Search

Background: Posterior medial meniscus root (PMMR) tears are a challenge to assess and treat. However, the forces sustained at the PMMR are yet to be fully characterized. In addition, it has been shown that meniscotibial ligament (MTL) injuries happen before PMMR tears, suggesting that insufficiency of the MTL results in a change of forces acting on the PMMR. Purpose/Hypothesis: The purpose of this study was to evaluate the 3-dimensional forces acting on the PMMR in the intact, MTL cut, and MTL tenodesis states. It was hypothesized that the MTL cut state would increase medial shear forces seen at the PMMR, whereas the medial shear force in the MTL tenodesis state would return PMMR forces to that of the intact state. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees were tested in 3 states (intact, MTL cut, and tenodesis). A 3-axis load cell was installed below the posterior tibial plateau and attached to the enthesis of the PMMR. The specimen was mounted to a load frame that applied an axial load, an internal torque, and an external torque. The amount of compression-tension, mediolateral shear force, and anteroposterior shear force acting on the PMMR was measured. Results: When the joint was loaded in compression, the MTL cut state significantly increased compression of the PMMR (P =.0368). The tenodesis state did not significantly restore forces of the PMMR (P =.008). When the joint was loaded in external torque, the MTL cut state significantly increased compression (P <.0001) and significantly decreased anterior shear on the PMMR (P =.0003). The tenodesis state did not significantly restore forces on the PMMR to the intact state (P <.0001). Increased flexion angle significantly increased medial shear forces of the PMMR when the joint was loaded in compression (P <.007 at every angle). Conclusion: When evaluated biomechanically, MTL insufficiency resulted in increased compressive force at the PMMR. A single-anchor centralization procedure did not restore PMMR forces to that of the intact state. Increased knee flexion angle resulted in increased medial shear force on the PMMR. Clinical Relevance: The findings in this study provide clinicians information on PMMR forces when the MTL is disrupted. These data can aid in the decision-making for adding an MTL repair to augment PMMR repairs. [ABSTRACT FROM AUTHOR]

The article discusses a research paper on the surgical management of knee joint. Topics mentioned include the main factors that need to be considered in knee joint preservation, the key reasons for the failure of reconstructing an anterior cruciate ligament (ACL), and the effect of an increased or a decreased posterior tibial slope on ACL reconstruction.

Background: Lateral extra-articular tenodesis (LET) is being performed more frequently with anterior cruciate ligament (ACL) reconstruction (ACLR) to decrease graft failure rates. The posterior tibial slope (PTS) affects ACL graft failure rates. The effect of ACLR + LET on tibial motion and graft forces with increasing PTS has not been elucidated. Hypothesis: LET would decrease anterior tibial translation (ATT), tibial rotation, and ACL graft force versus ACLR alone with increasing tibial slope throughout knee range of motion. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric knees (mean donor age, 40.5 years; all female) were tested in 4 conditions (intact, ACL cut, ACLR, and ACLR + LET) with varying PTSs (5°, 10°, 15°, and 20°) at 3 flexion angles (0°, 30°, and 60°). Specimens were mounted to a load frame that applied a 500-N axial load with 1 N·m of internal rotation (IR) torque. The amount of tibial translation, IR, and graft force was measured. Results: Increasing PTS revealed a linear and significant increase in graft force at all flexion angles. LET reduced graft force by 8.3% (–5.8 N) compared with ACLR alone at 30° of flexion. At the same position, slope reduction resulted in reduced graft force by 17% to 22% (−12.3 to −15.2 N) per 5° of slope correction, with a 46% (−40.7 N) reduction seen from 20° to 5° of slope correction. For ATT, ACLR returned tibial translation to preinjury levels, as did ACLR + LET at all flexion angles, except full extension, where ACLR + LET reduced ATT by 2.5 mm compared with the intact state (P =.019). Conclusion: Increased PTS was confirmed to increase graft forces linearly. Although ACLR + LET reduced graft force compared with ACLR alone, slope reduction had a larger effect across all testing conditions. No other clinically significant differences were noted between ACLR with versus without LET in regard to graft force, ATT, or IR. Clinical Relevance: Many authors have proposed LET in the setting of ACLR, revision surgery, hyperlaxity, high-grade pivot shift, and elevated PTS, but the indications remain unclear. The biomechanical performance of ACLR + LET at varying PTSs may affect daily practice and provide clarity on these indications. [ABSTRACT FROM AUTHOR]

The article presents the authors' response to a commentary on their paper about biomechanical analysis of tibial motion and anterior cruciate ligament graft forces after anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis. Identified by the commenters are several concerns including the decision to standardize each slope to 5 degrees before testing, accuracy of the methodology and the stiffness of the tibia after osteotomy.

Background: Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically. Purpose/Hypothesis: The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation. Results: Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (–41%) (all P <.05 vs intact), while LMAT restored all outcome measures (all P >.05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (–0.0479 N/mm2), 5.9% (–0.154 N/mm2), and 1.4% (–6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively. Conclusion: Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile. Clinical Relevance: Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient. [ABSTRACT FROM AUTHOR]

Background: Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are performed to treat focal chondral defects (FCDs); both are 2-step procedures involving a biopsy, followed by transplantation. There is little published research evaluating ACI/MACI in patients who undergo a biopsy alone. Purpose: To determine (1) the value of ACI/MACI cartilage biopsies and concomitant procedures in patients with FCDs of the knee and (2) the conversion rate to cartilage transplantation as well as the rate of reoperation. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of 46 patients (63% female) who underwent a MACI (or ACI) biopsy between January 2013 and January 2018. Preoperative data, intraoperative data, and postoperative outcomes were assessed at a minimum of 2 years after the biopsy. The conversion rate from a biopsy to transplantation and the reoperation rate were calculated and analyzed. Results: Among the 46 patients included, 17 (37.0%) underwent subsequent surgery, with only 12 undergoing cartilage restoration surgery, for an overall transplantation rate of 26.1%. Of these 12 patients, 9 underwent MACI/ACI, 2 underwent osteochondral allograft transplantation (OCA), and 1 underwent particulated juvenile articular cartilage implantation at 7.2 ± 7.5 months after the biopsy. The reoperation rate was 16.7% (1 patient after MACI/ACI and 1 patient after OCA) at 13.5 ± 2.3 months after transplantation. Conclusion: Arthroscopic surgery with debridement, chondroplasty, loose body removal, meniscectomy/meniscal repair, and other treatment approaches of knee compartment abnormalities at the time of a biopsy appeared to be sufficient in improving function and reducing pain in patients with knee FCDs. [ABSTRACT FROM AUTHOR]

Background: Lateral extra-articular tenodesis (LET) is being performed with increasing frequency in the setting of anterior cruciate ligament reconstruction (ACLR) as a way to decrease rotational instability and graft failure rates, especially in young, active patients. The degree of posterior tibial slope has been shown to affect ACL graft failure rates.1 The effect of LET plus ACLRs on tibial motion and graft forces in the setting of varying tibial slopes has not been elucidated. Hypothesis/Purpose: LET will decrease tibial translation, tibial rotation, and ACL graft forces compared to ACLR alone with increasing tibial slope throughout knee range of motion. Methods: Twelve cadaveric knees (40.5 mean age, all female) were tested in 4 conditions (1: intact; 2: ACLR; 3: ACLR + LET; and 4: ACL cut) with varying posterior tibial slopes (5°, 10°, 15°, and 20°) at three flexion angles (0°, 30, ° and 60°). Specimens were mounted to a load frame which applied a 500-N axial load with 1 N-M of internal rotation torque (Figure 1). The amount of tibial translation was measured using a laser sensor and rotation was measured along the axis of the load frame. ACL graft forces were measured via a force transducer. Results: No clinically relevant difference was found in graft force (all differences <6.8 N, except the 5° posterior tibial slope at 30° of flexion showing a 12.1 N reduction with LET), anterior tibial translation (all differences <2.4 mm), or internal rotation (all differences < 1.59°). Compared to the intact state, the cut ACL state had higher anterior tibial translation (maximum increase +9.1 mm at slope 20°, Flexion 60°) and internal rotation (maximum increase +4.3° at slope 5°, flexion 30°). Higher ACL graft forces were observed with increasing posterior tibial slope (ACLR graft force at 0° of flexion was 81.6 N at 5°, 97.8 N at 10°, 107.0 N at 15°, 113.9 N at 20° of slope). Figure 2 shows ACL graft forces in N, Figure 3 shows anterior tibial translation in mm and Figure 4 shows internal rotation in degrees. All figures present data at 30°of flexion. Conclusion: No clinically relevant difference was shown with the addition of LET in the setting of ACLR for patients with posterior tibial slopes from 5° to 20° at flexion angles of 0°, 30°, and 60° in regards to graft force, anterior tibial translation, and internal tibial rotation under a 500 N compressive load. Figure 1. AP and Posteromedial views of the testing specimen mounted on load frame Figure 2. ACL Graft Force at 500N compression at Flexion 30° for ACLR (Red) vs ACLR+LET (Blue) states at varying posterior tibial slopes (5°, 10°, 15°, and 20°) Figure 3. Anterior Tibial Translation at Flexion 30° for all states (Intact (blue), ACLR+LET (red), ACLR (green), ACL cut (orange)) at varying posterior tibial slopes (5°, 10°, 15°, and 20°) Figure 4. Internal Tibial Rotation at Flexion 30° for all states (Intact (blue), ACLR+LET (red), ACLR (green), ACL cut (orange)) at varying posterior tibial slopes (5°, 10°, 15°, and 20°) Reference: 1. Bernhardson AS, Aman ZS, Dornan GJ, et al. Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases. Am J Sports Med. 2019;47(2):296-302. doi:10.1177/0363546518820302 [ABSTRACT FROM AUTHOR]

Background: The effect of coronal plane alignment on the outcomes of repairs of the medial meniscus root remains unclear. Hypothesis: Increased preoperative varus alignment is associated with higher failure rates and lower patient-reported outcomes (PROs) after isolated repair of the medial meniscus root. Study Design: Case series; Level of evidence, 4. Methods: Patients aged 18 years or older who underwent arthroscopy-assisted repair of the medial posterior meniscus root over a 7-year period were included. The mechanical axis of the knee was measured preoperatively. Osteoarthritis was assessed radiographically preoperatively and at the final follow-up according to the Kellgren-Lawrence grading scale. Failure was defined as any patient having to undergo revision root repair, partial meniscectomy of the previously repaired meniscus, debridement, lysis of adhesions, or conversion to arthroplasty. Results: A total of 53 patients (29 women, 24 men) with a mean age of 51.3 years were included in the follow-up analysis. The mean time of follow-up after surgery was 3.3 years (range, 22-77 months). Significant improvements were observed in all PROs analyzed. Decreased varus as measured by alignment percentage was correlated with baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain (P =.023) and WOMAC Stiffness (P =.022). Alignment percentage was also significantly negatively correlated with postoperative WOMAC Stiffness (P =.005) and positively correlated with Lysholm (P =.003) and International Knee Documentation Committee (P =.009) scores. Higher baseline Kellgren-Lawrence grade was correlated with worse postoperative PROs (P <.05), except 12-Item Short Form Health Survey Mental Component Summary and satisfaction. Eight patients who underwent a concomitant high tibial osteotomy (HTO) achieved lower PROs in all scales analyzed, regardless of their alignment. When excluding patients who underwent HTO, postoperative Lysholm score (P =.004) and postoperative WOMAC Stiffness (p = 0.014) were inferior among the patients with >5° of varus. Conclusion: Lower extremity alignment closest to neutral correlated with improved PROs. Patients who underwent a concurrent HTO had worse PROs than those who did not undergo HTO. [ABSTRACT FROM AUTHOR]

Burke, J, Geller, JS, Perez, JR, Naik, K, Vidal, AF, Baraga, MG, and Kaplan, LD. The effect of passing plays on injury rates in the national football league. J Strength Cond Res 35(12S): S1–S4, 2021—The National Football League (NFL) has one of the highest all-cause injury rates in sports, yet our understanding of extrinsic injury risk factors is limited. The objective of this study was to assess the effect of play type on injury incidence in the NFL. We obtained data for every regular season game played during the 2013–2016 seasons from the official NFL game books. There were 2,721 in-game injuries during the 4 seasons examined, with an overall rate of 1.33 injuries per team per game. For statistical analysis, p < 0.05 was considered significant. Passing plays conferred significantly higher odds of injury than running plays (odds ratio [OR] 1.4, 95% confidence interval [CI]: 1.3–1.5, p < 0.0001). This primarily stems from increased risks in quarterbacks (OR 6.9, 95% CI: 3.6–13.3, p < 0.0001), receivers (OR 5.0, 95% CI: 3.7–6.6, p < 0.0001), and defensive backs (OR 2.3, 95% CI: 1.9–2.7, p < 0.0001). Our study suggests that passing plays confer a greater risk of overall injuries in the NFL when compared with running plays, specifically regarding concussions and core or trunk injuries. [ABSTRACT FROM AUTHOR]

Background: Meniscal deficiency has been reported to increase contact pressures in the affected tibiofemoral joint, possibly leading to degenerative changes. Current surgical options include meniscal allograft transplantation and insertion of segmental meniscal scaffolds. Little is known about segmental meniscal allograft transplantation. Purpose: To evaluate the effectiveness of segmental medial meniscal allograft transplantation in the setting of partial medial meniscectomy in restoring native knee loading characteristics. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen human cadaveric knees underwent central midbody medial meniscectomy and subsequent segmental medial meniscal allograft transplantation. Knees were loaded in a dynamic tensile testing machine to 1000 N for 20 seconds at 0°, 30°, 60°, and 90° of flexion. Four conditions were tested: (1) intact medial meniscus, (2) deficient medial meniscus, (3) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures, and (4) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures and 1 suture fixed through 2 bone tunnels. Submeniscal medial and lateral pressure-mapping sensors assessed mean contact pressure, peak contact pressure, mean contact area, and pressure mapping. Two-factor random-intercepts linear mixed effects models compared pressure and contact area measurements among experimental conditions. Results: The meniscal-deficient state demonstrated a significantly higher mean contact pressure than all other testing conditions (mean difference, ≥0.35 MPa; P <.001 for all comparisons) and a significantly smaller total contact area as compared with all other testing conditions (mean difference, ≤140 mm2; P <.001 for all comparisons). There were no significant differences in mean contact pressure or total contact area among the intact, transplant, or transplant-with-tunnel groups or in any outcome measure across all comparisons in the lateral compartment. No significant differences existed in center of pressure and relative pressure distribution across testing conditions. Conclusion: Segmental medial meniscal allograft transplantation restored the medial compartment mean contact pressure and mean contact area to values measured in the intact medial compartment. Clinical Relevance: Segmental medial meniscal transplantation may provide an alternative to full meniscal transplantation by addressing only the deficient portion of the meniscus with transplanted tissue. Additional work is required to validate long-term fixation strength and biologic integration. [ABSTRACT FROM AUTHOR]

Background: When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis: The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results: A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P =.02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P =.17). The odds of failure were 68% higher with medial versus lateral repairs (P <.001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk (P =.004). Conclusion: Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration: NCT00463099 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. Hypothesis/Purpose: The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscal tears and treatment would be predictors of the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) (all 5 subscales), and Marx activity level outcomes at 10-year follow-up after ACLR. Study Design: Cohort study (prognosis); Level of evidence, 1. Methods: Between 2002 and 2008, individuals with ACLR were prospectively enrolled and followed longitudinally using the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A proportional odds logistic regression model was built incorporating variables from patient characteristics, surgical technique, articular cartilage injuries, and meniscal tears and treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx outcomes at 10 years. Results: A total of 3273 patients were enrolled (56% male; median age, 23 years at time of enrollment). Ten-year follow-up was obtained on 79% (2575/3273) of the cohort. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC], 22%; lateral femoral condyle [LFC], 15%; medial tibial plateau [MTP], 4%; lateral tibial plateau [LTP], 11%; patella, 18%; trochlea, 8%) and meniscal pathology (medial, 37%; lateral, 46%). Variables that were predictive of poorer 10-year outcomes included articular cartilage damage in the patellofemoral (P <.01) and medial (P <.05) compartments and previous medial meniscal surgery (7% of knees; P <.04). Compared with no meniscal tear, a meniscal injury was not associated with 10-year outcomes. Medial meniscal repair at the time of ACLR was associated with worse 10-year outcomes for 2 of 5 KOOS subscales, while a medial meniscal repair in knees with grade 2 MFC chondrosis was associated with better outcomes on 2 KOOS subscales. Conclusion: Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscal surgery before ACLR were associated with poorer 10-year ACLR patient-reported outcomes, but meniscal injury present at the time of ACLR was not. There was limited and conflicting association of medial meniscal repair with these outcomes. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods: A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results: Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA (n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA (n = 26) and bilateral RTSA (n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion: The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs). Purpose: To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs. Study Design: Systematic review. Methods: A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients undergoing all-inside BHMT repair with ≥12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics (patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS). Results: Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58 years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3% at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had higher failure rates than other devices (P =.0003). Women (31%) were less likely to experience a failure than were men (69%) (P =.03). Longer follow-up duration resulted in higher failure rates (>30 months, 34.4%; <30 months, 23.4%; P =.016). In 4 studies reporting on both all-inside and inside-out repairs, no significant differences in failure rates were observed. No significant differences in failure rates were found between medial and lateral repairs nor repair with and without concurrent anterior cruciate ligament reconstruction (P >.05 for all). The overall average MCMS was 54.4 ± 12. Conclusion: The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the RapidLoc and Biofix Arrow, male sex, and longer follow-up duration. [ABSTRACT FROM AUTHOR]

Background: The cause of subsequent surgery after anterior cruciate ligament (ACL) reconstruction varies, but if risk factors for specific subsequent surgical procedures can be identified, we can better understand which patients are at greatest risk. Purpose: To report the incidence and types of subsequent surgery that occurred in a cohort of patients 6 years after their index ACL reconstruction and to identify which variables were associated with the incidence of patients undergoing subsequent surgery after their index ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients completed a questionnaire before their index ACL surgery and were followed up at 2 and 6 years. Patients were contacted to determine whether any underwent additional surgery since baseline. Operative reports were obtained, and all surgical procedures were categorized and recorded. Logistic regression models were constructed to predict which patient demographic and surgical variables were associated with the incidence of undergoing subsequent surgery after their index ACL reconstruction. Results: The cohort consisted of 3276 patients (56.3% male) with a median age of 23 years. A 6-year follow-up was obtained on 91.5% (2999/3276) with regard to information on the incidence and frequency of subsequent surgery. Overall, 20.4% (612/2999) of the cohort was documented to have undergone at least 1 subsequent surgery on the ipsilateral knee 6 years after their index ACL reconstruction. The most common subsequent surgical procedures were related to the meniscus (11.9%), revision ACL reconstruction (7.5%), loss of motion (7.8%), and articular cartilage (6.7%). Significant risk factors for incurring subsequent meniscus-related surgery were having a medial meniscal repair at the time of index surgery, reconstruction with a hamstring autograft or allograft, higher baseline Marx activity level, younger age, and cessation of smoking. Significant predictors of undergoing subsequent surgery involving articular cartilage were higher body mass index, higher Marx activity level, reconstruction with a hamstring autograft or allograft, meniscal repair at the time of index surgery, or a grade 3/4 articular cartilage abnormality classified at the time of index ACL reconstruction. Risk factors for incurring subsequent surgery for loss of motion were younger age, female sex, low baseline Knee injury and Osteoarthritis Outcome Score symptom subscore, and reconstruction with a soft tissue allograft. Conclusion: These findings can be used to identify patients who are at the greatest risk of incurring subsequent surgery after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Study design: Systematic review. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried through use of the terms anterior cruciate ligament and revision to identify all studies reporting outcomes of bone tunnel grafting in 2-stage revision ACL reconstruction. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. Results: The analysis included 7 studies with a total of 234 patients. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean ± SD of 4.2 ± 2.1 years. The indication for bone grafting and between-stage protocol varied among studies. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). Finally, 1 study compared ICBG to a synthetic bone substitute. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. In 4 studies, the authors reported the time interval between first and second surgeries, with an average of 6.1 months for ICBG compared with 8.7 months for allogenic and synthetic grafts. Revision ACL graft failure rates were reported by 5 studies, including 1 study with ABM (6.1%), 1 study with AC (8.3%), 1 study with TBA (0%), and 2 studies with ICBG (0% and 2%). Conclusion: The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. The available data indicate that autograft for bone tunnel grafting in 2-stage ACL revision may be associated with a lower risk of revision ACL reconstruction graft failure compared with allograft bone. [ABSTRACT FROM AUTHOR]

Background: Physicians' and patients' decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete. Purpose: To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft. Study Design: Cohort study; Level of evidence, 2. Methods: Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee. Results: A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P =.001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P =.004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P =.009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P =.004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee. Conclusion: There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft. [ABSTRACT FROM AUTHOR]

Background: Understanding the risk factors for loss to follow-up in prospective clinical studies may allow for a targeted approach to minimizing follow-up bias and improving the generalizability of conclusions in anterior cruciate ligament reconstruction (ACLR) and other sports-related interventions. Purpose: To identify independent risk factors associated with failure to complete (ie, loss to follow-up) patient-reported outcome measures (PROMs) at 2 years after ACLR within a well-funded prospective longitudinal cohort. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: All patients undergoing primary or revision ACLR enrolled in the prospectively collected database of the multicenter consortium between 2002 and 2008 were included. Multivariate regression analyses were conducted to determine which baseline risk factors were significantly associated with loss to follow-up at a minimum of 2 years after surgery. Predictors assessed for loss to follow-up were as follows: consortium site, sex, race, marital status, smoking status, phone number provided (home or cell), email address provided (primary or secondary), years of school completed, average hours worked per week, working status (full-time, part-time, homemaker, retired, student, or disabled), number of people living at home, and preoperative PROMs (Knee injury and Osteoarthritis Outcome Score, Marx Activity Rating Scale, and International Knee Documentation Committee). Results: A total of 3202 patients who underwent ACLR were enrolled. The 2-year PROM follow-up rate for this cohort was 88% (2821 of 3202). Multivariate analyses showed that patient sex (male: odds ratio [OR], 1.80) and race (black: OR, 3.64; other nonwhite: OR, 1.81) were independent predictors of 2-year loss to follow-up of PROMs. Education level was a nonconfounder. Conclusion: While education level did not predict loss to follow-up, patients who are male and nonwhite are at increased risk of loss to follow-up of PROM at 2 years. Capturing patient outcomes with minimal loss depends on equitable, not equal, opportunity to maximize generalizability and mitigate potential population-level health disparities. Registration: NCT00478894 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Knee laxity in the setting of anterior cruciate ligament (ACL) injury is often assessed through physical examination using the Lachman, pivot shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. Hypothesis: Increased preoperative knee laxity is associated with increased risk of revision ACL reconstruction, increased risk of contralateral ACL reconstruction, and poorer patient-reported outcomes at 6 years postoperatively. Study Design: Cohort study; Level of evidence, 2. Methods: 2333 patients who underwent primary isolated ACL reconstruction without additional ligament injury were identified. Patients reported by the operating surgeons to have an International Knee Documentation Committee (IKDC) grade D Lachman, anterior drawer, or pivot shift examination were classified as having a high-grade laxity. Multiple logistic regression models were used to evaluate whether having high-grade preoperative laxity was predictive of increased odds of undergoing subsequent revision or contralateral ACL reconstruction within 6 years of the index procedure, controlling for patient age, sex, body mass index, Marx activity level, sport, graft type, medial meniscal treatment, and lateral meniscal treatment. Multiple linear regression modeling was used to evaluate whether having high-grade preoperative laxity was predictive of poorer IKDC or Knee injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL) scores at 6 years postoperatively, after controlling for baseline score, patient age, ethnicity, sex, body mass index, marital status, smoking status, sport participation, competition level, Marx activity rating score, graft type, and articular cartilage and meniscal status. Results: In total, 743 of 2325 patients (32.0%) were noted to have high-grade laxity on at least 1 physical examination test. High-grade Lachman was noted in 334 patients (14.4%), high-grade pivot shift was noted in 617 patients (26.5%), and high-grade anterior drawer was noted in 233 patients (10.0%). Six-year revision and contralateral ACL reconstruction data were available for 2129 patients (91.6%). High-grade prereconstruction Lachman was associated with significantly increased odds of ACL graft revision (odds ratio [OR], 1.76; 95% CI, 1.10-2.80, P = .02) and contralateral ACL reconstruction (OR, 1.68; 95% CI, 1.09-2.69; P = .019). High-grade prereconstruction pivot shift was associated with significantly increased odds of ACL graft revision (OR, 1.75; 95% CI, 1.19-2.54, P = .002) but not with significantly increased odds of contralateral ACL reconstruction (OR, 1.30; 95% CI, 0.89-1.87; P = .16). High-grade prereconstruction laxity was associated with statistically significantly lower 6-year IKDC (β = −2.26, P = .003), KOOS-QOL (β = −2.67, P = .015), and Marx activity scores (β = −0.54, P = .020), but these differences did not approach clinically relevant differences in patient-reported outcomes. Conclusion: High-grade preoperative knee laxity is predictive of increased odds of revision ACL reconstruction and contralateral ACL reconstruction 6 years after ACL reconstruction. Poorer patient-reported outcome scores in the high-grade laxity group were also noted, but the difference did not reach a level of clinical relevance. [ABSTRACT FROM AUTHOR]

Background: The long-term prognosis and risk factors for quality of life and disability after anterior cruciate ligament (ACL) reconstruction remain unknown. Hypothesis/Purpose: Our objective was to identify patient-reported outcomes and patient-specific risk factors from a large prospective cohort at a minimum 10-year follow-up after ACL reconstruction. We hypothesized that meniscus and articular cartilage injuries, revision ACL reconstruction, subsequent knee surgery, and certain demographic characteristics would be significant risk factors for inferior outcomes at 10 years. Study Design: Therapeutic study; Level of evidence, 2. Methods: Unilateral ACL reconstruction procedures were identified and prospectively enrolled between 2002 and 2004 from 7 sites in the Multicenter Orthopaedic Outcomes Network (MOON). Patients preoperatively completed a series of validated outcome instruments, including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale. At the time of surgery, physicians documented all intra-articular abnormalities, treatment, and surgical techniques utilized. Patients were followed at 2, 6, and 10 years postoperatively and asked to complete the same outcome instruments that they completed at baseline. The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of the outcome. Results: A total of 1592 patients were enrolled (57% male; median age, 24 years). Ten-year follow-up was obtained on 83% (n = 1320) of the cohort. Both IKDC and KOOS scores significantly improved at 2 years and were maintained at 6 and 10 years. Conversely, Marx scores dropped markedly over time, from a median score of 12 points at baseline to 9 points at 2 years, 7 points at 6 years, and 6 points at 10 years. The patient-specific risk factors for inferior 10-year outcomes were lower baseline scores; higher body mass index; being a smoker at baseline; having a medial or lateral meniscus procedure performed before index ACL reconstruction; undergoing revision ACL reconstruction; undergoing lateral meniscectomy; grade 3 to 4 articular cartilage lesions in the medial, lateral, or patellofemoral compartments; and undergoing any subsequent ipsilateral knee surgery after index ACL reconstruction. Conclusion: Patients were able to perform sports-related functions and maintain a relatively high knee-related quality of life 10 years after ACL reconstruction, although activity levels significantly declined over time. Multivariable analysis identified several key modifiable risk factors that significantly influence the outcome. [ABSTRACT FROM AUTHOR]

Context: With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures.Evidence Acquisition: MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years.Study Design: Clinical review.Level Of Evidence: Level 4.Results: Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface.Conclusion: Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation. [ABSTRACT FROM AUTHOR]

Background: Avulsion fractures of the anterior tibial spine in young athletes are injuries similar to anterior cruciate ligament (ACL) injuries in adults. Sparse data exist on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity or injuries leading to ACL reconstruction. Purpose: To better delineate the incidence of delayed instability or ACL ruptures requiring delayed ACL reconstruction in young patients with prior fractures of the tibial eminence. Study Design: Case series; Level of evidence, 4. Methods: We identified 101 patients between January 1993 and January 2012 who sustained an ATSF and who met inclusion criteria for this study. All patients had been followed for at least 2 years after the initial injury and were included for analysis after completion of a questionnaire via direct contact, mail, and/or telephone. If patients underwent further surgical intervention and/or underwent later ACL reconstruction, clinical records and operative reports pertaining to these secondary interventions were obtained and reviewed. Differences between categorical variables were assessed using the Fisher exact test. The association between time to revision ACL surgery and fracture type was assessed by Kaplan-Meier plots. The association between need for revision ACL surgery and age, sex, and mechanism of surgery was assessed using logistic regression. Results: Nineteen percent of all patients evaluated underwent delayed ACL reconstruction after a previous tibial spine fracture on the ipsilateral side. While there were a higher proportion of ACL reconstructions in type II fractures, there was not a statistically significant difference in the number of patients within each fracture group who went on to undergo later surgery (P = .29). Further, there was not a significant association between fracture type, sex, or mechanism of injury as it related to the progression to later ACL reconstruction. However, there was a significant association between age at the time of injury and progression to later ACL reconstruction (P = .02). For every year increase in age at the time of injury, the odds of going on to undergo delayed ACL reconstruction were greater by a factor of 1.3 (95% CI, 1.1-1.6). Conclusion: Although an ATSF is a relatively rare injury, our cohort of patients suggests that a subset of young patients with all types of tibial spine fractures will require later ACL reconstruction. There is a need to counsel patients that a delayed ACL rupture is a potential risk after an ATSF, especially as children approach skeletal maturity. Further patient follow-up and prospective studies are required. [ABSTRACT FROM AUTHOR]

Higher rates of poor outcomes in displaced midshaft clavicle fractures treated nonoperatively have recently been reported. Along with expanding indications for operative fixation and increasing application of locked plate constructs, it is unknown whether complications related to bicortical penetration of the clavicle can be avoided using uni-cortical fixation. The purpose of this study is to compare the biomechanical properties of unicortical and bicortical fixation in precontoured vs manually contoured locking clavicle plates. Forty-eight Sawbone composite human clavicle specimens (item #3408; Pacific Research Laboratories, Vashon, Washington) with a midshaft clavicle osteotomy were reduced and plated in 8 specimens each using a bicortical and unicortical fixation for each of 3 locked plate constructs (3.5-mm LCP Reconstruction Plate; 3.5-mm LCP Superior Clavicle Plate; 3.5-mm LCP Superior Anterior Clavicle Plate; Synthes, Inc, West Chester, Pennsylvania). Specimens were tested for stiffness in axial torsion and cantilever bending and then loaded to failure in 3-point bending. Data were analyzed using 2-way analysis of variance and Tukey's test (P<.05). No significant differences were found between unicortical and bicortical fixation in failure load, cantilever bending, and cross body stiffness. Bicortical fixation was significantly stiffer than unicortical fixation in torsion only for the same plates. Significant differences also existed between plates in torsion. Unicortical locked plate fixation may be a reasonable option in the treatment of displaced midshaft clavicle fracture fixation to avoid complications associated with posteroinferior hardware penetration following clavicle fracture fixation based on the biomechanical performance of these constructs. However, it remains unclear whether these differences will be clinically significant. [ABSTRACT FROM AUTHOR]

The article presents a study on topic of “Factors Predictive of Concomitant Injuries Among Children and Adolescents Undergoing Anterior Cruciate Ligament Surgery" done by Justin T. Newman and colleagues at Children's Hospital Colorado, Aurora, Colorado, USA. The article mentions methods, statistical analysis and results. The findings show that the prevalence of concomitant knee injuries as well as the need for additional operative procedures was greater among older subjects when compared with younger subjects.

The article discusses a study which aimed to identify factors associated with anterior cruciate ligament (ACL) graft failure in an adolescent cohort. Results show that autograft failure tend to remain constant 24 to 48 months after initial surgery, while allograft failure risk continued to increase during postoperative months 24 to 48. It concluded that graft type and postoperative knee laxity are significant predictors of graft survival.

Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders.Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4.Results: Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25).Conclusions: Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race.Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders. Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patientreported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4. Results: Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25). Conclusions: Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Increased knee pain at the time of anterior cruciate ligament reconstruction may potentially predict more difficult rehabilitation, prolonged recovery, and/or be predictive of increased knee pain at 2 years.Hypothesis: A bone bruise and/or other preoperative factors are associated with more knee pain/symptoms at the time of index anterior cruciate ligament reconstruction, and the presence of a bone bruise would be associated with specific demographic and injury-related factors.Study Design: Cohort study (prevalence); Level of evidence, 2.Methods: In 2007, the Multicenter Orthopaedic Outcomes Network (MOON) database began to prospectively collect surgeon-reported magnetic resonance imaging bone bruise status. A multivariable analysis was performed to (1) determine if a bone bruise, among other preoperative factors, is associated with more knee symptoms/pain and (2) examine the association of factors related to bone bruise. To evaluate the association of a bone bruise with knee pain/symptoms, linear multiple regression models were fit using the continuous scores of the Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscales and the Short Form 36 (SF-36) bodily pain subscale as dependent variables. To examine the association between a bone bruise and risk factors, a logistic regression model was used, in which the dependent variable was the presence or absence of a bone bruise.Results: Baseline data for 525 patients were used for analysis, and a bone bruise was present in 419 (80%). The cohort comprises 58% male patients, with a median age of 23 years. The median Marx activity level was 13. Factors associated with more pain were higher body mass index (P < .0001), female sex (P = .001), lateral collateral ligament injury (P = .012), and older age (P = .038). Factors associated with more symptoms were a concomitant lateral collateral ligament injury (P = .014), higher body mass index (P < .0001), and female sex (P < .0001). Bone bruise is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction. None of the factors included in the SF-36 bodily pain model were found to be significant. After controlling for other baseline factors, the following factors were associated with a bone bruise: younger age (P = .034) and not jumping at the time of injury (P = .006).Conclusion: After anterior cruciate ligament injury, risk factors associated with a bone bruise are younger age and not jumping at the time of injury. Bone bruise is not associated with symptoms/pain at the time of index anterior cruciate ligament reconstruction. [ABSTRACT FROM PUBLISHER]

Background: There is no consensus for the optimal postoperative rehabilitation protocol after rotator cuff repairs.Objective: To determine if there is sufficient level I or II evidence available in the literature for establishment of a uniform, optimal rotator cuff rehabilitation protocol.Data Sources: A systematic review of level I and II English-language, prospective, randomized controlled trials published between 1966 and 2008 was performed. MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies that met the inclusion criteria. Search terms included rotator cuff, supraspinatus, infraspinatus, subscapularis, teres minor, rehab, rehabilitation, physical therapy, and physiotherapy.Study Selection: Inclusion criteria were English-language level I or level II studies, including randomized clinical trials involving the rehabilitation of rotator cuff repairs. Exclusion criteria were non-English language, level IV or V studies, or studies involving shoulder rehabilitation of diagnoses other than rotator cuff repairs. Three independent reviewers arrived at a consensus for including 4 studies in this review out of 12 studies identified by the literature search.Data Extraction: Included studies underwent worksheet quality appraisal independently by each of the 3 authors identifying strengths, weaknesses, and biases. The quality appraisal was then discussed among the authors and consensus reached regarding the strengths, weaknesses, and value of the included studies.Results: Two studies examined the use of continuous passive motion for rotator cuff rehabilitation, and 2 studies compared an unsupervised, standardized rehabilitation program to a supervised, individualized rehabilitation program. These studies did not support the use of continuous passive motion in rotator cuff rehabilitation, and no advantage was shown with a supervised, individualized rehabilitation protocol compared to an unsupervised, standardized home program. Each investigation had weaknesses in study design that decreased the validity of its findings.Conclusion: There is not enough high-level evidence to develop an evidence-based medicine approach to rotator cuff rehabilitation. There is a need for well-designed level I and level II trials to elucidate the optimal rotator cuff repair rehabilitation protocol. [ABSTRACT FROM AUTHOR]

Little is known about the long-term properties of fresh cold-stored osteochondral allograft tissue. We hypothesized fresh cold-stored tissue would yield superior material properties in an in vivo ovine model compared to those using freeze-thawed acellular grafts. In addition, we speculated that a long storage time would yield less successful grafts. We created 10-mm defects in medial femoral condyles of 20 sheep. Defects were reconstructed with allograft plugs stored at 4 degrees C for 1, 14, and 42 days; control specimens were freeze-thawed or defect-only. At 52 weeks, animals were euthanized and retrieved grafts were analyzed for cell viability, gross morphology, histologic grade, and biomechanical and biochemical analysis. Explanted cold-stored tissue had superior histologic scores over freeze-thawed and defect-only grafts. Specimens stored for 1 and 42 days had higher equilibrium moduli and proteoglycan content than freeze-thawed specimens. We observed no difference among any of the cold-stored specimens for chondrocyte viability, histology, equilibrium aggregate modulus, proteoglycan content, or hypotonic swelling. Reconstructing cartilage defects with cold-stored allograft resulted in superior histologic and biomechanical properties compared with acellular freeze-thawed specimens; however, storage time did not appear to be a critical factor in the success of the transplanted allograft. [ABSTRACT FROM AUTHOR]

The article presents information on anatomy, injury patterns, biomechanics, and kinematics of the anterior cruciate ligament. It also summarizes the surgical technique and augmentation procedures used in an anatomic two-bundle approach to anterior cruciate ligament reconstruction. Many medical studies find that single-bundle anterior cruciate ligament reconstruction is insufficient in controlling combined rotatory loads of internal tibial torque and valgus torque.