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The article compares the clinical outcomes of anterior cruciate ligament (ACL) reconstruction between smokers and nonsmokers to find an optimal graft in ACL reconstruction for smoking patients. It looks at the adverse effects of smoking on reconstruction outcomes with regard to stability and functionality. The records of 723 patients who underwent unilateral ACL reconstruction have been reviewed. It is also recommends bone-patellar tendon autograft for ACL reconstruction for smoking patients.

The article focuses on cohort analyses performed to understand the reconstructive surgery requirement for patients suffering from knee injuries. The retrospective study conducted involved 46 patients who had undergone posterolateral corner (PLC) reconstruction or PLC reconstruction with posterior cruciate ligament (PCL) injury with mild grade 2 or less posterior translation. The study found that patients who had undergone simultaneous reconstruction of PLC and PCL had improved stress levels.

Sixteen patients with bony mallet fingers were treated by a new technique of open reduction through a T-shaped dorsal incision and oblique wire fixation via pulp traction with additional primary extensor repair. Surgical indications included fractures with intra-articular involvement over 1/3 of the articular surface, distal phalanx subluxation, and displacement greater than 3 mm irreducible by extension block pinning. The cases were analysed prospectively for a mean follow-up period of 12 months. The results were evaluated using Crawford's criteria. Eleven cases were evaluated as excellent, three cases as good, and two cases as fair. Complications included three cases with transient nail deformity, two cases with flexion limitation of 5° and 10°, and three cases with extension lag between 5°-10°. This new method of accurate reduction achieves good clinical outcomes, with comparatively less complications in mallet fractures irreducible to closed extension block reduction. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the effect of percutaneous pie-crusting medial release on valgus laxity before and after surgery and on clinical outcomes.Methods: Eight-hundred fourteen consecutive patients who underwent an arthroscopic procedure for the medial compartment of the knee were evaluated retrospectively. Sex, age, type of operation (meniscectomy, meniscal repair, and posterior root repair), type of accompanying surgery (none, cartilage procedure, ligament procedure and osteotomy) were documented. Sixty-four patients who underwent percutaneous pie-crusting medial release (release group) and 64 who did not undergo medial release (non-release group) were matched using the propensity score method. Each patient was evaluated for the following variables: degree of valgus laxity on stress radiographs, Lysholm knee score, visual analog scale score, and International Knee Documentation Committee knee score and grade.Results: At the 24-month follow-up, no significant increase in side-to-side differences in the valgus gap was observed in comparison to the preoperative value in the release group [preoperative, - 0.1 ± 1.3 mm; follow-up, - 0.1 ± 1.4 mm; (n.s.)]. The follow-up Lysholm score, visual analog scale score and International Knee Documentation Committee knee score and grade were similar between the two groups.Conclusions: Percutaneous pie-crusting medial release is an additional procedure that can be performed during arthroscopic surgery for patients with a narrow medial joint space of the knee. Percutaneous pie-crusting medial release reduces iatrogenic injury to the cartilage and does not produce any residual valgus laxity of the knee.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to compare 2- and 5-year outcomes of ACL reconstruction between patients with and without generalized joint laxity and to perform comparative evaluation between two types of grafts used for ACL reconstruction in patients with generalized joint laxity.Methods: Two hundred and thirty-seven patients who underwent ACL reconstruction from 2001 to 2008 were included. Patients were classified into two groups according to the presence or the absence of generalized joint laxity, and further subdivided into two subgroups based on the type of graft used: bone-patellar tendon-bone (BPTB) or hamstring. Generalized joint laxity was assessed with the Beighton and Horan criteria using a point scoring system. Stability reflected by the Lachman test, pivot-shift test, and anterior translation measured with KT-2000, and functional outcomes reflected by Lysholm knee score, and International Knee Documentation Committee (IKDC) subjective score were investigated. IKDC objective grade and radiographic grade were also assessed. Clinical assessments were conducted preoperatively and at 2 and 5 years after operation.Results: Two-year follow-up results showed that patients with generalized joint laxity receiving hamstring grafts had poorer outcomes than those without generalized joint laxity. Five-year follow-up results showed that patients with generalized joint laxity experienced poorer outcomes than patients without generalized joint laxity, irrespective of the type of graft. Comparison of grafts used showed that, in patients with generalized joint laxity, BPTB graft provided significantly better stability and functional outcomes than hamstring graft at both 2- and 5-year follow-ups. Comparisons between serial outcomes measured at 2 and 5 years demonstrated that stability and functional outcomes deteriorated over time in patients with generalized joint laxity.Conclusions: Less satisfactory stability and functional outcomes were noted in patients with generalized joint laxity, compared to patients without generalized joint laxity. Comparisons of stability and functional outcomes after ACL reconstruction in patients with generalized joint laxity between two different grafts demonstrated that BPTB graft achieves better results than hamstring graft.Level Of Evidence: III, a retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: The purposes of this investigation were to compare outcomes of anterior cruciate ligament (ACL) reconstruction between patients with generalized joint laxity and those without it and to investigate the effect of generalized joint laxity on outcomes of ACL reconstruction from 2 to 8 years postoperatively.Methods: We retrospectively reviewed 163 patients who had undergone unilateral ACL reconstruction from January 2001 to December 2008. Patients were divided into 2 groups according to presence or absence of generalized joint laxity. The proportions of patients with meniscectomy, graft rupture, and contralateral ACL rupture were compared. Rupture rates were compared with Kaplan-Meier analysis. The Lachman test, pivot-shift test, and anterior translation measured with the KT-2000 arthrometer were evaluated. The Lysholm knee score and International Knee Documentation Committee (IKDC) subjective score were compared. The IKDC objective grade and radiographic grade were also evaluated. Follow-up assessments were performed at 2, 5, and 8 years postoperatively.Results: The proportions of meniscectomy, graft rupture, and contralateral ACL rupture in patients with generalized joint laxity were higher than in patients without generalized joint laxity during the whole evaluation period. However, differences in proportions and cumulative rupture rates did not reach significance (p > 0.05). Patients with generalized joint laxity had less stability and poorer functional outcomes at the 8-year follow-up compared with patients without generalized joint laxity. With regard to the Lachman test and anterior translation, poorer results were shown in patients with generalized joint laxity than in patients without generalized joint laxity during the whole evaluation period. The results of pivot-shift testing differed significantly at 5 years (p = 0.002) and 8 years (p = 0.007). Patients with generalized joint laxity also had worse Lysholm knee scores and IKDC subjective scores during the whole evaluation period; these differences may not be clinically important. Comparisons between serial outcomes measured at 2, 5, and 8-year follow-ups within each patient group showed that anterior translation (p = 0.002), Lysholm knee score (p = 0.014), and IKDC subjective score (p = 0.002) deteriorated over time, although the values at 8 years were similar to those at 5 years, in patients with generalized joint laxity.Conclusions: Generalized joint laxity as an inherent physiologic characteristic of patients was related to a significant adverse effect on stability and functional outcomes of ACL reconstruction for patients followed for 2 to 8 years. Generalized joint laxity should be considered a risk factor for poor outcomes after ACL reconstruction.Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: No previous study has examined arthritic change after meniscectomy with regard to extrusion of the medial meniscus. Purpose: (1) To determine the factors related to preoperative meniscal extrusion; (2) to investigate the relationship between medial meniscal extrusion and postoperative outcomes of partial meniscectomy, and to identify a cutoff point of meniscal extrusion that contributes to arthritic change after partial meniscectomy in nonosteoarthritic knees. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 208 patients who underwent partial meniscectomy of the medial meniscus between January 2000 and September 2006 were retrospectively reviewed. The extent of extrusion and severity of degeneration of the medial meniscus as shown on preoperative MRI were evaluated. The minimum follow-up duration was 7 years. Clinical function was assessed with the Lysholm knee scoring scale, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Tapper and Hoover grading system. Radiological evaluation was conducted by use of the IKDC radiographic assessment scale. Regression analysis was performed to identify factors affecting preoperative extrusion of the medial meniscus and factors influencing follow-up results after partial meniscectomy. Receiver operating characteristic curve was used to identify a cutoff point for the extent of meniscal extrusion that was associated with arthritic change. Results: The mean ± SD preoperative Lysholm knee score was 65.0 ± 6.3 and the mean IKDC subjective score was 60.1 ± 7.5. The mean follow-up functional scores were 93.2 ± 5.1 (P < .001) for the Lysholm knee score and 89.0 ± 6.2 for the IKDC subjective score (P < .001). Preoperative extent of meniscal degeneration (P < .001) and preoperative pattern of meniscal tear (P < .001) were related to preoperative meniscal extrusion. Preoperative extrusion of the meniscus showed a tendency to increase as the extent of intrameniscal degeneration increased, and the medial meniscus was extruded more in patients with horizontal, horizontal flap, and complex tears. The preoperative extent of meniscal extrusion had a statistically significant correlation with follow-up Lysholm knee score (coefficient = −0.10, P = .002), IKDC subjective score (coefficient = −0.09, P = .007), Tapper and Hoover grade (odds ratio = 1.05, P < .001), and IKDC radiographic grade (odds ratio = 1.13, P < .001) at the mean follow-up period of 88.6 months. The cutoff point for the relative value of preoperative meniscal extrusion associated with arthritic change was 34.6% (sensitivity = 69.3%; specificity = 82.7%; accuracy = 77.9%). Conclusion: The preoperative extent of intrameniscal degeneration and the preoperative patterns of meniscal tear including horizontal, horizontal flap, and complex tears were associated with preoperative extrusion of the medial meniscus. The preoperative extrusion of the medial meniscus was negatively correlated with outcomes of partial meniscectomy. The preoperative extent of meniscal extrusion can be used as a predictive factor for osteoarthritis in partial meniscectomy. [ABSTRACT FROM AUTHOR]

Background: There have been no clinical studies regarding the effect of decreased meniscal thickness on outcomes after meniscectomy.Purpose: To examine the postoperative outcomes of partial meniscectomy with or without horizontal resection compared with the outcomes of subtotal meniscectomy and to evaluate the influence of decreased thickness of the medial meniscus on out- comes after partial meniscectomy.Study Design: Cohort study; Level of evidence, 3.Methods: A total of 312 patients who underwent medial meniscectomy were retrospectively reviewed. Patients were divided into 3 groups: group A (n = 84) included patients with partial meniscectomy with vertical resection, group B (n = 140) consisted of those with partial meniscectomy with horizontal resection, and group C (n = 88) included those with subtotal meniscectomy. Clin- ical function was evaluated by use of the Lysholm knee scoring scale, International Knee Documentation Committee (IKDC) sub- jective knee evaluation form, and Tapper and Hoover grading system. Radiologic evaluation was performed with the IKDC radiographic assessment scale as well as with measurements of the medial compartment height at the tibiofemoral joint. Preop- erative values and postoperative values measured 5 years after operation were assessed.Results: Functional outcomes in group C were inferior to those in groups A and B according to the Lysholm knee score (mean ± SD for group A = 96.1 ± 4.7, group B = 94.9 ± 5.2, group C = 84.8 ± 11.4; P < .001), IKDC subjective score (group A = 92.1 ± 6.5, group B = 91.3 ± 8.8, group C = 81 ± 11.4; P < .001), and Tapper and Hoover grading system (P = .003). There was no significant difference in scores between groups A and B. With regard to radiologic evaluation, the IKDC radiographic grade for group C was worse than the grades for groups A and B (P < .001); there was no significant difference between groups A and B. However, the postoperative joint space on the affected side was higher for group A (4.7 ± 0.6 mm) than for groups B (4.3 ± 0.5 mm; P < .001) and C (3.7 ± 0.8 mm; P < .001). The joint space was higher in group B than in group C (P < .001).Conclusion: Despite joint space narrowing, decreases in meniscal thickness after partial meniscectomy for horizontal tear had no additional adverse effect on 5-year functional and radiographic outcomes compared with conventional partial meniscectomy pre- serving whole meniscal thickness. In treating horizontal tears of the meniscus, partial meniscectomy with complete resection of the unstable leaf was an effective method in a 5-year follow-up study. [ABSTRACT FROM AUTHOR]