Assessing Residual Moisture After Sterilization as an Overlooked Source of Intraoperative Bacterial Contamination in Knee Intra-articular Reconstructions: Evaluating the Reliability of Routine Procedures and Tests.

Background: Contamination of sterilized surgical instruments is not a typically suspected source of increased infection rate, especially if no abnormalities in the sterilization process are detected.

Purpose/hypothesis: The purpose of this study was to report increased infection rates after knee ligament reconstructions due to undetectable sterilization process errors leading to residual moisture, not limited to a specific surgical tool. It was hypothesized that (1) residual moisture on surgical tools due to autoclave overloading would not be detected by autoclave self-diagnostics, chemical and biological tests, or organoleptic assessment and (2) this kind of contamination may elevate infection rates, especially in knee intra-articular reconstruction procedures.

Adequate Failure Loads for Modified Lemaire Lateral Extra-articular Tenodesis Are Achieved With an Interference Screw, Staple, and Suture Anchor: A Biomechanical Study of Structural Properties.

Background: A lateral extra-articular tenodesis (LET) is increasingly being utilized to augment an anterior cruciate ligament reconstruction because it has been shown to reduce the risk of postreconstruction graft failure or recurrent rotatory instability. Various femoral fixation techniques are available, including the use of an interference screw, staple, or suture anchor.

Purpose: To determine and compare the biomechanical properties of an LET graft when using an interference screw, staple, or suture anchor for the femoral fixation for a modified Lemaire LET.

Posterior Medial Meniscus Root Tears: Clinical Implications, Surgical Management, and Post-operative Rehabilitation Considerations.

Tears of the posterior medial meniscus root (PMMR) are common in older patients and reportedly contribute to rapid joint degeneration over time. Recognition of these tear types and the appropriate diagnosis through clinical exam and diagnostic imaging have improved significantly in recent years, as have surgical techniques to address them. Standardized post-operative rehabilitation protocols specific to PMMR repair have not been established or well understood in the scientific literature.

Correlation of Increased Lateral Tibial Slope With Baseline Tibial Position in Intact Knees and Side-to-Side Anterior Tibial Translation for Knees With ACL Tears.

Background: Anterior cruciate ligament (ACL) stress techniques-including single-leg stress radiographs, Telos, and KT-1000 arthrometer-are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on magnetic resonance imaging is not conclusive or for judging if additional treatments, such as anterolateral complex augmentation, may be necessary.

Purpose/hypothesis: The purpose of this study was to evaluate the effect of increasing posterior tibial slope (PTS) on baseline tibial position (BTP) and side-to-side differences (SSD) in ATT.

Medial Meniscus Ramp Tears: State of the Art.

Medial meniscus ramp tears are tears of the posteromedial capsule or peripheral rim of the posteromedial meniscus that frequently occur with anterior cruciate ligament (ACL) tears. The incidence and prevalence of medial meniscus ramp tears has been increasing in the recent literature due to the increased understanding of the anatomy and diagnosis of these tears. When a patient presents with an ACL tear, a medial meniscus ramp tear should be suspected if the patient has a grade 3+ Lachman or pivot shift exam, a vertical line of increased signal intensity in the posterior capsule or peripheral meniscus on magnetic resonance imagining (MRI), or posteromedial tibial plateau bone bruising on MRI.

Patient-Reported Outcomes of Bicruciate Multiligament Versus Single Cruciate Multiligament Knee Injuries.

Background: Multiligament knee injuries (MLKIs) are heterogeneous, and bicruciate knee ligament injuries are considered a serious form of this injury. The current literature tends not to distinguish between single and bicruciate MLKI when reporting outcomes.

Purpose: To investigate patient-reported outcomes after surgical treatment of MLKI comparing single cruciate MLKI with bicruciate MLKI.

Patella Baja Revisited: Interposition of a Pedunculated Flap of the Hoffa Fat Pad to Treat Adhesions Between the Tibia and Patellar Tendon and Restore the Functional Length of the Patellar Tendon.

Adhesions in the deep infrapatellar region may occur as iatrogenic complications (e.g., after bone-patellar tendon-bone grafting), as part of arthrofibrosis or infrapatellar contracture syndrome, or owing to specific diseases such as Osgood-Schlatter disease.

Comparing Postoperative Outcomes of Isolated Anterior Cruciate Ligament Reconstruction and the "Terrible Triad" Anterior Cruciate Ligament Reconstruction With Medial Meniscus Ramp and Lateral Meniscus Root Repairs.

Background: A new "terrible triad" has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well known.

Purpose: To compare postoperative outcomes between isolated ACLR and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs.

Lower Extremity Blood Flow Restriction Training in Athletes Significantly Improves Strength-Related Outcomes in 58% of Studies Compared to Non-Blood Flow Restriction Control.

Purpose: To examine the role of lower extremity blood flow restriction (BFR) in the athletic population.

Methods: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Searches of Level I and II studies were performed on PubMed, Embase, and Cochrane databases.

Editorial Commentary: Increased Tibial Slope and Decreased Medial Proximal Tibial Angle Negatively Affect Anterior Cruciate Ligament Graft Maturation: Objective Evidence on When to Add a Lateral Extra-Articular Augmentation Procedure to a Soft-Tissue Anterior Cruciate Ligament Reconstruction.

Recent anterior cruciate ligament (ACL) research focuses on risk factors for ACL graft failure and techniques and augmentations to limit failure. One of the most recognized risk factors is sagittal malalignment in the form of high posterior tibial slope (PTS), especially PTS ≥12°, which leads to increased force through the ACL and ACL graft. To reduce the risk associated with increased PTS, lateral augmentation techniques, typically either a lateral extra-articular tenodesis or an anterolateral ligament reconstruction, improve clinical outcomes, and the authors preferred graft choice, particularly in such cases, is bone-patellar tendon-bone autograft.

The role of anterolateral complex surgery and slope-reducing osteotomies in revision ACL reconstructions: a narrative review.

Background And Objective: Anterior cruciate ligament reconstruction (ACLR) failures occur for various reasons including residual laxity, untreated concomitant injuries, poor graft quality, and high tibial slope. Various additional procedures can help to decrease revision ACLR failures including anterolateral complex (ALC) procedures and slope-reducing osteotomies for patients with high tibial slopes. This narrative review aims to review the literature on the roles of ALC augmentation procedures and slope-reducing osteotomies in the setting of patients undergoing revision ACLRs.

Strategies for Preventing Tunnel Convergence in Multiligament Knee Injury Reconstructions.

Background: Multiligament knee injuries (MLKIs) are complex and heterogeneous, often associated with concomitant injuries, and necessitates precise treatment strategies.

Preoperative Management: Effective preoperative management in MLKIs requires comprehensive evaluation, starting with a detailed patient history to identify the mechanisms of injury and prior treatments. Physical examination assesses for knee stability, while imaging techniques including magnetic resonance imaging (MRI) and radiographs detail ligament, cartilage, and meniscal injuries to identify all injured structures.

Slope-Reducing Proximal Tibial Osteotomy Improves Outcomes in Anterior Cruciate Ligament Reconstruction Patients With Elevated Posterior Tibial Slope, Especially Revisions and Posterior Tibial Slope ≥12.

Purpose: To explore the indications, outcomes, and complications related to slope-reducing osteotomies in the setting of anterior cruciate ligament (ACL) tears or graft failure. A secondary aim was to create an algorithm on the basis of the current literature and authors' opinions.

Methods: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Continuous Meniscal Repair Technique Allows for Shorter Operative Time and Learning Curve Compared With Traditional Vertical Mattress Technique in Controlled Arthroscopic Training in Porcine Model.

Purpose: To compare the amount of time used to perform meniscal suturing on a standardized lesion using either a traditional or continuous arthroscopic suturing technique.

Methods: A preclinical study was carried out with 21 medical doctors who underwent training in the 2 modalities of meniscal repair by arthroscopy in an animal model laboratory. Participants performed both types of sutures with a previously standardized lesion.

Medial Opening Wedge (MOW) Versus Lateral Closing Wedge (LCW) High Tibial Osteotomies for Knee Medial Compartment Osteoarthritis Show Similar Outcomes and Survivorship, While MOW Has Higher Rates of Tibial Fracture and LCW Has Higher Rates of Nerve Injury and Conversion to Total Knee.

Purpose: To compare the clinical and radiographic outcomes and complications between medial opening wedge (MOW) and lateral closing wedge (LCW) high tibial osteotomies (HTOs) in the setting of medial compartment osteoarthritis with genu varus alignment.

Methods: This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Studies that reported on MOW or LCW HTOs in the setting of medial compartment osteoarthritis were included.

Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis.

Purpose: Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects.

Diagnosis and Treatment Strategies of Meniscus Root Tears: A Scoping Review.

Background: Meniscus root tears comprise 10% to 21% of all meniscal tears. These tears alter knee biomechanics, elevating contact pressure, akin to a meniscectomy. Consequently, they are linked to advanced joint degeneration and cartilage damage in the affected compartment.

An Anatomic Reconstruction of Both the Anterior Cruciate Ligament and Fibular Collateral Ligament Using Autografts.

Fibular collateral ligament (FCL) tears rarely occur in isolation and are typically injured in conjunction with another ligament, including the anterior cruciate ligament (ACL). Reconstruction of both ACL and the FCL is critical to restore proper knee biomechanics and stability. This technique describes an anatomic reconstruction of both the ACL using a bone-patellar tendon-bone autograft and the FCL using a semitendinosus hamstring autograft.

Lateral femoral impaction fractures during an ACL tear extend posteriorly on the weight-bearing area of the tibiofemoral joint.

Purpose: Posterior elongation of the physiological terminal sulcus (TS) due to lateral femoral condyle impaction fracture (LFC-IF) after an anterior cruciate ligament (ACL) tear could potentially decrease the weight-bearing area of the tibiofemoral joint, decrease the tension on lateral meniscus and cause flattening of the LFC which would influence rotational knee motion and cause anisometry of the lateral and anterolateral stabilizers. Therefore, the purpose of the study was to assess if the LFC-IF elongates the physiological TS posteriorly.

Methods: One hundred patients magnetic resonance images (MRIs) (75 males, 25 females, mean age 32.

Approaching ramp lesions from the different world of posterior knee compartment: A review of evidence with a proposal of a new classification and treatment.

Unlabelled: Ramp lesions (RLs) are peripheral lesions that occur in the posterior part of the medial meniscus or where it attaches to the joint capsule. The classification of the medial meniscus RLs has been the focus of numerous studies and publications. This review provides an overview of RL's current classification and treatment options in anterior cruciate ligament deficient knees.