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Introduction: Patellar tendon ruptures make up about 5% of all extensor mechanism injuries. They mainly occur in young, athletic men who have contributing risk factors such as chronic tendinopathy. The aim of this study was to evaluate the return to sport after repair of an acute patellar tendon rupture. We hypothesized that surgical repair yields good functional outcomes with a high rate of return to competitive sports in patients treated with the same surgical technique., Methods: This retrospective study involved 23 cases of patellar tendon rupture in 20 patients (2 women, 18 men). The average age was 42.0±13.8 years (24-68). Eighteen ruptures occurred at the patellar attachment and five were mid-substance. Either transosseous reattachment or direct suture repair was carried out within 21 days; all tendons were augmented with a non-metallic tibiopatellar suture. At the final assessment, a clinical examination was carried out (extensor mechanism testing and range of motion) with collection of functional scores (pain, VISA-P, Lysholm and satisfaction), date of return to sport and final radiographs., Results: At a mean follow-up of 47.7 months (15-120), there were no cases of significant knee stiffness. Seventeen patients (94.4%) had returned to sport, 15 at their pre-injury level (83%). The mean time before running could be restarted was 9 months (6-15 months) and 17 months for sports at the same pre-injury level (8-18 months). The mean VISA score and the mean Lysholm score were 85.5 (62-99) and 67.3 (35-97) respectively; 85% of patients were satisfied or very satisfied. The prognosis was worse when the patient was older than 40 and had a BMI above 25. Early surgical repair of patellar tendon rupture yields good functional outcomes with return to sport possible at high levels., Level of Evidence: IV, Retrospective cohort study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: The widespread historical abandonment of lateral extra-articular procedures in anterior cruciate ligament (ACL) injuries occurred as a result of concerns about high rates of adverse events. Recently, the popularity of lateral extra-articular procedures has resurged, warranting an urgent evaluation of their safety profile., Purpose/hypothesis: The aim of this study was to perform an interim analysis of the ongoing SANTI randomized controlled trial to determine whether combined ACL and anterolateral ligament reconstruction (ACL + ALLR) is associated with an increased rate of adverse outcomes when compared with isolated ACL reconstruction (ACLR). The hypothesis was that there would be no significant difference between groups at a minimum follow-up of 1 year., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: Recruitment commenced in November 2016. Patients scheduled for ACLR were randomized to either isolated ACLR (with bone-patellar tendon-bone [BPTB] autograft) or combined ACL + ALLR (with hamstring tendon autograft). All patients with a minimum follow-up of 1 year by March 2019 were included. The evaluated parameters included complications and reoperations, knee laxity parameters, range of motion, and scores on the Tegner, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) instruments., Results: A total of 224 patients (112 in each group) with a mean ± SD follow-up of 12.3 ± 1.9 months (range, 12-19 months) formed the study population. A significantly higher rate of reoperation for cyclops syndrome was noted in the isolated ACLR group compared with the combined ACL + ALLR group (8.9% vs 0%, respectively; P = .0012). No significant differences were found in frequency of graft rupture (ACLR, 5.4%; ACL + ALLR, 0.9%; P = .1191), range of motion deficits, pain, or reoperation for meniscectomy between groups. No cases of postoperative infection, venous thromboembolism, or arthrofibrosis were seen. Subjective IKDC (81.2 vs 86.8; P = .0048), Lysholm (88 vs 92; P = .0131), and some components of the KOOS were significantly better in the combined ACL + ALLR group., Conclusion: This study demonstrates no evidence of an increased risk of short-term adverse events after combined ACL + ALLR compared with isolated ACLR with BPTB graft., Registration: NCT03740022 (ClinicalTrials.gov Identifier)., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.-C. has received research support, consulting fees, speaking fees, and royalties from Arthrex. J.-M.F. has received research support, consulting fees, and speaking fees from Arthrex. M.T. has received research support, consulting fees, and speaking fees from Arthrex. A.S. has received consulting fees 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) 2020.)

To date, there is no consensus concerning the treatment of acute Achilles tendon ruptures. Although surgical treatment decreases the risk of a recurrent rupture, it is not without complications. In particular, percutaneous sutures may cause a lesion of the sural nerve. The purpose of this Technical Note is to describe a reliable and reproducible surgical procedure for treating these lesions. The first operative phase consists of an ultrasound detection that makes it possible to identify the tendon extremities and the sural nerve, which is necessary to secure the posterolateral arthroscopic tract as well as to perform the percutaneous suture. The entry point is thus centered on the lesion and placed at a distance from any surrounding nerve risk. The second arthroscopic phase makes it possible to release the tendon lesion, control the transtendon passage of the surgical threads, and evaluate the dynamic contact of the tendon edges. At the end of the intervention, the complete disappearance from the transillumination via the rupture also makes it possible to ensure the disappearance of the tendon gap. Achilles tendon percutaneous sutures after the ultrasound detection and under arthroscopic control thus makes it possible to control the contact of the tendon edges, while at the same time decreasing the risk of a lesion of the sural nerve, with minimal scarring.

Background: Cyclops syndrome is characterized by loss of terminal knee extension due to proliferative fibrous nodule formation in the intercondylar notch. This complication occurs in the early postoperative period after anterior cruciate ligament reconstruction (ACLR). The pathogenesis of Cyclops syndrome is not well understood., Hypothesis: Persistent hamstring contracture after ACLR is associated with an increased risk of subsequent Cyclops syndrome., Study Design: Case-control study; Level of evidence, 3., Methods: The files of 45 patients who underwent arthroscopic debridement of a Cyclops lesion after ACLR were analyzed. Recorded data included demographic information and technical details of surgery. Preoperative magnetic resonance images were also analyzed, and patients with femoral bone bruising were identified. Passive and active range of motion were recorded in all patients preoperatively and at 3 and 6 weeks after surgery to address the Cyclops lesion. Passive extension deficit was evaluated in comparison with the contralateral limb and classified as secondary to hamstring contracture when contracture was observed and palpated in the prone position and when the extension deficit was reversed after exercises performed to fatigue the hamstrings. A control group was selected using a random numbers table among our entire ACLR cohort. Statistical analysis was performed to analyze differences between the 2 groups., Results: There was no significant difference between the groups with regard to age at ACLR, sex distribution, time from injury to surgery ( P > .05), proportion of professional athletes, presence of femoral bone bruise, or technical aspects of surgery. The overall extension deficit incidence was significantly higher in the Cyclops group at 3 weeks (Cyclops, 71%; control, 22%) ( P < .001) and at 6 weeks (Cyclops, 60%; control, 7%) ( P < .001). The extension deficit related to hamstring contracture was significantly higher in the Cyclops group at 3 weeks (Cyclops, 58%; control, 22%) ( P < .001) and at 6 weeks (Cyclops, 29%; control, 2%) ( P < .001)., Conclusion: The Cyclops lesion is associated with a persistent hamstring contracture at 3 and 6 weeks after ACLR., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.C. is a paid consultant, receives royalties, receives research support, and has made presentations for Arthrex. M.T. is a paid consultant, receives research support, and has made presentations for Arthrex.

Background: Rectus femoris injuries are common among athletes, especially in kicking sports such as soccer; however, proximal rectus femoris avulsions in athletes are a relatively rare entity., Purpose/hypothesis: The purpose of this study was to describe and report the results of an original technique of surgical excision of the proximal tendon remnant followed by a muscular suture repair. Our hypothesis was that this technique limits the risk of recurrence in high-level athletes and allows for rapid recovery without loss of quadriceps strength., Study Design: Case series; Level of evidence, 4., Methods: Our retrospective series included 5 players aged 31.8 ± 3.9 years with acute proximal rectus femoris avulsion injuries who underwent a surgical resection of the proximal tendon between March 2012 and June 2014. Four of these players had recurrent rectus femoris injuries in the 9 months before surgery, while 1 player had surgery after a first injury. Mean follow-up was 18.2 ± 12.6 months, and minimum follow-up was 9 months. We analyzed the age, sex distribution, physical examination outcomes, type and mechanism of injury, diagnosis, treatment and complications during surgery, postoperative follow-up, and time to return to play. The Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at 3-month follow-up, and isokinetic tests were performed before return to sports. A telephone interview was completed to determine the presence of recurrence at an average follow-up of 18.2 months., Results: At 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. Return to the previous level of play occurred at a mean of 15.8 ± 2.6 weeks after surgery, and none of the athletes suffered a recurrence. Isokinetic test results were comparable between both sides., Conclusion: The surgical treatment of proximal rectus femoris avulsions, consisting of resection of the tendinous part of the muscle, is a reliable and safe technique allowing a fast recovery in professional athletes., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.S-C. is consultant for and receives royalties from Arthrex. M.T. is consultant for Arthrex.

Recent evidence on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in the rotational control of the knee. This article describes a technique that allows for minimally invasive anterolateral ligament reconstruction as a complement to most techniques of anterior cruciate ligament reconstruction. A gracilis tendon autograft is harvested and prepared in a double-strand, inverted V-shaped graft. The graft is percutaneously placed through a femoral stab incision, and each strand is then passed deep to the iliotibial band, emerging through each tibial stab incision. After the femoral-end loop graft is fixed, the tibial fixation of each strand is performed in full extension for optimal isometry.