significant correlation between pre-op (0.4mm) and post-op (0.4mm) distances between the AHLM and the centre of the ACL footprint/graft. There was significant inter-observer correlation (paired T-test =0.89, p<0.05) in pre- and post-op measurements. No significant difference was found in the difference between the means in pre-op and post-op MRI scans between observers (p=0.79). These results suggest that the AHLM is a reliable and valid intra-operative marker for anatomic ACL tibial tunnel placement

Introduction: The Collagen Meniscus Implant (CMI) has been shown to be effective for the replacement of lost medial meniscus tissue; however, no such device has been available for treatment of similar injuries to the lateral meniscus. Loss of the lateral meniscus results in a rapidly increased rate of knee degeneration compared to similar medial injuries. The purpose of this study was to determine if a CMI developed for use in treatment of lateral meniscus deficiencies is as safe and effective as has been reported for the medial CMI. Methods: Prospectively, 60 patients (12–65 years of age) were enrolled at 7 sites between March 2006 and October 2007. Patients had irreparable lateral meniscus tears requiring partial meniscectomy. The knee had to be ligamentously stable and in neutral alignment and with no untreated Grade IV cartilage damage. Patients gave informed consent and agreed to comply with postoperative assessments and standardized rehabilitation. The surgical technique involved insertion of the dry implant into the lateral compartment of the knee joint. Fixation of the implant to the host meniscus rim was accomplished with either an all-inside suture technique or a hybrid all-inside/inside-out technique. Clinical evaluations and patient self-assessments were conducted preoperatively and at defined intervals through 2 years postoperatively. Procedure specific intraoperative parameters, radiographic evaluations, and adverse events were documented. Data collection was monitored by a third party according to GCP regulations. Results: 49 patients received a lateral CMI. Currently, 24 patients have 1-year follow-up and 13 patients have been followed approximately 2 years; the mean follow-up is 22 months. Follow-up included assessments of changes in Lysholm, pain, Tegner and patient satisfaction. All patients showed clinical improvement from the preoperative to the 1 year postoperative time points. Four patients experienced adverse events which required an additional arthroscopic procedure between 4 and 16 months and included removal of implant remnants, synovectomy and debridement. Conclusions: These preliminary results appear to suggest that implantation of lateral CMI leads to improved clinical outcomes in pain, function, self-assessment and activity levels. Frequency and type of adverse events are comparable to those for suture repair reported in the literature. Based on results reported for the medical CMI, we anticipate that these lateral CMI patients will have improved long-term results compared to partial lateral meniscectomy

INTRODUCTION. The purpose of this study is to report results from a prospective multicenter study of a bioresorbable type I collagen scaffold used to replace tissue loss following irreparable lateral meniscus injuries. METHODS. 49 non-consecutive patients (33M/16F; mean age 30.5 yrs, range 14.7–54.7 yrs) with irreparable lateral meniscus tears or loss requiring surgical treatment were prospectively enrolled at one of 7 EU centers. 11 patients (22%) had acute injuries of the lateral meniscus, while 38 (78%) had prior surgeries to the involved meniscus. Implantation of the LCMI (now Lateral Menaflex) was performed arthroscopically using an all-inside suturing technique (FASTFIX) combined with inside-out sutures in the more anterior meniscus aspect. Forty-three patients were evaluated with a 2 to 4-year follow-up (FU); mean FU duration was 45 months (range, 33–53 m). Patients were evaluated clinically and by self-assessment using Tegner activity and Lysholm function scores, as well as the Visual Analog Scales (VAS) for pain, and a satisfaction questionnaire. Evaluations were performed pre-operatively, 6 months, 1 year, 2 and 4 years after surgery. X-ray and/or MR-images were taken pre-operatively, and at 1 year and 2 years after surgery. RESULTS. At 3 months after surgery, all patients were able to return to activities of daily living without limitation. Post-op. mean values of all evaluated patients showed statistically significant improvement compared to the preoperative scores. Mean Tegner scores increased from 3.0 to 5.2 at 4 years (0.8 points less than the pre-injury “recall” value); mean Lysholm improved from 63 to 91; mean pain (VAS) decreased from 36 to 8. At the 4-year time point, 86% of the patients stated that they were satisfied with their results (compared to 78% at the one year FU time point). Function and pain scores improved continuously with the highest score at the latest FU evaluation. All data were statistically significant (p<0.001, except for Tegner with p=0.03). MRI examination revealed no changes to the articular cartilage and joint space; however, the newly formed tissue did not present a signal consistent with fully mature native meniscus tissue. Reoperations were necessary in 5 patients (10%) during the FU time period: 3 of the reoperations were for persistent swelling and pain, which were classified as related to the device (6%) and were treated by synovectomy and debridement. Patients recovered without sequelae. The re-op. rate in this series is comparable to re-op. rates reported after lateral meniscal repair. DISCUSSION. Based on available results with a minimum 2 year FU, 90% of the patients benefited from the Lateral Menaflex as evidenced by improved clinical outcomes associated with gains in activity and function. Longer-term FU continues to determine the extent and duration of the benefits observed

Purpose: The purpose of this study was to review the clinical results of a series of 108 children treated artroscopically for symptomatic discoid lateral menisci.

Methods: The medical records of more than 100 consecutive patients who underwent arthroscopic treatment for symptomatic discoid meniscus between 1990 and 2005 were reviewed.

Results: The mean patient age was 8.7 years (range, 2,5 to 14 years), with 55% female and 45% male patients. The mean duration of symptoms before surgery was 20 months (range, 2 to 48 months), with 95% having pain and 38% having mechanical impingment. All patients were treated arthroscopically. Partial or subtotal arthroscopic meniscectomy was performed. Operative classification of the menisci revealed 64 complete, 18 Wrisberg type and 26 incomplete discoid menisci, with meniscal tears being present in 48 knees (45%). At final follow-up, all patients exhibited full knee flexion beyond 135 degrees. Three patients reported residual knee pain, and four reported intermittent mechanical symptoms. At final follow-up, 3 years minimum, according to Ikeuchi clinical score more than 50 % of the patients were considered very good and 25 % good. Only 8 patients felt that their activity level remained partially limited.

Conclusions: Our results show the middle-term efficacy of arthroscopic partial or subtotal meniscectomy in cases of symptomatic lateral discoid menisci. Arthroscopic partial meniscectomy is preferrable only when the posterior attachment of the discoid meniscus is stable. A total meniscectomy is indicated for the Wrisberg-ligament type of discoid meniscus and when the meniscus is completely degenerated. This to our knowledge is the largest series of discoid lateral menisci arthroscopically treated.

Level of evidence: Level IV, therapeutic case series.

Abstract. Introduction. Meniscal repair is an accepted surgical option for meniscal tears. However, there remains trepidation with regard to offering such surgery to older patients. We aim to evaluate the outcomes in these such patients. Methodology. A single surgeons log was used to identify patients who underwent meniscal repair and were over the age of 40. Patients having concurrent anterior cruciate ligament reconstructions were excluded. Demographic data, surgical data and outcomes (pain visual analogue score (VAS); single assessment numerical evaluation (SANE) and knee injury and osteoarthritis outcome joint replacement (KOOS Jr) score) were collected prospectively. Final outcomes were collected between 6–12 months following surgery. Results. 24 meniscal tears in 22 knees (22 patients) were identified. Mean age was 52.2 (range; 40.6-70.3). Morphology of the tears were medial meniscus posterior root tear 10 (42%); medial meniscus posterior horn tear 9 (38%); lateral meniscus posterior horn tear 2 (8.3%); lateral meniscus posterior root tear 1 (4.2%); lateral meniscus body tear 1 (4.2%) and lateral meniscus anterior horn tear 1 (4.2%). Response rate was 86%. Statistically significant improvements in pain VAS (p=0.0001); SANE (p=0.0001) and KOOS Jr Score (p=0.0005) were found. 68% and 74% of patients had surpassed the MCID in their KOOS symptoms and KOOS quality of life subscales, respectively. Conclusion. Meniscal repair in patients over 40 years of age is an acceptable treatment with significant improvements in patients reported outcome measures, SANE and pain VAS

Aims. The aim of this study was to compare patient-reported outcomes (PROMs) following isolated anterior cruciate ligament reconstruction (ACLR), with those following ACLR and concomitant meniscal resection or repair. Methods. We reviewed prospectively collected data from the UK National Ligament Registry for patients who underwent primary ACLR between January 2013 and December 2022. Patients were categorized into five groups: isolated ACLR, ACLR with medial meniscus (MM) repair, ACLR with MM resection, ACLR with lateral meniscus (LM) repair, and ACLR with LM resection. Linear regression analysis, with isolated ACLR as the reference, was performed after adjusting for confounders. Results. From 14,895 ACLR patients, 4,400 had two- or five-year Knee injury and Osteoarthritis Outcome Scores (KOOS) available. At two years postoperatively, the MM repair group demonstrated inferior scores in KOOS pain (β = −3.63, p < 0.001), symptoms (β = − 4.88, p < 0.001), ADL (β = − 2.43, p = 0.002), sport and recreation (β = − 5.23, p < 0.001), quality of life (QoL) (β = − 5.73, p < 0.001), and International Knee Documentation Committee (β = − 4.1, p < 0.001) compared with the isolated ACLR group. The LM repair group was associated with worse KOOS sports and recreation scores at two years (β = − 4.264, p < 0.001). At five years, PROMs were comparable between the groups. At five years, PROMs were comparable between the groups. Participants undergoing ACLR surgery within 12 weeks from index injury demonstrated superior PROMs at two and five years. Conclusion. Our study showed that MM repair, and to a lesser extent LM repairs in combination with ACLR, were associated with inferior patient-reported outcome measures (PROMs) compared to isolated ACLR at two years postoperatively, while meniscal resection groups exhibited comparable outcomes. However, by five years postoperation, no significant differences in PROMs were evident. Further longer-term, cross-sectional studies are warranted to investigate the outcomes of ACLR and concomitant meniscal surgery

Validation of a new meniscal root repair technique that will be biomechanically superior to current gold standard procedures and, at the same time, will allow controlled adjustable fixation. Medial and lateral meniscus from 10 porcine knees were collected. An iatrogenic posterior root tear was created and a single transosseous tibial tunnel technique that closely replicates the repair procedure with a 2-mm-wide-knottable braided tape was performed. Randomly, in one group (A) two simple cinch stitch were applied to suture the posterior root of the meniscus and, in the other group (B), a simple stich that holds the meniscus in two points in a crosse match configuration was used. For final fixation, alternating surgeon's knots (A group) and a doubled suture knot that allows an adjustable fixation were used (B group). All repairs were standardized for location and the repair stiches were placed in the body of the meniscus. The new suture configuration (B group) showed a better biomechanical performance in terms of load for both the medial [151,0-560,3] 306,9±173,8N and the lateral posterior root fixation [268,2-463,1] 347,4±74,3N in comparison to the cinch stitch (A group) [219,0-365,2] 268,9±58,7N and [219,0-413,6] 318,0±72N. The maximum stiffness was also higher for the new tested suture configuration (B group) for both the medial meniscus [10,6-34,5] 18,9±9,2N/mm vs [7,1-12,7] 10,9±2,2N/mm and the lateral meniscus [16,0-27,9] 21,6±5,5N/mm vs [7,6-15,6] 12,6±3,5N/mm. The presented new meniscal root repair is biomechanically superior to current gold standard techniques, as the cinch stich made with tape, keeping the simplicity and reproducibility of the procedure and, at the same time, is economically advantageous since a single tape in needed and allows adjustable fixation of the repair over a button

Meniscal tears commonly co-occur with ACL tears, and many studies address their side, pattern, and distribution. Few studies assess the patient's short-term functional outcome concerning tear radial and circumferential distribution based on the Cooper et al. classification. Meniscal tears require primary adequate treatment to restore knee function. Our hypothesis is to preserve the meniscal rim as much as possible to maintain the load-bearing capacity of the menisci after meniscectomy. The purpose of this study is to document the location and type of meniscal tears that accompany anterior cruciate ligament (ACL) tears and their effect on patient functional outcomes following arthroscopic ACL reconstruction and meniscectomy. This prospective cross-sectional observational study was conducted at AL-BASRA Teaching Hospital in Iraq between July 2018 and January 2020 among patients with combined ipsilateral ACL injury and meniscal tears. A total of 28 active young male patients, aged 18 to 42 years, were included. All patients were subjected to our questionnaire, full history, systemic and regional examination, laboratory investigations, imaging studies, preoperative rehabilitation, and were followed by Lysholm score 6 months postoperatively. All 28 patients were males, with a mean age of 27 ± 0.14 years. The right knee was the most commonly affected in 20/28 patients (71.4%). The medial meniscus was most commonly injured in 11 patients, 7 patients had lateral meniscal tears, and 10 patients had tears in both menisci. The most common tear pattern of the medial meniscus was a bucket handle tear (36.4%), while longitudinal tears were the most frequent in the lateral meniscus (71.4%) (P-value = 0.04). The most common radial tear location was zone E-F (5/28, 17.8%), and the most common circumferential zone affected was the middle and inner third, reported in 50% of tears. Good and excellent outcomes using the Lysholm score after 6 months were obtained in 42.9% and 17.9% of patients, respectively. Better functional scores were associated with lateral meniscal tears, bucket handle tears, tears extending to a more peripheral vascular area, and if no more than one-third of the meniscus was resected (P-value = 0.002). Less favourable outcomes were reported in smokers, posterior horn tears, and when surgery was delayed more than 1 year (P-value = 0.03). We conclude that there is a negative correlation between the amount of meniscus resected and functional outcome. Delayed ACL reconstruction increases the risk of bimeniscal tears. Bucket handle tears are the most common tears, mostly in the medial meniscus, while longitudinal tears are most common in the lateral meniscus. We recommend performing early ACL reconstruction within 12 months to reduce the risk of bimeniscal injuries

Although remnant-preserved ACL reconstruction (ACLR) restores knee joint stability and dampens the problem of acute ACL rupture-induced knee pain, an increasing number of patients still develop post-traumatic osteoarthritis (PTOA) after 10 to 15 years of ACLR. We previously found that remnant-preserved ACLR with concomitant medial and lateral meniscus repair may not prevent cartilage degeneration and weaken muscle strength, while the clinical features of PTOA are not clear. We hypothesized that remnant-preserved ACLR with concomitant medial and lateral meniscus tears is related to early cartilage damage, worse function recovery, patient-reported outcomes (PROs) and delayed duration to return to sports. The aim is to evaluate the remnant-preserved ACLR with complicated meniscal injuries in predicting which patients are at higher risk of osteoarthritic changes, worse function and limited activities after ACLR for 12 months. Human ethical issue was approved by a committee from Xi'an Jiaotong University. 26 young and active patients (24 male, 2 female) with ACL injuries (Sherman type I and II) with concomitant medial and lateral meniscus within 2 months were included from January 2014 to March 2022. The average age of the ACLR+ meniscus repair was 26.77±1.52 (8 right, 5 left) and isolated ACLR control was 31.92±2.61 years old (7 left, 6 right). Remnant-preserved ACLR with a 5- to 6-strand hamstring tendon graft was operated on by the same sports medicine specialists. MRI CUBE-T. 2. scanning with 48 channels was conducted by a professional radiologist. The volume of the ACL graft was created through 3 dimensional MRI model (Mimics 19, Ann Arbor). Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS) was applied to score visible cartilage damage. IKDC 2000 score and VAS were assessed by two blinded researchers. Results were presented as mean± SEM of each group. The cross-sectional area and 3D volume of the ACL graft were greater in the remnant-preserved ACLR+meniscus group compared with isolated ACLR (p=0.01). It showed that ACLR+ meniscus group had early signs of joint damage and delayed meniscus healing regarding ACLOAS compared to control group (p=0.045). MRI CUBE-T. 2. prediction of radiographic cartilage degeneration was not obvious in both groups post remnant-preserved ACLR over 12 months (p>0.05). However, higher VAS scores, lower IKDC scores, and long-last joint swelling were reported in the ACLR+ meniscus repair group at the end of 12 months follow-up. Although remnant-preserved ACLR+ meniscus was able to maintain the restore the knee function, it showed delayed timing (>12 months) to return to play at the pre-injury stage, while no difference between the timing of returning to the normal daily routine of their ACLR knee compared to control (p=0.30). The cost of ACLR+ meniscus (average 10,520.76$) was higher than the control group (6,452.92$, p=0.018). Remnants-preserved ACLR with concomitant injured medial and lateral meniscus repair shows a higher risk of cartilage damage, greater cost, worse functional performance, and longer time for young male patients to return to sports after 12-month follow-up compared to isolated ACLR. Further evidence and long-term follow-up are needed to better understand the association between these results and the risk of development of PTOA in this patient cohort

Discoid meniscus (DM) is a congenital variant of the knee joint that involves morphological and structural deformation, with potential meniscal instability. The prevalence of the Discoid Lateral Meniscus (DLM) is higher among the Asians than among other races, and both knees are often involved. Meniscal pathology is widely prevalent in the adult population, secondary to acute trauma and chronic degeneration. The true prevalence in children remains unknown, as pathologies such as discoid menisci often go undiagnosed, or are only found incidentally. A torn or unstable discoid meniscus can present with symptoms of knee pain, a snapping or clicking sensation and/or a decrease in functional activity, although it is not known if a specific presentation is indicative of a torn DM. While simple radiographs may provide indirect signs of DLM, magnetic resonance imaging (MRI) and arthroscopy is essential for diagnosis and treatment planning. Asymptomatic patients require close follow-up without surgical treatment, while patients with symptoms often require surgery. Partial meniscectomy is currently considered the treatment of choice for DLM. For children are more likely to achieve better results after partial meniscectomy