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

Aims

Sagittal plane imbalance (SPI), or asymmetry between extension and flexion gaps, is an important issue in total knee arthroplasty (TKA). The purpose of this study was to compare SPI between kinematic alignment (KA), mechanical alignment (MA), and functional alignment (FA) strategies.

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

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

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

The October 2023 Children’s orthopaedics Roundup. 360. looks at: Outcomes of open reduction in children with developmental hip dislocation: a multicentre experience over a decade; A torn discoid lateral meniscus impacts lower-limb alignment regardless of age; Who benefits from allowing the physis to grow in slipped capital femoral epiphysis?; Consensus guidelines on the management of musculoskeletal infection affecting children in the UK; Diagnosis of developmental dysplasia of the hip by ultrasound imaging using deep learning; Outcomes at a mean of 13 years after proximal humeral fracture during adolescence; Clubfeet treated according to Ponseti at four years; Controlled ankle movement boot provides improved outcomes with lower complications than short leg walking cast

Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular augmentation, and/or osteotomy. Although revision ACLr reliably restores knee stability and function, clinical outcomes and reoperation rates are worse than for primary ACLr.

Cite this article: Bone Joint J 2023;105-B(5):474–480.

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

Aims

To fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle.

Abstract. Introduction. The popularity of all-inside meniscal repair devices has led to a shift away from inside-out meniscus repair without comparative studies to support the change. The aim of this study was to compare the failure rate and time to failure of all-inside and inside-out meniscus repair performed in elite athletes. Methodology. A retrospective review was performed of all elite athletes who underwent meniscal repair, with a minimum of two-year follow-up between 2013 and 2019. Repairs were classified as all-inside or inside-out according to the repair technique. Failure was defined as undergoing a subsequent surgery to address a persistent meniscal tear. Results. 192 (135 lateral and 57 medial) meniscal repairs in elite athletes were included and 41 (21%) failed. Medial meniscus tears repaired with the all-inside technique failed at a significantly higher rate (58%) than medial meniscus tears repaired with the inside-out (23%) or lateral meniscus tears repaired with the all-inside (12%) or inside-out (14%) technique (p<.001). At 1 year following repair, 8% of lateral meniscus repairs had failed regardless of technique. Medial meniscus repairs failed at an approximate rate of 15% for inside-out technique and 42% for all-inside technique. By 2 years, approximately 54% of all-inside medial meniscus repairs had failed and by 5 years over 60% of repairs had failed. Conclusion. All-inside medial meniscal repair led to a higher rate of failure compared to inside-out medial or lateral meniscus repair in elite athletes. Medial meniscus repairs failed at a high rate than lateral meniscal repairs

Abstract. Introduction. The outcome of revision anterior cruciate ligament reconstruction (ACL-R) is guarded, particularly their return to sports activities. It is important to know the factors affecting the functional outcomes following a revision ACL-R. Methods. We analysed results from 39 patients, who underwent a revision ACL reconstruction by a single surgeon and was followed up over a year. Some of them were treated in 2-stage revision while the rest were single-stage revision, depending upon their size of bone tunnel or osteolysis as assessed by pre-operative CT scan. Result. We analysed data from 39 patients with a mean age of 31 (17–52) and an average follow-up of 3.6 years (2–5 years). The average KOOS quality of life score was 58.94 (±23.02) and the mean Lysholm score was 89.48 (±10.1). Medial meniscal tear was significantly correlated with Lysholm score (p<0.005), but not with KOOS-QOL. Tear in lateral meniscus was not related significantly. Patients having Grade II or above cartilage damage showed inferior outcomes in terms of Lysholm score and poor return to sports, and it was statistically significant (p<0.02). There was no significant differences in outcomes between single stage revision and 2-stage revision (p=0.336). 15 patients (42.5%) returned to their pre-injury sports activities after revision surgery with the mean return to sports score of 58.65 (±16.1). Conclusions. The long-term functional outcome after revision ACL reconstruction is satisfactory, but not the return to sports. Expectations on outcome should be carefully managed particularly those having concomitant medial meniscal injury or cartilage damage

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

Abstract. Introduction. High posterior tibial slope (PTS) has been recognised as a risk factor for anterior cruciate ligament rupture and graft failure. This prospective randomised study looked at intra-operative findings of concomitant intra-articular meniscal and chondral injuries during a planned ACL reconstruction. Material and Methods. Prospective data was collected as part of a randomised trial for ACL reconstruction techniques. Intra-operative data was collected and these findings were compared with the PTS measured on plain radiograph by a single person twice through a standardised technique and intra-observer analysis was performed. Results. 49 confirmed ACL rupture patients were in the trial. The average age was 34 (23–66) years and 12 patients were female. 17 patients (34%) had PTS of 12 degrees or more. The intra-observer analysis for PTS measurements in a 2-sided paired T test, showed a mean difference of 0.03 degrees with a P value = 0.83. 23 patients had medial meniscal pathology identified, 15 (65%) had a PTS <12 degrees. 16 patients had lateral meniscus pathology and 9 (56%) had a PTS <12 degrees. Chondral damage did not appear significantly different in the two groups (<12 degrees 15% vs >12 degrees 23%). Conclusion. In this sample, a PTS >12 degrees was not associated with a higher incidence of meniscal or chondral damage after a confirmed ACL rupture

Aims

Anterior cruciate ligament (ACL) rupture commonly leads to post-traumatic osteoarthritis, regardless of surgical reconstruction. This study uses standing MRI to investigate changes in contact area, contact centroid location, and tibiofemoral alignment between ACL-injured knees and healthy controls, to examine the effect of ACL reconstruction on these parameters.

Aims

Meniscal injuries are common and often induce knee pain requiring surgical intervention. To develop effective strategies for meniscus regeneration, we hypothesized that a minced meniscus embedded in an atelocollagen gel, a firm gel-like material, may enhance meniscus regeneration through cell migration and proliferation in the gel. Hence, the objective of this study was to investigate cell migration and proliferation in atelocollagen gels seeded with autologous meniscus fragments in vitro and examine the therapeutic potential of this combination in an in vivo rabbit model of massive meniscus defect.

Recent findings have identified the importance of previously undiagnosed or neglected meniscus lesions in association with anterior cruciate ligament (ACL) injuries (e.g. medial meniscus ramp lesions and posterior root tears of the lateral meniscus). There is increasing biomechanical evidence that they bear the potential to alter both anteroposterior and rotational laxity patterns in ACL injured knees. Few data exist with respect to the presence of these specific tear entities in large series of ACL injured patients. The purpose of the study was to analyze the meniscus tear pattern in a series of ACL injured knees with a special focus on ramp lesions of the medial meniscus and posterior root lesions of the lateral meniscus. The hypothesis was that a significant number of ACL injured patients would display these types of lesions. Data from 358 patients undergoing an ACL reconstruction (227 males /131 females, age: 28±10) were extracted from a center-based registry. The type of ACL tear (partial versus complete) as well as the presence of associated meniscus lesions were documented. Meniscus lesions were classified into the following categories: medial ramp lesions, lateral root lesions, medial ramp and lateral root lesion, other medial meniscus injuries, other lateral meniscus injuries, other bimeniscal injuries. Chi-square tests were used to determine whether the percentage of meniscal lesions differed between types of ACL tear, gender and age (below 21, 21–35, above 35). Significance was set at p < 0.05. Isolated ACL tears were present in 107 (30%) of the operated knees (31 partial; 327 complete). Complete ACL lesions were more likely to present an associated meniscus injury (321 out of 327, 71%) than partial tears (13 out of 31, 42%). The incidence of meniscus injuries which are associated with ACL tears is very high (70%). Previously undiagnosed or neglected meniscus injuries like medial ramp or lateral root tears could be identified in 35% of patients. As such, the hypothesis was confirmed that an important amount of ACL injured knees display this specific intraarticular soft tissue damage. A systematic evaluation of these lesions under arthroscopy should thus be performed and specific repair needs to be evaluated

Several studies have highlighted the relationship between anterior cruciate (ACL) injury and knee geometry particularly tibial slope (TS). However, clinical data are inconsistent, whether the lateral or medial or slopes have a different influence on ACL injury. Our goal was to assess whether the medial, lateral slopes are associated with ACL injury and whether meniscus geometry is associated with ACL injury. In addition, we sought to determine if lateral meniscal height could serve as a simple surrogate measurement for ACL injury risk. A case-controlled study compared 68 patients with an ACL injury and 68 matched nested controls. Radiological analysis of MRI measured the anterior-posterior distance of the medial and lateral plateaus, the tibial slope of both plateaus and meniscus geometry. Groups were compared using a Mann-Whitney test and α < 0 .05. The lateral tibial plateau slope was significantly higher in the ACL injured group (6.92 degrees ±5.8) versus the control group 2.68 ±5.26 (p 0.0001). In addition, the lateral meniscal slope was significantly steeper with (ACL injuries: −1 ±4.7 versus −4.73 ±4.4 (p 0.0001) in the control group. The ACL Injured group had a significantly lower lateral meniscal height 0.76 cm ±0.09, compared to the control group that has 0.88 cm ±0.12 (p 0.0001). The Lateral meniscal height had a sensitivity of 76.47% and specificity 75% for predicting ACL injury using a cut off of. Patients with ACL-injury had significantly higher lateral tibial plateau slope. Lateral meniscus height was found to be an easy measurement to make on MRI with a high specificity for predicting ACL injury. Lateral tibial slope and meniscal Geometry can be used to identify patients with high risk of an ACL injury, that might benefit from further surgery to optimize rotational stability in high-risk patients

Aims

Mobile-bearing unicompartmental knee arthroplasty (UKA) with a flat tibial plateau has not performed well in the lateral compartment, leading to a high rate of dislocation. For this reason, the Domed Lateral UKA with a biconcave bearing was developed. However, medial and lateral tibial plateaus have asymmetric anatomical geometries, with a slightly dished medial and a convex lateral plateau. Therefore, the aim of this study was to evaluate the extent at which the normal knee kinematics were restored with different tibial insert designs using computational simulation.