All-Arthroscopic Treatment of Schatzker Type III Lateral Tibial Plateau Fracture Without Fluoroscopy.

Tibial plateau fracture treatment remains challenging for orthopaedic surgeons around the world, especially in case of type III fractures according to the Schatzker classification, which are a pure depression of the lateral tibial plateau. Whereas open surgical procedures are associated with increased soft-tissue trauma because of the extent of the surgical approach and do not always allow for proper visualization of the fracture site, arthroscopic-assisted surgeries have been proven to have benefits over the former in terms of minimizing soft-tissue trauma, improved visual control of the fracture reduction, and the time of recovery. Most arthroscopic techniques, however, require using fluoroscopy.

Anterior Closing Wedge Proximal Tibial Osteotomy for Slope Correction in Failed ACL Reconstructions.

Increased sagittal plane posterior tibial slope has been identified as a risk factor for primary anterior cruciate ligament reconstruction (ACLR) failure. Although ACLR failure is multifactorial, correction of sagittal plane posterior tibial slope should be evaluated in patients with an ACLR graft rupture. There are limited technical descriptions of proposed decreasing tibial slope osteotomy procedures; therefore, the purpose of this Technical Note is to describe the current senior author's technique of performing an anterior closing wedge proximal tibial osteotomy to decrease sagittal plane tibial slope in patients requiring a revision ACLR.

Variability of Reporting Recurrence After Arthroscopic Bankart Repair: A Call for a Standardized Study Design.

Background: High recurrence rates have been reported after anterior shoulder dislocations, regardless of the treatment utilized. However, the definition of recurrent instability has been inconsistent, making a comparison between studies difficult.

Purpose: To report on the nature with which the rate of recurrent instability is reported after arthroscopic Bankart repair, across all levels of evidence, and to analyze factors that may affect the reported rate of recurrence.

Quantitative mapping of acute and chronic PCL pathology with 3 T MRI: a prospectively enrolled patient cohort.

Background: The diagnosis of incomplete acute and chronic posterior cruciate ligament (PCL) tears can be challenging with conventional magnetic resonance (MR) imaging, particularly for injuries in which the ligament appears continuous as occurs with chronic PCL tears that have scarred in continuity. Quantitative mapping from MR imaging may provide additional useful diagnostic information in these cases. The purpose of this study was to assess the feasibility of quantifying transverse relaxation time (T2) mapping values at 3 Tesla (T) in a prospectively enrolled patient cohort with chronic PCL tears.

Quantitative and Qualitative Assessment of Posterolateral Meniscal Anatomy: Defining the Popliteal Hiatus, Popliteomeniscal Fascicles, and the Lateral Meniscotibial Ligament.

Background: Surgical treatment of lateral meniscal tears can be challenging due to the greater mobility of the lateral meniscus, thin capsule, and management of the popliteal hiatus. There has been a lack of quantitative assessments of the structural attachments to the posterior horn of the lateral meniscus (PHLM) to guide repairs.

Purpose: To qualitatively and quantitatively describe the anatomy of the PHLM, popliteomeniscal fascicles, and the posterolateral capsule.

Lateral Posterior Tibial Slope in Male and Female Athletes Sustaining Contact Versus Noncontact Anterior Cruciate Ligament Tears: A Prospective Study.

Background: Lateral posterior tibial slope (PTS) has been identified as a risk factor for primary anterior cruciate ligament (ACL) tears.

Purpose/hypothesis: The purpose was to prospectively determine if there was a difference in lateral PTS between male and female athletes sustaining contact ACL tears as compared with a group of sex-, age-, and activity-matched athletes who sustained noncontact ACL tears. It was hypothesized that there would be no difference in degree of lateral PTS between contact and noncontact mechanisms among patients sustaining primary ACL tears in sports.

International Expert Consensus on a Cell Therapy Communication Tool: DOSES.

Background: The lack of a standardized system for describing cell therapies acts as a barrier to advancement in clinical and basic research and practice. The aim of this study was to establish an international expert consensus on strategies to improve standardization and transparency when describing cell therapies. The secondary aim was to develop a consensus among experts on the contents of a standardized tool for describing cell therapies.

Utilization of Transtibial Centralization Suture Best Minimizes Extrusion and Restores Tibiofemoral Contact Mechanics for Anatomic Medial Meniscal Root Repairs in a Cadaveric Model.

Background: Although posterior medial meniscal root (PMMR) repairs are often successful, postoperative meniscal extrusion after a root repair has been identified as a potential clinical problem.

Purpose/hypothesis: The purpose was to quantitatively evaluate the tibiofemoral contact mechanics and extent of meniscal extrusion after a PMMR repair. It was hypothesized that the addition of a centralization suture (into the posterior medial tibial plateau) would help restore normal joint load-bearing characteristics and restore the native amount of meniscal extrusion after a root tear.

Possible Approaches to Endoscopic Treatment of Popliteal Cysts: From the Basics to Troublesome Cases.

Popliteal cysts can be an oppressive symptom in patients with concomitant intra-articular knee pathologies. Because isolated treatment of intra-articular lesions is usually not sufficient to resolve the problems associated with a large symptomatic popliteal cyst, a popliteal cyst should be concurrently addressed with other knee pathologies to maximize patient outcomes. Conservative treatment and open surgical excision are associated with high rates of recurrence, so arthroscopic techniques are the preferred treatment options for recalcitrant cases.

The Medial Patellofemoral Ligament Is a Dynamic and Anisometric Structure: An In Vivo Study on Length Changes and Isometry.

Background: Medial patellofemoral ligament (MPFL) reconstruction is associated with a high rate of complications, including recurrent instability and persistent knee pain. Technical errors are among the primary causes of these complications. Understanding the effect of adjusting patellofemoral attachments on length change patterns may help surgeons to optimize graft placement during MPFL reconstruction and to reduce graft failure rates.

Meniscal Root Tears.

Meniscus root tears are a specific type of meniscal injury that have gained attention over the past 5 years and have been reported to account for 10% to 21% of all meniscal tears, affecting nearly 100,000 patients annually. Meniscal root tears either are defined as an avulsion of the insertion of the meniscus attachment or complete radial tears that are located within 1 cm of the meniscus insertion. Biomechanical studies have demonstrated that meniscal root injuries interrupt the continuity of the circumferential fibers, and hence lead to failure of the normal meniscal function to convert axial loads into transverse hoop stresses.

A Hamstring-Based Anatomic Posterolateral Knee Reconstruction With Autografts Improves Both Radiographic Instability and Functional Outcomes.

Purpose: To report the subjective outcomes and objective stability in a series of chronically grade III posterolateral injured knees treated with a hamstring-based anatomic posterolateral corner (PLC) reconstruction technique using autografts.

Methods: An outcome study of patients with a chronic complete tear of all ligamentous structures of the PLC (>5 mm of varus gapping at 30, ≥10° of external tibial rotation during the dial test, ≥4 mm of increased lateral compartment opening during varus stress radiographs) was performed. The patients were evaluated subjectively with Lysholm, International Knee Documentation Committee (IKDC), and Tegner scores and objectively with varus stress radiographs at 20° of knee flexion, IKDC objective scores, and recurvatum evaluation.

Re-revision Anterior Cruciate Ligament Reconstruction: An Evaluation From the Norwegian Knee Ligament Registry.

Purpose: To identify the rate of re-revision anterior cruciate ligament reconstruction (ACLR) to estimate the influence of patient-related factors on the risk of re-revision ACLR. The secondary aim of the study was to report the intra-articular findings and patient-related factors at the time of revision ACLR and to compare these with the findings in a matched controlled group of primary ACLR.

Methods: Patients with primary ACLR without a subsequent need of revision and patients with a revision ACLR identified in the Norwegian Knee Ligament Registry from June 2004 through September 2016 were included.

Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline.

Background: A small number of randomized controlled trials have found ultrasound-guided injection of platelet-rich plasma (PRP) to be no more effective than saline for several tendinopathies; limited information exists for patellar tendinopathy. In addition, different PRP formulations that produce varying concentrations of leukocytes have not been directly compared for patellar tendinopathy.

Purpose/hypothesis: To determine if a single ultrasound-guided PRP injection, either leukocyte-rich PRP (LR-PRP) or leukocyte-poor PRP (LP-PRP), was superior to saline injection for the treatment of patellar tendinopathy.

Characterization of Growth Factors, Cytokines, and Chemokines in Bone Marrow Concentrate and Platelet-Rich Plasma: A Prospective Analysis.

Background: Platelet-rich plasma (PRP) and bone marrow concentrate (BMC) are orthobiologic therapies with numerous growth factors and other bioactive molecules. Before the clinical utility of PRP and BMC is optimized as a combined therapy or monotherapy, an improved understanding of the components and respective concentrations is necessary.

Purpose: To prospectively measure and compare anabolic, anti-inflammatory, and proinflammatory growth factors, cytokines, and chemokines in bone marrow aspirate (BMA), BMC, whole blood, leukocyte-poor PRP (LP-PRP), and leukocyte-rich PRP (LR-PRP) from samples collected and processed concurrently on the same day from patients presenting for elective knee surgery.

Percutaneous Lengthening of a Regenerated Semitendinosus Tendon for Medial Hamstring Snapping.

In this surgical technique article, the authors describe a percutaneous tendon lengthening technique for surgical treatment of a regenerated semitendinosus tendon in snapping syndrome. Snapping syndromes are caused by 2 adjacent anatomic structures having a frictional catching, which may be associated with an audible pop. At the knee, they may have an intra- or extra-articular origin.

Minimally Invasive, Arthroscopic-Assisted, Anatomic Posterolateral Corner Reconstruction.

As the anatomy and biomechanics of the posterolateral corner (PLC) of the knee have become better understood, the importance of the PLC's proper function has become a more frequently raised subject. Misdiagnosed chronic posterolateral instability may lead to serious consequences, including cruciate ligament reconstruction graft failure. It has been proved that high-grade PLC injuries need to be treated operatively.

Patellar Tendon Tenotomy for Treatment of Patella Baja and Extension Deficiency.

Extension loss due to patella baja is a rare but devastating postoperative complication associated with knee surgery. The most common causes of patella baja are prolonged postoperative immobilization, over-distalization of the patellar tendon during patella-related surgical procedures (i.e.

Fibular Collateral Ligament Reconstruction in Adolescent Patients.

Fibular collateral ligament (FCL) injuries can present as lateral-sided knee pain with feelings of side-to-side instability during activity. Patients with FCL injuries can have accompanying symptoms related to irritation of the common peroneal nerve. Preoperative diagnosis is imperative and should include a thorough physical examination complemented with varus stress radiographs before surgical reconstruction is indicated.

Tips and Pearls for All-Inside Medial Meniscus Repair.

The medial meniscus is one of the most commonly injured structures in the knee. When the importance of its proper function is well understood, an adequate management in meniscus tear is a key issue for whole knee joint well-being. Although it has been proven that meniscal repairs have better long-term results than meniscectomy, there is still no consensus as to which suturing technique is the best.

Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears.

Background: Given the variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics.

Purpose/hypothesis: To biomechanically compare vertical mattress and cross-stitch suture techniques, in single- and double-row configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscal tear model. The hypothesis was that there would be no difference between the vertical mattress and cross-stitch double-row suture techniques but that the double-row technique would provide significantly improved biomechanical parameters versus the single-row technique.

Tibial Slope and Its Effect on Graft Force in Posterior Cruciate Ligament Reconstructions.

Background: A flattened posterior tibial slope may cause excessive unwanted stress on the posterior cruciate ligament (PCL) reconstruction graft and place patients at risk for PCL reconstruction graft failure. To date, there is a paucity of biomechanical studies evaluating the effect of posterior tibial slope on the loading properties of single-bundle (SB) and double-bundle (DB) PCL grafts.

Purpose/hypothesis: The purpose of this study was to quantify the effect of sagittal plane tibial slope on PCL reconstruction graft force at varying slopes and knee flexion angles for SB and DB PCL reconstructions.