BACKGROUND:The resistance to gap development under repetitive loading influences the probability of meniscal healing after meniscal repair. The optimal meniscal suture interval spacing for repairing longitudinal meniscal tears is poorly understood. This study aimed to investigate the effect of varying suture interval spacings on the biomechanical properties of vertical meniscal repairs. HYPOTHESIS:There is a critical meniscal suture interval spacing beyond which the gap development during cycling loading increases and the stiffness of the construct decreases. STUDY DESIGN:Controlled laboratory study. METHODS:In 50 bovine menisci, complete vertical circumferential meniscal tears were created. All lesions were repaired using two 2-0 braided sutures with the vertical mattress inside-out technique. Five suture spacings (3, 5, 7, 9, and 11 mm) with 10 samples each were tested. Each sample underwent 1000 loading cycles between 5 and 20 N (combined load) at a 75-mm/min crosshead speed and subsequent load-to-failure testing. The tear opening gap between the 2 meniscal sutures was measured using the Digital Image Correlation system with 2 high-speed cameras after 10, 100, 500, and 1000 cycles. Gap formation, cyclic stiffness, and failure modes were measured. A 1-way analysis of variance with post hoc t testing with Bonferroni correction for significant pairwise analysis of all outcome variables was performed. Statistical significance was set at a P value <.05. RESULTS:Meniscal repairs with suture interval spacings of 3 mm, 5 mm, and 7 mm demonstrated statistically significantly smaller gap formation-a mean of 36% less-compared with spacings of 9 mm and 11 mm. There were no significant differences in gap formation between the suture interval spacings of 3 mm, 5 mm, and 7 mm. Construct stiffness was significantly higher with a suture interval spacing of 7 mm and less compared with ≥9 mm (all P < .05). No significant differences in construct stiffness were observed among the 3-mm, 5-mm, and 7-mm suture intervals. Suture breakage occurred in 76% of cases (38/50), suture cut-through in 22% (11/50), and a combination of both in 2% (1/50). Failure mode did not correlate with suture distance. CONCLUSION:Meniscal repair with a suture interval spacing of ≤7 mm demonstrates significantly lower gap formation and higher construct stiffness during cyclic loading than interval spacings of >7 mm. Based on these biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears. CLINICAL RELEVANCE:On the basis of this biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears.
The preferred technique for femoral implant sizing in primary total knee arthroplasty (TKA) is debatable. Sizing is based on the anterior femoral cortex or posterior condylar reference. Using a single knee system, this study compared anterior referencing (AR) versus posterior referencing (PR) in patients undergoing simultaneous bilateral TKA, where one reference technique was randomized to each knee. This prospective study compared the two sizing references using one posterior stabilized knee system. The study included 81 subjects with osteoarthritis and similar varus deformity in both knees. All subjects underwent identical surgical procedures, aside from the selected femoral sizing reference. Subjects were followed for at least 2 years. The two sizing techniques did not significantly differ in all measured radiographic, operative, and clinical parameters. The mean posterior condylar offset ratios were similar. Two-year mean knee flexion and Revised Oxford Knee Scores showed no difference. Eighty-four percent of patients stated no preference for either technique. Knees sized with anterior referencing had similar functional outcomes to those sized with posterior referencing. Using a current knee system with multiple sizing options, there is no discernable difference in all measured study parameters. Either reference is acceptable. Level of Evidence 2 (Randomized cohort study).
Neglected multi-ligament knee injury (MLKI) or tibial-femoral knee dislocation is a rare injury with significant consequences. This review aims to summarise injury patterns, treatment recommendations, and outcomes. MEDLINE, PubMed, and EMBASE were searched on 28 January 2025. Neglected MLKI was defined as untreated or inadequately treated MLKI or knee dislocations where definitive surgical management was unintentionally delayed for ≥3 weeks without appropriate interim management. PRISMA, R-AMSTAR and Cochrane guidelines were followed. Eighteen case reports (19 patients; 20 knees) were included. Mean age was 41.5 years (range: 17–65 years) with 11.1
INTRODUCTION/OBJECTIVES:To conduct a survey of orthopedic surgeons asking them to rank factors they believed to be most strongly influential on revision risk following primary anterior cruciate ligament reconstruction (ACLR), and to evaluate whether these perceptions differed across global regions and years in practice. METHODS:An international cross-sectional survey was distributed to five professional orthopedic societies. Factors were broken down into the following domains: demographic and anatomic variables, injury-related variables, and surgical and rehabilitation variables, ranked from one (least important) to 50 (most important). Descriptive statistics were reported, and differences in medians between factors within each domain, and medians between continents and practice volumes, were analyzed using the Kruskal-Wallis and Dunn's post-hoc tests with Benjamini-Hochberg correction. RESULTS:A total of 136 surgeons completed the survey. Respondents were primarily from North America (n = 53; 39%), Asia (n = 42; 30.9%), and Europe (n = 37; 27.2%). A total of 118 (86.8%) had received fellowship training in performing ACLRs. Involvement in high-pivoting sports had the highest demographic/anatomical rating (median 45, [IQR 10]). Overall, surgeons demonstrated substantial agreement in factor rankings, with high-pivoting sports, concomitant collateral or posterolateral corner injury, early return to sport, smaller graft diameter, and lack of lateral extra-articular procedure (LEAP) consistently rated among the most important risk factors worldwide. Ratings stratified by practice volume or financial practice model did not differ significantly statistically. CONCLUSION:Surgeons worldwide generally demonstrated agreement regarding key demographic, injury-related, and surgical risk factors for ACLR revision, although regional variation did exist in perceived importance of certain variables. Highly rated demographic factors included involvement in high-pivoting sports, while highly rated injury factors included concomitant collateral injury, posterolateral corner injury, and preoperative pivot shift of greater than grade two. Highly rated surgical and rehabilitation factors included early return to sport, graft diameter below 8 mm, and lack of concomitant LEAP. LEVEL OF EVIDENCE:V.
