Abstract Purpose We hypothesized that patients undergoing anterior cruciate ligament reconstruction (ACL‐R) are more likely to develop patellofemoral osteoarthritis (PFOA) than those with an ACL injury managed non‐surgically. Study design Systematic review and Meta‐analysis. Methods A systematic literature review and meta‐analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Studies reporting PFOA assessment by radiographic or magnetic resonance imaging after ACL‐R compared to non‐surgical treatment of ACL injury were included. Studies involving individuals with concurrent other ligamentous or chondral injuries treated surgically were excluded to minimize bias. Results A total of six studies were included in the systematic review. The meta‐analysis demonstrated that patients undergoing ACL‐R had a significantly higher likelihood of developing PFOA compared to those who received non‐surgical treatment after ACL injury (odds ratio [OR] = 2.21; 95% confidence interval [CI]: 1.13−4.35; p = 0.02). Patients who underwent ACL‐R with bone–patellar tendon–bone (BPTB) autograft exhibited a significantly higher prevalence of PFOA than those with HT autograft (p < 0.01). Moreover, male patients exhibited a higher association with PFOA than females in both the ACL‐R (34.38% vs. 7.77%, p < 0.001) and non‐surgical ACL injury groups (28.13% vs. 0.97%, p < 0.001). Conclusions ACL‐R significantly increases the likelihood of PFOA compared to non‐surgical ACL treatment, especially when using BPTB autografts. Male patients demonstrated a higher association with PFOA in both groups. Targeted preventive strategies, including optimized graft selection and enhanced rehabilitation protocols, are crucial for reducing the risk of PFOA following ACL‐R. Level of Evidence Level III.

Medial open-wedge high tibial osteotomy (MOWHTO) is widely used to treat varus knee osteoarthritis, but its impact on patellofemoral biomechanics remains incompletely understood. In particular, the sagittal tibial tubercle–trochlear groove (sTT-TG) distance, a novel parameter linked to patellofemoral contact pressure, has not been evaluated in this context. This study aimed to assess changes in sTT-TG following MOWHTO and identify anatomical predictors of its postoperative magnitude. In this retrospective study, 34 knees from 33 patients (mean age 36.6 ± 9.5 years, mean BMI 26.2 ± 4.3 kg/m²) undergoing ascending biplanar MOWHTO with pre- and postoperative MRI and radiographs were analyzed. The sTT-TG, Caton–Deschamps Index (CDI), posterior tibial slope (PTS), and tibiofemoral rotation angle (TFRA) were measured. Correlation and multivariable regression analyses were performed to identify predictors of postoperative sTT-TG. MOWHTO significantly decreased the sTT-TG distance from 6.25 ± 5.34 mm to 3.74 ± 6.81 mm (p = .009), indicating anteriorization of the tibial tubercle. Patellar height (CDI) decreased from 1.14 ± 0.20 to 0.99 ± 0.15 (p < .001), and TFRA was reduced from 4.74 ± 5.54° to 2.62 ± 5.50° (p = .017). Multivariable regression identified preoperative sTT-TG, postoperative medial PTS, and CDI as independent predictors of postoperative sTT-TG (adjusted R² = 0.697). A steeper medial PTS and lower patellar height were associated with greater tibial tubercle anteriorization. MOWHTO resulted in a significant anteriorization of the tibial tubercle in the sagittal plane. Postoperative sTT-TG is strongly influenced by tibial slope and patellar height, emphasizing the need to account for these factors during surgical planning, particularly in patients with patellofemoral cartilage changes. Future biomechanical studies should explore the clinical relevance of these changes on joint loading.

Background: Patellofemoral cartilage defects can be caused by patellar instability, maltracking, trauma, or osteochondritis dissecans. Although cartilage restoration techniques, such as matrix-associated autologous chondrocyte implantation (MACI), are well-established, reducing contact pressures and shear forces on the graft remains critical for improving outcomes. This video demonstrates the surgical technique of patellofemoral offloading through tibial tubercle osteotomy (TTO) and lateral retinacular lengthening (LRL), combined with MACI, to optimize biomechanical alignment and enhance clinical results. Indications: This case presents a 34-year-old woman with anterior knee pain, effusions, and a history of patellar instability, which failed to resolve with conservative treatment. Imaging revealed patella alta, trochlear dysplasia, and a full-thickness cartilage defect of the lateral patellar facet, which was confirmed during diagnostic arthroscopy as a 1.5 × 1.5 cm lesion. Due to persistent clinical symptoms in the setting of structural abnormalities, the patient was indicated for TTO with MACI and LRL. Technique Description: The extensor mechanism is exposed through a midline incision slightly lateral to the patella. The tibial tubercle is identified, and an anteromedial osteotomy is performed using a saw and osteotome. The angle of osteotomy determines the degree of anteriorization, medialization, and distalization. Next, the lateral retinaculum is dissected, cut 1 to 2 cm from the patellar attachment, and lifted from the underlying capsule. A lateral and partial medial arthrotomy is performed to expose the patella. The patellar chondral lesion is debrided, and the prepared MACI membrane is placed on the recipient site and secured with fibrin glue. The patella is reduced, and the tubercle is repositioned and fixed with 6.5-mm cancellous screws. The lateral retinaculum is reapproximated with appropriate length and tension. Results: Combining MACI with TTO improves clinical outcomes compared with isolated MACI, with high rates of return to activity. TTO significantly reduces patellofemoral contact pressure, protecting the graft, while LRL enhances patellofemoral biomechanics, reducing instability and preserving vastus lateralis integrity. Discussion/Conclusion: Cartilage restoration techniques, when combined with patellofemoral offloading, offer an effective strategy for addressing complex patellofemoral defects, especially in cases of malalignment and soft tissue imbalance. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

BACKGROUND:The tibial tubercle-trochlear groove (TT-TG) distance is a key metric in evaluating patellofemoral (PF) pathology, with increased values linked to instability and cartilage degeneration. The sagittal TT-TG (sTT-TG), defined as the horizontal distance between the trochlear groove and tibial tubercle in the sagittal plane, may offer insights into PF joint loading. However, its relationship to contact pressure and the influence of femoral rollback, patella height, and joint line height remain unclear. PURPOSE:To investigate the relationship between sTT-TG and PF contact pressure and assess how femoral rollback, patellar height, and joint line height influence sTT-TG and PF loading. METHODS:A two-dimensional sagittal knee model was developed. Outputs included sTT-TG, patellar tendon angle (PTA), and PF contact pressure. Simulations were performed from 0° to 140° flexion. Tibial tubercle position was varied (±10 mm), joint line height shifted (±10 mm), and patellar tendon length altered (±30%) to simulate patella alta and baja. Sensitivity analysis quantified effects. RESULTS:Posteriorizing the tubercle by 10 mm increased PF pressure by 29.4% at 0° and 27.5% at 30°; anteriorization reduced it by 21.6% and 18.2%, respectively. Femoral rollback led to a 5.5 mm decrease in sTT-TG up to 60°. Patella baja increased, and alta decreased, PF pressure by ∼9%, with minimal sTT-TG changes. Joint line shifts affected pressure but not sTT-TG. CONCLUSION:sTT-TG is a biomechanically relevant, flexion-dependent parameter for assessing PF joint loading, but its interpretation must consider patella and joint line height.

INTRODUCTION:The aim of this study was to establish a consensus-based classification of postoperative events following anterior cruciate ligament reconstruction (ACLR), clearly distinguishing no complication/normal clinical course, minor complication, major complication, and failure, using a structured Delphi methodology among international experts in anterior cruciate ligament (ACL) surgery. METHODS:A three-round modified Delphi process was conducted involving international high-volume ACL surgeons. An initial set of statements addressing potential postoperative events after ACLR was developed by a working group based on clinical expertise and contemporary literature. Panelists classified each statement as no complication/normal clinical course, minor complication, major complication, or failure. Consensus was predefined as ≥75% agreement within a single category. Statements reaching consensus were retained, whereas non-consensus statements were revised and re-evaluated in subsequent rounds. RESULTS:Thirty-nine experts completed the first and second Delphi rounds, and 30 (76.9%) completed the third round. The initial 52 statements were expanded to 67 in round two and refined to 46 in round three. Consensus was achieved for 14 statements (26.9%) in round one, 21 statements (31.3%) in round two, and 20 statements (43.5%) in round three. Overall, consensus was reached for 55 statements, forming the final classification framework. The panel clearly distinguished graft failure-defined as graft insufficiency or symptomatic instability-from major complications requiring surgical intervention or associated with substantial morbidity, and from minor complications or expected postoperative findings. Notably, traumatic graft rupture following a clearly documented new injury was not considered a postoperative complication. CONCLUSIONS:This international Delphi consensus establishes a standardized and clinically meaningful classification of postoperative events following ACLR. By clearly distinguishing no complication, minor complication, major complication, and failure, this framework provides a shared language that may improve consistency in outcome reporting, facilitate comparison across studies, and enhance the interpretability of clinical research and registry data. LEVEL OF EVIDENCE:V, expert consensus.

Objectives: The tibial tubercle to trochlear groove (TT-TG) distance is a key metric for evaluating patellofemoral (PF) pathologies, with larger distances associated with instability and cartilage degeneration. The sagittal TT-TG (sTT-TG), measured as the horizontal distance from the trochlear groove to the tibial tubercle in the sagittal plane, has emerged as a potential indicator of increased PF pressures. Nonetheless, the connection between PF pressure and factors such as femoral rollback and patellar height remains unclear, but these elements are crucial for improving surgical techniques like tibial tubercle osteotomy (TTO). This study aimed to define the association between sTT-TG and PF contact pressure and examine how femoral rollback, patellar height, and joint line height affect sTT-TG and PF loading using a computational model. Methods: A two-dimensional sagittal knee model was developed, with the femur as a circle and patella as a rectangular block. Parameters including sTT-TG, patellar tendon angle (PTA), and PF contact pressure were calculated across 0°–140° flexion using femoral rollback data. Tibial tubercle position was varied (±10 mm), joint line height adjusted (±10 mm), and patellar tendon length altered (±30%) to simulate patella alta and baja. Sensitivity analysis quantified these effects. Results: Posteriorizing the tibial tubercle by 5 mm increased PF contact pressure by 10% at 0° and 0.8% at 30° flexion, while anteriorization by 10mm reduced it by 21.6% and 18.2% (R² > 0.985). The sTT-TG decreased 5.5 mm from 0° to 60° due to femoral rollback, then rose in deeper flexion. Patella baja increased contact pressure by 8.8%–9% at 0° and 30°, patella alta decreased it similarly, with sTT-TG changes minimal (<0.2 mm). Joint line shifts significantly affected contact pressure but not sTT-TG. Conclusion: This study demonstrates that the sagittal TT–TG is a biomechanically relevant measure for assessing PF contact pressure, particularly in early flexion. However, its diagnostic and surgical value must be interpreted with caution at varying degrees of flexion and considering that patellar height and joint line height significantly influence loading without proportionally affecting the sTT–TG value.

Objectives: The sagittal tibial tubercle–trochlear groove (sTTTG) distance has emerged as a novel parameter in assessing patellofemoral malalignment. Its role in predicting postoperative outcomes especially after trochleoplasty remains unclear. This study aimed to evaluate the association between sTTTG and patient-reported outcomes following medial patellofemoral ligament reconstruction (MPFLR) and deepening trochleoplasty. Methods: A retrospective analysis was conducted on 101 patients (male/ female 29/72; 22.7 ± 6.6 years) who underwent combined MPFLR and trochleoplasty for recurrent lateral patellar instability with high-grade trochlear dysplasia. The sTTTG distance was measured on preoperative axial T2-weighted magnetic resonance imaging (MRI) sequences. Specifically, the measurement involved identifying the nadir of the anterior trochlear cartilage and the most prominent point of the tibial tubercle. A line was drawn parallel to the posterior condylar axis at each of these points, and the perpendicular distance between these lines was calculated to determine the sTTTG distance. Postoperative outcomes assessed included pain levels (Numerical Rating Scale), subjective knee function, and the Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) score. Univariable and multivariable linear regression analyses were performed, adjusting for age, BMI, Caton–Deschamps index, Dejour classification, and TT-TG. Results: Univariable analysis demonstrated that a higher preoperative sTTTG was significantly associated with improved postoperative subjective function (β=0.088, p=0.014), lower pain levels ( β = – 0.10, p=0.048), and higher BPII 2.0 scores ( β=0.98, p=0.019). These associations remained statistically significant after adjusting for confounding variables (Function: β=0.096, p=0.011; Pain: β=–0.11, p=0.044; BPII 2.0: β=0.91, p=0.037). The multivariable models exhibited moderate explanatory power, with adjusted R² values ranging from 0.03 to 0.06. Conclusion: The preoperative sTTTG distance is a significant and independent predictor of postoperative patient-reported outcomes in individuals undergoing deepening trochleoplasty. Higher sTTTG values were associated with better functional recovery, reduced pain, and enhanced patellofemoral quality of life. These findings support the incorporation of sagittal alignment parameters into preoperative evaluations and risk stratification for patients with severe trochlear dysplasia.

Background: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure with generally favorable outcomes, yet graft failure remains a significant challenge, particularly in young and active patients. While various anatomical and biomechanical risk factors for graft failure have been proposed, the influence of the sagittal tibial tubercle–trochlear groove (sTTTG) distance, representing anterior–posterior alignment of the tibial tubercle, has not been sufficiently explored. This study aimed to evaluate the association between sTTTG and ACL graft failure and assess contributing biomechanical variables, including tibiofemoral rotation (TFR), posterior tibial slope (PTS), and knee flexion angle. Methods: For this secondary analysis, a retrospective matched case–control study was conducted, involving 151 patients with ACL graft failure who underwent revision ACLR and 151 controls with intact grafts after a minimum 2-year follow-up period. sTTTG was measured on axial MRI as the anteroposterior distance from the trochlear groove to the tibial tubercle, perpendicular to the posterior femoral condylar axis. Secondary measurements included TT-TG, TFR, medial and lateral PTS, and knee flexion angle. Group differences as well as factors predictive of sTTTG were analyzed. Results: The ACLR failure group demonstrated a significantly lower sTTTG distance compared to controls (0.5 ± 4.6 mm vs. 2.4 ± 4.8 mm, p = 0.001). Logistic regression analysis revealed that a 1 mm increase in sTTTG was associated with an 8% reduction in revision risk (OR = 0.93 per 1 mm increase; 95% CI, 0.88–0.97; p = 0.003), although the predictive accuracy was low (AUC = 0.6). Multivariable analysis identified lateral PTS and knee flexion as significant independent predictors of sTTTG. Conclusions: A decreased sTTTG distance was significantly associated with ACL graft failure, underscoring the relevance of sagittal tibial tubercle positioning in ACL biomechanics. While not an independent clinical decision-making tool, sTTTG appears relevant to graft failure and may be considered in future risk assessment strategies.

Multi-ligament knee injuries (MLKI) are complex injury patterns that affect two or more ligaments of the knee. Although surgical intervention can improve functional and clinical outcomes, a large percentage of patients are unable to return to preoperative activity levels. One reason for this is loss of knee range of motion (ROM), which characterizes the exaggerated pro-inflammatory environment of arthrofibrosis and is associated with future osteoarthritis risk. The purpose of this study is to assess the effectiveness of a 30-day course of losartan, a common angiotensin II antagonist, in improving surgical outcomes one year after MLKI surgery by reducing arthrofibrosis and pro-inflammatory signaling. Our hypothesis is that individuals who undergo MLKI reconstruction and take losartan will report an increased ability to return to activity, improved ROM, and decreased synovitis. This is a randomized, double-blinded, placebo-controlled clinical trial that aims to recruit 90 patients who are undergoing MLKI reconstruction. Upon enrollment, patients will be randomly assigned to a 30-day postoperative course of oral losartan or placebo on a 1:1 basis. The primary outcome will be the Cincinnati Occupational Rating Scale (CORS) Questionnaire Score which will quantify self-reported physical function. The secondary outcomes will include the time to return to active duty, work, and/or sport after surgery; International Knee Documentation Committee (IKDC) Subjective Knee Scores; Visual Analogue Scale (VAS) Pain Scores; knee ROM; quadricep strength; and ultrasound measures of persistent synovitis. There is an unmet need for interventions to reduce inflammation and arthrofibrosis following MLKI to both rescue ROM and improve rates of return to activity. The LION Trial is a randomized, placebo-controlled clinical trial that will evaluate the efficacy of a 30-day course of losartan following MLKI reconstruction. The results of this study have the potential to redefine perioperative management and improve long-term functional outcomes for all patients undergoing ligament reconstruction with a widely available and inexpensive medication. Clinicaltrials.gov #NCT06933706. Registered on April 11th, 2025.

Introduction Hurricane Helene in September 2024 disrupted saline distribution, causing a months-long shortage in US hospitals. Saline is essential for irrigation in orthopedic procedures, including arthroscopy. While alternatives such as lactated Ringer’s and multielectrolyte solutions have gained attention, evidence comparing their safety and efficacy to saline remains limited. Objectives To evaluate the effect of saline, lactated Ringer’s, and multielectrolytes solution on chondrocyte viability and extracellular matrix release in an in vitro osteochondral (OC) explant model. Methods OC explants (6×10mm) were harvested from OC allograft remnants and tested with saline, lactated Ringer’s, and a multielectrolytes solution. Explants were incubated in each solution (1 hour, 37 °C), then analyzed for chondrocyte viability and gene expression, while the conditioned supernatant was assessed for glycosaminoglycan release. Additional explants were flushed with one of the solutions using a syringe and 18-gauge needle to simulate pulse lavage, followed by chondrocyte viability analysis. Results No significant differences in chondrocyte viability were observed across the 3 solutions (P>.90). Compared to saline, gene expression analysis showed lactated Ringer’s reduced MMP13, COL2A1, and IL6, though not significantly, while the multielectrolytes significantly reduced all 3 (P<.001). No significant differences were found between lactated Ringer’s and multielectrolytes. Glycosaminoglycan release was similar across the 3 solutions. Conclusions Neither lactated Ringer’s nor multielectrolytes solution caused increased chondrocyte death or cartilage damage compared to saline in this in vitro model, both for incubation and bone marrow flushing. These solutions may be viable alternatives for preserving cartilage integrity in orthopedic procedures.

Background:Meniscal root tears have an estimated prevalence of 60 to 70 persons per 100,000, and they have gained increased interest recently. Meniscal extrusion is defined as an extrusion >3 mm for medial meniscus tears from the tibial articular cartilage. Root tear-associated meniscal extrusion has been associated with degenerative cartilage damage, particularly since it contributes to increased tibiofemoral stresses during axial loading. Indications:Medial meniscus extrusion >3 mm in the setting of medial meniscus posterior root horn tears. Technique Description:The medial meniscus is released from the capsule from its body to the posterior horn. The medial meniscus root is repaired using the pullout technique. The meniscus body is then centralized using a 1.8-mm single-loaded, all-suture, knotless anchor. Additional all-inside sutures are added for increased stability and enhanced healing of the meniscus. Results:Two- and 3-year outcomes demonstrated a significant decrease in meniscal extrusion following centralization at the time of medial meniscus posterior root repair, and no conversion to total knee arthroplasty was reported. Discussion/Conclusion:Medial meniscus centralization provides increased contact surface between the femur and tibia and thus helps prevent progression of knee osteoarthritis in the early follow-up. Patient Consent Disclosure Statement:The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Purpose: To evaluate the accuracy and informational quality of YouTube videos related to osteochondral allograft (OCA) transplantation as a potentially valuable educational resource for patients and health care professionals. Methods: A systematic analysis of YouTube videos retrieved through a predefined search strategy using the key words “osteochondral allograft” was performed. Videos were categorized by content sources, such as health care professionals with and without commercial bias, individuals, or personal testimonials. The video’s duration, the publication date, and number of likes and views were recorded. To evaluate the accuracy, reliability and quality of video content, each video was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria, Global Quality Score (GQS), DISCERN, and a newly developed Osteochondral Allograft Quality (OCA-QAL) score, designed specifically for this procedure. Results: In total, 80 YouTube videos were included. Overall, the quality of OCA-related YouTube videos was low, with mean scores of 2.16 (JAMA), 2.28 (GQS), 32.58 (DISCERN), and 5.71 (OCA-QAL). Only one video was rated as “excellent” on OCA-QAL, and none achieved full points on JAMA or GQS. Video categories included educational content with (27.5%) or without (51.3%) commercial bias for health care professionals, content for nonhealth care individuals (13.8%), and testimonials (7.5%). Strong positive correlations emerged between OCA-QAL, GQS, and DISCERN scores, whereas views and likes did not predict quality. Conclusions: YouTube videos on OCA transplantation generally do not meet the quality standards like peer-reviewed validation necessary for reliable patient education. Given the low quality of available content, health care providers should be cautious in recommending YouTube as a resource for OCA transplantation information and should guide patients to more rigorously reviewed resources. Clinical Relevance: As cartilage procedures like OCA transplantation become more common, surgeons and patients lack reliable online resources. This study underscores the need for improved digital health content to ensure accurate and trustworthy patient education.

Background:Female patients tend to suffer a greater risk of reinjury and worse patient-reported outcome measures (PROMs) after anterior cruciate ligament reconstruction (ACLR) than male patients, regardless of the graft type used. Purpose/Hypothesis:This study explored the role of donor-recipient sex mismatching to help explain these sex-based disparities in outcomes after ACLR with an allograft. The hypothesis was that allograft donor-recipient sex mismatch would adversely affect surgical outcomes at a 2-year follow-up, with male-to-female graft donations yielding the lowest rates of success. Study Design:Cohort study; Level of evidence, 3. Methods:Patients who underwent primary ACLR with an allograft between 2012 and 2022 were eligible for recruitment. The following PROMs were collected from baseline through a 2-year follow-up: Knee injury and Osteoarthritis Outcome Score subscales, Marx activity rating scale, visual analog scale for pain, and Veterans RAND 12-Item Health Survey. Demographic and graft-specific variables were also collected. Sex-matched cases were compared with sex-mismatched cases and an identical subgroup analysis was performed for female patients only. Results:Of the 112 included patients (N = 70 women), 59 (52.7%) were sex mismatched. The mean patient age was 40.7 ± 10.9 years, and the mean body mass index was 26.8 ± 4.7 kg/m2. Most reconstructions (89.3%) used a semitendinosus tendon graft, with a mean implanted graft diameter of 9.7 ± 0.5 mm (quadrupled). Of the mismatched cases, 96.6% involved a male allograft donated to female recipients. Overall, the matched group demonstrated higher PROM scores across all time points compared with the mismatched group, although statistical significance was only reached for the Marx score at baseline (P = .012) and 1 year postoperatively (P = .022). In the female-only subgroup analysis, a larger graft diameter was measured in the mismatched cases (receiving male allografts) compared with the matched female cases (9.7 ± 0.6 vs 9.2 ± 0.4 mm, respectively; P = .002). Moreover, the mismatched cases tended to report better postoperative PROM scores, although this trend was not statistically significant. Conclusion:The study findings indicated that male donors provided larger allografts than female donors, and that donor-recipient allograft sex matching did not contribute significantly to ACLR outcomes. Other factors may be more important to outcomes in female patients.

Osteoarthritis (OA) is a joint disease characterized by chronic pain and currently has no cure. A subset of OA, posttraumatic osteoarthritis (PTOA), can occur after a joint injury. The knee is one of the most affected joints, and among knee injuries, injuries to the ACL are among the most common. Symptomatic OA, which is accompanied by changes to the joint such as cartilage degradation and osteophyte formation, can develop years after the initial injury, but early joint changes can be detected shortly after. Inflammation is considered one of the contributing factors in PTOA development, and the pro-inflammatory mediators produced in response to an injury can catalyze PTOA development. In animal models, surgically injuring structures in the knee is a widely used method of OA induction, and a common surgical technique is an ACL transection (ACLT). The purpose of this study is to describe our ACLT technique for the induction of OA, as well as methods to monitor joint inflammation and quantify OA severity. To assess inflammation post-surgery, we describe a technique for measuring knee edema as well as a technique for harvesting and analyzing knee synovial fluid. To evaluate the long-term joint changes associated with OA, we present a semi-quantitative scoring system we developed to evaluate OA severity via microCT imaging.

This retrospective study investigates whether the degree of infrapatellar fat pad (IFP) fibrosis influences postoperative pain 6 months following patellofemoral arthroplasty (PFA). Furthermore, this study explores whether sex and patellar height are impacted by the degree of IFP fibrosis. A total of 64 patients who underwent PFA from 2010 to 2023 were included, all of whom had a preoperative knee MRI and at least 1 year of follow-up. Patients were categorized into low (grades 0-1) and increased (grades 2-5) IFP fibrosis groups based on defined MRI findings. Pain outcome was assessed via a numeric rating scale. Demographic data, imaging parameters (e.g., preoperative Insall-Salvati index (IS), pre- and postoperative Caton-Deschamps index (CD), and patella morphology), and implant survivorship were analyzed. Contrary to the hypothesis, no significant association was found between IFP fibrosis degree and postoperative pain levels 6 months following PFA. Notably, the low IFP fibrosis group had a significantly higher prevalence of females (p = 0.02) and a higher preoperative IS index (p < 0.05), suggesting a connection among IFP fibrosis status, sex, and patellar height. No differences between groups were observed in age, body mass index, delta CD index, patella type, or implant survivorship. The lack of association between IFP fibrosis and postoperative pain suggests that IFP fibrosis may not be a determinant of PFA outcomes, potentially guiding surgeons to focus on other factors for optimizing postoperative pain management and implant success. Further studies are needed to elucidate the roles of sex and patellar height in the development of IFP fibrosis. The study provides level III evidence.

Focal cartilage lesions of the tibial plateau present unique challenges due to limited regenerative potential and complex biomechanical demands. This Technical Note outlines an osteochondral allograft transplantation technique for treating isolated central defects of the lateral tibial plateau. Fresh donor allografts are precisely matched and prepared, with careful debridement and socket creation to ensure a stable press-fit implantation, secured with bioresorbable nails. The described approach emphasizes technical precision and patient selection. This method offers a targeted and effective solution for central tibial plateau lesions, addressing an unmet clinical need while preserving knee function and structural integrity.

Ehlers-Danlos syndrome often presents with patellofemoral instability and, less commonly, proximal tibiofibular joint (PTFJ) instability, leading to compounded symptoms and functional impairment. This Technical Note describes a combined surgical approach for managing dual instability in patients with Ehlers-Danlos syndrome, involving medial patellofemoral ligament reconstruction and tibial tubercle osteotomy, in conjunction with PTFJ stabilization using an adjustable-loop cortical suspension device. This technique addresses biomechanical abnormalities and improves joint stability. Postoperative rehabilitation emphasizes controlled mobilization and progressive weightbearing. This comprehensive approach optimizes functional outcomes in patients with complex patellofemoral instability and PTFJ.

Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility, ligamentous laxity, and frequent joint injuries. These features could increase the risk of anterior cruciate ligament (ACL) tears, typically managed through ACL reconstruction (ACLR). Surgical intervention in EDS is challenging due to potential complications such as poor wound healing and tissue fragility. Limited evidence exists regarding the outcomes of ACLR in EDS patients; therefore, in this study we aimed to evaluate survival rates of primary and revision ACLR and examine associated demographic and anatomic risk factors for failure after ACLR. A retrospective review of 21 EDS patients (25 knees) who underwent ACLR between 1993 and 2023 was conducted. Patients with vascular EDS were excluded. Demographic and surgical data, including graft type, cause of injury, concomitant procedures such as meniscus repair and anatomical measurements (posterior tibial slope, intercondylar notch width, lateral femoral condyle morphology, tibiofemoral rotation and tibial tubercle- trochlear groove distance), were collected. Survival analysis was performed using Kaplan–Meier curves, with endpoints defined as ACLR failure or conversion to total knee arthroplasty (TKA). A multivariable survival analysis was used to identify predictors of outcomes. In addition, the influence of demographic and anatomical factors on the development of concomitant injuries and concomitant procedures were assessed. Anatomical factors were then compared with non-EDS patients from the existing literature. The overall survival rate was 85.7

ABSTRACT:Post-traumatic osteoarthritis (PTOA) is a form of osteoarthritis that arises secondary to trauma or an injury. The knee is most commonly affected, and risk for PTOA increases substantially following anterior cruciate ligament (ACL) injury. Blood-based biomarkers have been analyzed following ACL injury to predict PTOA progression and severity. The purpose of this review is to synthesize the literature on blood biomarkers related to inflammation and cartilage turnover in association with the development of PTOA following an ACL injury. Of the eight identified studies, the majority, 75%, were cohort based (n = 6). The collective findings suggest potential value in blood biomarkers for evaluating the systemic changes after ACL injury. However, current evidence for the clinical utility of these markers to identify individuals after ACL injury who will develop PTOA is inconclusive. Further work is needed to advance these findings and clarify differences by sex, race, and ethnicity.