BACKGROUND:Complex repairs of radial meniscal tears have shown increased fixation strength compared to conventional sutures. A simplified 2-suture hybrid and a novel dual tie-grip repair with interconnected vertical mattress sutures spanning the tear were tested and compared to all-inside double-horizontal and tie-grip repairs. HYPOTHESIS:The dual tie-grip repair would increase the initial compression load across the tear and show the least cyclic displacement and highest failure strength. STUDY DESIGN:Controlled laboratory study. METHODS:A total of 40 porcine medial menisci were assigned to 4 repair groups: double-horizontal, hybrid, tie-grip, and dual tie-grip (10 per group). Results from tie-grip repairs were used to assess the effect of vertical mattress suture interconnection. After suture placement according to the described technique and fixation, the initial compressive load, stiffness, and relief displacement were measured. The repaired specimens underwent cyclic loading between 5 and 30 N over 1000 cycles (0.75 Hz), while cyclic stiffness and displacement were measured. Ultimate stiffness and load-to-failure were analyzed at 3.15 mm/s. RESULTS:Analysis of variance revealed that dual tie-grip and hybrid repairs showed higher initial compressive load and relief displacement than the other techniques, with dual tie-grip repair reaching the highest values for both metrics (load: 19.3 ± 2.3 N [P < .001]; displacement: 0.75 ± 0.19 mm [P < .001]). The double-horizontal repair had the lowest initial stiffness (P < .001). Cyclic displacement was lowest for the dual tie-grip repair and highest for the double-horizontal repair (both P < .001). All repaired specimens stiffened during cycling without intergroup differences. Analysis of covariance for stiffness over displacement revealed higher stabilization (P < .040) with dual tie-grip repair and reduced stabilization (P < .001) with double-horizontal repair. Despite comparable ultimate stiffness across groups, the dual tie-grip repair failed predominantly by suture rupture at the highest ultimate load (275.5 ± 26.2 N; P < .001), whereas the double-horizontal repair failed by tissue rupture the earliest (127.2 ± 15.9 N; P < .001). CONCLUSION:The dual tie-grip repair provided the highest initial compression across the radial meniscal tear, the lowest cyclic displacement, and the greatest load-to-failure among all techniques in a porcine cadaveric model. The simplified 2-suture hybrid repair showed higher initial compression than other repairs and comparable cyclic stability to the tie-grip repair. CLINICAL RELEVANCE:The dual tie-grip repair provided high compression across the radial tear and strong resistance to cyclic displacement. Future clinical series assessing differences in healing rates among different repair groups are warranted.

Similar to primary anterior cruciate ligament reconstruction (ACLR), meniscal pathology is frequently encountered during revision ACLR (RACLR). In the revision setting, however, meniscal disease often presents a greater challenge because tissue quality may be compromised, particularly when prior meniscal treatment was performed at the index ACLR. This review highlights key considerations and treatment strategies for managing extensive, complex meniscal lesions in the setting of RACLR. Graft failure significantly increases the incidence of meniscal tears. Furthermore, graft insufficiency may result in extensive, complex, and sometimes, irreparable meniscal tears. Meniscal treatment strategies, and ultimately joint preservation, have been studied to restore appropriate knee anatomy and biomechanics. Furthermore, special considerations must be made to best treat a wide range of meniscal pathologies in the RACLR, especially in a suboptimal joint environment. Graft failure requiring revision ACL reconstruction is often accompanied by extensive, complex meniscal tearing. Meniscus-preserving strategies may help restore knee anatomy and biomechanics and, in turn, may slow the progression of osteoarthritis.

To critically examine the evidence addressing whether meniscal extrusion represents a distinct and clinically meaningful pathologic entity, elucidate its underlying biomechanical and anatomic causes, and review current and emerging strategies for diagnosis and management. This review synthesizes contemporary literature on imaging criteria, pathophysiology, and the evolving role of restorative interventions, particularly meniscus centralization, in mitigating extrusion-related joint degeneration. Meniscus extrusion (> 3 mm radial displacement) exists as both physiologic and pathologic, associated with root tears, radial tears, and osteoarthritis. Normative values (e.g., < 2 mm in healthy knees) and cut-offs (> 2–3 mm for pathology) vary by imaging (MRI/US). Etiology involves hoop stress loss and meniscotibial ligament disruption. Treatments like root repair and centralization may reduce extrusion, improve biomechanics (e.g., contact pressure/area), and enhance outcomes (e.g., KOOS scores improved by 20–30 points post-centralization). Meniscal extrusion is a real and clinically significant consequence of meniscal biomechanical failure, most commonly related to root disruption and peripheral instability. Treatment paradigms have shifted from symptom management toward biomechanical restoration, with growing evidence that meniscus centralization can reduce extrusion and improve clinical outcomes. Nevertheless, long-term prospective data are required to establish whether these interventions can meaningfully alter the natural history of knee osteoarthritis.

Background:Data comparing primary fixation of hamstring tendon (HT) grafts for all-inside anterior cruciate ligament reconstruction (ACLR) using direct ripstop (RS) suturing of free graft limbs with the adjustable loop device (ALD) versus standard grafts are lacking. Purpose:To evaluate the biomechanical effect of direct RS suturing backup fixation of free graft limbs to the adjustable loop in 4- and 6-strand HT grafts compared with standard cerclage sutured grafts in all-inside ACLR. Study Design:Controlled laboratory study. Methods:Four different HT groups (n = 8 per group) with 9-mm graft diameter were prepared: 4- and 6-strand grafts with standard cerclage suturing (4HT/6HT) and additional direct RS suturing (4HT-RS/ 6HT-RS) of the free graft limbs to the ALD. Each construct was preconditioned with graft retensioning (250 N) followed by a total of 3000 cycles. This included 1 position-controlled and 2 force-controlled load blocks (1000 cycles each), with a constant valley (10 N) and 2 different peak loads (250 N, 400 N). Residual graft force, dynamic elongation, and stiffness were analyzed. The ultimate strength was evaluated during pull to failure (50 mm/min). One-way analysis of variance and Holm-Sidak post hoc tests were used as statistical methods. Results:The maintenance of residual graft force of RS suturing groups (4HT-RS, 68.3% ± 2.8%; 6HT-RS, 72.1% ± 4.9%) was higher (P≤ .002) than both controls (4HT, 6HT) (≤61.0% ± 3.1%). The control groups showed lower dynamic stiffness (250 N: 125.2 ± 5.4 N/mm vs 139.4 ± 7.4 N/mm, 124.8 ± 6.9 N/mm vs 145.3 ± 10.9 N/mm; 400 N: 140.1 ± 5.3 N/mm vs 154.1 ± 8.3 N/mm, 139.4 ± 6.4 N/mm vs 162.1 ± 13.1 N/mm; P≤ .04) and higher dynamic elongation (each P < .001) at each peak load, resulting in higher total elongation (4.4 ± 0.4 mm vs 2.9 ± 0.5 mm, 3.9 ± 0.6 mm vs 2.3 ± 0.4 mm; P≤ .001) compared with both RS suturing groups. The ultimate stiffness of 4HT (162.4 ± 13.7 N/mm) was lower (P≤ .02) than in both RS groups (4HT-RS: 181.9 ± 9.2 N/mm; 6HT-RS: 185.4 ± 17.3 N/mm). The ultimate load of 6HT-RS (1133.4 ± 67.9 N) was higher (P≤ .003) than for other groups. The predominant failure mode was suture rupture of the ALD. Conclusion:This study demonstrated that direct RS suturing of free graft limbs to the adjustable loop significantly decreased graft tension loss, increased construct stiffness, and reduced cyclic elongation in 4- and 6-strand all-inside HT grafts compared with standard grafts with cerclage suturing. Improved primary fixation may ensure more homogeneous load distribution across the graft limbs and reduce the risk of early clinical failure. Clinical Relevance:Direct RS suturing of the free graft ends to the ALD improved primary construct stability in all-inside ACLR, but future studies will determine if the improved time-zero biomechanics translate into favorable clinical outcomes.

Meniscus allograft transplant (MAT) can provide meaningful improvement in patient outcomes in those who are otherwise meniscus deficient. A common finding in the setting of a failed MAT is meniscus extrusion. Meniscus centralization is a technique performed to reduce the meniscus to its intra-articular location and has been shown to improve postoperative pain and function in patients with an extruded meniscus. Prior techniques have been described for meniscus centralization in the setting of a meniscus root tear or with the use of single tension devices that are tensioned after meniscocapsular fixation. We present a minimally invasive technique for meniscus centralization that can be performed in conjunction with MAT using a centralization stabilization suture and re-tensionable root-fixation subchondral anchors that can be secured prior to meniscocapsular fixation.

Injury to the medial complex of the knee may result in persisting valgus and rotatory instability. In combination with concomitant meniscotibial ligament disruption, maldistributed contact forces are placed on the medial compartment, which may result in the progression of osteoarthritis. When facing chronic valgus and/or posteromedial instability, definitive treatment with medial ligament complex reconstruction in combination with additional repair of the meniscotibial ligament when necessary should be done to anatomically restore proper knee biomechanics and kinematics. This technique describes reconstruction of both the superficial medial collateral ligament (sMCL) and posterior oblique ligament with a single allograft, with additional suture tape augmentation used to reinforce the sMCL. Additionally, less invasive onlay fixation is used via a knotless loop mechanism to secure the posterior oblique ligament to its tibial insertion and the sMCL at 2 points along its distal tibial insertion.

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament that requires surgical intervention. Surgical options to address ACL ruptures include reconstruction using autograft or allograft or performing primary repair. Subsequent ACL graft failure is a significant postoperative concern in the younger patient population. The addition of suture tape to the final construct is thought to protect the graft during moments of high stress by increasing graft stiffness under high load and preventing substantial graft elongation. Given the normal anatomic lengthening of the ACL from knee flexion to full extension, final fixation of both the suture tape and the graft is done with the knee hyperextended to avoid overconstraint. The use of adjustable loop fixation for both femoral and tibial fixation with the all-inside technique allows the graft to be retensioned after final suture tape fixation and subsequent knee cycling. This ensures that the suture tape is slightly laxer than the graft so that the graft experiences loads that are essential for its healing, with the suture tape sharing the load only during times of high stress.

Background:Optimized surgical fixation and meniscal stabilization during rehabilitation increase healing success. However, the latest generation of all-inside devices has not yet been biomechanically compared with inside-out suture tape (IO-ST) repair. Hypothesis:(1) The contact area of a suture anchor (SA) would compensate for a meniscal defect better than polyether ether ketone anchors (PA); (2) adjustable tensioning for all-inside meniscal repair fixation would result in higher initial load than IO-ST repair; and (3) stiffer constructs would decrease secondary displacement. Study Design:Controlled laboratory study. Methods:This study investigates human menisci (N = 39) via microscopic imaging and a biomechanical testing protocol. For the imaging protocol, needles of an all-inside SA or PA device and an IO-ST device were inserted after staining to measure the iatrogenic defect created by the needle insertion (n = 20) and the length, width, and meniscus contact area of deployed all-inside anchors (n = 6). For biomechanical testing, menisci with longitudinal bucket handle tears were prepared, and single stitches were repaired (each n = 9). After suture tensioning (50 N) and fixation, initial load, initial stiffness, and relief displacement were measured. Constructs underwent cyclic loading between 2 and 20 N, with 10,000 cycles (0.75 Hz), and stiffness and displacement were measured. Ultimate stiffness and load-to-failure were analyzed at 3.15 mm/sec. Results:All-inside needles created greater iatrogenic meniscal defects (P < .001) than IO-ST repair. While PAs were longer (P < .001), SAs were wider with a greater meniscal contact area (both P < .001). IO-ST repair resulted in the lowest initial load (P < .001) and relief displacement (P < .001), whereas SA repair resulted in a higher initial load (P < .007) and stiffness (P < .023) than PA repair. The overall stiffer SA fixation (P < 001) significantly reduced cyclic displacement compared with other repairs (P < .044). The PA group failed due to an anchor fracture at a significantly lower load (84.3 ± 10.7 N; P < .001) than the IO-ST (136.4 ± 10.5 N) and the SA repair (122.1 ± 17.5 N), with a suture-based failure mode. The ultimate stiffness of SA constructs was higher (P < .045) than that of other repairs. Conclusion:While all-inside devices showed improved primary stability, the IO-ST construct demonstrated the highest load-to-failure. In a human cadaveric model, meniscal repair with a more compact and conforming SA was stiffer and reduced cyclic displacement compared with PA and IO-ST repair. Clinical Relevance:All-inside SA repair improved primary stability. Future clinical series will define the overall significance of healing rates.

Background: Recent biomechanical evidence for adjustable suture anchor (ASA)-based posterior medial meniscus root (PMMR) fixation has shown promising results compared with conventional transtibial pull-out repair (TPOR). However, ASA fixation has not been evaluated in human tissue to 100,000 cycles. Hypothesis: ASA repair would lead to increased primary fixation strength and less cyclic displacement than conventional TPORs. Study Design: Controlled laboratory study. Methods: A total of 32 human medial menisci were used, 8 of which were intact specimens and served as native controls. For the others, PMMR tears were created and repaired using 3 different techniques (n = 8 group). Two conventional PMMR repairs were prepared consisting of two No. 2 simple sutures (TSS) and two No. 2 sutures in a Mason-Allen (MA) configuration, all tied over a cortical button. The knotless ASA repair was fixed in MA with repair sutures tensioned at 120 N (MA-120). The repairs' initial force, stiffness, and relief displacement from the tensioned state toward repair unloading (2 N) were measured after fixation. All repair constructs were loaded for 100,000 cycles, with displacement and stiffness measured, and finally were pulled to failure. Results: The TPORs demonstrated similar primary fixation and cyclic loading behavior except for initial cyclic displacement (cycle 10). The ASA repair provided a higher initial repair load (P < .001) and stiffness (P < .001) with relief displacement similar to conventional TPORs. Lower initial cyclic displacement (P < .011; cycle 10) with overall higher repair stiffness (P < .011) resulted in significantly lower displacement (P < .001) throughout testing for ASA repair. Although both TPORs were completely loose after 100,000 cycles, the ASA repair achieved near-native dynamic meniscal stabilization. The TSS repair had lower overall ultimate load (P < .001) and ultimate stiffness (P < .023) compared with the ASA repair. All repairs had lower ultimate stiffness and loads than the native meniscus (P < .001). Conclusion: The ASA repair resulted in improved primary PMMR fixation that was stiffer with less cyclic displacement than conventional TPORs and approached that of the human meniscal function after 100,000 load cycles in a cadaveric model. However, all repair techniques had lower ultimate strength than the native human PMMR. Clinical Relevance: Knotless ASA meniscus root fixation resulted in higher tissue compression and less displacement in a cadaveric model; however, future clinical series with surveillance imaging will define the overall significance of healing rates.

Meniscal root tears have been shown to significantly impact tibiofemoral mechanics and contribute to accelerated development of osteoarthritis. A common finding in conjunction with a meniscal root tear is extrusion of the meniscus. Meniscal extrusion is an independent risk factor for tibiofemoral cartilage loss and the progression of osteoarthritis. Meniscus centralization was first introduced to directly address extrusion alongside root repair techniques. To date, reported techniques for meniscus centralization generally involve anchoring the meniscus directly to the tibia in some fashion, which can limit the normal anatomic motion of the meniscus. We present a technique for meniscus centralization that aims to maintain natural meniscal motion by utilizing the meniscotibial ligaments.

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Historically, nonsurgical management for these injuries has been favored for a majority of grade I-III sprains, particularly femoral-based. However, when coupled with other injuries such as meniscotibial ligament tears or distal Stener type avulsion tears, early surgical management for these cases is recommended. This will allow for stabilization and protection of the meniscus in addition to preventing residual valgus laxity, especially related to more severe Stener-like avulsions of the superficial MCL that can be seen with meniscotibial ligament tears. Utilizing an open approach, meniscotibial repair with suture anchors with internal brace augmentation for the MCL repair can provide a strong final construct, and a safe and fast recovery.

The integrity of the posterior meniscus root attachment is vital for the preservation of knee joint biomechanics. Meniscus root tears treated nonoperatively or with meniscectomy lead to poor functional outcomes and progressive knee degeneration. Repair returns knee biomechanics back to the intact state and has an established record of positive mid-term to long-term results. Although transtibial pullout repair has been the gold standard, innovation is needed to overcome the limitations inherent to traditional approaches. The latest generation of transtibial pullout repair devices is adjustable, permits suture anchor placement directly into the root footprint, and has demonstrated encouraging early results in biomechanical analysis. This Technical Note describes an arthroscopic technique for medial meniscus posterior root repair that uses a knotless adjustable implant (SutureLoc; Arthrex) for aperture fixation via a transtibial approach with intratunnel soft anchor direct fixation and rip-stop suture configuration.

Combined medial and lateral posterior meniscal root tears in the setting of an acute anterior cruciate ligament (ACL) rupture are extremely rare. The following case report demonstrates a high school football player who sustained a noncontact knee injury while performing a spin move at practice. The patient is a 17-year-old high school football defensive end who was presented to the clinic 1 week following the injury complaining of persistent knee pain with associated swelling, limited range of motion (ROM), and complaint of instability. During physical examination, the patient was found to have anterior cruciate laxity. Magnetic resonance imaging (MRI) demonstrated a complete midsubstance tear of the ACL and increased signal within the posterior horn of the medial meniscus with no obvious signs of pathology localized to the lateral meniscus. ACL reconstruction (ACLR) was performed and intraoperatively, both medial and lateral root tears were found. A standard bone patellar-tendon bone (BTB) autograft ACLR was performed with combined medial and lateral root repair utilizing a transtibial pull-out method for both. The clinical importance is root tears with associated ACL tears can be hard to diagnose on preoperative MRI, especially laterally, so careful assessment of both meniscal roots at the time of arthroscopy is critical. Furthermore, careful creation of the needed root repair tunnels for transtibial repair is critical to avoid coalescence with the ACL tibial tunnel.

Abstract Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1–25.1) and a mean follow-up of 37.9 months (95% CI: 35.8–40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2–92.9] vs. 82.6 [95% CI: 79.0–86.2]; p  < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5–0.8] vs. 1.2 [95% CI: 0.8–1.5]; p  = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. Level of Evidence: case series, IV

Background: The potential intra-articular effects of ≥1 year after anterior cruciate ligament reconstruction (ACLR) with independent suture tape augmentation (STA) are not fully understood. Purpose: To investigate whether incorporating suture tape in an all–soft tissue quadriceps tendon autograft (QTA) ACLR leads to satisfactory patient outcomes while having no intra-articular side effects as determined by magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Included were 25 patients with a mean age of 19.9 years (95% CI, 17.3-22.5 years) who underwent QTA ACLR with STA between 2016 and 2019. All patients underwent MRI at ≥1 year postoperatively and had at least a 2-year follow-up (mean, 28 months [95% CI, 26.5-29.5 months]) that included physical examination with anterior laxity testing with KT-1000 arthrometer, radiographs, and patient-reported outcome measures (PROMs). At the final follow-up, the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for applicable PROMs were applied to each patient. Postoperative graft and joint integrity were assessed using the Howell classification and the MRI Osteoarthritis Knee Score (MOAKS) joint effusion/synovitis grade. The Mann-Whitney U test for continuous variables and the chi-square or the Fisher exact test for categorical variables were used for statistical analyses. Results: The MRI assessment of the grafts demonstrated intact grafts in all patients. Overall, 96% of patients demonstrated grades 0 or 1 MOAKS for joint effusion/synovitis. All patient outcomes significantly improved from preoperatively to the final follow-up ( P < .001), except for the Marx score, which decreased significantly (14.2 [95% CI, 12.7-15.8] vs 9.72 [95% CI, 7.3-12.2]; P = .0014). At least 68% of the patients achieved the MCID threshold, and 92% achieved the PASS threshold for all applicable PROMs. Conclusion: QTA ACLR with STA did not demonstrate adverse intra-articular changes on MRI at ≥1 year postoperatively. In addition, STA did not appear to negatively affect PROMs.

Background: The rate of failed anterior cruciate ligament reconstruction (ACLR) remains high in the younger and more active patient populations. Suture tape augmentation (STA) in addition to ACLR may reduce the risk for revision surgery. Purpose/Hypothesis: The purpose of this study was to compare patient outcomes between patients who underwent primary all-inside quadrupled semitendinosus hamstring tendon autograft (QST-HTA) ACLR with and without STA. It was hypothesized that the STA cohort would demonstrate a lower incidence of subsequent revision ACLR while maintaining comparable patient-reported outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: All patients ≤40 years of age who received primary all-inside QST-HTA ACLR with and without independent STA augmentation were identified. The following validated patient-reported outcome measures (PROMs) were collected: visual analog scale for pain, Single Assessment Numeric Evaluation, Knee injury and Osteoarthritis Outcome Score subscales, and Tegner activity scale. KT-1000 arthrometer measurements were collected pre- and postoperatively. Cox proportional hazards model and nominal logistic regression analysis were used to assess additional variables associated with revision ACLR. Results: A total of 104 patients with a mean age of <22 years were included in the final data analysis (STA: 36 patients; control: 68 patients). Significantly fewer patients in the STA group sustained a graft failure necessitating revision surgery at the final follow-up (5.6% vs 24%; relative risk, 0.24 [95% CI, 0.06-0.97]; P = .017). Four-year graft survival was significantly higher in the STA group (97.2% vs 82.4%; P = .031). All PROMs significantly improved postoperatively except for Tegner levels, which decreased in both groups compared with their preinjury levels ( P < .001). Return to sports was similar in both groups with >70% of patients returning to their previous level of competition. Regression analysis demonstrated increased risk for revision ACLR in younger patients, high school athletes, and those with higher postoperative activity levels. Conclusion: QST-HTA ACLR with STA was associated with reduced risk for revision ACLR compared with nonaugmented QST-HTA ACLR in this young patient population. Furthermore, the addition of suture tape did not appear to affect postoperative patient-reported and return-to-sports outcomes.

PurposeTo evaluate ≥ 2-year patient outcomes following primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes.MethodsAll high school and collegiate athletes who underwent primary ASQT ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated PROMs pre- and postoperatively. The minimal clinically important difference (MCID) was calculated for each PROM based on this study population and applied to the individual patient. Return to sport (RTS), subsequent surgical intervention including contralateral ACLR, and KT-1000 arthrometer measurements for knee laxity were collected. Complications were assessed by physical examination, radiological studies, or obtained via telephone.ResultsThere were a total of 60 patients included in final data analysis with a mean age of 16.8-years-old (95% CI, 16.2-17.4) and mean final follow-up of 37.1 months (95% CI, 33.1-41.1). Twelve patients (20%) necessitated subsequent surgery on the ipsilateral knee which included seven patients having a subsequent meniscal procedure and three patients underwent arthrolysis. 0% sustained a graft failure and six patients sustained a contralateral ACL injury necessitating surgery. All PROMs improved at final follow-up (p < 0.001). Additionally, KT-1000 arthrometer measurements significantly improved postoperatively at 1-year clinical follow-up (p < 0.001). A majority of patients obtained the MCID thresholds for each PROM at final follow-up. There were 48 patients (80%) who participated in pivoting sports. The RTS rate at same level was 54 patients (90%) with six patients (10%) not returning to same level due to graduation.ConclusionASQT ACLR with STA in a young athletic patient population may result in a low graft failure rate while maintaining satisfactory patient outcomes at short-term follow-up, including a return to sport at the same level of 90%.Level of EvidenceRetrospective Case Series, IV

PURPOSE:To investigate patient outcomes, including revision rate, following primary bone patellar-tendon bone autograft (BPTB) anterior cruciate ligament reconstruction (ACLR) with and without suture tape augmentation (STA) in a young and active cohort. METHODS:All eligible patients who received primary BPTB ACLR with a minimum of 2-year follow-up were included in this retrospective cohort study. All patients receiving STA were augmented with the same device. Patients completed the following patient-reported outcome measures (PROMs): the visual analog scale, the Single Assessment Numeric Evaluation, the Knee Injury and Osteoarthritis Outcome Score subscales, and the Tegner activity scale. Anteroposterior knee laxity was assessed using a KT-1000 arthrometer preoperatively and 1-year postoperatively. Posterior tibial slope, femoral tunnel angle, and tibial tunnel placement were calculated for all patients. Subsequent surgical interventions and return to sport (RTS) were obtained from each patient. RESULTS:One hundred fourteen patients (52 BPTB ACLR with STA, 62 traditional BPTB ACLR) with a mean patient age <19 years and a mean final follow-up of ≥5 years were included. Compared with the control group, the STA group demonstrated significantly less subsequent revision ACLR (0 vs. 5, P = .036). All PROMs and KT-1000 measurements improved at final follow-up (P < .001) and were comparable between groups. There were no differences seen in either posterior tibial slope or graft tunnel placement between groups. More than 85% of the patients were able to return to the sport that led to their injury at full capacity with no differences seen in RTS rate, time to RTS, or level of competition between groups. CONCLUSIONS:Compared with traditional BPTB ACLR, additional STA appeared to safely and effectively lead to less subsequent revision ACLR while maintaining acceptable PROMs and objective joint laxity measurements in a young and active patient population. LEVEL OF EVIDENCE:Level III, retrospective cohort study.

Background: While posterior medial meniscus root (PMMR) techniques have evolved, there remains a need to both optimize repair strength and improve resistance to cyclic loading. Hypothesis: Adjustable tensioning would lead to higher initial repair strength and reduce displacement with cyclic loading compared with previously described transtibial pull-out repair (TPOR) fixation techniques. Study Design: Controlled laboratory study. Methods: A total of 56 porcine medial menisci were used. Eight intact specimens served as a control for the native meniscus. For the others, PMMR tears were created and repaired with 6 different TPOR techniques (8 in each group). Fixed PMMR repairs were executed using 4 different suture techniques (two No. 2 cinch sutures, two cinch tapes, two No. 2 simple sutures, and two No. 2 sutures in a Mason-Allen configuration) all tied over a cortical button. Adjustable PMMR repairs using Mason-Allen sutures were fixed with an adjustable soft tissue anchor fixation tensioned at either 80 N or 120 N. The initial force, stiffness, and relief displacement of the repairs were measured after fixation. Repair constructs were then cyclically loaded, with cyclic displacement and stiffness measured after 1000 cycles. Finally, the specimens were pulled to failure. Results: The PMMR repaired with the 2 cinch sutures fixed technique afforded the lowest ( P < .001) initial repair load, stiffness, and relief displacement. The adjustable PMMR repairs achieved a higher initial repair load ( P < .001) and relief displacement ( P < .001) than all fixed repairs. The 2 cinch sutures fixed technique showed an overall higher cyclic displacement ( P < .028) and was completely loose compared with the native meniscus functional zone. Repairs with adjustable intratunnel fixation showed displacement with cyclic loading similar to the native meniscus. With cyclic loading, the Mason-Allen adjustable repair with 120 N of tension showed less displacement ( P < .016) than all fixed repairs and a stiffness comparable to the fixed Mason-Allen repair. The fixed Mason-Allen technique demonstrated a higher ultimate load ( P < .007) than the adjustable Mason-Allen techniques. All repairs were less stiff, with lower ultimate failure loads, than the native meniscus root attachment ( P < .0001). Conclusion: Adjustable TPOR led to considerably higher initial repair load and relief displacement than other conventional fixed repairs and restricted cyclic displacement to match the native meniscus function. However, the ultimate failure load of the adjustable devices was lower than that of a Mason-Allen construct tied over a cortical button. All repair techniques had a significantly lower load to failure than the native meniscus root. Clinical Relevance: Knotless adjustable PMMR repair based on soft anchor fixation results in higher tissue compression and less displacement, but the overall clinical significance on healing rates remains unclear.