Search

Background: Recently, the posterior horn lateral meniscal oblique radial tear (LMORT) was identified in 12% of acute anterior cruciate ligament (ACL) injuries. However, patient-reported outcomes for repair of this relatively common tear have not been reported., Purpose: To determine the minimum 2-year functional outcomes after LMORT repair at the time of ACL reconstruction (ACLR) compared to a matched cohort of patients who underwent isolated ACLR (iACLR)., Study Design: Cohort study; Level of evidence, 3., Methods: Included were 100 patients (mean age at surgery, 21 years; range, 13-45 years) who underwent primary ACLR between 2010 and 2018. The mean follow-up period was 4.1 ± 2.0 years (range, 2.0-9.2 years). A total of 50 patients with surgically repaired LMORT type 3 or type 4 lesions, defined as partial or complete tears >10 mm from the root (LMORT group) were matched 1:1 based on age, date of surgery, and graft choice with 50 patients who underwent iACLR (iACLR group). The postoperative outcomes were compared between groups using the International Knee Documentation Committee subjective score (sIKDC) and the Tegner activity scale. An updated medical history was obtained via the electronic medical record to determine any subsequent complications and reoperations., Results: There was 1 ACL graft failure in each group as well as 5 (10%) reoperations per group. None of the patients in the LMORT group necessitated a lateral meniscal revision repair or partial meniscectomy. The LMORT and iACLR groups reported comparable sIKDC scores (92.5 ± 6.8 vs 91.9 ± 8.2, respectively; P = .712) as well as Tegner scores (6.7 ± 1.8 vs 6.6 ± 1.8, respectively; P = .910) at final follow-up. No failures of the LMORT repairs were reported., Conclusion: The study findings demonstrated that reoperations, graft failure rates, patient-reported outcomes, and patient activity levels at ≥2 years after type 3 and 4 LMORT repairs at the time of ACLR compared favorably with those of a matched cohort of patients who underwent iACLR with intact meniscus., Competing Interests: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the US National Institutes of Health. One or more of the authors has declared the following potential conflict of interest or source of funding: Research support was received from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950) and from the Foderaro-Quattrone Musculoskeletal/Orthopaedic Surgery Research Innovation Fund. E.T. has received a grant from Arthrex, education payments from Arthrex, and hospitality payments from Stryker. M.J.S. has received research support from Stryker, education payments from Arthrex, consulting fees from Arthrex, nonconsulting fees from Arthrex, and royalties from Arthrex. B.A.L. has received consulting fees from Arthrex and Smith & Nephew; nonconsulting fees from Arthrex, Smith & Nephew, and Linvatec; royalties from Arthrex; and stock from COVR Medical. P.A.S. has received research support from Arthrex; education payments from United Orthopedics and Elite Orthopedics; consulting fees from Arthrex; nonconsulting fees from Arthrex, Kairos Surgical, United Orthopedics, Medical Device Business Services, Elite Orthopedics, and Alpha Orthopedic systems; royalties from Arthrex; and stock options from Spinal Simplicity. A.J.K. has received research support from Aesculap, B. Braun, Ceterix, Arthritis Foundation, Histogenics, and Arthrex; a grant from DJO; consulting fees from Arthrex, Vericel, JRF Ortho, and Responsive Arthroscopy; nonconsulting fees from Arthrex; royalties from Arthrex and Responsive Arthroscopy; honoraria from JRF Ortho, MTF Biologics, and Responsive Arthroscopy; and hospitality payments from Gemini Mountain Medical and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Mayo Clinic (reference No. PR15-000601-09)., (© The Author(s) 2023.)

Background: Biomechanical studies support the use of suture tape reinforcement for limiting graft elongation and increasing strength in knee ligament reconstructions., Purpose: To compare posterior cruciate ligament (PCL) laxity, complication and reoperation rates, and patient-reported outcomes (PROs) after all-inside single-bundle PCL reconstruction (PCLR) with versus without independent suture tape reinforcement., Study Design: Cohort study; Level of evidence, 3., Methods: A retrospective cohort study of consecutive patients who underwent primary, all-inside allograft single-bundle PCLR with and without independent suture tape reinforcement at a single academic institution from 2012 to 2019. Medical records were reviewed for patient characteristics, additional injuries, and concomitant procedures. PRO scores (including the International Knee Documentation Committee [IKDC], Tegner activity scale, and Lysholm scores), bilateral comparison kneeling radiographs, and physical examination findings were collected at a minimum of 2 years postoperatively., Results: Included were 50 patients: 19 with suture tape reinforcement (mean age 30.6 ± 2.9 years) and 31 without suture tape reinforcement (control group; mean age 26.2 ± 1.6 years). One PCLR graft in the suture tape group failed. Posterior drawer examination revealed grade 1+ laxity in 4 of 19 (21%) of the suture tape cohort versus 6 of 31 (19%) of the control cohort ( P > .999). Bilateral kneeling radiographs showed similar side-to-side differences in laxity between the groups (suture tape vs control: mean, 1.9 ± 0.4 vs 2.6 ± 0.6 mm; P = .361). There were no statistically significant differences between the groups in postoperative IKDC (suture tape vs control: 79.3 vs 79.6; P = .779), Lysholm (87.5 vs 84.3; P = .828), or Tegner activity (5.6 vs 5.7; P = .562) scores., Conclusion: All-inside single-bundle PCLR with and without independent suture tape reinforcement demonstrated low rates of graft failure, complications, and reoperations, with satisfactory PROs at a minimum 2-year follow-up. Radiographic posterior tibial translation was comparable between the 2 groups., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Support was received from the Foderaro-Quattrone Musculoskeletal-Orthopaedic Surgery Research Innovation Fund. This study was partially funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (grant T32AR56950). A.P. has received hospitality payments from Medical Device Business Services. A.J.K. has received grant support from DJO; consulting fees from Arthrex, JRF Ortho, and Responsive Arthroscopy; speaking fees from Arthrex; royalties from Arthrex and Responsive Arthroscopy; and honoraria from Vericel and JRF Ortho. A.P. is a board member for the Musculoskeletal Transplant Foundation. M.J.S. has received education payments from Elite Orthopedics. B.A.L. has received education payments from Linvatec, consulting fees from Arthrex, speaking fees from Arthrex and Smith & Nephew, and royalties from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Arthrofibrosis (AF) is an exaggerated immune response to a proinflammatory insult leading to pathologic periarticular fibrosis and symptomatic joint stiffness. The knee, elbow, and shoulder are particularly susceptible to AF, often in the setting of trauma, surgery, or adhesive capsulitis. Prevention through early physiotherapeutic interventions and anti-inflammatory medications remain fundamental to avoiding motion loss. Reliable nonoperative modalities exist and outcomes are improved when etiology, joint involved, and level of dysfunction are considered in the clinical decision making process. Surgical procedures should be reserved for cases recalcitrant to nonoperative measures. The purpose of this review is to provide an overview of the current understanding of AF pathophysiology, identify common risk factors, describe prevention strategies, and outline both nonoperative and surgical treatment options. This manuscript will focus specifically on sterile AF of the knee, elbow, and shoulder., Competing Interests: Disclosure: C.L.C. reports personal fees and nonfinancial support from Arthrex, nonfinancial support from Zimmer Biomet, nonfinancial support from Stryker Corporation. A.J.K. reports grants from Aesculap/B.Braun, other from American Journal of Sports Medicine, personal fees and other from Arthrex Inc., grants from Arthritis foundation, grants from Ceterix, grants from Histogenics, other from International Cartilage Repair Society, other from International society of Arthroscopy, Knee surgery, and orthopaedic sports medicine, other from Minnesota Orthopedic society, personal fees and other from Musculoskeletal Transplant Foundation, personal fees from Vericel, personal fees from DePuy, personal fees from JRF, grants from Exactech, grants from Gemini Medical, personal fees from Responsive Arthroscopy. M.J.S. reports involvement in the editorial or governing board for the American Journal of Sports Medicine, grants and personal fees from Arthrex Inc., grants from Stryker. M.P.A. reports involvement in the board or committee member of AAOS, publishing royalties, financial or material support from Springer, and IP royalties from Stryker. B.A.L. reports personal fees from Arthrex Inc.: IP royalties; Paid consultant, grants from Biomet: Research support, editorial or governing board for Clinical Orthopaedics and Related Research, Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Orthopedics Today; grants and personal fees from Smith & Nephew: Paid consultant; Research support, grants from Stryker: Research support, personal fees from Linvatec: Faculty/speaker, personal fees from COVR Medical LLC. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Arthroscopy of the shoulder, elbow, hip, and knee has become increasingly utilized due to continued advancements in technique, training, and instrumentation. In addition, arthroscopy is generally safe and effective in the utilization of joint preservation surgical techniques. The arthroscopist must utilize a thorough understanding of the surgical anatomy, detailed care with patient positioning, and safe instrumentation portals to prevent associated neurological injury. In the event of postoperative neurological complications, the physician must carefully document the patient history and physical examination while considering the utilization of additional imaging, testing, or surgical nerve exploration with a specialized team depending upon the severity of neurological injury. In this review, we discuss the prevention, evaluation, and treatment of neurological complications related for arthroscopic procedures of the shoulder, elbow, hip, and knee., Competing Interests: Disclosure: M.J.S. reports other from Arthrex Inc., during the conduct of the study; other from Americal Journal of Sports Medicine, grants and personal fees from Arthrex Inc., grants from Stryker, outside the submitted work. A.J.K. reports grants from Aesculap/B.Braun, other from American Journal of Sports Medicine, personal fees and other from Arthrex Inc., grants from Arthritis foundation, grants from Ceterix, grants from Histogenics, other from International Cartilage Repair Society, other from International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, other from Minnesota Orthopedic Society, personal fees and other from Musculoskeletal Transplant Foundation, personal fees from Vericel, personal fees from DePuy, personal fees from JRF, grants from Exactech, grants from Gemini Medical, personal fees from Responsive Arthroscopy, outside the submitted work. B.A.L. reports personal fees from Arthrex Inc.: IP royalties; Paid consultant, grants from Biomet: Research support, editorial or governing board for Clinical Orthopaedics and Related Research, Journal of Knee Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Orthopedics Today; grants and personal fees from Smith & Nephew: Paid consultant; Research support, grants from Stryker: Research support, personal fees from Linvatec: Faculty/speaker, personal fees from COVR Medical LLC. C.L.C. reports personal fees and non-financial support from Arthrex, non-financial support from Zimmer Biomet, non-financial support from Stryker Corporation, outside the submitted work. The remaining authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Many different techniques with multiple graft types have been described for the reconstruction of the injured posterior cruciate ligament (PCL); autograft versus allograft, single- versus double-bundle, open inlay versus arthroscopic inlay versus arthroscopic transtibial, and recently described the arthroscopic "all-inside" socket technique. Reported clinical outcomes have demonstrated no significant difference in any of these PCL reconstruction techniques, likely because of the heterogeneity in injury characteristics and patient population. The ideal surgical technique should be safe, simple, and reproducible while allowing treatment of concomitant knee injuries resulting and return to function., Competing Interests: A.P. reports nonfinancial support from Stryker Corporation, outside the submitted work. M.J.S. reports other from American Journal of Sports Medicine, grants and personal fees from Arthrex, Inc, grants from Stryker, outside the submitted work. B.A.L. reports personal fees from Arthrex, Inc: IP royalties; Paid consultant, grants from Biomet: Research support, other from Clinical Orthopaedics and Related Research: Editorial or governing board, other from Journal of Knee Surgery: Editorial or governing board, other from Knee Surgery, Sports Traumatology, Arthroscopy: Editorial or governing board, other from Orthopedics Today: Editorial or governing board, grants and personal fees from Smith & Nephew: Paid consultant; Research support, grants from Stryker: Research support, personal fees from Linvatec: Faculty/speaker, personal fees from COVR Medical LLC, outside the submitted work., (Thieme. All rights reserved.)

Objectives: This study seeks to evaluate the incidence rate of heterotopic ossification (HO) formation in patients afflicted by an isolated limb fracture (ILF) and a concomitant mild traumatic brain injury (mTBI)., Methods: The current study is an observational study including ILF patients with or without a concomitant mTBI recruited from an orthopedic clinic of a Level 1 Trauma Hospital. Patients were diagnosed with a mTBI according to the American Congress of Rehabilitation Medicine (ACRM) criteria. Radiographs taken on average 3 months post-trauma were analyzed separately by two distinct specialists for the presence of HO proximally to the fracture site (joints or extra joints). Both raters referred to Brooker's and Della's Valle's classification to establish signs of HO. First, analyses were conducted for the full sample. Secondly, a matched cohort was used in order to control for specific factors, namely age, sex, type of injury, and time elapsed between the accident and the analyzed radiograph., Results: The full sample included a total of 183 patients with an ILF (94 females; 47.5 years old), of which 50 had a concomitant mTBI and 133 without. Radiographic evidence of HO was significantly higher in patients with an ILF and a mTBI compared to ILF patients (X 2  = 6.50; p  = 0.01). The matched cohort consisted of 94 participants (i.e.; 47 patients from the ILF + mTBI group and 47 patients from the ILF group). Again, ILF + mTBI patients presented significantly higher rates of HO signs in comparison to ILF patients (X 2  = 3.69; p  = 0.04). Presence of HO was associated with prolonged delays to return to work (RTW) only in ILF + mTBI patients (F = 4.055; p  = 0.05) but not in ILF patients (F = 0.823; p  = 0.37)., Conclusions: Study findings suggest that rates of HO are significantly higher proximally to fracture sites when ILF patients sustain a concomitant mTBI, even after controlling for factors known to influence HO. Moreover, results show that HO is associated with a prolonged RTW only in ILF patients with a concomitant mTBI but not in ILF-only patients. The impact of mTBI on HO formation warrants further attention to detect early signs of HO, to identify shared physiopathological mechanisms and, ultimately, to design targeted therapies.