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Background: Athletes are at higher risk of popliteomeniscal ligament (PML) injury due to sudden, repetitive, rotational knee movements when practicing sports. Damage to these ligaments leads to a hypermobile lateral meniscus, potentially locking during deep knee flexion, and persistent posterolateral knee pain. Due to the intricated anatomy of the posterolateral corner of the knee, clinical and radiologic diagnosis of isolated PML injury remains challenging, and its relevance is still questioned. This study aims to describe the clinical presentation of two soccer players that failed conservative treatment after being diagnosed with isolated PML injuries and intact lateral meniscus and required urgent surgical fixation. Case report: Two professional soccer players (31 and 16 years old) consult after experiencing an acute injury. The physical examination was normal except for posterolateral knee pain (no joint line pain, swelling, deformity, or instability). MRI examinations revealed no meniscus injury but an increased signal in the posterolateral corner of the knee and thickening of the PML fasciculi compatible with an isolated tear. Failed conservative treatment in both athletes due to lateral meniscus instability prompted arthroscopic lateral meniscus repair. Conclusion: Early arthroscopic assessment and meniscus fixation in isolated PML injuries yield good outcomes. Conservative treatment encouraged by meniscus indemnity on MRI assessment might be at risk of failure due to meniscus instability/injury and knee locking.

Abstract Purpose This systematic review evaluated the clinical outcomes of hardware-free MPFL reconstruction techniques in patients with recurrent patellofemoral instability, focusing on patient-reported outcome measures (PROMs), redislocation rate, and complications. The hypothesis was that hardware-free MPFL reconstruction in patients with recurrent patellofemoral instability is safe and effective. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library databases were accessed in October 2021. All the clinical studies investigating the efficacy and feasibility of hardware-free MPFL reconstruction were screened for inclusion. Only studies with a minimum 24-month follow-up were considered eligible. Kujala Anterior Knee Pain Scale improvement and redislocation rate after surgical treatment were evaluated as primary outcomes. The rate of postoperative complications was evaluated as a secondary outcome. The quality of the methodological assessment was assessed using the Modified Coleman Methodology Score. Results Eight studies were included in the present systematic review. The quality of the methodological assessment was moderate. Short- to long-term improvement of Kujala score was observed in all included studies. Mean score improvement ranged from + 13.2/100 to + 54/100, with mean postoperative scores ranging from 82/100 to 94/100. Patellar redislocation was observed in 8.33% (8 of 96) patients. Conclusion Hardware-free MPFL reconstruction with or without associated soft-tissue or bony realignment procedures provided reliable clinical improvements and was associated with a low rate of redislocation in patients with recurrent patellofemoral instability. Advantages such as safety, femoral physis preservation, and comparable complication profiles with implant-based techniques endorse its implementation. Orthopedic surgeons in cost-sensitive environments may also benefit their patients with lower costs, no need for implants, lack of implant-related complications, or surgery for implant removal. Level of evidence: Level IV.

Introduction: The use of orthobiologics in the treatment of sports injuries has increased because of athletes' desire to heal faster and early return to sports. These therapies comprise platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cells (MSCs) injections which promote the native musculoskeletal system healing and regeneration potential. Objectives: To evaluate the clinical outcomes of PRP, BMAC, and MSCs injections in treating sport-related injuries for professional football (PF) players. Methods: Following the PRISMA guidelines, PubMed, Embase, Scopus, and The Cochrane Central Register of Controlled Trials (CENTRAL) databases were accessed in January 2022. Clinical studies evaluating the outcomes of PRP, BMAC, and MSCs injections in sports-related injuries among PF players were considered eligible. The methodological quality was assessed using the modified Coleman Methodology Score (mCMS), and a short version of the Minimum Information for studies evaluating Biologics in Orthopaedics (MIBO) was recorded for every PRP study. Results: Eleven studies met the eligibility criteria. All implemented PRP, most of them in treating muscle and ligament injuries. Only one study implemented BMAC, and no study implementing MSCs injections in PF players was found. The average mCMS value demonstrated a poor level of methodological quality. Studies reported only 26.13% of the relevant data of the short-MIBO. Conclusions: There is scarce evidence on orthobiologics implementation in PF players other than PRP injections to treat muscle, ligament cartilage, bone, tendon, fascial, and capsular injuries. However, evidence lacks methodological quality and adherence to MIBO to support its implementation.