The bone–patellar tendon–bone (BPTB) graft is a reference autograft for anterior cruciate ligament reconstruction because of its consistent dimensions and early bone-to-bone healing. However, traditional harvesting through a long anterior incision is associated with donor-site morbidity, including anterior knee pain, sensory disturbance, and, rarely, patella fracture. This current technique describes a minimally invasive two-incision BPTB harvesting method using a low-profile cutting guide device. It is indicated for primary reconstruction in active patients who require reliable graft fixation. The key steps are careful dissection of the paratenon, stable fixation of a positioning guide with Kirschner wires, and advancement of a sliding tendon cutter along the fixed guide. This guided track standardizes the graft width at 10 mm and protects the tendon and paratenon. The depth of the patellar bone cut is limited to reduce the risk of fracture. In our early single-center experience, graft width was reproducible (10.0–10.2 mm), and there was no tendon transection or patella fracture. Arthroscopy confirmed preservation of the paratenon, and anterior knee pain and localized numbness were uncommon at short-term follow-up. The instruments, the step-by-step technique, and pearls and pitfalls are presented with an operative video. Level 1 Knee. Level 2 Anterior cruciate ligament reconstruction - autograft harvesting.
Lateral meniscus posterior root tears (LMPRTs) compromise load transmission and secondary stability in the anterior cruciate ligament (ACL)–injured knee and may be missed on magnetic resonance imaging (MRI). This narrative current-concepts review addresses incidence, risk factors, biomechanics, diagnosis, classification, treatment, and outcomes, while distinguishing root tears from lateral meniscal oblique radial tears (LMORTs). Primary ACL reconstruction (ACLR) cohorts report LMPRT frequencies of 7.1%, 10.0%, and 12.2%; a mixed primary/revision cohort reports 6.6% and selected revision cohorts report 20.5% and 40.7%. These study-specific estimates differ in lesion definition and ascertainment. Contact injury, concomitant medial meniscal pathology, and increased lateral posterior tibial slope are recurring associations. Individual MRI signs have limited sensitivity; combined assessment and arthroscopic inspection and probing support diagnosis. LaPrade et al. describe root-tear morphology, Forkel and Petersen additionally consider meniscofemoral ligament integrity, and LMORT typing describes posterior-horn oblique radial tears. The systems overlap for near-root lesions and are descriptive frameworks rather than validated treatment algorithms. Selected stable lesions may be observed; repairable unstable lesions are generally treated with footprint fixation or side-to-side repair, according to anatomy and tissue quality. Repair with ACLRn is associated with improved patient-reported outcomes and high complete-or-partial healing proportions in selected series. Clinical improvement in ACL graft survivorship has not been demonstrated. Heterogeneous definitions, predominantly lower-level evidence, variable rehabilitation, and limited long-term comparative data, constrain conclusions about cartilage preservation and optimal treatment.
Introduction Intercondylar notch dimensions, anterior cruciate ligament (ACL) width, and posterior tibial slope (PTS) are recognized as important anatomical factors associated with ACL injury risk, and anatomical reference values for these parameters are derived predominantly from Western cohorts. Individual studies suggest that ACL-related knee morphology may vary across populations, but whether such differences are consistent between Asian and Western populations across commonly assessed magnetic resonance imaging (MRI)-measured parameters remains uncertain. Aim The aim of the present study was to determine whether MRI-measured knee morphology differs between geographically defined Asian and Western adult populations with radiologically intact ACLs across six prespecified parameters: femoral notch volume (FNV), notch width (NW), notch width index (NWI), medial tibial slope (MTS), lateral tibial slope (LTS), and ACL width. Methods This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD420261403854]. Four electronic databases were searched from inception to June 11, 2026 for MRI studies reporting eligible morphometric outcomes in adults with radiologically intact ACLs. Studies were classified as Asian or Western by country of cohort recruitment, reflecting geographic origin rather than verified individual ethnicity. Single-arm random-effects meta-analyses using restricted maximum likelihood estimation were pooled separately by cohort and compared using the Q test for subgroup differences. Meta-regression evaluated geographic cohort, measurement technique, mean age, and sex composition as potential sources of between-study variation. Statistical significance was defined as two-sided p < 0.05. Results Thirty-one studies (2,463 knees; 15 Asian, 16 Western) were included in the present study. No statistically significant between-cohort differences were identified for FNV (7.26 versus 7.64 cm3, p = 0.78), NW (20.13 versus 19.86 mm, p = 0.77), NWI (0.28 versus 0.24, p = 0.45), MTS (5.66° versus 6.04°, p = 0.67), or LTS (5.73° versus 6.24°, p = 0.53). ACL width also did not differ statistically significantly (5.20 versus 7.62 mm, p = 0.08). Heterogeneity, quantified using the I2 statistic, was substantial across all outcomes (I2 = 75-100%) and prediction intervals (PIs) were wide and overlapping between cohorts. Geographic cohort was not a statistically significant moderator of any outcome (p = 0.09-0.82). Measurement technique was associated with LTS (p = 0.03), explaining 44% of the between-study variance (R2), but with no other outcome (p = 0.28-0.89), whereas study-level sex composition was associated with NW (regression coefficient [β] = 6.48 mm, p = 0.02), FNV (β = 5.34 cm3, p = 0.04) and mean cohort age was associated with both MTS (β = 0.11°/year, p = 0.02) and LTS (β = 0.11°/year, p < 0.01). Within Asian cohorts, males had statistically significantly greater FNV than females (7.65 versus 5.66 cm3, p < 0.01). Conclusion MRI measures of femoral notch morphology, PTS, and ACL width did not differ statistically significantly between Asian and Western populations with radiologically intact ACLs (p = 0.08-0.78). Given the substantial heterogeneity and wide prediction intervals, these findings indicate an absence of detectable differences in the available literature rather than anatomical equivalence between populations, and clinically important differences cannot be excluded. Clinically, geographic origin alone should therefore not be considered a surrogate for individual knee morphology when assessing ACL-related anatomical risk or planning reconstruction. Although study-level sex composition, mean age, and measurement technique may contribute to variations in the measured parameters, these associations should be interpreted cautiously given the ecological nature of the analysis. Level of evidence Level IV (systematic review and meta-analysis of Level III-IV observational studies).
Septic arthritis after ligament reconstruction is uncommon but potentially devastating. Vancomycin graft presoaking was developed as an adjunct to standard systemic prophylaxis and sterile technique to reduce viable Gram-positive contamination before implantation and biofilm maturation. This State-of-the-Art review evaluates its biological rationale, clinical effectiveness, safety, implementation, graft-specific considerations, hypersensitivity, antimicrobial stewardship, geographic variation, cost-effectiveness, and unresolved controversies. A structured narrative search of PubMed was updated through October 11, 2026, supplemented by backward citation screening and targeted review of relevant guidance and evidence syntheses.The clinical evidence remains predominantly observational. Large comparative cohorts and pooled analyses consistently associate vancomycin graft presoaking with lower rates of septic arthritis after anterior cruciate ligament reconstruction (ACLR), with the most direct evidence applying to hamstring autografts. Limited randomized evidence is available but remains underpowered for a rare postoperative infection outcome. Absolute benefit varies with baseline infection risk. Laboratory, animal, and clinical studies have not demonstrated harm within commonly studied short-exposure protocols, although the most direct clinical safety evidence also derives from hamstring autografts. Evidence for bone-patellar tendon-bone grafts, quadriceps tendon grafts, allografts, revision procedures, and non-ACL ligament reconstructions remains substantially more limited or indirect. One uncontrolled 2026 quadriceps tendon series represents an unconfirmed graft-specific safety signal rather than evidence of a contraindication. No alternative graft-presoaking antibiotic currently has a clinical evidence base comparable to vancomycin.Based on the current evidence, vancomycin graft presoaking may be considered as an adjunct to standard systemic prophylaxis in hamstring autograft ACLR within a standardized protocol. It should not replace established infection-prevention measures, and extrapolation to other graft types or reconstruction settings should reflect the directness of the available evidence. Future research should prioritize graft-specific protocol optimization, prospective comparative evidence, antimicrobial-resistance surveillance, and long-term graft and cartilage outcomes.
Introduction The University of California, Los Angeles (UCLA) Activity Scale is a widely used score used to assess physical activity. No reliable Persian validation of the UCLA score in total knee arthroplasty (TKA) patients exists. This study aimed to translate, culturally adapt, and validate the Persian version of the UCLA (p-UCLA) activity scale in TKA patients. Methods Following the established cross-cultural guidelines, the UCLA activity scale was translated to Persian using forward-backward translation. A total of 104 TKA patients completed the p-UCLA, Oxford Knee Score (OKS), International Knee Documentation Committee Subjective Form (IKDC-SF), and Forgotten Joint Score-12 (FJS-12). Construct validity was assessed using the Spearman correlation coefficient, while reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland–Altman analysis. Floor and ceiling effects were examined. Results The p-UCLA showed excellent test-retest reliability (ICC = 0.98; P < 0.001). Construct validity was supported by moderate-to-strong correlation with OKS (r = 0.75–0.78; P < 0.001), IKDC-SF (r = 0.34–0.66; P < 0.001), and FJS-12 (r = 0.69; P < 0.001). No floor or ceiling effects were observed. Bland–Altman analysis showed minimal bias and high measurement stability. Conclusion The p-UCLA activity scale is a reliable and valid instrument for assessing activity levels in Persian patients after TKA. Level of evidence III.
