Subjective Outcomes After Allograft Reconstruction and Nonoperative Treatment of Anterior Cruciate Ligament Ruptures Are Similar in Patients Aged 40 Years and Older: A 2:1 Propensity Score-Matched Analysis.

Purpose: To compare subjective outcomes and rates of subsequent operations for patients aged 40 years and older with anterior cruciate ligament (ACL) ruptures who elected nonoperative management or allograft ACL reconstruction (ACLR).

Methods: This was a retrospective study comparing 2-year minimum results of nonoperative treatment and primary allograft ACLR among patients aged 40 years and older presenting to a single institution between the years 2005 and 2016. Patients who elected nonoperative management were 2:1 propensity score (PS)-matched to patients who elected ACLR based on age, sex, body mass index, sports-related mechanism of injury, Outerbridge grade III or IV chondral lesions, and medial or lateral meniscus tears.

High Levels of Satisfaction and Adequate Patient-Reported Outcomes After Operative Reconstruction of Multiligament Knee Injury With Allograft Among Patients Aged 40 Years and Older.

Purpose: To describe injury characteristics and patient-reported outcomes (PROs) among patients aged 40 years and older who underwent allograft reconstruction for multiligament knee injury (MLKI).

Methods: Records of patients aged 40 years and older who underwent allograft multiligament knee reconstruction at a single institution between 2007 and 2017 with a minimum of 2 years of follow-up were retrospectively reviewed. Demographic information, concomitant injuries, patient satisfaction, and PROs including International Knee Documentation Committee and Marx activity scores were obtained.

Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older.

Purpose: To perform a predictive analysis to identify preoperative patient factors associated with failure to achieve a newly defined patient acceptable symptom state (PASS) for the International Knee Documentation Committee (IKDC) Score after anterior cruciate ligament reconstruction (ACLR) in patients aged ≥ 40 years with a minimum of 2-year follow-up.

Methods: This was a secondary analysis of a retrospective review of all patients aged 40 years or older receiving a primary allograft ACLR at a single institution between the years of 2005 and 2016, with 2-year minimum follow-up. Using an updated PASS threshold of 66.

Revision Soft-Tissue Allograft Anterior Cruciate Ligament Reconstruction Is Associated With Lower Patient-Reported Outcomes Compared With Primary Anterior Cruciate Ligament Reconstruction in Patients Aged 40 and Older.

Purpose: To evaluate patient-reported outcomes (PROs) and graft failure rates in revision allograft anterior cruciate ligament reconstruction (ACLR) in patients aged 40 and older and compare them with primary ACLRs.

Methods: Patients aged 40 and older who underwent arthroscopic soft-tissue allograft ACLR between 2005 and 2016 with a minimum 2-year follow-up were retrospectively reviewed. Patients were grouped based on revision versus primary ACLR.

Nonsurgical Management of Osteoarthritis of the Knee: What You Should Be Injecting Now and in the Future.

Osteoarthritis of the knee affects many Americans. With the aging of the population and increasing comorbidities (eg, obesity, diabetes, hypertension, heart disease), the use of oral or topical NSAIDs is often contraindicated. Injectable treatment options are advantageous because of the ability to decrease or avoid the unwanted systematic adverse effects of NSAIDs.

The Majority of Patients Aged 40 and Older Having Allograft Anterior Cruciate Ligament Reconstruction Achieve a Patient Acceptable Symptomatic State.

Purpose: To evaluate patient satisfaction, retear rates, and patient-reported outcomes (PROs) in patients aged 40 and older undergoing allograft anterior cruciate ligament reconstruction (ACLR). The secondary goal was to compare these parameters between groups of patients with intact versus failed grafts, and to evaluate these in relation to a historically reported International Knee Documentation Committee (IKDC) patient-acceptable symptoms state (PASS) score.

Methods: Records of patients aged 40 and older who underwent ACLR between 2005 and 2016 at a single institution with a minimum 2-year follow-up were retrospectively reviewed.

Patient-reported outcomes of meniscal repair and meniscectomy in patients 40 years of age and older show similar good results.

The purpose of this study is to evaluate patient-reported outcome measures (PROMs) in patients aged 40 years and older who underwent meniscal repair or meniscectomy. All patients aged 40 and older who underwent a meniscal repair at a single institution from 2006 to 2017 were included. Meniscal repair cases were matched with a meniscectomy control group in a 1:3 ratio, selected for an equal proportion of concomitant ACL reconstruction in each group.

Editorial Commentary: Return to Sport Should Not Be Your Goal Following High Tibial Osteotomy With Concomitant Medial Meniscal Allograft Transplantation.

Meniscal allograft transplantation has been done for 3 decades as a salvage procedure for patients with painful compartments following total or near-total meniscectomy. In malaligned joints, periarticular osteotomies often are performed in conjunction with the transplantation. The goal has been to reduce pain and improve function.

The 2019 Arthroscopy Association of North America Traveling Fellowship-Los Gallos: New Friends on an Old Town Road.

We came in with high expectations, yet the Arthroscopy Association of North America (AANA) Traveling Fellowship far exceeded them. The 4 traveling fellows came from different backgrounds, different parts of North America, and different practice settings, including an independent private practice, a hybrid private-academic practice, the military, and academia. We were lucky to have been ushered along the way by our godfather, the distinguished John Richmond, M.

Safety and Efficacy of Repeat Administration of Triamcinolone Acetonide Extended-release in Osteoarthritis of the Knee: A Phase 3b, Open-label Study.

Introduction: The aim of this work is to assess the safety and efficacy of repeat administration of triamcinolone acetonide extended-release (TA-ER) in patients with symptomatic knee osteoarthritis (OA), including those with advanced radiographic severity.

Methods: In this phase 3b, single-arm, open-label study, patients aged ≥ 40 years received the first intra-articular TA-ER injection on day 1. Patients received the second injection timed to the response to the first injection (at either week 12, 16, 20, or 24).

Delayed ACL Reconstruction in Patients ≥40 Years of Age Is Associated With Increased Risk of Medial Meniscal Injury at 1 Year.

Background: Anterior cruciate ligament (ACL) tears in the pediatric and young adult ACL-deficient knee are often associated with meniscal or chondral injury with delayed time to surgery. The incidence of ACL reconstruction performed in patients aged ≥40 years is rising, and it is unclear if delayed surgery in this cohort similarly affects the health of the meniscus and cartilage.

Purpose: To evaluate whether delayed reconstruction in a cohort of patients aged ≥40 years is associated with an increased risk of meniscal or chondral injury.

Anterior Cruciate Ligament Reconstruction.

The past 3+ decades have been a period of intense interest in the anterior cruciate ligament. Graft choices, techniques, and fixation devices have all evolved. Our understanding of the anatomy has improved.

Periarticular osteotomies for degenerative joint disease of the knee.

Periarticular osteotomies, either a high tibial osteotomy for a varus deformity or a distal femoral osteotomy for a valgus deformity, are performed for symptomatic unicompartmental degenerative joint disease (DJD) of the knee. These procedures provide pain relief by realigning the mechanical axis and unloading the degenerative compartment. Although arthroplasty has become a reliable procedure for DJD, premature wear and revision remain a concern for younger individuals as well as for individuals who desire to participate in high impact activities.

Surgery for osteoarthritis of the knee.

Although total knee replacement is an excellent treatment of end-stage osteoarthritis of the knee in the older (>65 years) population, many patients with less severe disease are significantly impacted by their symptoms and have failed to respond to less invasive treatment alternatives. For this group, there are several less invasive surgical alternatives, including arthroscopic meniscectomy, grafting of symptomatic areas of bone marrow lesions, unloading osteotomy, and unicompartmental knee replacement. Current total knee arthroplasty designs can be expected to survive 20 years or more in the older, less active population.

Synovial inflammation in patients undergoing arthroscopic meniscectomy: molecular characterization and relationship to symptoms.

Objective: Traumatic and degenerative meniscal tears have different anatomic features and different proposed etiologies, yet both are associated with the development or progression of osteoarthritis (OA). In established OA, synovitis is associated with pain and progression, but a relationship between synovitis and symptoms in isolated meniscal disease has not been reported. Accordingly, we sought to characterize synovial pathology in patients with traumatic meniscal injuries and determine the relationships between inflammation, meniscal and cartilage pathology, and symptoms.

Clinical signs and anatomical correlation of patellar tendinitis.

Background: Patellar tendinitis is one of the several differential diagnosis of anterior knee pain. The clinical diagnosis of patellar tendinitis is based on tenderness to palpation at the inferior pole of the patella. The tenderness has been noted to be maximal when the knee is extended and the quadriceps relaxed, but a definite clinical sign for diagnosis is lacking.

Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery.

Background: Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment. The purpose of the present study was to evaluate the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery.

Methods: Data were collected prospectively during a single-center study.

Bioresorbable scaffolds for anterior cruciate ligament reconstruction: do we need an off-the-shelf ACL substitute?

Currently available anterior cruciate ligament (ACL) graft sources, autograft and allograft, present potential problems that a natural biomaterial ACL graft might be able to solve. Earlier efforts in the development of synthetic ACL grafts were less than optimal, and those devices have largely been abandoned. We can learn from these past failures, and potentially develop a bioresorbable scaffold for ACL reconstruction, which will provide immediate stability, promote and direct tissue in growth, and degrade at an appropriate rate, without harmful wear debris.