Patients submitted to re-revision ACL reconstruction present more knee laxity, more complications, and a higher failure rate than patients submitted to the first revision ACL reconstruction.

Background: Few comparative studies have evaluated patients who underwent two revision anterior cruciate ligament reconstruction (ACLR) and patients who underwent one revision ACLR, and many of them have a short postoperative follow-up and a relatively small number of patients. The objective of this study is to evaluate the functional results, complications, and failure rates of patients who underwent one revision ACLR and patients who underwent two revision ACLRs.

Methods: This is a retrospective study comparing patients who underwent one revision ACLR (Group 1) with patients who underwent a re-revision ACLR (Group 2).

Recovery of Full Hyperextension After Anterior Cruciate Ligament Reconstruction Is Associated With Better Functional Outcomes but Greater Anterior Cruciate Ligament-Related Laxity After a Minimum 24-Month Follow-Up.

Purpose: To evaluate patients who had anterior cruciate ligament (ACL) reconstruction with preoperative hyperextension and compare physical examination (KT-1000 and pivot shift) and patient-reported outcome measures of patients who recovered the entire hyperextension with patients who did not.

Methods: Patients aged 18 to 60 years with more than 5° of knee hyperextension who had anatomic ACL reconstruction with any graft from June 2013 to June 2021 and at least a 24-month follow-up were evaluated retrospectively. Hamstrings and patellar tendon grafts were fixed around 20° to 30° of flexion and in full extension, respectively.

Comparative study of patients with midshaft clavicle fracture fixed with a locked plate via an open versus percutaneous approach.

Objective: To compare the results of surgical treatment of midshaft clavicle fractures, treated with the technique of minimally invasive plate osteosynthesis (MIPO) with locking compression plate versus open reduction and internal fixation (ORIF) with locked plate.

Methods: Quasi-randomized comparative study, evaluating displaced midshaft clavicle fractures treated with MIPO versus ORIF, with procedures performed by a single surgeon. We evaluated patients at 12 months using the University of California at Los Angeles (UCLA) scale and radiographically at 8, 12, 26 and 52 weeks, in addition to describing complications.

Risk Factors for Symptomatic Cyclops Lesion Formation after Anterior Cruciate Ligament Reconstruction.

 To evaluate the incidence of symptomatic cyclops lesions requiring surgical treatment after anterior cruciate ligament (ACL) reconstruction and to establish possible intraoperative risk factors related to it.  Three hundred and eighty-nine patients aged between 18 and 50 years who underwent primary ACL reconstruction were retrospectively evaluated. Patients were divided into groups according to the presence or absence of symptomatic cyclops lesions, and their characteristics were compared.

Patients With More Than 6.5° of Knee Hyperextension are 14.6 Times More Likely to Have Anterior Cruciate Ligament Hamstring Graft Rupture and Worse Knee Stability and Functional Outcomes.

Purpose: To create a cut-off point for hyperextension that best discriminates retear and to verify whether this cut-off point can predict retear regardless of other characteristics after primary anterior cruciate ligament (ACL) reconstruction with hamstrings autograft.

Methods: A cohort of patients submitted to primary isolated ACL reconstruction with hamstrings autografts was retrospectively evaluated. Patients were stratified according to the degree of passive knee hyperextension measured in the normal contralateral knee.

THE USE OF ADHESIVE RADIOPAQUE GRIDS IN GENICULAR NERVE BLOCK BY RADIOSCOPY.

Unlabelled: The performance of genicular nerve block requires an imaging method to guide the procedure. Radioscopy has the disadvantage of being radiation dependent.

Objective: To assess whether the use of adhesive radiopaque grids reduce radiation exposure in these cases.

MINIMALLY INVASIVE OSTEOSYNTHESIS FOR CLAVICULAR FRACTURE WITH LOCKED PLATE.

Objective: To evaluate the clinical and radiographic results of the surgical treatment of fractures of the middle third of the clavicle, using the technique of minimally invasive plate osteosynthesis (MIPO) with locking.

Methods: Prospective case series, evaluating displaced fractures of the middle third of the clavicle submitted to MIPO with locking, with procedures performed by a single surgeon. Patients were evaluated at 12 months using the University of Los Angeles (UCLA) scale and anteroposterior radiographs of the clavicles with 45° cranial and caudal inclination, as well as reporting complications.

Small Hamstring Tendon Graft for Anterior Cruciate Ligament Reconstruction Combined With Anterolateral Ligament Reconstruction Results in the Same Failure Rate as Larger Hamstring Tendon Graft Reconstruction Alone.

Purpose: To compare patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring grafts 7 mm or less in diameter combined with anterolateral ligament (ALL) reconstruction versus isolated ACL reconstruction with grafts greater than 7 mm in diameter.

Methods: We retrospectively evaluated the descriptive data and clinical outcomes of patients who underwent primary ACL reconstruction with hamstring grafts from June 2013 to January 2020 and had a minimum follow-up period of 2 years. Patients with quadrupled or quintupled semitendinosus and gracilis autograft 7 mm or less in diameter combined with single-strand ALL reconstruction (ACL-ALL group) were matched in a 1:2 propensity ratio to patients who underwent isolated single-bundle ACL reconstruction with hamstring grafts greater than 7 mm (ACL group).

Comparative study of superficial medial collateral ligament reconstruction combined with posterior oblique ligament reconstruction or posteromedial capsule advance in grade III injuries of the medial compartment in a complex knee injury scenario.

Background: The purpose of this study was to compare the combined reconstruction of the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL) with the reconstruction of the sMCL associated with the advancement of the posteromedial capsule in a complex knee injury scenario. We hypothesized that both techniques would present similar knee stability and failure rates.

Methods: This is a retrospective case-control study designed to compare the results of the two reported techniques for grade III MCL instability.

Quantitative alpha-defensin testing: Is synovial fluid dilution important?

Background: Alpha-defensin has been widely studied for the diagnosis of periprosthetic joint infection (PJI). However, there is a lack of detailed information regarding the proper laboratory technique of the enzyme-linked immunosorbent assay (ELISA) method, such as sample dilution.

Aim: To assess the influence of dilution in the synovial fluid during ELISA for the diagnosis of knee PJI; and determine which dilution presents a better performance.

The Addition of Either an Anterolateral Ligament Reconstruction or an Iliotibial Band Tenodesis Is Associated With a Lower Failure Rate After Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Trial.

Purpose: To compare the failure rate in patients who underwent revision anterior cruciate ligament (ACL) reconstruction alone or associated with an extra-articular procedure. Secondary objectives were to compare ACL laxity, patient-reported outcome measures, and complication rates in these patients and, subsequently, to compare the outcomes of patients who underwent revision ACL reconstruction associated with anatomical anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET).

Methods: This was a retrospective comparative study.

Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction.

Background: Revision anterior cruciate ligament (ACL) reconstructions are usually complex owing to previous tunnels. The objective of this study is to report the results of a revision ACL reconstruction technique with a tibial tunnel performed from the anterolateral plateau associated with an anterolateral ligament (ALL) reconstruction.

Methods: Patients with at least two ACL reconstructions that failed and who had significant enlargement and confluence of tunnels in the medial tibial plateau and underwent revision ACL reconstruction associated with ALL reconstruction with the tibial tunnel for the ACL performed from the lateral plateau between 2017 and 2019 were evaluated.

Knee Hyperextension Greater Than 5° Is a Risk Factor for Failure in ACL Reconstruction Using Hamstring Graft.

Background: The degree of knee hyperextension in isolation has not been studied in detail as a risk factor that could lead to increased looseness or graft failure after anterior cruciate ligament (ACL) reconstruction.

Purpose: To analyze whether more than 5° of passive knee hyperextension is associated with worse functional outcomes and greater risk of graft failure after primary ACL reconstruction with hamstring tendon autograft.

Study Design: Cohort study; Level of evidence, 3.

Performance of alpha-defensin lateral flow test after synovial fluid centrifugation for diagnosis of periprosthetic knee infection.

Background: The quantitative alpha-defensin enzyme-linked immunosorbent assay (ELISA) demands a prior synovial fluid centrifugation, whereas this processing is not routinely required prior to the alpha-defensin lateral flow test.

Aim: To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection (PJI) diagnosis.

Methods: Fifty-three cases were included in this study: 22 classified as PJI and 31 classified as aseptic cases, according to Musculoskeletal Infection Society 2013 criteria.

Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment.

Purpose: To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema, and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion.

Methods: From 2012 to 2018, patients who had this specific meniscus pathology and underwent arthroscopic surgical treatment were retrospectively evaluated.

Evaluation of Polyethylene Wear in a Brazilian Ultracongruent Knee Prosthesis with a Rotating Platform.

 To evaluate the wear of polyethylene in a Brazilian ultracongruent knee prosthesis with a rotating platform (Rotaflex, Víncula, Rio Claro, SP, Brasil).  We used the test method with the loading and preparation parameters mentioned in the standards regulation , and the measurement methods mentioned in the standards regulation , for the evaluation of the wear behavior of a Brazilian prosthesis with a rotating platform. The equipment used for the wear test was the ISO 14243-1 gait simulator (EndoLab, Riedering, Germany).

High Incidence of Osteoarthritis Observed in Patients at Short- to Midterm Follow-Up after Delayed Multiligament Knee Reconstruction.

The aim of this study was to evaluate the incidence of knee osteoarthritis, failure rate of reconstruction, and clinical outcomes of patients with chronic multiligament knee injuries subjected to surgical treatment. Sixty-two patients with chronic knee dislocation subjected to multiligament reconstruction between April 2008 and July 2016 were evaluated, with a minimum follow-up of 24 months. Anteroposterior and lateral radiographs were performed in the pre- and last postoperative evaluation; the progression of degenerative changes according to the Kellgren-Lawrence classification (KL) was assessed.

Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury.

Background: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies.

Purpose: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging.

Anatomical Risk Factors for Anterior Cruciate Ligament Injury Are Not Important As Patellar Instability Risk Factors in Patients with Acute Knee Injury.

To compare in magnetic resonance imaging the anatomical risk factors for anterior cruciate ligament (ACL) injury and patellar dislocation among patients who suffered acute knee injury, 105 patients with acute knee injury resulting in 38 patellar dislocations (patella group), 35 ACL injuries (ACL group), and 32 meniscus or medial collateral ligament injuries (control group) were included. These groups were compared for risk factors for patellar dislocation (patellar height, trochlear dysplasia, and quadriceps angle of action) and for ACL injury (intercondylar width, posterior inclination of tibial plateaus, and depth of the medial plateau). Univariate analysis found statistically significant differences ( < 0.

High Potential for Complications After Traumatic Exposure in Patients With a Total Knee Replacement.

Objective: The purpose of this study is to describe cases of traumatic exposure during the early postoperative period in patients with a total knee replacement (TKR) and to report the treatments instituted and complications of this adverse event.

Methods: A retrospective review of postoperative patients with TKR performed at the Universidade de São Paulo from 2001 to 2017 who subsequently were treated at the emergency room due to trauma to the TKR region accompanied by surgical wound dehiscence in deep planes and implant exposure was conducted. The initial treatment, evolution, and complications of each patient were reported.

Alternative Techniques for Lateral and Medial Posterior Root Meniscus Repair Without Special Instruments.

Improved understanding and treatment of posterior medial and lateral meniscus root tears have attracted increasing interest. These lesions significantly compromise meniscal function, which can result in an outcome resembling total meniscectomy, and are also a potential cause of knee instability. Despite facilitating repair procedures and reducing the operative time for these lesions, all-inside meniscal repair devices are not available in all circumstances or registered for use in all countries worldwide.

The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention.

Background: Wound healing complications are causal factors of prosthesis infection and poor postoperative evolution of patients after total knee arthroplasty (TKA). Negative-pressure wound therapy (NPWT) can be an option to minimize these complications. The aim of this study is to compare the complications of patients undergoing TKA who used a portable NPWT device in the immediate postoperative period with those of a control group.