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Background: Isolated soft tissue injuries of the posterior capsulolabral complex can be addressed arthroscopically, with various anchor systems available for repair. Purpose: To evaluate clinical and patient-reported outcomes after arthroscopic capsulolabral repair in patients with posterior shoulder instability (PSI) and to compare differences in outcomes between patients treated with a suture-first technique (PushLock anchor) and an anchor-first technique (FiberTak all-suture anchor). Study Design: Cohort study; Level of evidence, 3. Methods: Included were 32 patients with dynamic structural PSI (type B2 according to the ABC classification) treated with an arthroscopic posterior capsulolabral repair. After a mean follow-up time of 4.8 ± 3.4 years (range, 2-11) patients were evaluated clinically, and standardized outcome scores were obtained for the Subjective Shoulder Value (SSV), the Western Ontario Shoulder Instability Index (WOSI), Rowe, Kerlan-Jobe Orthopaedic Clinic (KJOC), patient satisfaction (0-5 [best]), and pain on a visual analog scale (VAS; 0-10 [worst]). Results: The overall satisfaction level with the outcome of the surgery was 4.6 ± 0.5 (range, 4-5). No patient suffered from instability events. The mean VAS level for pain was 0.4 ± 0.9 (range, 0-4) at rest and 1.9 ± 2.0 (range, 0-6) during motion. The mean SSV was 80 ± 17 (range, 30-100), the mean postoperative WOSI score 75% ± 19% (range, 18-98), the mean Rowe score 78 ± 20 (range, 10-100), and the mean KJOC score was 81 ± 18 (range, 40-100) for the entire cohort. There was no significant difference between the techniques with regard to range of motion, strength, or clinical outcome scores. Conclusion: Arthroscopic posterior capsulolabral repair was a satisfactory method to treat structural PSI type B2 with regard to stability, pain relief, and functional restoration. The majority of patients had good outcomes. No differences in outcomes were observed between the anchor-first and suture-first techniques.

Background: Recently, there has been an increase in interest in the quadriceps tendon (QT) as an alternative autologous graft option for primary anterior cruciate ligament (ACL) reconstruction. Indication: Anterior cruciate ligament reconstruction in skeletally mature patients (high-risk patients for re-rupture and patients with medial instability). Technique Description: The QT graft is harvested with a 4-cm skin incision over the superior pole of the patella. A double knife and an oscillating saw are used to obtain the QT graft with a bone block from the patella (65 mm x 10 mm graft and 15 mm bone block). Then an arthroscopy is carried out with assessment of the ACL tear and treatment of further intraarticular injuries. ACL reconstruction begins with debridement of the femoral insertion to expose the land marks. The medial portal is used for femoral tunnel drilling with the knee in more than 110° of flexion. A special portal aiming device is introduced via the anteromedial portal and a guide wire is placed in the area of the femoral anteromedial insertion. This guide wire is gradually overdrilled with various drills and dilators of increasing size. The final diameter should be 0.5 mm smaller than the diameter of the bone block of the graft to allow for press-fit fixation. Then, the tibial tunnel is drilled using a tibial drill guide leaving the tibial stump of the original ACL intact. The graft is pulled into the joint through the tibial tunnel until the bone block stops at the femoral tunnel entrance. The bone block is then pushed through the medial portal into the femoral tunnel (press-fit fixation). The tibial fixation is performed with an interference screw and optionally with an extracortical button. Results: Prior studies with 2 years follow-up have shown that the clinical outcomes in primary and revision ACL reconstruction were not significantly different between the use of QT grafts with femoral press-fit fixation and the use of hamstring grafts with femoral suspension fixation. Discussion/Conclusion: Quadriceps tendon bone autograft and femoral press-fit fixation provides an excellent alternative as a graft choice in ACL reconstruction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Aims and Objectives: The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon. Materials and Methods: We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score. Results: The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups. Conclusion: Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.

Background: The choice of graft in anterior cruciate ligament (ACL) reconstruction is still under discussion. The hamstrings are currently the most used grafts for primary ACL reconstruction in Europe. However, increased interest has arisen in the quadriceps tendon (QT) as an alternative autologous graft option for primary ACL reconstruction. Purpose: To evaluate knee stability and the subjective outcome after ACL reconstruction using either autologous QT graft in implant-free femoral press-fit fixation technique or semitendinosus tendon (ST) graft. Study Design: Cohort study; Level of evidence, 2. Methods: We evaluated 50 patients who underwent ACL reconstruction, including 25 patients who received autologous ipsilateral QT graft (QT group) and 25 patients who received the ipsilateral ST graft (ST group). The follow-up for this prospective comparative study was at least 2 years after surgery, comprising KT-1000 arthrometer testing, pivot-shift test, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and rerupture rate. Results: The mean patient age was 31.72 years (9 women, 16 men) in the QT group and 32.08 years (13 women, 12 men) in the ST group. The mean ± standard deviation postoperative side-to-side difference assessed using KT-1000 arthrometer was 1.56 ± 1.56 mm for the QT group and 1.64 ± 1.41 mm for the ST group, with no significant difference. No significant difference was found on any of the KOOS subscale scores ( P = .694) or the Lysholm score ( P = .682). No rerupture or positive pivot-shift test occurred during follow-up. No difference was found in donor-site morbidity between the study groups. Conclusion: Clinical outcomes were not significantly different between QT and ST grafts in the current study. Thus, the QT may serve as a good alternative graft for primary ACL reconstruction.

Aims and Objectives: Extrusion of the medial meniscus in MRI is an indirect radiological sign for a meniscus root tear. However, a recent study has shown that ultrasound-detectable dynamic extrusion is considered physiological in healthy volunteers. The aim of our study was to analyze the dynamic meniscal extrusion in patients with proven root injury in ultrasound. Our hypothesis was that dynamic extrusion is reduced in patients with root injury of the medial meniscus compared to healthy volunteers. Materials and Methods: Inclusion criteria for this prospective study were MRI signs for a root lesion of the medial meniscus (ghost sign, extrusion > 3 mm). An age matched group of healthy volunteers served as control. Exclusion criterion was osteoarthritis > II° of the medial compartment according to Kellgren & Lawrence. The extrusion of the medial meniscus (MME) of the affected knee was measured by ultrasound (US) in supine position and under full weight bearing. Results: 25 patients with a medial root lesion were included in the study. The evaluation of the ultrasound results revealed a significant decreased dynamic medial displacement of the meniscus in patients with root injury. In the supine position, the mean medial meniscus extrusion was 3.60 mm (± 1.00 mm). In the standing position, the mean medial meniscus extrusion increased to 3.72 mm (± 0.96 mm). The mean delta-extrusion was 0.11 mm (± 0.17 mm). This difference was statistically not significant. In 14 patients, no dynamic extrusion was detectable at all. All patients belonging to the medial root tear group had a significant varus deformity (mechanical axis hits the tibial joint line more than 15 mm medially form the center). In the control group, the mean medial meniscus extrusion was 1.34 mm (± 0.37 mm) in supine position and 2.20 mm (± 0.34 mm) under full weight bearing. The mean delta-extrusion was 0.85 mm (± 0.30 mm). The difference in mean delta-extrusion between the root tear and control group was statistically significant. Conclusion: Ultrasonography is a diagnostic tool to detect the dynamic extrusion of the medial meniscus. Lack of dynamic extrusion (“dead meniscus sign”) may serve as an indicator for medial root injury.