A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee.

Background: There are limited randomized controlled trials with long-term outcomes comparing autologous chondrocyte implantation (ACI) versus alternative forms of surgical cartilage management within the knee.

Purpose: To determine at 5 years after surgery whether ACI was superior to alternative forms of cartilage management in patients after a failed previous treatment for chondral or osteochondral defects in the knee.

Study Design: Randomized controlled trial; Level of evidence, 1.

Staged meniscal allograft transplantation as a biologic treatment of the meniscal deficient knee: A prospective case series of 26 patients with maximum 88-month follow-up.

Introduction: The meniscal deficient knee often exists within the setting of associated pathology including instability, malalignment and chondral injury. The aim of this study was to establish the role of meniscal allograft transplantation (MAT) as part of a staged approach to treatment of the previously menisectomised knee and report: (a) primary data endpoints (pre and post-operative Knee Injury and Osteoarthritis outcome scores (KOOS), Tegner scores, satisfaction scores and graft survival), and (b) secondary endpoints:(complication/reoperation rates, and meniscal extrusion measurements as determined by MRI).

Material And Methods: This prospective study included all patients that underwent arthroscopic fresh frozen allograft MAT at our institution (2010-2017) using a soft tissue fixation technique.

A comparison of femoral tunnel placement in ACL reconstruction using a 70° arthroscope through the anterolateral portal versus a 30° arthroscope through the anteromedial portal: a pilot 3D-CT study.

Background: Graft malposition is a risk factor for failure of anterior cruciate ligament reconstruction. A 70° arthroscope improves visualisation of the medial wall of the lateral femoral condyle without switching portals. We investigated whether the use of this arthroscope affected the accuracy and precision of femoral tunnel placement.

Remnant preservation does not affect accuracy of tibial tunnel positioning in single-bundle ACL reconstruction.

Purpose: Remnant preservation, in anterior cruciate ligament (ACL) reconstruction, has potential biological advantages. However, graft positioning remains vital to functional outcome and the prevention of failure. The aim of this study was to investigate the accuracy and precision of tibial tunnel positioning in remnant preservation single-bundle hamstring reconstruction.

Bone Marrow Oedema in the Knees of Asymptomatic High-Level Athletes: Prevalence and Associated Factors.

Background: Bone marrow oedema (BMO), seen on magnetic resonance imaging, can be associated with various injuries to the knee but may also occur in asymptomatic athletes. The prevalence and causal factors for these observations are not well understood. The aim of this study was to determine the prevalence of BMO in asymptomatic knees of athletes, competing at a high level, and to investigate the associated factors.

Biomechanical testing of fixed and adjustable femoral cortical suspension devices for ACL reconstruction under high loads and extended cyclic loading.

Purpose: To compare loop elongation after 5000 cycles, loop-elongation at failure, and load at failure of the fixed-loop G-Lok device and three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT), during testing over extended cycles under high loading.

Methods: Five devices of each type were tested on a custom-built rig fixed to an Instron machine. The testing protocol had four stages: preloading, cyclic preconditioning, incremental cyclic loading and pull-to-failure.

Failure to Return to Preinjury Activity Level after Hamstring Anterior Cruciate Ligament Reconstruction: Factors Involved and Considerations in Goal Setting.

Background: Recent interest in the return to sports, following anterior cruciate ligament reconstruction, has focused on the influence of psychological factors. However, many factors contribute to this endpoint. This study aimed to investigate the ability of nonprofessional athletes to return alongside the reasons for failure.

Flexible reamers create comparable anterior cruciate ligament reconstruction femoral tunnels without the hyperflexion required with rigid reamers: 3D-CT analysis of tunnel morphology in a randomised clinical trial.

Purpose: The hyperflexion required for femoral tunnel drilling in anterior cruciate ligament reconstruction can be challenging in patients with increased body habitus or musculature. Whilst allowing femoral tunnel creation without hyperflexion, additional benefits of flexible reamers have been proposed in terms of tunnel dimensions. The purpose of this study was to examine whether these theoretical benefits are seen in a clinical study.

Tibial Tuberosity Transfer in Combination With Medial Patellofemoral Ligament Reconstruction: Surgical Technique.

The stability of the patellofemoral joint relies on the tenuous interplay of soft tissue and bony factors. Anatomic risk factors for instability include a shallow trochlea, an abnormally lateral tibial tubercle position, patella alta, hypermobility, or a secondary injury to the medial patellofemoral ligament (MPFL). There is an increasing interest in restoring normal anatomy to achieve stability, and at times more than 1 abnormality exists.

The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture.

Objective: The magnetic resonance imaging (MRI) appearance of the anterolateral ligament (ALL) has been described. However, the appearance of this structure and injury, in the presence of anterior cruciate ligament (ACL) injury, is less well defined. We studied the incidence of injury to the ALL and the pattern of this injury on MRI.

Anatomic Anterior Cruciate Ligament Reconstruction: The Use of the Anterior Horn of the Lateral Meniscus as a Guide to Tibial Tunnel Placement.

Anatomic anterior cruciate ligament reconstruction has been shown to reduce the risk of graft failure and to improve patient-related clinical outcomes. The posterior border of the anterior horn of the lateral meniscus is a useful marker for anatomic tibial tunnel placement. Assessment of a preoperative magnetic resonance imaging scan can allow surgical planning of tibial tunnel placement to allow for anatomic, patient-specific tibial tunnel placement during anatomic anterior cruciate ligament reconstruction.

Combined Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Transfer Results at a Follow-Up of 2 years.

There is limited data on the effectiveness of combined medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle transfer (TTT) in patients with patella instability. The aim of our study was to analyze the functional outcome in patients treated with MPFL reconstruction and TTT. Between July 2008 and April 2013, 18 patients (21 knees) underwent combined MPFL reconstruction and TTT; 15 patients (16 knees) with a mean age of 24 years (16-41) had a mean follow-up of 30 months (26-55).

Medial patellofemoral ligament reconstruction: a technique with a "v"-shaped patellar tunnel.

Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation.

Acute calcific deposition in the lateral collateral ligament of the knee.

We present a rare case of a patient presenting with acute onset knee pain, which was subsequently diagnosed and treated as acute calcific deposition in the lateral collateral ligament. A 51-year-old gentleman presented to the emergency department with acute onset, excruciating, and left knee pain. There was no preceding history of trauma or systemic upset.

The use of radiofrequency energy for arthroscopic chondroplasty in the knee.

We present a review of the current literature surrounding the use of radiofrequency energy for arthroscopic chondroplasty in the knee. This review article summarizes basic science, clinical efficacy, and recent advances in the understanding of radiofrequency energy use for the treatment of chondral lesions. Laboratory evidence of increased mechanical stability and decreased release of inflammatory mediators associated with the use of radiofrequency energy chondroplasty is described with clinical evidence of decreased pain and increased functional scores when compared with mechanical chondroplasty.

Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique.

Patellar instability is a common clinical problem affecting a young, active population. A large number of procedures have been described to treat patellar instability. We present the clinical results in a case series of 25 medial patellofemoral ligament reconstructions in 21 patients with up to 30 months follow-up (mean: 7.

ACL reconstruction: a meta-analysis of functional scores.

From individual randomized studies, it is unclear whether patellar tendon grafts or hamstring tendon grafts yield the best functional results after ACL reconstruction. Therefore, we performed a meta-analysis to provide quantitative data to compare patellar with hamstring grafts after ACL reconstruction with regard to knee function. We searched computerized databases for randomized controlled trials reporting one of the following outcomes related to function: final overall International Knee Documentation Committee score and return to preinjury level of activity.

Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis.

Objectives: To compare bone-patellar tendon-bone autografts with hamstring autografts for reconstruction of the anterior cruciate ligament.

Data Sources: Medline, WebSPIRS, Science Citation Index, Current Contents databases, and Cochrane Central Register of Controlled Trials. Review methods All randomised controlled trials reporting one or more outcome related to stability (instrumented measurement of knee laxity, Lachman test, or pivot shift test) and morbidity (anterior knee pain, kneeling test, loss of extension, or graft failure).