Meniscal preservation is a cornerstone of anterior cruciate ligament reconstruction (ACLR), reflecting the meniscus' critical role in joint homeostasis and long-term knee health. Concomitant meniscal injuries are common and increasingly managed with repair rather than resection. This educational review summarizes current strategies for the most frequent acute meniscal tears encountered during ACLR. Contemporary practice favors repair whenever feasible, supported by evidence linking meniscal preservation to improved outcomes and reduced osteoarthritis risk. Lateral meniscus posterior root tears are commonly managed with transtibial or anchor-based repair. Ramp lesions require systematic inspection and selective repair, with both all-inside and suture-based techniques yielding favorable results. Bucket-handle tears are repaired using all-inside, inside-out, or combined approaches depending on tear location, with high survival rates when performed alongside ACLR. Radial tears, particularly in vascular zones, should be repaired to restore hoop stress, although optimal suture configurations remain debated. Successful outcomes rely on mechanically stable repairs, individualized rehabilitation, knee stability and alignment, and a supportive biological environment.
Background and purpose - Unicompartmental knee arthroplasty (UKA) is advocated to achieve greater satisfaction and improved function when compared with total knee arthroplasty (TKA), but there is little evidence from large-scale cohorts to support this contention. We aimed to determine, from the patients' perspective, if UKA leads to postoperative differences in satisfaction, knee pain, function, and quality of life when compared with TKA. Methods - Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) compared PROMs scores for patients with either a UKA or TKA. EQ-5D-5L, Oxford Knee Scores (OKS), and a knee pain rating were recorded preoperatively and 6 months after surgery with additional assessments of satisfaction and patient-perceived change. Comparisons were made for change in mean score after surgery, while percentage change and proportions achieving minimal clinically important change (MCIC) were compared using odds ratios (OR). Results - 3,329 UKAs and 56,816 TKAs were included. UKA patients had higher mean scores for all PROMs measures before surgery, and scores increased similarly to or less than for TKA patients after surgery. Mean OKS was 39 (95% confidence interval [CI139-39) after UKA and 38 (CI 38-38) after TKA. Compared with TKA there was a smaller change in mean OKS for the UKA group (-1.3, CI-1.6 to-1.0), which was below the threshold for MCIC. Similar proportions of patients achieved an OKS improvement which met the MCIC threshold. Quality of life improvement after surgery was equivalent for both groups (EQ-5D-5L utility change 0.3 units) as was knee pain improvement (OR 1.1, CI 0.9-1.4) with the UKA group having higher odds of being satisfied (OR 1.2, CI 1.0-1.3) and feeling better (OR 1.12, CI 1.0-1.4), compared with the TKA group. Conclusion - Based on patient assessments, the difference between UKA and TKA did not achieve the published threshold for a minimal important difference.
Background and purpose: Cemented stem fixation in total hip arthroplasty (THA) reduces early femoral fracture risk in elderly patients, but the optimal method of cup fixation remains controversial. We aimed to compare cup revision risk between cemented and uncemented acetabular cups in patients aged 65 years or older undergoing primary THA. Methods: This registry-based cohort study used data from the Nordic Arthroplasty Register Association (NARA). We included patients aged 65 years or older who underwent primary THA for primary osteoarthritis or sequelae of childhood hip disorders between 1995 and 2018. The primary outcome was all-cause cup revision, with prespecified analyses stratified by age and sex. Cox regression adjusted for age, sex, femoral head size, time period, and nation was used. Follow-up was divided into 3 periods: 0–1, 1–6, and 6–26 years. Results: Among 310,515 patients, cemented cups were associated with a lower risk of all-cause cup revision during the first year (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.41–0.53) and a higher risk at 6–26 years (aHR 1.91, CI 1.72–2.13). In patients aged 80 years or older, the sex-specific adjusted hazard ratios after the first year were close to 1, with wide confidence intervals. Conclusion: Cemented cups were associated with a lower risk of cup revision during the first year across all age groups and a higher risk at 6–26 years in the overall cohort. Among patients aged 80 years or older, we found no evidence of an association between fixation method and cup revision after the first year.
