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Bone allografts are clinically used in a variety of surgical procedures, and tissue banks are responsible for harvesting, processing, quality testing, storing, and delivering these materials for transplantation. In tissue banks, the bone is processed for the removal of all organic content, remaining only the tissue structure (scaffold). However, several studies have shown that even after using different processing methods, viable cells, functional proteins, and DNA may still persist in the tissue, which constitute the main causes of graft rejection. Therefore, the objective of this study was to establish techniques and biological parameters for quality validation of allografts. To this end, we propose the use of 3 combined methods such as microscopy, histology, and molecular biology techniques to evaluate the quality of allografts harvested and processed by the Brazilian National Institute of Traumatology and Orthopedics (INTO) tissue bank according to the donation criteria of the Brazilian National Health Surveillance Agency and the Brazilian National Transplant System. Bone fragments from different processing stages showed no viable cells on histology, an intact extracellular matrix on scanning electron microscopy, and gradual reduction in DNA amount. Different techniques were used to demonstrate the quality of allografts produced by the INTO tissue bank and to establish biological parameters for ensuring the safety and quality of these products. Future studies need to be undertaken to assess and validate the efficacy of the decellularization process in larger bone grafts with diverse architectural configurations., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Tourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet., Methods: In a prospective and randomized study, 60 patients with osteoarthritis were evaluated for total knee replacement, divided in two groups: 'without tourniquet' and 'optimized tourniquet'. Outcomes were mean creatine phosphokinase levels, Knee Society Score and knee isokinetic strength. Data were considered significant when p < 0.05., Results: Creatine phosphokinase levels and functional score were similar between groups. There were no differences between groups regarding knee extension strength on the operated limbs, although the knee flexors' peak torque in the operated limb in the optimized tourniquet group was significantly higher at 6 months relative to preoperative and 3 months assessments., Conclusions: The optimized tourniquet protocol use in total knee replacement combines the benefits of tourniquet use without compromising functional recovery and without additional muscle damage and strength deficits compared to surgery without its use., Competing Interests: The authors declare that they have no conflict of interest., (© 2023 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.)

The treatment of severe musculoskeletal injuries, such as loss of bone tissue and consolidation disorders, requires bone transplantation, and the success of this bone reconstruction depends on the grafts transplant's osteogenic, osteoconductive, and osteoinductive properties. Although the gold standard is autograft, it is limited by availability, morbidity, and infection risk. Despite their low capacity for osteoinduction and osteogenesis, decellularized bone allografts have been used in the search for alternative therapeutic strategies to improve bone regeneration. Considering that bone marrow stromal cells (BMSCs) are responsible for the maintenance of bone turnover throughout life, we believe that associating BMSCs with allograft could produce a material that is biologically similar to autologous bone graft. For this reason, this study evaluated the osteogenic potential of bone allograft cellularized with BMSCs. First, BMSC was characterized and allograft decellularization was confirmed by histology, scanning electron microscopy, and DNA quantification. Subsequently, the BMSCs and allografts were associated and evaluated for adhesion, proliferation, and in vitro and in vivo osteogenic potential. We demonstrated that, after 2 hours, BMSCs had already adhered to the surface of allografts and remained viable for 14 days. In vitro osteogenic assays indicated increased osteogenic potential of allografts compared with beta-tricalcium phosphate (β-TCP). In vivo transplantation assays in immunodeficient mice confirmed the allograft's potential to induce bone formation, with significantly better results than β-TCP. Finally, our results indicate that allograft can provide structural support for BMSC adhesion, offering a favorable microenvironment for cell survival and differentiation and inducing new bone formation. Taken together, our data indicate that this rapid methodology for cellularization of allograft with BMSCs might be a new therapeutic alternative in regenerative medicine and bone bioengineering., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The primary function of the posterior cruciate ligament (PCL) is to restrict the posterior translation of the tibia, and its secondary function is to limit the tibial external rotation, mainly at 90° and 120° of knee flexion. The prevalence of PCL rupture ranges between 3% and 37% of patients with knee ligament tears. This ligament injury often is associated with other ligament injuries. Surgical treatment is recommended for acute PCL injuries associated with knee dislocations or when stress radiographs show a tibial posteriorization greater than or equal to 12 mm. The techniques classically described for the surgical treatment are inlay and transtibial, which can be performed in a single- or double-bundle fashion. Biomechanical studies suggest that the double-bundle technique is superior to the single femoral bundle, suggesting less postoperative laxity. However, such superiority has not yet been proven in clinical studies. This paper will describe the step-by-step technique for PCL surgical reconstruction. The tibial fixation of the PCL graft is performed by using a screw and spiked-washer, and the femoral fixation can be done with a single- or double-bundle technique. We will explain the surgical steps in detail, with tips to perform them simply and safely., (© 2023 The Authors.)

Background: The results of recent studies investigating tourniquet (TNQ) use for knee arthroplasty are controversial. Therefore, this study aimed to compare patients undergoing total knee arthroplasty who did not have a TNQ to those in whom an optimized TNQ protocol was applied., Methods: We prospectively evaluated 127 patients who had knee osteoarthritis who had undergone total knee arthroplasty and randomized them into two groups: "without TNQ" and "optimized TNQ" (TNQ inflation before skin incision, deflation after cementing, with pressure one hundred millimeters of mercury above the systolic blood pressure, and without articular suction drain usage). The means of surgery and TNQ duration, blood loss, number of blood transfusions, degree of pain, edema, range of motion (ROM), functional score over time, and postoperative complications were compared between the groups. Statistical significance was set at P < .05., Results: No significant differences were found in terms of surgical timing, blood loss, thigh and knee pain, edema, ROM, functional scores, and complications between the "without TNQ" and "optimized TNQ" groups., Conclusion: The use of an optimized TNQ in primary total knee arthroplasty presents similar clinical results to surgery without a TNQ and did not increase the incidence of postoperative complications. Its use allowed surgery to occur with the benefits of a clean and dry surgical field provided by TNQ without increasing procedure-related comorbidities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR)., Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status., Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score., Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

Questionnaires and physical tests are tools to determine the ability of an individual to perform tasks of the daily living. In our institution, a standardized knee performance evaluation including patient-reported outcome measures (PROMs) and physical performance tests has been applied to all patients undergoing total knee arthroplasty (TKA). Our goal was to identify which preoperative tools influence the outcomes of a TKA and if physical performance tests can be of value if used along with PROMs in predicting functional outcomes. Classification and regression tree was used to analyze which preoperative factors influence function after TKA. Western Ontario and McMaster Universities Arthritis Index (WOMAC) function (WOMAC-F), 6-minute walk test (6MWT), and timed up and go (TUG) test at the 12th postoperative month were the dependent variables. Age, body mass index, preoperative WOMAC function and pain score, muscle strength, 6MWT, and TUG test score were used as preoperative predictors of dependent variables. TUG ≤19.3 seconds and age <62 years were preoperative predictors of better scores in the WOMAC-F (5.5). Strength of extensor muscles of the nonoperated knee ≥99.43 N·m/kg and 6MWT> 328 m were preoperative predictors of a better postoperative 6MWT (499 m). TUG <12.3 seconds and 6MWT ≥421 m were preoperative predictors of better postoperative TUG (7.3 seconds). Preoperative performance in physical tests had an influence on postoperative outcome scores than PROMs after TKA. Less age, good muscular strength, greater capacity of walking, and smaller TUG times were associated with better outcomes., Competing Interests: None declared., (Thieme. All rights reserved.)

Osteoarthritis (OA) of the knee is highly prevalent and causes pain, stiffness, and harms the quality of life of millions of patients. Scientific evidence about radiofrequency ablation or rhizotomy of genicular nerves has been presented with increasing frequency in the literature for the treatment of chronic pain related to knee OA as an alternative to total knee arthroplasty. The main indication for this procedure is symptomatic OA unresponsive to conservative treatment, regardless of the disease evolution, although more common indications are in Kellgren-Lawrence grade III or IV, in post-total knee arthroplasty residual pain without an identified cause, in patients with comorbidities and high surgical risk, and those who do not want to undergo surgery. The aim of this study is to describe the step-by-step rhizotomy technique with pulsed radiofrequency of the 3 genicular nerves, guided by radioscopy and ultrasonography., (© 2021 The Authors.)

Objective: To evaluate qualitative and quantitative magnetic resonance imaging (MRI) criteria for injury of the common peroneal nerve (CPN) in patients with acute or subacute injuries in the posterolateral corner (PLC) of the knee, as well as to evaluate the reproducibility of MRI evaluation of CPN alterations., Materials and Methods: This was a retrospective study of 38 consecutive patients submitted to MRI and diagnosed with acute or subacute injury to the PLC of the knee (patient group) and 38 patients with normal MRI results (control group). Two musculoskeletal radiologists (designated radiologist A and radiologist B, respectively) evaluated the images. Nerve injury was classified as neurapraxia, axonotmesis, or neurotmesis. Signal strength was measured at the CPN, the tibial nerve (TN), and a superficial vein (SV). The CPN/TN and CPN/SV signal ratios were calculated. The status of each PLC structure, including the popliteal tendon, arcuate ligament, lateral collateral ligament, and biceps tendon, was classified as normal, partially torn, or completely torn, as was that of the cruciate ligaments. For the semiquantitative analysis of interobserver agreement, the kappa statistic was calculated, whereas a receiver operating characteristic (ROC) curve was used for the quantitative analysis., Results: In the patient group, radiologist A found CPN abnormalities in 15 cases (39.4%)-neurapraxia in eight and axonotmesis in seven-whereas radiologist B found CPN abnormalities in 14 (36.8%)-neurapraxia in nine and axonotmesis in five. The kappa statistic showed excellent interobserver agreement. In the control group, the CPN/TN signal ratio ranged from 0.63 to 1.1 and the CPN/SV signal ratio ranged from 0.16 to 0.41, compared with 1.30-4.02 and 0.27-1.08, respectively, in the patient group. The ROC curve analysis demonstrated that the CPN/TN signal ratio at a cutoff value of 1.39 had high (93.3%) specificity for the identification of nerve damage, compared with 81.3% for the CPN/SV signal ratio at a cutoff value of 0.41., Conclusion: CPN alterations are common in patients with PLC injury detected on MRI, and the level of interobserver agreement for such alterations was excellent. Calculating the CPN/TN and CPN/SV signal ratios may increase diagnostic confidence. We recommend systematic analysis of the CPN in cases of PLC injury.

Objective: The objective of the present study was to identify patterns of femoral diaphyseal fractures which are associated with fractures of the ipsilateral femoral neck according to the AO classification. We propose an algorithm of investigation based on plain radiographs, recognizing cases that need additional screening with computed tomography., Patients and Methods: This observational retrospective study included patients with combined diaphyseal and femoral neck fractures. These patients were retrieved from a total of 1398 patients with the diagnoses of diaphyseal fractures of the femur, who were admitted to our hospital for surgical treatment between January 2009 and October 2019. All included cases had both fractures analyzed for their geometry and were classified according to the AO Classification, seeking to find a correlation between the types of fractures., Results: Sixteen diaphyseal fractures associated with ipsilateral neck fractures were detected during the period. The distribution of the diaphyseal fractures according to the AO Classification was as follows: 5 of type A3 (31,2%) 6 type B2 (37.5%), 1 type B3 (6,2%), 2 type C2 (12,5%) and 2 type C3 (12,5%). One A2 femoral fracture occurred during the surgical procedure. No type A1 fractures were detected., Conclusion: The patterns of high-energy diaphyseal fractures (A3, B and C) have a higher prevalence of associated ipsilateral neck fractures. Our study suggests that routine additional methods of image investigation of femoral neck fractures may be unnecessary for diaphyseal fractures type A1 and A2., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest related to this manuscript., (Copyright © 2021. Published by Elsevier Ltd.)

Schatzker introduced one of the most used classification systems for tibial plateau fractures, based on plain radiographs. Computed tomography brought to attention the importance of coronal plane-oriented fractures. The goal of our study was to determine if the addition of computed tomography would affect the decision making of surgeons who usually use the Schatzker classification to assess tibial plateau fractures. Image studies of 70 patients who sustained tibial plateau fractures were uploaded to a dedicated homepage. Every patient was linked to a folder which contained two radiographic projections (anteroposterior and lateral), three interactive videos of computed tomography (axial, sagittal, and coronal), and eight pictures depicting tridimensional reconstructions of the tibial plateau. Ten attending orthopaedic surgeons, who were blinded to the cases, were granted access to the homepage and assessed each set of images in two different rounds, separated to each other by an interval of 2 weeks. Each case was evaluated in three steps, where surgeons had access, respectively to radiographs, two-dimensional videos of computed tomography, and three-dimensional reconstruction images. After every step, surgeons were asked to present how would they classify the case using the Schatzker system and which surgical approaches would be appropriate. We evaluated the inter- and intraobserver reliability of the Schatzker classification using the Kappa concordance coefficient, as well as the impact of computed tomography in the decision making regarding the surgical approach for each case, by using the chi-square test and likelihood ratio. The interobserver concordance kappa coefficients after each assessment step were, respectively, 0.58, 0.62, and 0.64. For the intraobserver analysis, the coefficients were, respectively, 0.76, 0.75, and 0.78. Computed tomography changed the surgical approach selection for the types II, V, and VI of Schatzker ( p  < 0.01). The addition of computed tomography scans to plain radiographs improved the interobserver reliability of Schatzker classification. Computed tomography had a statistically significant impact in the selection of surgical approaches for the lateral tibial plateau., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Treatment of distal femur fractures in the coronal plane can be challenging. Depending on fracture line orientation, topography and associated comminution, decision-making regarding approach and fixation is not straightforward and can result in complications. Therefore, treatment of coronal plane distal femur fractures (Busch-Hoffa fractures) should be approached in a systematic manner, leading to efficient planning and operative execution. Here, we offer a proposed treatment algorithm, guiding treatment, approach and fixation based on the modified Letenneur classification of coronal plane distal femur fractures., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: The objective of this study was to evaluate the dynamic balance of the injured and uninjured limb before and after the anterior cruciate ligament (ACL) reconstruction and compare with the control group., Study Design: Prospective longitudinal., Setting: Biomechanics laboratory., Participants: Participants are 24 males (mean age, 27.5 years) with unilateral ACL injury (ACLG) and 24 male healthy volunteers (CG)., Main Outcomes Measures: The modified star excursion balance test (SEBT) and isokinetic knee extensor and flexor strength were applied in the ACLG preoperatively and after surgery. The dominant limb of CG was evaluated at a single time., Results: There was no difference between the injured and the uninjured limb of the ACLG (P > 0.05) before and after surgery. Preoperatively, both ACLG limbs had a significantly lower reach distance in posteromedial (PM) and posterolateral (PL) directions and in composite reach (CR) score compared to the control group (P < 0.001). Postoperatively, no significant differences were found between ACLG and CG (P > 0.05). There was a positive correlation between preoperative PL (0.59) and CR (0.51), postoperative PM (0.36), PL (0.36) and CR (0.46) with flexor strength at 12 months after surgery., Conclusion: Patients with ACL injury presented a worse performance in the SEBT in the preoperative period compared to the control group. After ligament reconstruction, the performance in the SEBT became equivalent to that of the control group. The strong correlation between flexor strength and posterior directions of the injured limb demonstrates the importance of the knee flexor muscles in the neuromuscular control of patients submitted to ACL reconstruction., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: This study addresses functional data, pain, and the reoperation rate in patients undergoing primary total knee arthroplasty (TKA) during which the patella was or was not replaced., Methods: Fifty-three knees were included, 18 with the patella replaced and 35 with the patella not replaced. WOMAC and SF-12 scores and knee pain were analyzed preoperatively and 3, 6, and 12 months after TKA. The reoperation rate was also evaluated., Results: Both groups presented significant improvement in WOMAC score and pain at all postoperative follow-up appointments. There was no significant difference between the groups in all evaluated variables. Two subjects in the group did not undergo patellar replacement due to complaints of anterior knee pain after arthroplasty. There was no difference between the groups in relation to the reoperation rate., Conclusion: Patients receiving patellar replacement during TKA did exhibit significant differences in the rate of reoperation, function, or pain when compared to patients in which the patella was replaced. Level of Evidence III; Cohort study. , Competing Interests: All authors declare no potential conflict of interest related to this article.

The posterior cruciate ligament (PCL) is a fundamental structure in knee kinematics. PCL tears may lead to adverse consequences, such as impaired functional performance and an increased risk of osteoarthritis. Although surgical treatment is a well-established option for the patients of PCL rupture, many surgeons opt for conservative treatment because of the lack of consensus in the orthopedic literature concerning the best surgical method with less risk of iatrogenic lesions to the neurovascular structures in the popliteal region. Here, we describe an onlay technique for PCL reconstruction, which has some advantages over the traditional transtibial and over inlay techniques. The technique described in this study avoids the "killer angle"-frequently considered the cause of laxity of the reconstructed ligament-while simultaneously permitting safe retraction of the neurovascular structures without the need for a change in the patient's position. This technique has been used at our institution for approximately 10 years with very satisfactory results. The aim of this study is to describe the technique and perform a retrospective evaluation of the results of a case series., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The use of suspensory graft fixation methods in arthroscopic reconstruction of the anterior cruciate ligament has become increasingly popular with the more frequent use of tendon grafts and anatomical techniques involving the creation of bone tunnels. An important technical step to ensure adequate fixation of the graft when using EndoButton-type implants, particularly in the femur, involves flipping the EndoButton plate at the correct length to avoid performing this maneuver before the appropriate time or leaving soft tissue between the plate and lateral cortex of the femur. In the present study, we describe a simple arthroscopic technique for indicating the correct time to flip/deploy the EndoButton plate., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Complex fractures of the lateral tibial plateau may extend to the posterior rim of the knee and to the tibial spines. Displaced fractures of the posterolateral corner of the tibial plateau may result in joint incongruity and instability, especially with the knee in flexion. Anatomical reduction of the joint surface and containment of the tibial rim are the primary goals of the treatment in such cases. Dedicated surgical approaches including dissection of the peroneal nerve, sometimes in association with an osteotomy of the fibular head are typically used to address these injuries. Some techniques require special positioning of the patient on the operative table. Anatomical studies of the knee allowed us to conclude that an osteotomy of the lateral epicondyle of the femur may be a natural extension of the standard anterolateral approach to the tibial plateau. The main advantage of this approach is the broad exposure of the lateral joint surface, allowing its anatomical reduction. It does not violate the proximal tibiofibular joint or pose a risk to the peroneal nerve. The main limitation is the lack of visualization of the posterior metaphysis of the tibia, preventing the application of a buttress plate parallel to the plane of fracture split. To overcome this limitation, we describe a method to support the posterior tibial plateau rim, in cases of bicondylar tibial plateau fractures, combining the extended anterolateral with the posteromedial approach. For selected cases, with a significant compromise of the posterolateral and anterolateral quadrants of the tibial plateau, including the tibial spines, the extended anterolateral approach may be complemented by a planned detachment of the anterior horn of the lateral meniscus. In such variant, a complete exposure of the entire surface of the lateral tibial plateau and tibial spines is achievable, assuring optimal conditions for an anatomical reduction of the articular surface., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: Opening-wedge osteotomy of the proximal tibia is a widely performed procedure for treating medial gonarthrosis in active patients and in the presence of varus malalignment of the lower limb. The fixation method is controversial, and the use of conventional implants has been abandoned in favor of implants with more modern locking screws. The aim of the present clinical study was to assess the maintenance of the correction achieved in cases wherein fixation was performed using conventional implants., Methods: This retrospective study included 51 patients who underwent opening-wedge high tibial osteotomy wherein fixation was performed using conventional implants (4.5-mm DCP plate and non-locking screws). Radiological findings regarding patellar height, tibial slope, and varus correction postoperatively and after consolidation were analyzed to assess the maintenance of the correction achieved by osteotomy., Results: The mean loss of correction angle, calculated by the difference between the correction angle in the immediate postoperative period and that after consolidation, was 0.92° ± 0.9°. In addition, changes in patellar height determined by the Blackburne-Peel method and in the sagittal slope of the tibial plateau were not significant or clinically relevant., Conclusions: The use of conventional plates and screws is viable in the fixation of opening-wedge high tibial osteotomy because they provide enough stability to maintain the achieved correction until consolidation, without significant changes.

Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a singlestage basis, provided soft tissues are not an adverse factor, with open reduction and internal fixation. Stable fixation and early painless joint movement are related to a better prognosis. New developments as locked plates, bone replacements, intraoperative 3D imaging are promising and will certainly contribute for less invasive procedures and better outcomes.

The integrity of posterior cruciate ligament (PCL) is essential for the normal kinematics of the knee. Injury to the PCL has adverse consequences, with worsening of functional performance and an increased risk to develop osteoarthritis. Conservative treatment is sometimes adopted, not only because it is an acceptable option for selected patients but also due to the lack of consensus in the orthopedic literature regarding the best surgical method. Hereby we describe a simplified technique for onlay PCL reconstruction pointing out possible advantages if compared with the traditional transtibial or inlay techniques., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Purpose: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. The usual reason given to justify the use of a drain is to minimize patient pain and stiffness of the knee joint. The purpose of this study was to assess the validity of this approach., Methods: In this study 118 consecutive ACL reconstruction patients were randomized to no drain or a postoperative intra-articular suction drain. Inclusion criteria included a successful ACL reconstruction via either 4-strand hamstrings or bone-patellar tendon-bone autograft as a graft source. The primary outcomes were defined as pain (assessed by pain scores and analgesic counts) and range of motion (ROM) (assessed by loss of flexion and extension compared with the nonoperative leg). An independent statistical analysis was performed., Results: The 2 groups were comparable with respect to patient demographics, surgical findings, and procedures performed. There were no differences between the treatment groups for the primary outcomes of pain and ROM during the 8-week follow-up period. The study had adequate power to detect a clinically significant difference. Regarding the secondary outcomes, there was a difference in the grade of hemarthrosis between the groups at week 1 but not at week 4 or 8. However, the difference in subjective grade of hemarthrosis at 1 week did not have any effect on the primary outcomes of pain and ROM. During the study period, there were no complications in either group., Conclusions: The routine use of intra-articular drains after arthroscopic ACL surgery was not supported by this study., Level of Evidence: Level II, randomized controlled trial without narrow confidence intervals.