Anterior Cruciate Ligament Reconstruction with Internal Brace Augmentation Results in Fewer Reruptures Compared to Reconstruction without Augmentation.

 To compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction using autografts with and without internal brace augmentation.  Data from patients who underwent ACL reconstruction with hamstring and quadriceps tendon autografts, with a minimum follow-up of one year, with or without internal brace augmentation were collected prospectively analyzed retrospectively. The Lysholm and Tegner functional scores were collected before and after surgery, as well as data on postoperative complications.

New Graft Choices for ACL Reconstruction: Update Article.

Reconstruction of the anterior cruciate ligament (ACL) is a common procedure for injuries to this ligament, especially in athletes. There are different types of grafts used, and the choice depends on several factors. Autologous grafts, from the patients themselves, are the most common option, with rapid incorporation and a lower failure rate.

Larger Chondral Lesions Treated with Collagen Membrane - Matrix-Induced Autologous Chondrogenesis - Show Larger Increase in Clinical Scores.

 To evaluate clinically and radiologically the results of the treatment of chondral lesions using collagen membrane - autologous matrix-induced chondrogenesis (AMIC).  This is a series of observational cases, in which 15 patients undergoing AMIC were analyzed. The clinical evaluation was made by comparing the Lysholm and International Knee Document Commitee (IKDC) scores in the pre- and postoperative period of 12 months, and radiological evaluation using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score in the same postoperative period.

Comparative Study of the Function and Quality of Life of Patients Submitted to Total Knee Arthroplasty with Fixed and Mobile Tibial Platforms.

 To compare the function and quality of life of patients undergoing total knee arthroplasty (TKA) with fixed tibial platform and mobile tibial platform.  We evaluated 240 patients with knee osteoarthritis, randomized into two groups - Group A consisted of 120 patients who underwent TKA with fixed tibial platform, and the B group, consisting of 120 patients who underwent mobile platform arthroplasty. Patients were accessed according to the function and quality of life by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Short Form Health Survey (SF-36), and pain scores by visual analog scale (VAS) of pain, preoperatively and at 6 months, 1 year, 2 years, 4 years and 8 years of surgery.

Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: a biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion.

Purpose: The primary objective of this study is to evaluate the contact areas, contact pressures, and peak pressures in the medial compartment of the knee in six sequential testing conditions. The secondary objective is to establish how much the medial meniscus is able to extrude, secondary to soft tissue injury while keeping its roots intact.

Methods: Ten cadaveric knees were dissected and tested in six conditions: (1) intact meniscus, (2) 2 mm extrusion, (3) 3 mm extrusion, (4) 4 mm extrusion, (5) maximum extrusion, (6) capsular based meniscal repair.

Small lateral meniscus tears propagate over time in ACL intact and deficient knees.

Purpose: To quantify propagation of small longitudinal tears in the lateral meniscus in ACL intact and deficient knees.

Methods: Using a robotic testing system, 5-Nm of external tibial torque + 5-Nm of valgus torque + 250-N of axial compression was applied to 14 fresh-frozen cadaveric knees while the knees were flexed from 30° to 90°. Knees were divided into two groups: intact (N = 8) and ACL deficient (N = 6).

Preoperative Meniscal Extrusion Predicts Unsatisfactory Clinical Outcomes and Progression of Osteoarthritis after Isolated Partial Medial Meniscectomy: A 5-Year Follow-Up Study.

The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outcomes and progression of osteoarthritis and to determine the extent of meniscal extrusion associated with unsatisfactory clinical outcomes and progression of osteoarthritis. Ninety-five patients who underwent partial medial meniscectomy with a minimum follow-up of 5 years were retrospectively reviewed. Preoperative meniscal extrusion was evaluated with magnetic resonance imaging.

Medial Opening Wedge High Tibial Osteotomy Decreases Medial Meniscal Extrusion and Improves Clinical Outcomes and Return to Activity.

Background: Medial meniscal extrusion (MME) is defined as displacement of the meniscus that extends beyond the tibial margin. Knee varus malalignment increases MME.

Purpose/hypothesis: The purpose of this study was to quantify MME before and after medial opening wedge high tibial osteotomy (HTO) and to correlate the reduction of MME with clinical outcomes and return to activity.

THE 50 MOST CITED ARTICLES IN THE BRAZILIAN MEDICAL LITERATURE ON KNEE SURGERY.

Objective: To provide an analysis of the 50 most cited articles on knee surgery in the Brazilian medical literature.

Methods: This is a study of systematic review and meta-analysis, level of evidence 3. It was carried out through search in the SCOPUS database to identify scientific articles published in the Brazilian medical literature.

Does Lateral Extra-articular Tenodesis of the Knee Affect Anterior Cruciate Ligament Graft In Situ Forces and Tibiofemoral Contact Pressures?

Purpose: To quantify the effects of lateral extra-articular tenodesis (LET) on tibiofemoral compartment contact area and pressures, knee kinematics, and forces.

Methods: Nine cadaveric knees were tested using a robotic testing system. Two loading conditions, (1) anterior tibial translational load coupled with axial compression and (2) internal tibial torque coupled with axial compression, were applied for each knee state at full extension and 30°, 60°, and 90° of knee flexion.

Partial Lateral Meniscectomy Affects Knee Stability Even in Anterior Cruciate Ligament-Intact Knees.

Background: The effects of a partial lateral meniscectomy on knee kinematics and forces in the lateral meniscus are critical to understand. The purpose of this study was to quantify the effects of varying sizes of partial lateral meniscectomies of the posterior horn and a total lateral meniscectomy on knee kinematics and resultant forces in the lateral meniscus.

Methods: Using a robotic testing system, loads (134-N anterior tibial load + 200-N axial compression, 5-Nm internal tibial torque + 5-Nm valgus torque, and 5-Nm external tibial torque + 5-Nm valgus torque) were applied to 10 fresh-frozen cadaveric knees.

Pediatric Anterior Cruciate Ligament Reruptures Are Related to Lower Functional Scores at the Time of Return to Activity: A Prospective, Midterm Follow-up Study.

Background: Skeletally immature patients show a higher rate of anterior cruciate ligament (ACL) reruptures. A better understanding of the risk factors for an ACL rerupture in this population is critical.

Purpose/hypothesis: The objective of this study was to analyze preoperative, intraoperative, and postoperative characteristics of pediatric patients undergoing ACL reconstruction and determine the relationship of these factors with an ACL rerupture.

Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament.

Background: Meniscal ramp lesions are possible concomitant injuries in cases of anterior cruciate ligament (ACL) deficiency. Although recent studies have investigated the influence of ramp lesions on knee kinematics, the effect on the ACL reconstruction graft remains unknown.

Purpose/hypothesis: The purpose was to determine the effects of ramp lesion and ramp lesion repair on knee kinematics, the in situ forces in the ACL, and bony contact forces.

Lateral Meniscal Allograft Transplantation With Bone Block and Suture-Only Techniques Partially Restores Knee Kinematics and Forces.

Background: The ability of lateral meniscal allograft transplantation (MAT) to improve knee stability and the meniscal load-bearing function in patients after meniscectomy is critical for surgical success.

Purpose: To compare the effects of 2 lateral MAT fixation techniques-bone block and suture only-on knee kinematics and forces.

Study Design: Controlled laboratory study.

ASSESSMENT OF THE REGENERATION CAPACITY OF SEMITENDINOSUS AND GRACILIS TENDONS.

Objectives: To evaluate the regenerative capacity of gracilis (G) and semitendinosus (ST) tendons, to examine the sensitivity and specificity of signs and symptoms in the assessment of hamstring tendons, and to assess the thickness and insertion site of regenerated tendons.

Methods: Thirty sequential knees were subjected to anterior cruciate ligament reconstruction with semitendinosus and gracilis tendons. After surgery, the patients were followed up clinically with physical examination and magnetic resonance imaging (MRI).

Higher Axial Tibiofemoral Rotation and Functional Outcomes with Mobile-Bearing Compared with Fixed-Bearing Total Knee Arthroplasty at 1- but Not at 2-Year Follow-Up-A Randomized Clinical Trial.

The objective of this study was to determine in vivo knee kinematics and clinical outcomes of patients who underwent fixed- and mobile-bearing total knee arthroplasty (TKA) at 1- and 2-year follow-up. This prospective double-blinded randomized controlled trial was performed from November 2011 to December 2012. A total of 64 patients were randomized to fixed- and mobile-bearing TKA groups (32 patients in each group).

Long-Term Survival Analysis and Outcomes of Meniscal Allograft Transplantation With Minimum 10-Year Follow-Up: A Systematic Review.

Purpose: To investigate the long-term survivorship rates and functional outcomes of meniscal allograft transplantation (MAT) in patients with minimum 10-year postoperative follow-up.

Methods: Two reviewers independently searched EMBASE, MEDLINE, and PubMed from database inception for literature related to MAT according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Data are reported in a narrative summary fashion with descriptive statistics.

The effect of adipose-derived stem cells on enthesis healing after repair of acute and chronic massive rotator cuff tears in rats.

Background: Chronic massive rotator cuff tears heal poorly and often retear. This study investigated the effect of adipose-derived stem cells (ADSCs) and transforming growth factor-β3 (TGF-β3) delivered in 1 of 2 hydrogels (fibrin or gelatin methacrylate [GelMA]) on enthesis healing after repair of acute or chronic massive rotator cuff tears in rats.

Methods: Adult male Lewis rats underwent bilateral transection of the supraspinatus and infraspinatus tendons with intramuscular injection of botulinum toxin A (n = 48 rats).

Static Lateral Tibial Plateau Subluxation Predicts High-Grade Rotatory Knee Laxity in Anterior Cruciate Ligament-Deficient Knees.

Background: In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphologic features have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated.

Purpose: To determine whether static tibial subluxation as measured on magnetic resonance imaging (MRI) is associated with the grade of rotatory knee laxity in ACL-D knees.

Ultrasonography for evaluation of hamstring tendon diameter: is it possible to predict the size of the graft?

Objective: Perform the preoperative measurement of the hamstring tendons using ultrasound imaging, validating and correlating the measured value with that found during surgical reconstruction of the ligament.

Methods: A cross-sectional study was carried out with 24 patients who underwent ultrasonographic measurement of the semitendinosus and gracilis muscle tendons and were subsequently submitted to surgical reconstruction of the ACL, with ipsilateral semitendinosus and gracilis tendon grafting.

Results: The patients' ages ranged from 16 to 43 years, with a mean of 24.

Bone Bruise Patterns in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: Shock-Absorbing Function of the Physis.

Background: Bone bruises are frequently found on magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) injury and have been related to the force associated with the trauma. Yet, little is known about the bone bruise distribution pattern of skeletally immature (SI) patients, as the presence of an open physis may play a role in energy dissipation given its unique structure.

Purpose: To describe and compare the location and distribution of tibial and femoral bone bruises, observed on MRI, between 2 groups of ACL-injured knees: the first group with an open physis and the second with a closed physis.

The Role of Osteotomy for the Treatment of PCL Injuries.

Purpose Of Review: The purposes of this review are to (1) describe the anatomic and biomechanical rationale for high tibial osteotomy (HTO) in the setting of posterior cruciate ligament (PCL) deficiency, (2) review the indications for concomitant HTO and PCL reconstruction, (3) provide guidance for the clinical assessment of the patient with suspected PCL deficiency, and (4) summarize the key surgical steps necessary to attain the appropriate sagittal and coronal plane corrections.

Recent Findings: The preponderance of available biomechanical data pertaining to the PCL-deficient knee suggests that an increased proximal tibial slope limits posterior tibial translation under axial compressive loads. Moreover, recent clinical data has demonstrated that decreased proximal tibial slope may exacerbate residual anterior-posterior laxity and jeopardize the durability of PCL reconstruction.

Higher Gene Expression of Healing Factors in Anterior Cruciate Ligament Remnant in Acute Anterior Cruciate Ligament Tear.

Background: Anterior cruciate ligament (ACL) reconstruction with remnant preservation has been described and related to potential advantages. Literature is lacking regarding gene expression of potential factors related to ligament healing in the ACL remnant and its relation to time from injury.

Hypothesis: The mRNA expression of ligament healing factors in the ACL remnant would be higher in acute tears (<3 months from injury) than in intermediate (3-12 months) and chronic (>12 months) injuries.