PURPOSE:To define gait kinematics and kinetics in patients with medial meniscus posterior root (MMPR) tear and repair, compared with healthy, age-matched controls. METHODS:This was a cross-sectional, observational study conducted between October 4, 2022, and March 3, 2025, and involved 3 distinct groups: individuals with acute or chronic unrepaired MMPR tears, patients who had undergone MMPR repair, and healthy controls matched for age, sex, and body mass index. All individuals in the repair group had previously undergone transtibial pullout repair performed by a single fellowship-trained surgeon at least 6 months before study inclusion (mean: 19.7 ± 14.2; range: 6.0-47.3). Gait analysis was performed using a marker-based 3D motion capture system and force plates. Primary outcomes included knee joint kinematics and kinetics. Statistical comparisons were conducted using discrete kinematic and kinetic data and Statistical nonParametric Mapping to evaluate intergroup differences across the gait cycle. Patient-reported outcomes were also assessed using International Knee Documentation Committee Subjective Knee Form, the Knee Injury and Osteoarthritis Outcome Score Jr., the Veterans RAND 12 Item Health Survey, and Visual Analog Scale pain scores, with Patient Acceptable Symptom State (PASS) reported using previously validated absolute thresholds. Group comparisons were performed using the Kruskal-Wallis test. The significance level was set at 5%. RESULTS:A total of 58 knees were analyzed: MMPR tear (n = 22), MMPR repair (n = 19), and healthy controls (n = 17). Both MMPR tear and repair groups exhibited increased knee varus thrust (Tear: 5.0° ± 2.1; Repair: 5.2° ± 2.0; Control: 3.3° ± 0.9; P < .01), decreased tibial internal rotation at loading response (Tear: -6.2° ± 5.3; Repair: -2.1° ± 3.6; Control: 2.2° ± 5.8; P < .01), and greater knee adduction angle (varus) at midstance (Tear: 0.1° ± 3.9; Repair: -0.1° ± 5.0; Control: -5.9° ± 4.1; P < .01). The MMPR repair group exhibited higher functional scores (International Knee Documentation Committee Subjective Knee Form: 75.3 ± 19.9 vs 43.6 ± 14.2; the Knee Injury and Osteoarthritis Outcome Score Jr.: 84.7 ± 15.4 vs 59.7 ± 8.9; P < .01), lower pain levels (Visual Analog Scale: 1.5 ± 2.1 vs 3.8 ± 2.4; P < .01), and tibial internal rotation compared with the tear group (P < .01). PASS achievement differed significantly between groups (P < .001), with rates of 71.4%-81.0% in the repair group, 10.5%-26.3% in the tear group, and 88.2%-100% in controls. CONCLUSIONS:The repair group showed more favorable clinical (higher PASS rates) and biomechanical characteristics compared with the tear group. However, both tear and repair groups showed knee kinematic and kinetic patterns currently established as biomechanical risk factors for knee OA progression, such as varus thrust. LEVEL OF EVIDENCE:Level III, retrospective comparative case series.

Objective: A large proportion of individuals affected by medial meniscus posterior root (MMPR) tear progress to knee OA even after surgical repair. Gait analysis could assist in the identification of modifiable biomechanical (kinetic and kinematic) risk factors to optimize knee joint loading through gait modification interventions. The objective of this study was to define gait kinematics and kinetics in patients with MMPR tear and repair, compared to healthy, age-matched controls. We hypothesized that MMPR tear and repair patients would present altered gait characteristics associated with joint degeneration. Methods: In this cross-sectional study, a total of 58 knees were analyzed: MMPR tear (n=20), MMPR repair (n=21), and healthy controls (n=17) (Table 1). All individuals in the repair group had previously undergone transtibial pullout repair performed by a single fellowship-trained surgeon. Gait analysis was performed using a marker-based 3D motion capture system and force plates. Primary outcomes included knee joint kinematics and kinetics. Statistical comparisons were conducted using discrete analysis and Statistical Parametric Mapping to evaluate intergroup differences across the gait cycle. Patient-reported outcomes were also assessed using IKDC, KOOS Jr., VR-12, and VAS pain scores. Group comparisons were performed using the Kruskal-Wallis test. The significance level was set at 5%. Results: Both MMPR tear and repair groups exhibited increased varus thrust range of motion (Tear: 5.0° ± 2.1; Repair: 5.2° ± 2.0; Control: 3.3° ± 0.9), increased tibial internal rotation at loading response (Tear: -6.2° ± 5.3; Repair: -2.1° ± 3.6; Control: 2.2° ± 5.8), and greater knee adduction angle (varus) at midstance (Tear: 0.1° ± 3.9; Repair: -0.1° ± 5.0; Control: -5.9° ± 4.1) (Figure 1 and Table 2). The MMPR repair group exhibited higher functional scores (IKDC: 75.3 ± 19.9 vs. 43.6 ± 14.2; KOOS Jr.: 84.7 ± 15.4 vs. 59.7 ± 8.9), lower pain levels (VAS: 1.5 ± 2.1 vs. 3.8 ± 2.4) (Table 3), and higher tibial internal rotation compared to the tear group (p<0.05). Conclusions: The repair group demonstrated more favorable clinical and biomechanical characteristics than the tear group, however, both displayed established biomechanical risk factors for knee OA progression, such as varus thrust. Motion analysis can be used to detect early biomechanical dysfunction and may help identify MMPR tear and repair candidates for timely gait-modification interventions to optimize long-term joint health.

Background:There is a lack of consensus regarding the optimal identification of motion-based subgroups (biokinetic profiles) of patients with patellofemoral pain (PFP) to guide effective management strategies. Purpose:To investigate different biokinetic profiles among patients with PFP during a step-down task and compare their clinical and physical characteristics. Study Design:Descriptive laboratory study. Methods:A total of 49 patients with PFP had their 3-dimensional kinematics assessed during a step-down task using an optoelectronic system. The variables analyzed were trunk and lower limb joint angles. Self-organizing maps and K-means clustering techniques were used to identify distinct biokinetic profiles. Clinical characteristics compared among profiles were hip/knee isometric strength and passive range of motion, descriptive characteristics, and patient-reported outcome measures. Results:Four biokinetic profiles were identified for the step-down task in patients with PFP. Profile 1 (Balanced Alignment Profile) exhibited a trunk-hip-knee aligned movement pattern, with increased knee flexion (P < .05). This profile presented the highest International Knee Documentation Committee (IKDC) Subjective Form and the lowest visual analog scale (VAS)-Pain scores (P < .05). Profile 2 (Trunk-hip-knee Compensation Profile) and Profile 3 (Pelvic-Hip Interactor Profile) exhibited increased dynamic knee valgus during the step-down task. However, Profile 2 presented limited trunk (P < .05) and knee flexion, while Profile 3 presented increased anterior pelvic tilt (P < .05) and trunk flexion. Profile 2 had excessive passive hip internal rotation (P < .05) and a majority of women (P < .05), while Profile 3 exhibited increased isometric hip and knee strength (P < .05) and lower levels of pain. Profile 4 (Protective Movement Profile) exhibited a possibly protective adaptation, showing decreased hip, knee, and pelvis peak angles and decreased ipsilateral trunk tilt (P < .05), as well as the lowest IKDC scores and the highest VAS-Pain scores (P < .05). Conclusion:This study identified 4 clinically relevant biokinetic profiles of patients with PFP based on their kinematics during a step-down task. The principal clinical value of this study is the development of a functional classification for patients with PFP. Each profile exhibits characteristics that may provide valuable insights for clinicians to implement targeted interventions and improve patient care. Acknowledging the variability in movement profiles and their implications in PFP underscores the importance of moving beyond one-size-fits-all treatment strategies. Clinical Relevance:This study uncovers previously unknown movement-based biokinetic profiles in patellofemoral pain and identifies several modifiable clinical characteristics associated with each profile, which could be addressed through targeted interventions.

Background:Management of isolated medial meniscus posterior root (MMPR) tears is challenging, especially in older patients, where indications for repair must be weighed against potential repair failure and osteoarthritic progression. Purpose:To compare patient-reported outcomes and incidence of failure after anatomic transtibial pullout repair for isolated MMPR tears in patients >60 versus ≤60 years of age. Study Design:Cohort study; Level of evidence, 3. Methods:Included in the study were patients aged ≥18 years who underwent isolated anatomic transtibial pullout repair using either the single- or double-tunnel technique for MMPR tears at a single institution between January 2016 and September 2020. Patients with a minimum 2-year follow-up were divided based on age at surgery (>60 vs ≤60 years). Patients completed the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), and Veterans RAND 12-Item Health Survey (VR-12) Physical score preoperatively and at final follow-up. Differences between age groups in outcome scores as well as repair failures (defined as the need for repeat arthroscopy) were analyzed using the 2-sided Student t test or chi-square test. Results:A total of 20 patients aged >60 years (mean age, 65.7 ± 4.1 years; range, 60.2-74.9 years) were identified and compared against 40 patients aged ≤60 years (mean age, 49.3 ± 9.0 years; range, 23.4-59.8 years). Significant improvement on all outcomes scores was observed in both groups at final follow-up when compared with preoperative values, with no significant between-group difference on any of the scores at final follow-up. Revision repair was required in 1 patient (2.5%) in the ≤60-year group but not in patients in the >60-year group. Conclusion:Anatomic transtibial pullout repair for isolated MMPR tears resulted in improved IKDC, KOOS JR, and VR-12 Physical scores at minimum 2-year follow-up, with no significant differences between our cohorts of patients >60 versus ≤60 years of age.

Objective  To evaluate the external rotation angle between the transepicondylar axis (TEA) and the posterior condylar axis (PCA) in a Brazilian population to determine whether the universal use of 3° of external rotation of the femoral component is appropriate in these patients undergoing total knee arthroplasty (TKA). Methods  We measured the angle of external rotation in 167 magnetic resonance imaging (MRI) scans using 4 different methods for the PCA according to the posterior landmarks: measurement A - chondral prominences; measurement B - bony prominences; measurement C - lateral bony prominence and medial chondral prominence; and measurement D - lateral chondral prominence and medial bony prominence. We statistically compared these measurements with the traditional 3° of external rotation used in TKA. Results  The mean angles of external rotation in measurements A, B, C, and D were of 5.44° ± 2.39°, 4.94° ± 2.10°, 8.56° ± 2°, and 2.33° ± 2° respectively. All measurement methods resulted in significant differences regarding the universal value of 3° ( p  > 0.0001). All intergroup comparisons showed statistical differences among the measurement methods ( p  > 0.0001), except for the comparison between measurements A and B ( p  = 0.1614). Conclusion  Using a chondral or bony reference point for the PCA, the TEA in the Brazilian population studied presented approximately 5° of external rotation. The traditional rotation of the femoral component of 3° regarding the PCA may be insufficient in the Brazilian population, especially in valgus knees. Therefore, we emphasize the significance of an individualized approach to achieve the ideal rotational alignment of TKA components.

Purpose: To evaluate the incidence of postoperative complications after an isolated primary Latarjet procedure for anterior shoulder instability at a minimum 2-year follow-up. Methods: A systematic review was performed in accordance with 2020 PRISMA guidelines. EMBASE, Scopus, and PubMed databases were queried from database inception through September 2022. The literature search was limited to human clinical studies reporting on postoperative complications and adverse events after a primary Latarjet procedure with a minimum 2-year follow-up. Risk of bias was measured using the Newcastle-Ottawa Scale. Results: Twenty-two studies, consisting of 1,797 patients (n 1/4 1,816 shoulders), with a mean age of 24 years were identified. The overall postoperative complication rate ranged from 0% to 25.7%, with the most common complication being persistent shoulder pain (range: 0%-25.7%). Radiological changes included graft resorption (range: 7.5%-100%) and glenohumeral degenerative changes (range: 0%-52.5%). Recurrent instability following surgery was documented in 0% to 35% of shoulders, while the incidence of bone block fractures ranged from 0% to 6% of cases. Postoperative nonunion, infection, and hematomas had a reported incidence rate ranging from 0% to 16.7%, 0% to 2.6%, and 0% to 4.4%, respectively. Overall, 0% to 7.5% of surgeries were reported failures, and 0% to 11.1% of shoulders required reoperation, with a revision rate ranging from 0% to 7.7%. Conclusions: The incidence of complications following the primary Latarjet procedure for shoulder instability was variable, ranging from 0% to 25.7%. High rates of graft resorption, degenerative changes, and nonunion were present while failure and revision rates remained low at a minimum 2-year follow-up. Level of Evidence: Level III, systematic review of Level I-III studies.

Background: Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus. Hypothesis: Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy. Study Design: Controlled laboratory study. Methods: Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint. Results: Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( P = .008 and P < .001, respectively), increased peak contact pressure at 30° ( P = .04), and decreased mean contact area in all flexion angles compared with the native condition ( P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( P = .002 and P = .003, respectively) and increased contact area at 30° and 60° ( P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( P > .05). Conclusion: The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status. Clinical Relevance: Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.

Objectives To compare patient-reported outcomes (PROs), failure, and healing rates following all-inside (AI) repair versus inside-out (IO) repair for the treatment of meniscal radial tears. Methods A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Scopus, PubMed, and Embase computerized databases. Level of evidence I through IV human clinical studies evaluating PROs and/or the incidence of failure and healing following AI versus IO repairs for meniscal radial tears were included. Study quality was assessed using the MINORS criteria and MCMS score. Results Ten studies comprising 205 patients were identified including 142 patients who underwent AI repair and 63 patients who underwent IO radial repair. Postoperative Lysholm and Tegner scores ranged from 90.8 to 95.6 and 5.7 to 8.2, respectively, in the AI repair group, compared to 86.9 to 94.2 and 6 to 7.5, respectively, in the IO repair group. Clinical failure ranged from 0% to 21.4% % and 0% to 62.5% in the AI and IO groups, respectively. Healing assessments on second-look arthroscopy revealed failure rates ranging from 0% to 8% in the AI repair group and 0% to 30% in the IO group. Complete and partial healing ranged from 13% to 69% in the AI group and from 22% to 58.3% in the IO group. Postoperative complications ranged from 0%-2% within the AI group compared to the IO group ranging from 0% to 25%. No implant-related complications were reported in any study group. Conclusion All-inside and inside-out repairs for meniscal radial tears both demonstrate improved PROs; however, current literature suggests that the IO technique may present higher failure and complication rates relative to AI repair techniques.

BACKGROUND:The microvasculature of the human meniscus has been previously described by Arnoczky and Warren. However, to date, the qualitative and quantitative extra-articular vascular anatomy of the medial meniscus has not been characterized. PURPOSES:To perform a qualitative and quantitative anatomic study of the extra-articular medial meniscal vasculature and to introduce the novel "medial meniscal artery" (MMA), potentially providing future guidelines for the treatment of meniscal abnormalities. STUDY DESIGN:Descriptive laboratory study. METHODS:A total of 33 unpaired, frozen human cadaveric knees were dissected. The femoral artery was identified and cannulated using an angiocatheter. The arteries were perfused with a red acrylic paint solution, allowing for improved visualization. Artery dimensions and distances were measured using a digital caliper. Perfused specimens were imaged using computed tomography and segmented using 3D reconstruction software to identify vessels and repeat artery measurements digitally. RESULTS:The MMA was consistently identified in all specimens. In 27 (82%) of 33 specimens, the MMA branched directly from the popliteal artery; in 5 (15%), the MMA shared a common trunk with the inferior medial genicular artery; and in 1 specimen (3%), the MMA shared a common branch with the inferior lateral genicular artery. The MMA was easily distinguishable from the superior, inferior, and middle genicular arteries, given its direct course to the medial joint line with terminal branches to the posterior horn of the medial meniscus and deep to the semimembranosus tendon. The MMA exhibited a consistently smaller vessel diameter relative to the genicular arteries. CONCLUSION:This is the first study to identify and quantitatively describe the MMA in the human knee. The MMA can be identified consistently on gross anatomic dissection in cadaveric donors of varying demographics. Further research is needed to identify and characterize the artery in vivo and to determine the MMA's role in meniscus preservation surgery. CLINICAL RELEVANCE:The findings of this study will provide future avenues of research toward understanding medial meniscus vascularization and the genesis of potential degenerative changes when vascularization is poor. This will help to further refine diagnostic and treatment options for meniscus revascularization and compartment preservation. Additionally, this study may help define safe zones in the knee during posterior approaches and expand the base of knowledge for emerging vascular procedures such as genicular artery embolization.

PurposeTo conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT).MethodsA literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status.ResultsSixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full-thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT.ConclusionsConflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure.Level of EvidenceLevel IV.

Background: Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is not without potential complications. Purpose: To evaluate the reported incidence of complications and adverse events after isolated MMPR repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed, and Scopus databases with the following search terms combined with Boolean operators: “meniscus,”“root,” and “repair.” Inclusion criteria consisted of level 1 to 4 human clinical studies in English or English-language translation reporting complications and adverse events after isolated posterior medial meniscus root repairs. The overall incidence of specific complications was estimated from the pooled sample of the included studies. Results: Eleven studies with a total pooled sample of 442 patients were identified. The mean patient age was 58.1 years, while the mean final follow-up time was 37.2 months (range, 12-84.8 months). The overall incidence of complications was 9.7% (n = 43/442), with the most commonly reported complication being progressive degenerative changes within the knee (10.4%; n = 25/240; n = 5 studies). A total of 1.25% (n = 3/240) of patients who experienced degenerative changes required conversion to total knee arthroplasty. Repair failures were reported in 3.1% (n = 10/327; n = 8 studies) of patients. Conclusion: Repairing MMPR tears is critical in preventing accelerated progression of knee osteoarthritis in patients without significant knee osteoarthritis preoperatively. While this repair is still recommended and necessary in appropriate patients, this review found that the incidence of complications after isolated posterior medial meniscus root repair was 9.7%, primarily involving the presence of progressive degeneration, while repair failure was reported in 3% of patients.

PurposeTo investigate whether allograft substitutes may be used to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties of the labral suction seal under several scenarios, including: (1) intact labrum, (2) rim preparation, (3) labral repair, (4) labral augmentation with iliotibial band (ITB), and (5) labral augmentation with a dermis allograft.MethodsEleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the 5 labral states, 3 testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen.ResultsEleven specimens were tested and 8 specimens (age: 58.6 ± 5.4 years, body mass index: 28.6 ± 6.8 kg/m2; 4 female patients; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0% ± 0% for all), rim preparation (89.0% ± 9.2%, 93.3% ± 20.6%, 85.1% ± 9.0%), repair (61.3% ± 17.9%, 88.4% ± 36.9%, 58.1% ± 16.7%), ITB allograft (62.7% ± 24.9%, 83.9% ± 21.6%, 59.4% ± 22.4%), and dermis allograft (57.8% ± 27.2%, 88.2% ± 29.5%, 50.0% ± 20.1%). Regarding peak force, intact state was significantly greater compared with the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (P < .001). No significant differences were demonstrated between displacement at peak force (P = .561). Regarding work, both intact state and rim preparation states were significantly greater than the repair, ITB augmentation, and dermis allograft augmentation states (P < .001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state.ConclusionsLabral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared with the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero.Clinical RelevanceThis study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation, which can be used for surgical decision-making.

Background: Meniscus root tears comprise 10% to 21% of all meniscal tears. These tears alter knee biomechanics, elevating contact pressure, akin to a meniscectomy. Consequently, they are linked to advanced joint degeneration and cartilage damage in the affected compartment. Purpose: To systematically evaluate and relate the current literature describing the diagnosis and treatment strategies for meniscus root tears. Study Design: Scoping review; Level of evidence, 4. Methods: This review was conducted following the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Inclusion criteria encompassed English-language clinical and preclinical research, technical notes, and narrative reviews on meniscus root tears. Exclusion criteria were studies on patellar tendon rupture, studies on medial patellofemoral ligament rupture with additional knee joint ligament injuries, studies of patients <16 years old, and studies involving open fractures. The data were summarized using a descriptive analysis and a thematic analysis. Results: After 1425 articles were identified, 461 studies were included; 17% (n = 78) were case reports or case series, 15% (n = 71) were technical notes, 9% (n = 41) addressed aspects of diagnosis, 7% (n = 32 ) were narrative reviews, and 5% (n = 21) were systematic reviews or meta-analyses. Studies presenting original data comprised 57% (n = 262) of all included studies, and 97% of the studies were of evidence levels 3 to 5. Contributions were mainly from the United States (n = 123; 27%), Republic of Korea (n = 102; 22%), and Japan (n = 99; 21%). Many studies (n = 216; 47%) focused on the treatment and outcomes of meniscus root tears. A significant chronological surge in the quantity of studies addressing the diagnosis and treatment of meniscus root tears was evident, particularly over the past 3 years. Consensus was found regarding the definition of meniscus root tears, the advantages of early repair, and postoperative rehabilitation protocols. The variations in surgical techniques and operative strategies created the greatest amount of contention, along with clinical assessment and imaging modalities. Conclusion: High-level evidence studies for diagnosing and managing meniscus root tears were scarce. A consensus has yet to be reached regarding the role of concomitant osteotomy, comparison of repair techniques, the use of a centralization stitch, patient factors affecting outcomes, and long-term outcomes of nonoperative management.

PURPOSE:To compare the efficacy of common intra-articular injections used in the treatment of knee osteoarthritis, including corticosteroid (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC), with a minimum follow-up of 6-months. METHODS:A literature search was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in August 2022 in the following databases: PubMed/MEDLINE, Scopus, Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews. Level I to II randomized clinical trials with a minimum follow-up of 6 months that investigated the treatments of interest were included. Patient-reported outcome scores for pain and function at baseline and at latest follow-up were extracted, and the change in scores was converted to uniform 0 to 100 scales. Arm-based Bayesian network meta-analysis using a random-effects model was created to compare the treatment arms in pain and function. RESULTS:Forty-eight studies comprising a total of 9,338 knees were included. The most studied intra-articular injection was HA (40.9%), followed by placebo (26.2%), PRP (21.5%), CS (8.8%), and then BMAC (2.5%). HA and PRP both led to a significant improvement in pain compared with placebo. HA, PRP, and BMAC all led to a significant improvement in function scores when compared with placebo. Surface under the cumulative ranking curves (SUCRAs) of the interventions revealed that PRP, BMAC, and HA were the treatments with the highest likelihood of improvement in both pain and function, with overall SUCRA scores of 91.54, 76.46, and 53.12, respectively. The overall SUCRA scores for CS and placebo were 15.18 and 13.70, respectively. CONCLUSIONS:At a minimum 6-month follow-up, PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS. LEVEL OF EVIDENCE:Level II, meta-analysis of Level I to II studies.

Management of meniscal radial and root tears and extrusion is complex and has changed significantly over recent years. It is important to provide a comprehensive overview of the management of radial and root tears and meniscal extrusion and be aware of the currently available evidence on repair techniques, rehabilitation, and outcomes following radial and root repairs.

Objectives: Much literature has been devoted to determining the proper tunnel positioning during arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR). However, to date, no literature has assessed whether the tunnel centroid closely approximates the final bone-patellar tendon-bone (BTB) graft positioning following interference screw fixation. Thus, the purpose of this human cadaveric study was to assess the difference in position between the native ACL footprint, drilled tunnel, and tendinous portion of a BTB graft following ACLR. It was hypothesized that the tendon position would be significantly more offset than the tunnel position from the native ACL footprint, given that the patellar tendon is not centered on the bone plugs of the BTB graft. Methods: Ten cadaveric specimens were included. A standard BTB graft was harvested from each specimen using an oscillating saw and scalpel and bone plugs were sized to a diameter of 10 mm for graft passage. The native ACL footprint (femur and tibia) of each specimen was mapped with a MicroScribe 3-dimensional (3D) coordinate digitizer. The centroid of each femoral footprint was determined by creating a 3D surface patch using an area-weighted technique. A guidewire was placed at the centroid of the native footprint and a 10 mm tunnel was overreamed to best approximate the centroid of the native footprint. The borders of the tunnel were then subsequently mapped out using the digitizer. A BTB graft was passed and secured in hyperextension with an 8 x 20 mm interference screw. Following fixation, the tendinous portion of the graft was mapped and a centroid was derived. This was repeated for the tibial side. Results: On the femur, mean cross-sectional area of the ACL footprint, tunnel, and tendinous portion of the graft were 154.89 ± 55.10 mm2, 86.45 ± 12.65 mm2, and 40.14 ± 10.68 mm2, respectively. The tendinous portion provided 26.7% coverage of the native footprint. The tendon centroid was significantly further than the tunnel centroid from the native footprint (2.90 ± 0.98 mm2 vs 0.38 ± 0.15 mm2, p ≤ 0.001). The tendon was mean 2.84 ± 0.83 mm2 from the tunnel, in the 6 o’clock direction (inferior). On the tibia, mean cross-sectional area of the ACL footprint, tunnel, and tendinous portion of the graft were 143.60 ± 19.00 mm2, 86.48 ± 8.76 mm2, 42.84 ± 6.70 mm2. The tendinous portion provided 30.01% coverage of the native footprint. The tendon centroid was significantly further that the tunnel centroid from the native footprint centroid (3.13 ± 0.23 mm2 vs 0.28 ± 0.07 mm2, p ≤ 0.001). The tendon centroid was mean 3.02 ± 0.16 mm2 from the tunnel centroid in the 11 o’clock direction (posterolateral). Conclusions: The findings of this study suggest that the soft tissue portion of BTB grafts is significantly offset from the tunnel centroid following ACLR fixation. While previous studies have emphasized tunnel placement from an isometry and biomechanical standpoint, future studies should study tunnel position in the context of where the soft tissue of the BTB graft ends up relative to the tunnel centroid. Future avenues of study would include determining whether a tunnel "cheat distance and direction" can be determined to routinely center the soft tissue of the ACLR graft appropriately within the anteromedial bundle of the native ACLR footprint for an optimal anatomic reconstruction.

CONTEXT:Many clinicians, trainers, and athletes do not have a true understanding of the effects of commonly used performance-enhancing drugs (PEDs) on performance and health. OBJECTIVE:To provide an evidence-based review of 7 commonly used pharmacological interventions for performance enhancement in athletes. DATA SOURCES:PubMed and Scopus databases were searched on April 8, 2022. STUDY SELECTION:Systematic reviews (SRs) and meta-analyses (MAs) assessing the performance-enhancing effects of the following interventions were included: androgenic anabolic steroids (AAS), growth hormone (GH), selective androgen receptor modulators (SARMs), creatine, angiotensin-converting enzyme (ACE)-inhibitors, recombinant human erythropoietin (rHuEPO), and cannabis. STUDY DESIGN:Umbrella review of SRs and MAs. LEVEL OF EVIDENCE:Level 4. DATA EXTRACTION:Primary outcomes collected were (1) body mass, (2) muscle strength, (3) performance, and (4) recovery. Adverse effects were also noted. RESULTS:A total of 27 papers evaluating 5 pharmacological interventions met inclusion criteria. No studies evaluating SARMs or ACE-inhibitors were included. AAS lead to a 5% to 52% increase in strength and a 0.62 standard mean difference in lean body mass with subsequent lipid derangements. GH alters body composition, without providing a strength or performance benefit, but potential risks include soft tissue edema, fatigue, arthralgias, and carpel tunnel syndrome. Creatine use during resistance training can safely increase total and lean body mass, strength, and performance in high-intensity, short-duration, repetitive tasks. Limited evidence supports rHuEPO benefit on performance despite increases in both VO2max and maximal power output, and severe cardiovascular risks are documented. Cannabis provides no performance benefit and may even impair athletic performance. CONCLUSION:In young healthy persons and athletes, creatine can safely provide a performance-enhancing benefit when taken in controlled doses. AAS, GH, and rHuEPO are associated with severe adverse events and do not support a performance benefit, despite showing the ability to change bodily composition, strength, and/or physiologic measures. Cannabis may have an ergolytic, instead of ergogenic, effect.