BACKGROUND:Previous reviews comparing mobile-bearing and fixed-bearing implants in unicompartmental knee arthroplasty report mixed results. It has yet to be explored whether such differences are influenced by study design. This systematic review and meta-analysis aimed to compare adverse events, patient-reported outcomes, and range of motion between the two implant types, overall and by study design (randomized trial, observational study, and registry study). METHODS:We searched three databases up to February 4, 2025, for primary research studies comparing mobile- and fixed-bearing implants in unicompartmental knee arthroplasty patients. The outcomes of interest were adverse events, patient-reported outcomes, and range of motion. We performed DerSimonian-Laird random-effects meta-analyses, stratified by study design; assessed the risk of bias using the Cochrane and Risk Of Bias In Non-Randomized Studies-of Interventions tools; and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework. A total of 30 observational studies (9,454 patients), six randomized trials (485 patients), and three registry studies (60,461 patients) were included. RESULTS:The meta-analyses found that fixed-bearing implants lowered the risk of revision (relative risk [RR] 0.65 [95% confidence interval [CI] 0.48 to 0.86]) and dislocation (RR 0.16 [95% CI 0.07 to 0.37]) and improved Western Ontario and McMaster University Osteoarthritis Index scores (mean difference 1.44 [95% CI 0.71 to 2.17]). Tests of subgroup differences revealed few differences in treatment estimates by study design, although observational studies had greater statistical power and thus demonstrated statistically significant findings more often. The certainty of the evidence for most outcomes was low to very low. CONCLUSIONS:Fixed-bearing implants may provide a significantly lower risk of revision and dislocation and improved function compared to mobile-bearing implants for unicompartmental knee arthroplasty patients. The lack of randomized trials limits the certainty of the evidence and remains a priority to confirm observational study findings.

Recurrent patellar instability is a common orthopaedic condition, particularly in young and active patients. Medial patellofemoral ligament (MPFL) reconstruction has emerged as the gold standard for surgical management in cases of objective instability. In this technical note, a quasianatomic MPFL reconstruction is described using an autologous gracilis tendon with preservation of its distal insertion. The graft is passed behind the adductor magnus to replicate the native femoral MPFL path, avoiding femoral tunnel drilling. It is passed in a subretinacular plane and fixed to the patella through convergent bone tunnels using high-strength sutures (FiberWire; Arthrex, Naples, FL). This minimally invasive, implant-free technique preserves graft vascularity, reduces surgical morbidity, and offers a biologically favorable alternative to traditional MPFL reconstruction, particularly in skeletally immature patients.

Background Persistent pain after total knee arthroplasty (TKA) remains a challenging clinical problem with multifactorial etiology. Immunogenetic susceptibility has been proposed as a potential contributor to implant-related adverse reactions. Recent prospective biological evidence has reported associations between silicone implants and autoimmune markers, particularly involving major histocompatibility complex (MHC) genes such as human leukocyte antigen (HLA). These observations suggest that immunogenetic susceptibility could represent a contributing factor in patients with persistent pain of unknown origin after total knee arthroplasty (TKA). Purpose This study aimed to explore the prevalence of selected HLA alleles in patients with painful TKA of unclear origin, specifically HLA-DRB1*03 and HLA-B*08. Study Design and Level of evidence: Observational pilot study; Level IV evidence. Methods This observational pilot study included 50 patients with persistent unexplained pain following primary TKA, who fulfilled the predefined inclusion criteria of the study. All patients underwent standardized clinical evaluation to exclude common mechanical and infectious causes of postoperative pain. Demographic and clinical characteristics were recorded. HLA typing for HLA-B*08 and HLA-DRB1*03 was performed using DNA extracted from buccal swabs. Results The mean age of the cohort was 74.7 (SD 8.1). The mean body mass index was 31.3 kg/m² (SD 4.4). HLA-DRB1*03 was detected in 13 patients (26%), HLA-B*08 in 6 patients (12%), and combined positivity in 4 patients (8%). Overall, 15 patients (30%) tested positive for at least one of the analyzed HLA alleles. Conclusion In this pilot cohort of patients with persistent unexplained pain after TKA, HLA-B*08 and HLA-DRB1*03 were identified in a subset of patients. These descriptive findings provide preliminary data for the design of future controlled studies investigating potential immunogenetic contributions to persistent postoperative pain. Level of evidence Level IV, observational pilot study.

AbstractPurposeTibial valgus osteotomy has shown to be a successful and cost‐effective procedure. The advent of image processing and three‐dimensional (3D) printing is an interesting tool for achieving more accurate and reproducible results. The aim of our study was to compare the accuracy of the conventional technique and the use of customized guides in the correction of tibial deformities in tibial varus patients, the surgical and clinical benefits, and the impact of treatment in the outpatient setting.MethodsA prospective cohort of 30 patients who underwent tibial valgus osteotomy were selected and randomized into two groups (3D‐printed guidewires and conventional techniques). All patients underwent a complete radiological study to plan the surgical procedure. During the surgical procedure, the surgical time and X‐ray exposure were analysed. The following results were evaluated: surgical time and X‐ray exposure, the correlation between the planned correction and the correction obtained at 3 post‐operative months, pre‐ and post‐operative knee injury and osteoarthritis outcome score (KOOS) value at 3 and 12 months, and differences between the two groups in terms of the correction obtained.ResultsRadiation exposure in the ‘3D‐guide’ group was significantly different (8 [±4.51], p < 0.05), whereas surgical time was not significantly different between the control and guide 3D groups (60.69 [±8.89] and 53.43 [±11.69], respectively). At the 3‐month follow‐up, the post‐operative hip–knee–ankle and post‐operative mechanical–proximal–tibial angle were not significantly different (p > 0.05). At 3‐ and 12‐month post‐surgery, the Knee Injury and Osteoarthritis Outcome Score (KOOS) did not significantly differ between the conventional technique and the 3D‐guide technique (p > 0.05). The KOOS at 3 months were 87.86 (±5.64) for the control group and 88.46 (±3.53) for the 3D‐guide group, while at 12 months they were 91.5 (±5.72) for the control group and 88.57 (±8.81) for the 3D‐guide group.ConclusionCustomized 3D‐printed guides do not permit better correction or functional results than the conventional technique; rather, they reduce surgical time and intraoperative radiation exposure.Level of EvidenceII.

Purpose Current surgical methods for multi-ligament knee reconstruction involve the creation of several reconstruction tunnels in the distal femur. However, the limited bone mass in the knee increases the risk of tunnel convergence. Increasing the accuracy of tunnel direction can minimize tunnel collision during anatomical reconstruction. 3D-printed patient-specific instrumentation (PSI) has gained prominence in orthopaedic surgery due to its precision. This study aims to compare the accuracy of PSI with that of the 'freehand' approach by an experienced surgeon for drilling the medial and lateral femoral tunnels while adhering to the recommended angulations for multi-ligament knee injuries. Methods Ten cadaveric knees underwent computerized tomography (CT) scans to identify anatomical femoral attachments of the lateral collateral ligament (LCL), popliteal tendon (PT), medial collateral ligament (MCL) and posterior oblique ligament (POL). Using Materialise Mimics Medical v25.0 software, virtual planning of a bone tunnel for each ligament was performed, and a total of four tunnels per knee were obtained. Ten PSIs were designed for five knees: five for the medial side and five for the lateral side. The first five knees were operated on via PSI, and the other five knees were operated on by an experienced surgeon using freehand drilling based on preoperative plans. The angular deviation and entry point were assessed by overlaying post-operative CT images onto preoperative CT images. Results In the freehand group, the median angular deviation was 22.3 degrees, with an interquartile range (IQR) of 17.6-25.2 degrees. The PSI group presented a significantly greater accuracy in angular deviation for femoral tunnels of 5.7 degrees, with an IQR of 4-8.2 degrees (p < 0.001). Compared with that in the preoperative planning group, the median entry point distance in the freehand group was 5.5 mm, with an IQR of 2.6-8.8 mm. The PSI group had a median entry point distance of 4.2 mm, with an IQR of 3.6-5.7 mm (p = n.s). Conclusions Compared with the freehand technique performed by an experienced surgeon, PSI demonstrated significantly greater accuracy in terms of the mean angular deviation.

Purpose: The purpose of this study was to analyse the impact on peri-prosthetic joint infection (PJI) rate and prosthetic survival using antibiotic-loaded bone cement (ALBC) versus plain cement during total knee arthroplasty (TKA). Methods: A retrospective cohort study was conducted. The main data source was the Catalan Arthroplasty Register (RACat). TKAs with surgery date between 1 January 2011 and 31 December 2020 were analysed and followed up until 31 December 2023. The main variable of interest was the type of cement (ALBC vs. plain cement), and several endpoints (septic revision, aseptic revision, and all-cause revision) were considered. The analysed outcomes were revision rates, survival rates and risk factors' hazard ratios (HR). Results: A total of 22,781 TKAs were analysed, 13,125 (57.6%) of them with plain cement and 9656 (42.4%) with ALBC. The septic revision rate was lower in the ALBC group after 3 months of follow-up (0.52% vs. 0.78%, p value = 0.04). Prosthetic survival with respect to the aseptic revision endpoint was also higher for the ALBC group during the whole follow-up period (similar to 158 months). Regarding risk factors for infection, ALBC showed a protective effect, HR: 0.53 (0.44, 0.63), while sex (being male) and the analysed comorbidities increased the risk. Conclusions: ALBC is associated with a reduction in both the septic revision and the aseptic revision rate after TKA, and thus with higher prosthetic survival. Level of EvidenceLevel III, Therapeutic, retrospective.

Purpose The number of cyclists and cycling crashes have increased in the last years around the world. Road Cycling and Mountain Bike are probably the most frequent practiced styles. The main purpose of our study was to analyze the severity of the injuries related to these two disciplines. Furthermore, we evaluated the frequency and the risk factors associated to these two sports within the broad category of cycling. Methods We performed a prospective study including 149 injured Road or Mountain Bike cyclists that we received to our Emergency Trauma Department between the period of November 2020 and October 2021. We analyzed the severity of the lesions by using the Injury Severity Score (ISS). Other associated variables like mechanism of the injury, use of helmet, alcohol or drugs consumption and the experience of the cyclist were also evaluated. Results We observed significant higher values on the ISS score and less frequency of the injuries in the Road Cycling group compared to the Mountain Bike one (67,1% vs 32,9% respectively). We also found a relation between the age of the cyclist and the severity of the injury. Older patients suffered more serious lesions. Conclusion Road Cycling crashes were less frequent than Mountain Bike ones but provided more risk of serious injuries. Older cyclist had more risk to suffer severe lesions.

Purpose Multiple-ligament knee reconstruction techniques often involve the creation of several bone tunnels for various reconstruction grafts. A critical step in this procedure is to avoid short tunnels or convergences among them. Currently, no specific template guide to reproduce these angulations has been reported in the literature, and the success of the technique still depends on the experience of the surgeon. The aim of this study is to analyze the accuracy and reliability of 3D-printed patient-specific instrumentation (PSI) for lateral and medial anatomical knee reconstructions. Methods Ten cadaveric knees were scanned by computed tomography (CT). Using specific computer software, anatomical femoral attachments were identified: (1) on the lateral side the lateral collateral ligament (LCL) and the popliteal tendon (PT) and (2) on the medial side the medial collateral ligament (MCL) and the posterior oblique ligament (POL). Four bone tunnels were planned for each knee, and PSI with different directions were designed as templates to reproduce the planned tunnels during surgery. Twenty 3D-printed PSI were used: ten were tailored to the medial side for reconstructing MCL and POL tunnels, and the other ten were tailored to the lateral side for reconstructing LCL and PT tunnels. Postoperative CT scans were made for each cadaveric knee. The accuracy of the use of 3D-printed PSI was assessed by superimposing post-operative CT images onto pre-operative images and analyzing the deviation of tunnels performed based on the planning, specifically the entry point and the angular deviations. Results The median entry point deviations for the tunnels were as follows: LCL tunnel, 1.88 mm (interquartile range (IQR) 2.2 mm); PT tunnel, 2.93 mm ( IQR 1.17 mm); MCL tunnel, 1.93 mm ( IQR 4.26 mm); and POL tunnel, 2.16 mm ( IQR 2.39). The median angular deviations for the tunnels were as follows: LCL tunnel, 2.42° ( IQR 6.49°); PT tunnel, 4.15° ( IQR 6.68); MCL tunnel, 4.50° ( IQR 6.34°); and POL tunnel, 4.69° ( IQR 3.1°). No statistically significant differences were found in either the entry point or the angular deviation among the different bone tunnels. Conclusion The use of 3D-printed PSI for lateral and medial anatomical knee reconstructions provides accurate and reproducible results and may be a promising tool for use in clinical practice.

Background This study aimed to assess whether use of continuous passive motion (CPM) could improve range of motion in patients after total knee arthroplasty (TKA), if it could affect the surgical wound aspect (SWA) and if it could influence on pain management after TKA. Methods We randomized 210 patients in two groups, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain were measured before surgery, on the 1st, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the “surgical wound aspect score” (SWAS) in the next 48 h after surgery. This scale analyzes swelling, erythema, hematoma, blood drainage and blisters. Results There was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for hematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain. Conclusions The application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in hematoma appearance.

The objective of this study was to evaluate the effects on the posterior tibial slope of different distances from the joint line to start the osteotomy and of varying the placement of the opening wedge in high tibial osteotomy. Starting the osteotomy more distally and an incorrect location for the tibial opening wedge were hypothesized to increase the posterior tibial slope. A cadaveric study was conducted using 12 knees divided into two groups based on the distance from the joint line to the start of the osteotomy: 3 and 4 cm. The preintervention posterior tibial slope was measured radiologically. Once the osteotomy was performed, the medial cortex of the tibia was divided into anteromedial, medial, and posteromedial thirds. A 10° opening wedge was sequentially placed in each third, and the effect on the posterior tibial slope was evaluated radiographically. Results: Significant changes were observed only in the 3-cm group (p = 0.02) when the wedge was placed in the anteromedial zone. In contrast, in the 4-cm group, significant differences were observed when the opening wedge was placed at both the medial (p = 0.04) and anteromedial (p = 0.012) zones. Correct control of the posterior tibial slope can be achieved by avoiding a low point when beginning the osteotomy and placing the opening wedge in the posteromedial third of the tibia when performing an opening-wedge high tibial osteotomy. Controlled laboratory study.

INTRODUCTION:Persistent pain after total knee replacement is an underestimated outcome leading to significant health burden. Sensory testing has been explored to help surgeons in decision making and better patient selection. Patients with different chronic pain syndromes exhibit a poor descending pain inhibition that can be quantified through experimental paradigms (conditioned pain modulation). A poor preoperative descending pain inhibition response predicted persistence of pain after surgery in previous studies. METHODS:This study investigated the correlation between a preoperative inefficient endogenous analgesia and a bad postoperative pain outcome (painful prosthesis). One hundred forty-six patients were studied preoperatively by quantitative sensory testing. Conditioned pain modulation was calculated as the relative decrease in pain intensity (thermal stimulus) during heterotopic painful stimulation. RESULTS:Approximately 21.2% of patients had a bad pain outcome (painful prosthesis), 6 months after surgery. Preoperatively, 47.9% of patients exhibited an insufficient endogenous analgesia. The probability to develop persistent pain after surgery in that group was higher than that in patients with a sufficient endogenous analgesia (31.4% [20.9-43.6, 95% CI] vs 11.8% [5.5-21.3, 95% CI], respectively; P < 0.004). Correlation between conditioned pain modulation values and postoperative intensity of pain was also established. Besides, a preoperative lower quality of life (mental component) predicted a worse pain outcome, too. CONCLUSIONS:This cohort study shows that preoperative sensory testing predicts a bad pain outcome after total knee replacement. This tool could help clinicians in a better indication of patients with advanced knee osteoarthritis for replacement surgery. REGISTRATION DETAILS:ClinicalTrials.gov: NCT01811888 (prospective).

High tibial osteotomy is an established and helpful treatment for unicompatimental osteoarthritis associated with varus deformity. However, asupratubercle high tibial osteotomy leads to a decrease in patellar height making the technique not suitable in case of concomitant patella baja. Moreover, this kind of osteotomy can change in situ forces at patellofemoral joint and the lateral patellar tilt. With the aim to widen the indication of high tibial osteotomy was proposed a biplane opening wedge high tibial osteotomy with a distal tuberosity osteotomy (B-OWHTO). This technique provide that the tibial tuberosity remains joined to the tibial metaphysis so as not to theoretically alter the patellar height. However, some Authors claim that BOWHTO could lead to an increase in tibial slope. The purpose of the present study was to assess the tibial slope, patella-femoral changes and axial correction as well as functional outcomes following a B-OWHTO. Patients operated on with a B-OWHTO and a minimum 24 months of follow-up were included. The mechanical alignment of the lower limb, patellar height, lateral patellar tilt and posterior tibial slope were calculated preoperatively, immediately after surgery and at the 24-month follow-up. The clinical results were evaluated using the Lysholm, Kujala and Hospital for Special Surgery knee scores. The possible postoperative development of patellofemoral pain or radiologic patellofemoral alteration was also evaluated. Twenty-three patients were included with a mean follow-up of 33 months (range 27-41). The mechanical alignment of the lower limb shifted from a mean 9.3º ± 2.5 varus preoperatively to a mean 0.2º ± 2.2 valgus postoperatively. No changes in patellar height, lateral patellar tilt or in the posterior tibial slope were observed. The mean Lysholm and HSS scores improved from 68.3 ± 9.1 and 64.2 ± 5.2 preoperatively to 93.2 ± 2.1 and 94.1 ± 3.6 at final follow-up (p < 0.01). The mean Kujala score improved from 67.3 ± 9.8 to 86.4 ± 7.6 at final follow up (p < 0.01). No patients developed both radiological or clinical symptoms at patellofemoral joint. Open wedge high tibial osteotomy with a dihedral L-cut distal and posterior to the tibial tubercle accurately corrected axial malalignment without any change at patella-femoral joint or any modification to the posterior tibial slope while providing improved knee function at short-term follow-up. The radiographic as well as the clinical results support the use of this technique to treat medial compartment knee osteoarthritis and varus malalignment in young and middle-aged patients with a normal-to-low patellar height. Case series with no comparison group, Level IV.

ObjectiveThe aim of this study was to evaluate whether the establishment of a preoperative screening and decolonization protocol for Staphylococcus aureus carriers undergoing total knee arthroplasty (TKA) could decrease the incidence of periprosthetic joint infection (PJI) caused by this microorganism.MethodsWe conducted a retrospective study comparing a control group comprising 400 patients (134 men, and 266 women; mean age: 72.2 ± 6.8 years) who went through surgery between January 2009 and December 2013, with a second intervention group of 403 patients (125 men, and 278 women; mean age: 72.4 ± 6.9 years) in which the protocol of screening and decolonization of S. aureus nasal carriers was applied between January 2014 and December 2016. During this latter period patients were preoperatively screened and, if positive, treated with mupirocin nasal ointment and chlorhexidine soap, for 5 days prior to surgery.ResultsIn the control group, 17 of 400 patients (4.2%) had a SSI, 8 (2%) of them caused by S. aureus and 9 (2.2%) by other microorganisms. In the intervention group 20.6% of patients had a positive S. aureus nasal swab and were treated according to the protocol. 5 of 403 patients (1.2%) in this group had a SSI, 1 (0.2%) due to S. aureus and 4 (1%) to other microorganisms. When comparing surgical-site infection (SSI) rates between the two groups, we found a statistically significant reduction in both global SSI (p = 0.009) and specifically S. aureus SSI (p = 0.02), in the intervention group. No decolonized S. aureus nasal carrier presented a SSI.DiscussionIn patients undergoing TKA a preoperative screening and decolonization protocol for S. aureus nasal carriers, using mupirocin nasal ointment and chlorhexidine soap, is an effective measure to reduce the rate of SSI caused by this microorganism.Level of EvidenceLevel III; Therapeutic Study.

Background: The optimal treatment of partial anterior cruciate ligament (ACL) tears continues to be debatable. Short-term results of selective bundle reconstruction have already been widely shown. The purpose of this study was to assess functional outcomes, subjective satisfaction and the failure rate of selective bundle reconstructions for partial ACL tears over a five to nine year follow-up period. Methods: Patients who underwent ACL selective bundle reconstruction between October 2008 and October 2012 were studied. Functional assessment was performed with the objective International Knee Documentation Committee (IKDC) ligament evaluation form, the Lysholm knee scale and the Tegner activity level scale. Cumulative failure and level of satisfaction have also been investigated. Results: Seventy-six patients were included. The average follow-up period was 85 months (range 65-110). Thirty-four had AMB tear and 42 had PLB tears. An overall statistically significant improvement (p < 0.001) was obtained in terms of the subjective IKDC and the Lysholm questionnaire between preoperative and last follow-up. The same or no more than one level lower Tegner score was restored in 97.3% of the cases. Cumulative failure was observed in two patients (2.6%). Dissatisfied patient percentage was 15% (4/76). Conclusions: Selective bundle reconstruction in partial ACL tears leads to excellent long-term functional outcomes, a low percentage of failures and a high degree of subjective satisfaction in patients. (C) 2019 Elsevier B.V. All rights reserved.

Purpose: The purpose of this study was to analyze postoperative computed tomography (CT) scan evaluations of patients who had undergone a combined anterior cruciate ligament (ACL) reconstruction and modified Lemaire anterolateral tenodesis (ALT) with femoral fixation through a bony tunnel. Methods: Postoperative CT scans of 52 patients who had undergone combined ACL and ALT were prospectively evaluated. ACL femoral tunnels were drilled through an anteromedial portal in the center of the native footprint. An ALT fixation tunnel was drilled 5 mm proximal to the lateral epicondyle, aiming at an inclination of 30 degrees proximally and 30 degrees anteriorly. Two independent observers evaluated the CT scans measuring any degree of collision, the shortest distance between the tunnels, and the inclination of the ALT tunnels. Measurements were carried out at both the cortical level and on a plane passing 1 cm deeper in the lateral condyle. Results: At the level of the cortex, no convergence of the tunnels was identified. In 14 of 52 cases (26.9%), the shortest distance between the tunnels was less than 5 mm. Tunnel collision occurred in 8 of 52 cases (15.4%), and the bone bridge between the tunnels was less than 5 mm in 11 cases (21.1%) when the measurements were made on the deeper plane. When the inclination on the axial plane was less than 15 degrees, a collision always (P < .001) occurs. When it was more than 20 degrees, no collision occurred (P < .001). No correlation between convergence and the inclination of the ALT tunnel on the coronal plane was detected. Conclusions: To fix a modified Lemaire ALT through a femoral tunnel avoiding any interference with an anatomic femoral ACL tunnel, we recommend that the femoral tunnel be drilled with an inclination of at least 20 degrees anteriorly.

PURPOSE:To compare the radiographic results (in terms of graft extrusion) and the functional results of lateral meniscus allograft transplantations (MAT) performed with a bony fixation technique or with a soft tissue fixation technique after capsulodesis. METHODS:A prospective series of 29 consecutive lateral MAT was analyzed. The inclusion criterion for MAT was lateral joint line pain due to a previous meniscectomy. Malalignment, patients who had an Ahlback grade greater than II, and patients with a body mass index over 30 were considered as the exclusion criterion to prevent confounding results. Fifteen of the grafts were fixed with a bony fixation technique (group A). The remaining 14 cases (group B) were fixed with sutures through bone tunnels after lateral capsular fixation (capsulodesis). All patients were studied with magnetic resonance imaging to determine the degree of meniscal extrusion at an average of 18 months of surgery (range, 12-48 months). Meniscal extrusion was measured on coronal magnetic resonance imaging. To standardize the results, the percentage of meniscus extruded for each group was also calculated and compared. The functional results were analyzed by means of standard knee scores (Lysholm, Tegner, and visual analog scale). RESULTS:If we consider the first 4 cases of group B as the learning curve of the new technique, we observe that group A had 8 cases (53.3%) of major extrusion, whereas group B had 1 case (7.1%) (P = .02). When comparing the degree of meniscal extrusion with the type of fixation employed, an even lower percentage of extruded menisci was found in group B (P = .01). The final follow-up Lysholm score in group A was 94.33 ± 5.96 (P < .001) and 91.43 ± 6.19 (P < .001) in group B. The median follow-up Tegner score significantly improved from 4 (range, 2-5) to 7 (range, 6-9) in group A (P < .001) and from 4 (range, 3-5) to 7 (range, 6-8) in group B (P < .001). The average visual analog scale score dropped down 5.87 and 7.29 points in groups A and B, respectively (P < .001). The Knee Injury and Osteoarthritis Outcome Score improved from 51.98 ± 2.84 to 90.88 ± 7.53 in group A (P < .001) and from 50.44 ± 2.32 to 92.01 ± 6.71 in group B (P < .001). Patient satisfaction with regard to the procedure stood at a mean of 3.6 ± 0.2 points out of a maximum of 4 in group A and 3.8 ± 0.4 in group B. There were no complications in this series. CONCLUSIONS:The capsulodesis technique in lateral MAT proved not to be statistically different at decreasing the degree of meniscal extrusion with respect to the bone-bridge fixation. If the first 4 cases using the new capsulodesis technique had not included in the results, the capsulodesis technique would have effectively presented better results relative to the degree of meniscal extrusion compared with the bone-bridge fixation technique. In addition, the functional results were similar. LEVEL OF EVIDENCE:Level II, prospective comparative study.

Why anterior cruciate ligament (ACL) autograft soaking in a 5 mg/ml vancomycin solution decreases the rate of infection has not been well-explained. One hypothesis is that grafts can be contaminated during harvesting and vancomycin eradicates the bacteria. The purpose of the present study is to assess how the vancomycin solution acts against ACL graft contamination during graft harvesting and preparation.

Purpose: To report the magnetic resonance imaging (MRI) and clinical outcomes at a minimum 5-year follow-up in a series of patients with postmeniscectomy syndrome and treated with a polyurethane scaffold. Methods: All consecutive patients operated on from September 2008 to February 2011 for either persistent medial or lateral joint line compartmental pain receiving a polyurethane scaffold due to a previous partial meniscus resection with a minimum 5-year followup were included. Functional scores (Knee Injury and Osteoarthritis Outcomes Score, International Knee Documentation Committee, Lysholm, and Tegner) were assessed preoperatively and at the last follow-up. The state of the scaffold as well as postoperative scaffold extrusion and the total remaining meniscal volume was also evaluated in MRI. Results: Thirty-two patients were included. The mean follow-up was 70.8 +/- 7.5 months. The functionality of the knees improved in all the scores used (P < .001) except for the Tegner score that stayed steady. Most of meniscal implants showed extrusion of 2.4 mm (95% confidence interval [ CI], 1.1-3.7) were smaller and a hyperintensity signal was seen in the MRI. Three scaffolds were resorbed at the last follow-up. The meniscal volume, determined by MRI, was 1.14 cm(3) (95% CI, 0.96-1.31) preoperatively and 1.61 cm(3) (95% CI, 1.43-1.7) at the last follow-up. No differences were presented. Conclusions: The use of a polyurethane meniscal scaffold in patients with a symptomatic meniscus deficit had a good functional outcome at 5 years after surgery. However, the implanted scaffolds did not present normal meniscal tissue with MRI, and the implant volume was considerably less than expected. The fact that most of patients included received different concomitant procedures during scaffold implantation introduces a degree of performance bias into the results.

High tibial osteotomy (HTO) is a useful alternative in the treatment of symptomatic varus malalignment. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. On the other hand, patella baja often causes anterior knee pain and, over time, may favor degeneration of the patellofemoral joint. The aim of this study is to describe a technical modification of the standard open-wedge HTO. It consists of a double inverted L-shaped cut, which includes the anterior tibial tuberosity in the proximal fragment, to avoid any alteration of patellar height and control the eventual increase of the posterior tibial slope.

Patellar instability has been shown to be associated with different major factors. However, studies have demonstrated that soft tissue reconstructions are adequate enough to reestablish patellar constraint. In recent years, the medial patellofemoral ligament has been recognized as the primary passive restraint for lateral translation of the patella. Their reconstruction has gain popularity as the procedure is quite simple and fast. Although several surgical techniques have been described for their reconstruction, no clear consensus has been reached as to which is best. We present an implant-free, medial patellofemoral ligament reconstruction technique that uses a gracilis tendon autograft, 2 bone convergent tunnels at the original patellar attachment, and looping the graft around the adductor magnus tendon that is used as a pulley for femoral fixation.