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The outcomes of anterior cruciate ligament reconstruction (ACLR) in patients with generalized joint laxity (GJL) are not clearly understood. In this study, we compared the outcomes of ACLR with quadruple hamstring autograft between GJL and non-GJL patients.In a retrospective case-control study, 36 patients with GJL, according to the Beighton and Horan Joint Mobility Index, who underwent ACLR surgery, were included. Forty-four group-matched non-GJL patients were included in the control group. The mean follow-up of the patients was 20.65 ± 6.93‏ months. The outcomes of ACLR were evaluated by the Lachman test, pivot shift test, anterior tibial translation and KT-1000 side-to-side difference, and International Knee Documentation Committee (IKDC) scale.The results of the Lachman and pivot shift test were not significantly different between the GJL and non-GJL patients (P = 0.67 and P = 0.27, respectively). The mean anterior tibial translation was 7.06 ± 1.41 mm in the GJL group and 6.11 ± 1.53 mm in the non-GJL group (P = 0.006). The mean KT-1000 side-to-side difference was 2.25 ± 1.31 mm in the case and 2.5 ± 1.44 mm in the control group (P = 0.42). The mean IKDC score of the patients was not significantly different between the GJL and non-GJL groups (66.1 ± 20.6 vs. 69.9 ± 16.1, P = 0.35). ACLR failure occurred in 2 (5.5%) patients of the GJL group and no patients of the control group (P = 0.21).The present findings suggest ACLR with quadruple hamstring autograft as an adequate treatment for GJL patients, at least in short-term follow-up.

Background: Assessing the reduction of syndesmosis is highly recommended due to the complications occurring after the malreduction of the syndesmosis. This study evaluated the post-operative Computed Tomography (CT) scans and standard plain radiographs for assessing the reduction of syndesmosis post-operatively. Objectives: Evaluating the radiologic assessments of post-operative reduction of syndesmosis. Methods: In this retrospective cohort study, 45 patients presented with ankle fractures and syndesmosis failure to the emergency department of our hospital between 2015 and 2019 were evaluated by post-operative CT scans and plain radiographs. Results: Diastasis was demonstrated in 18 patients (40%) in plain radiographs, in 4 patients (8%) by tibial clear space, in 5 patients (11%) by medial clear space, in 10 patients (22%) by AP tibiofibular overlap, and in patients 8 (17%) by mortise tibiofibular overlap. Diastasis was demonstrated in 24 patients (53%) in CT scans, of whom 18 patients had abnormal radiographic parameters, while 6 patients had normal radiographic parameters. Conclusion: We found a post-operative CT scan more useful than standard plain radiographic measurement for assessing the reduction of the syndesmosis. We suggest the use of post-operative CT scan as a routine to evaluate the syndesmosis reduction.

The human amniotic membrane (HAM) has been viewed as a potential regenerative material for a wide variety of injured tissues because of its collagen-rich content. High degradability of HAM limits its wide practical application in bone tissue engineering. In this study, the natural matrix of the decellularized amniotic membrane was developed by the double diffusion method. The results confirmed a reduction of the amniotic membrane's degradability because of the deposition of calcium and phosphate ions during the double diffusion process. Real-time PCR results showed a high expression of osteogenesis-related genes from adipose-derived mesenchymal stem cells (ADMSCs) cultured on the surface of the developed mineralized amniotic membrane (MAM). Further in vivo experiments were conducted using an MAM preseeded with ADMSCs and a critical-size rat calvarial defect model. Histopathological results confirmed that the MAM + cell sample has excellent potential in bone regeneration.

Background: Despite the advances in the methods of treating femoral neck fractures, treating some types of these fractures is still challenging. Therefore, understanding these fractures, their treatments, and the ways to control their complications are necessary for the orthopedists. Objectives: In this study, we evaluate patients with acute femoral neck fractures with respect to the type of fractures and complications. Methods: In a 4-year cross-sectional study, the patients with acute femoral neck fractures who were admitted to Rasoul Akram Hospital were selected. Anatomical features and the type of fracture were determined by using plain radiography and CT scan. Fractures were classified according to the Garden classification. The patients were also evaluated for any postoperative complications for at least 6 months. Results: A total of 124 patients were enrolled. The Mean±SD age of the patients was 64.9±12.7 years and 87 (74.4%) were male. Based on the Garden classification, 7 fractures (5.9%) belonged to type I, 10 fractures (8.5%) to type II, 48 fractures (41%) to type III, and 52 fractures (44.4%) to type IV. Avascular necrosis in 28 cases (23.9%), non-union in 14 cases (12%), and claudication and pain in 35 cases (29.9%) were noted. The mean age of patients was different between fracture groups (P=0.01). Conclusion: Our results showed that most of the patients with femoral neck fractures admitted to Rasoul Akram Hospital were associated with displacement. In this study, the most common complications were pain and claudication, avascular necrosis of the femoral head, and nonunion. In sum, further displacement of the fracture will result in more complications.

Background: There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies. Objectives: In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm. Methods: In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation). Results: Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071). Conclusion: The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome.

Background: Combined injuries of Mid-shaft clavicle fracture and Acromioclavicular (AC) joint dislocation are rare, and only a few cases have been reported. Several treatment options including surgical, conservative and hybrid approach have been described. Yet, there is no consensus regarding the optimal management approach for this injury. Objectives: Here we reported a case of Mid-shaft clavicle fracture with associated type IV AC joint dislocation in a 29-year-old male following a cycling accident. Methods: Both parts of the injury were fixed surgically. Meanwhile, the patient did not follow the postoperative protocol and started the heavy sports activities one month after the surgery. Results: The patient showed up 6weeks after the surgery with slightly uncorrected AC joint. However, he was satisfied with the results and accordingly no intervention was done for the correction of the AC joint. Conclusion: Our case reveals the importance of adherence to the postoperative protocol in this combined and challenging injury and we recommend surgical fixation for such injury.

Tarsal coalition is a condition characterized by abnormal connections between ≥2 tarsi. Although tarsal coalition is not rare, tarsal coalitions involving >2 tarsi are very unusual. In this report, we describe a case of multiple tarsal coalitions in a 24-year-old male who experienced progressively worsening pain for 3 to 4 months before presenting for care. This case was unique in that all the tarsal and tarsometatarsal bones in the foot were fused and formed 1 integrated tarsal. All of the metatarsals were fused as well, and the patient had no joints or ranges of motion in the hindfoot or midfoot. The patient's pain was responsive to anti-inflammatory medications, and no surgical intervention was necessary. To the best of our knowledge, this is the most extensive case of multiple tarsal coalitions described in the literature to date.

Avascular necrosis (AVN) could remain with negligible clinical symptoms, but it would get worsen over the time if it’s left untreated and at the most cases will require surgical treatment. Prevalence of femoral head AVN is almost 0.45% among HIV patients which is approximately 45 times more than the rest of Society. AVN occurs 0.088%-1.33% annually among HIV victims. Avascular necrosis of the femoral head is a bone deteriorating plight. At this study, the clinical prevalence of it has been analyzed among a group of 180 patients at Rasool-e-Akram Hospital (Iran, between 2008 and 2016). Patients were including 121 men and 59 women. Analysis results showed that the prevalence of HCV, HBV, and HIV was 1.7%, 1.1%, and 1.1% respectively. It was found that 63% of patients was currently using immunosuppressive drugs. 17% had a history of drug abuse among which 3.3% were using IV drugs. It was concluded that femoral head AVN is more common among hepatitis and HIV patients.

Background: Orthopaedic patients are at risk of having irregular levels of vitamin D and calcium due to lack of motility and sun light exposure. Among entire population of patients, Juvenile members of society are considered high-risk groups for vitamin D inadequacy. By considering the high prevalence of this complaint according to domestic studies in Iran, this study aims to provide a report of vitamin D and related factors among orthopaedic patients in Iran. Methods: Participants were selected based on simple non-probable sampling method. Variables were including age, gender, the serum level of vitamin D, calcium, phosphorus, concurrent diseases, and history of taking nutritional supplements. Results were analysed using SPSS software (version 22, USA). Results: 696 patient with mean age 15.5±1.8 were involved among which 440 participants were male and 256 cases were female. Mean of vitamin D calcium, phosphorous serum level was 12.1±4.3, 9.7± 0.5 and 4.3±0.8 respectively. 208 cases were living at urban and 488 members were living at rural locations. 176 cases had degrees of muscular pain, and 72 patients were suffering from developmental problems, and 32 patients were presenting obvious skeletal deformities. Conclusion: Vitamin D deficiency is a common issue among orthopaedic patients. Young patients are in a high danger for consequence of vitamin deficiency in orthopaedic ward due to critical age of bone formation and growth.

Introduction: Genu valgum could be approached by uniplanar or biplanar osteotomy in which site union and postoperative knee range of motion play important roles in technique selection. Methods: Study was performed on 30 cases including 14 males and 16 females. Two of them had severe genu varum deformity and 28 had genu valgum. Participants underwent biplanar lateral distal femoral osteotomy. Osteotomy requirement was assessed by Lateral distal femoral angle measurement. Results: Thirty patients underwent the biplanar procedure over the 4 years. Two years follow up showed complete union, full knee range of motion and within the acceptable alignment. Conclusion: Biplanar osteotomy is an effective method to create the wider inner cancellous surface to achieve better osteotomy site union and knee range of motion.

Introduction It has been shown that long bone fractures are correlated with the inflammatory response. In the initial injury, surgical reduction and fixation of fractures induce the immunoinflammatory response. This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. Material and methods This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. The patients were randomly divided into two groups using the method of block randomization including early surgery (within 24 h) and delayed surgery (after 48 h). Serum levels of inflammatory markers in both groups including interleukin (IL)-1, 5, 6, tumor necrosis factor α (TNF-α) and interferon γ (IFN-γ) were determined using specific kits. From each patient 10 ml blood was collected for cytokine assay in their serum. Results Our findings suggest that serum levels of IL-8 were markedly decreased from 12 h until 48 h postoperatively (p < 0.05). Moreover, the results indicated that serum levels of TNF-α were significantly increased in the early hours, but after 48 h a decreasing trend was detected (p < 0.05). Furthermore, serum levels of IL-10, IFN-γ, and IL-6 were significantly increased from 12 h until 48 h postoperatively (p < 0.05). Conclusions The inflammatory status of the patient may be a useful adjunct in clinical decisions. With an improved understanding of the molecular basis of the inflammatory response, and by identifying relevant clinical markers of inflammation, surgeons can better manage the timing of surgical stabilization.

The article's abstract is not available.

MicroRNAs (miRNAs) involved in key signaling pathways and aggressive phenotypes of osteosarcoma (OS) was discussed, including PI3K/AKT/MTOR, MTOR AND RAF-1 signaling, tumor suppressor P53- linked miRNAs, NOTCH- related miRNAs, miRNA -15/16 cluster, apoptosis related miRNAs, invasion-metastasis-related miRNAs, and 14Q32-associated miRNAs cluster. Herrin, we discussed insights into the targeted therapies including miRNAs (i.e., tumor-suppressive miRNAs and oncomiRNAs). Using bioinformatics tools, the interaction network of all OS-associated miRNAs and their targets was also depicted.

BACKGROUND: Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut. AIM: To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries. METHODS: The released smoke from electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons (n = 25). Surgical smoke was produced with an electrocautery device for 4 min. RESULTS: None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues. The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). ‏The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues (Toluene, Ethylbenzene, and Styrene). No toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue. CONCLUSION: Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs. Therefore, we recommend that surgeons avoiding the electrocautery of these tissues.

Heparin-induced thrombocytopenia (HIT) is a high-risk adverse drug reaction because of its associated risk of life- and limb-threatening thrombosis. Rivaroxaban may be considered as an ideal nonheparin anticoagulant alternative for the management of HIT. In this preliminary retrospective study, the efficacy and safety of rivaroxaban to control the clinically suspected HIT (4Ts score 4 points or greater) were evaluated. Patients with chronic kidney disease, hepatic impairment, mechanical heart valves, and active bleeding were excluded. Forty-two eligible patients who received rivaroxaban for clinically suspected HIT were evaluated by medical records review, with 12-month follow-up after the first dose of rivaroxaban. End points included confirmed thrombosis (primary end point), mortality, and adverse treatment-related events. HIT-associated thrombosis was found in 17/42 (40.5%) patients before receiving rivaroxaban. After rivaroxaban therapy, platelet counts normalized in all patients, with only 1/42 (2.3%) patients developing new thrombosis. No hemorrhagic event was recorded in the patients. Twelve patients (28.6%) died, but the cause of death was not related to the thrombosis, hemorrhage, or adverse effects of rivaroxaban. Our findings are consistent with the available emerging data, suggesting that rivaroxaban is a safe and effective drug for the management of clinically suspected HIT. Rivaroxaban is a particularly valuable treatment option in developing countries, where there are issues of cost and availability of approved alternative agents.

Background Fracture healing complications are associated with significant healthcare and economic burden. In this study, we aimed to investigate how the combined administration of local simvastatin and ezetimibe into the femoral defect of the animal model affects the bone-healing process in comparison with their monotherapy. Methods A total of 32 four-month-old adult male Wistar rats were randomized into the four study groups: simvastatin + ezetimibe-loaded nanofibers (group 1), simvastatin-loaded nanofibers (group 2), ezetimibe-loaded nanofibers (group 3), and non-loaded nanofibers (group 4). After the generation of femoral defects, the predesigned nanofibers were locally administered into the defect site. The healing measures were serum and bone osteoprotegerin (OPG) expression, pathologic evaluation of union (Allen's fracture healing scores), and radiographic evaluation of bone density (Hounsfield scale) at weeks 2 and 4. Results The improvement of all evaluated healing measures was remarkably superior in rats that were treated with loaded nanofibers in comparison with the control group. Also, the improvement of all evaluated healing measures was considerably more in the simvastatin-ezetimibe combination therapy group compared to their monotherapy. All the evaluated measures were superior in the ezetimibe monotherapy group compared to the simvastatin monotherapy group. Conclusion The cumulative effect of simvastatin and ezetimibe on the induction of bone healing is more significant than the individual effect of these drugs. Therefore, local administration of nanofibers loaded with simvastatin and ezetimibe could be regarded as a promising osteoinductive compound for the acceleration of bone repair.

Introduction: Various bone analysis methods are used clinically in examining the mineral content. In a laboratory, the effects of environmental factors such as foods, drugs, diseases and various exposures can be examined by working on samples extracted from bone. The current research was conducted to examine the long-term effects of exposure to drug on the content of mineral elements in the bone. Methodology: Among the trauma patients admitted to the hospital, 35 addicted men and 42 healthy men were studied. Patients were in the age range of 18 to 47 years. The bone graft of patients was prepared and the value of mineral elements in them was evaluated. Results: The concentration of the metals examined in this research is different in healthy and addicted subjects, so that the value of some of the most important elements such as calcium is significantly lower in the addicted people than that in healthy people. Moreover, the accumulation of toxic elements in addicted people is more than that in healthy people. Conclusion: People with long history of using opium have lower useful elements in bone metabolism, which it might be associated with increased risk of fracture and reduced restoration ability. Moreover, higher accumulation of toxic elements in the bone often results from biological accumulation over time, which might result in short-term and long-term complications, such as skeletal and muscular pain and even cancers.

In a descriptive cross-sectional study, we evaluated clinical, morphologic, and demographic characteristics of bipartite patella (BP) in 20 patients referred to clinics affiliated to Iran University of Medical Sciences from 2011 to 2015. Simple radiography, computerized topography scanning, and magnetic resonance imaging characteristics of BP plus demographic data include age, gender, co-morbidities, and side of involvement were recorded. Male to female ratio was 17:3 (5.6) with total mean age of 39.1 ± 13.4 years. Sixteen patients (80%) had unilateral involvement, and among them right- and left-side involvements were seen in 11 and 5 patients, respectively. The BP position included superolateral (8 patients, 40%), lateral (5 patients, 25%), and inferomedial (7 patients, 35%). Knee pain, joint stiffness, and decrease the motion range were seen in 13 (65%), 7 (35%), and 11 (55%) patients, respectively. Chondromalacia (7 patients, 35%) and bone marrow edema (7 patients, 35%) were the most common co-morbidities. The mean diameter of the cartilage that covered the segment in right and left sides were 8.92 ± 3.63 and 9.01 ± 2.22 mm, respectively (P > 0.05). The right and left sides distance of segment to patella were 2.50 ± 0.86 and 3.17 ± 1.45 mm, respectively (P > 0.05). No significant associations were detected between age, gender, decrease the motion range, pain, and joint stiffness with sides of involvement (P > 0.05). Just patients with bone marrow edema had significant higher diameter of cartilage that covered the segment in comparison to patients without bone marrow edema (P = 0.010). In summary, higher percentage of male, existence of pain, and decrease the motion range plus superolateral position of the bipartite segment were noticeable which must be considered in the future research.

Background In this study, the results of the partial lateral facetectomy of the patella to better patellofemoral motion and congruence are compared with the results of the osteophyte removal of the patella and neurectomy only in total knee arthroplasty (TKA). Methods Data from 55 patients undergoing TKA with osteophytes removal of the patella and neurectomy only, and those undergoing osteophytes removal of the patella and neurectomy and partial lateral facetectomy were reviewed retrospectively. Clinical outcomes were evaluated by knee society score (KSS) and functional score of knee. Clinical anterior knee pain (AKP) rating and knee range of motion and extension lag were assessed for each patient. Results There was significant difference between two groups in AKP (p 0.05). Conclusion Partial lateral facetectomy of the patella can decrease AKP and can be used routinely for every patient that surgeon does not decide to resurface the patella.

Background: Precise assessment of preoperative mental health and psychological determinants may be useful in identifying patients at risk for poor postoperative outcomes of total knee arthroplasty (TKA). The aim of this study was to investigate the influence of psychological status and physical and mental health on the outcome of patients undergoing TKA. Methods: Fifty-two patients undergoing unilateral TKA were assessed preoperatively with Oxford Happiness Inventory, Eysenck Personality Inventory, 12-item short form health survey (SF-12), and Knee Injury and Osteoarthritis Outcome Score (KOOS) for evaluating depression, personality traits, physical and mental health, and function, respectively. At 1 year after surgery, health-related quality of life (HRQL) and function were assessed using the SF-12 and KOOS. Results: HRQL and function of all personality traits increased significantly after TKA, without significant difference among them. Extroversion and neuroticism did not have significant correlation with subjective well-being, HRQL, and function before and after surgery. Subjective well-being and the baseline physical and mental health scores were correlated strongly and directly with postoperative physical component summary, mental component summary, and KOOS scores and their improvement. Among many factors that significantly affected the outcomes of TKA, the only independent predictor of physical, mental, and functional outcome was depression. Conclusions: Outcomes of surgery were not significantly different among diverse personality traits. Patients with less depressive symptoms and higher baseline mental and physical scores had significantly greater improvement in HRQL after surgery. The only independent factor affecting the physical, mental, and functional outcome was depression. © 2020 by The Korean Orthopaedic Association.

Background: Adult degenerative disorders of hip and spine are common. The recent studies inconsistently havediscussed about the influence of spinal disorders on total hip arthroplasty (THA). In this review, we discussed clearlyabout these relationships and their effects on the most appropriate position of the acetabular component.Methods: We searched on databases and evaluated the articles about spinopelvic parameters in patients with spinaldisorders who needed THA.Results: The literature search showed a prevalence of 21.2 % to 60.4% of low back pain (LBP) in patients, whoare candidates for primary THA. The coexistence of degenerative disease of hip and spine or other diseases cansignificantly alter spinopelvic alignment. Accordingly, pain management or any other treatment in these patientsrequires proper understanding about the biomechanics of the hip and the spinal and their corresponding interactions.In this review article, we discussed about these interactions and their effects on the most appropriate position of theacetabular component.Conclusion: We concluded that counseling sessions among patients, orthopedic surgeons and spine surgeonscan result in obtaining the best outcome for these individuals.Level of evidence: I

Osteosarcoma (OS) is one of the most prevalent malignant cancers with lower survival and poor overall prognosis mainly in children and adolescents. Identifying the molecular mechanisms and OS stem cells (OSCs) as new concepts involved in disease pathogenesis and progression may potentially lead to new therapeutic targets. Therefore, therapeutic targeting of OSCs can be one of the most important and effective strategies for the treatment of OS. This review describes the new molecular targets of OS as well as novel therapeutic approaches in the design of future investigations and treatment.

Background Management of acetabular bone defects, especially massive ones, is a challenging issue for surgeons during total hip arthroplasty (THA). Inadequate bone coverage can lead to weakness of acetabular component fixation and instability, and finally, failure of surgery. In recent decades, different techniques and methods have been reported in literature to manage these defects according to their size and location. However, the routine use of many of these new methods is impossible in the majority of patients because of existing financial limitations. The aim of the present study was to evaluate the clinical and radiographic outcomes of THA with acetabular defect reconstruction using shelf-autograft. Methods This study was designed and conducted in two phases of retrospective and prospective. Between 2012 and 2017, 423 THA surgeries were performed in two hospitals by senior surgeon. A total of 38 THA procedures using shelf autograft were performed. The short-term clinical and radiological results were evaluated in the present study. Results The mean coverage angle by graft was 45.5 ± 7.3% (range: 33 - 72%) and horizontal coverage percentage by graft was 79.3 ± 12.8% (range: 54 - 100%). After a mean follow-up of 26 months (range: 12 - 56 months), no evidence of instability was found in any of these hips. Considering loosening and revision as an end-point, the survival rate was 100%. The patients’ mean Harris hip score (HHS) improved from a mean of 35.50 ± 9.11 preoperatively to 95.10 ± 4.71 at the last follow-up. Rigid fixation of graft to host bone, medial insertion of acetabular cementless cup, and avoidance of lateral or high hip center were found to result in excellent THA with shelf graft outcomes. Conclusions Despite the development of more advanced methods to manage acetabular defects during total hip replacement, using shelf-graft is a valuable and accessible strategy for hip surgeons, and by the use of suitable techniques, we can expect excellent outcomes even in massive defects.

Background Anterior cruciate ligament reconstruction (ACLR) surgery is frequently used to manage anterior cruciate ligament (ACL) tear. The non-anatomic positioning of the graft may cause graft failure. This study aimed at evaluating the association of the ACLR outcome with factors affecting the anatomic positioning of the graft, including the tibial tunnel, femoral tunnel, and graft inclination angles. Methods A total of 37 patients, who had undergone ACLR surgery, were included in this retrospective study. All surgeries were performed by the transportal arthroscopic reconstruction technique. The tibial and femoral tunnel angles were evaluated on both anteroposterior (AP) and lateral radiographs. Graft inclination angle was evaluated on AP radiograph. Outcome measures included: International Knee Documentation Committee (IKDC), the Lachman and the pivot shift test, and KT-1000 arthrometer score. Results The mean age of the patients was 30.1 ± 9.4 years. The ACLR surgery was successful in 36 (97.3%) patients and failed in one patient (2.7%). No significant association was found between the femoral/tibial tunnel angles and outcome measures on both AP and lateral view. A negative significant correlation was found between the IKDC score and the graft inclination angle (P = 0.049, r = -0.326), indicating that with graft angle between 20° and 36°, the more horizontal graft was associated with better IKDC score. Conclusions According to the results, graft inclination angle, yet not femoral/tibial tunnel angles, were associated with the outcome of the ACLR surgery However, further studies are required to address ‎the inconsistent results of different investigations.

Background Nowadays open meniscal repair approach is completely replaced by arthroscopic meniscal repair. Objectives The current study aimed at assessing the results of arthroscopic meniscal repair using the outside-in technique. Methods Patients diagnosed with meniscal tearing from 2008 to 2014 fulfilling the inclusion criteria were entered to the current cohort study. Outcomes of arthroscopic meniscal repair were assessed by 2 known questionnaires, IKDC (international knee documentation committee) and KOOS (knee injury and osteoarthritis outcome score), as well as magnetic resonance imaging (MRI) of knee. Results A total of 63 patients were assessed. The mean age and follow-up period were 28.8 ± 4.8 years and 44.3 ± 20.3 months, respectively; 82% of the subjects were male and 60.3% had injuries in both meniscus and anterior cruciate ligament (ACL); 76% of the patients had medial meniscal injury; 67% had posterior horn tear, and 56% had longitudinal meniscal tear. There was no significant association between age, gender, grade of tear, number of sutures, anatomic site of tear, and type of tear with the level of patient’s satisfaction. Patients with simultaneous reconstruction of ACL had significant difference compared with the ones with isolated meniscal injury. Grading of tear in MRI had no association with the better outcomes according to the questionnaires. Conclusions Arthroscopic meniscal repair using the outside-in technique yielded acceptable results.