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Orthop J Sports Med 2021 Mar 22;9(3):2325967121989252. Epub 2021 Mar 22.

Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: After posterior cruciate ligament injury, stress radiography is a common method of quantifying posterior instability, defined as the side-to-side difference in posterior tibial displacement (PTD) between the injured knee and contralateral noninjured knee. However, no study has evaluated the reliability of PTD according to knee flexion angle (KFA) measurements on stress radiographs.

Purpose: To evaluate the test-retest reliability of stress radiographic measurements of the KFA in the noninjured knee. Read More

Zhonghua Wai Ke Za Zhi 2021 Jun;59(6):464-469

Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.

To investigate the types of meniscal tears and cruciate ligamentous injuries in patients with tibial plateau fracture(TPF) following arthroscopic examination. The clinical data of 216 patients with TPF who underwent closed reduction and internal fixation (CRIF) from January 2016 to January 2019 at Trauma Emergency center, the Third Hospital of Hebei Medical University were analyzed retrospectively. There were 147 males (147 knees) and 69 females (69 knees),aged 46. Read More

JBJS Case Connect 2021 06 8;11(2). Epub 2021 Jun 8.

San Antonio Military Medical Center, Fort Sam Houston, Texas.

Case: There has been a reemergence of anterior cruciate ligament (ACL) repair. We present the unique case of an ACL repair in a service member with a chronic tear. The patient went on to have a successful outcome with return to full activities without symptoms and functional outcomes scores equal to preinjury levels. Read More

Oper Orthop Traumatol 2021 Jun 3. Epub 2021 Jun 3.

Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.

Objective: Description of a reproducible surgical technique for single-bundle anterolateral reconstruction of the posterior cruciate ligament (PCL) based on a septum-sparing approach. This technique is less traumatic than the trans-septum approach. The article illustrates surgical steps to simplify the technical aspects of the procedure. Read More

Knee Surg Sports Traumatol Arthrosc 2021 May 31. Epub 2021 May 31.

Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.

Purpose: The purpose of this study was to evaluate the clinical outcomes of patients who were treated with an arthroscopic popliteus bypass (PB) technique, in cases of a posterolateral rotational instability (PLRI) and a concomitant posterior cruciate ligament (PCL) injury of the knee.

Methods: This was a retrospective case series in which 23 patients were clinically evaluated after a minimum of 2 years following arthroscopic PB and combined PCL reconstruction. Lysholm, Tegner and Knee Injury and Osteoarthritis Outcome scores as well as visual analog scales (VAS) for joint function and pain were evaluated. Read More

J Arthroplasty 2021 May 5. Epub 2021 May 5.

Orthopaedic Foundation, Stamford, CT.

Background: Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA.

Methods: Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included. Read More

Arthroscopy 2021 May 27. Epub 2021 May 27.

OrthoCarolina - Sports Medicine Center, 1915 Randolph Road, Charlotte, NC 28207; Atrium Health - Musculoskeletal Institute, 1320 Scott Ave, Charlotte, NC, 28203. Electronic address:

Purpose: To determine the rate of intraoperative and early postoperative (90-day) complications of multiligamentous knee reconstruction surgeries, both medical and surgical, and associated variables from the 15-year experience of a single academic institution.

Methods: Patients treated at a single academic institution between 2005-2019 who underwent multiligament knee surgery were identified. Inclusion criteria included intervention with 2+ ligament reconstructions performed concurrently, and more than 90 days postoperative follow-up. Read More

Sports Health 2021 May 26:19417381211014487. Epub 2021 May 26.

IRCCS Istituto Ortopedico Rizzoli, II Clinica Ortopedica e Traumatologica, Bologna, Italy.

Background: In adolescents, the rate of meniscal injury at the time of anterior cruciate ligament (ACL) reconstruction, the rate of ACL graft revision, and clinical outcomes has not yet been investigated.

Hypothesis: In patients younger than 16 years, the rate of meniscal injuries at the time of ACL reconstruction increases with time from injury. The mid-term revision rate and reoperation rate after ACL reconstruction with hamstrings and lateral tenodesis are lower than those reported in literature for isolate ACL reconstruction. Read More

Knee 2021 May 21;30:322-336. Epub 2021 May 21.

Alfred Health, Melbourne, Victoria, Australia.

Purpose: To evaluate the efficacy and safety of the Ligament Augmentation and Reconstruction System (LARS) in posterior cruciate ligament (PCL) reconstruction in isolated PCL injuries and multiligament knee injuries, analysing clinical, radiographic, and patient reported outcome measures (PROMs).

Methods: A systematic review according to PRISMA guidelines was performed through Embase via Ovid, PubMed, and the Cochrane Library to identify studies reviewing LARS use for PCL reconstruction. The methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Read More

Arthrosc Sports Med Rehabil 2021 Apr 3;3(2):e505-e513. Epub 2021 Feb 3.

Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A.

Purpose: To quantify the amount of strain across an anterior cruciate ligament reconstruction (ACLR) before and after a lateral meniscus (LM) posterior root complex tear and determine whether a meniscal root repair effectively protects the ACLR against excessive strain.

Methods: Fresh-frozen cadaveric knees were tested with an 88-N anterior drawer force and an internal and external torque of 5-Nm applied at 0°, 15°, 30°, 60°, and 90° of flexion. A simulated pivot shift was also applied at 0, 15, and 30° of flexion. Read More

Arthrosc Sports Med Rehabil 2021 Apr 31;3(2):e367-e372. Epub 2021 Jan 31.

Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.

Purpose: To evaluate the incidence of complete lateral meniscal posterior root tears (LMPRTs) repaired at revision as compared with primary anterior cruciate ligament (ACL) reconstruction (PACLR) and to determine whether other demographic or surgical characteristics were associated with LMPRTs needing repair.

Methods: A chart review was performed to identify the PACLR and revision ACL reconstruction (RACLR) cohorts. Demographic and surgical characteristics were recorded. Read More

Cartilage 2021 May 24:19476035211014588. Epub 2021 May 24.

Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan.

Objective: The process of anterior cruciate ligament (ACL) injury-induced meniscal tear formation is not fully understood. Clinical studies have shown that ACL reconstruction (ACLR) reduces the development of secondary meniscal tears, but it is difficult to gain insight into the protective effects of ACLR from clinical studies alone. Using rat ACL transection (ACLT) and ACLR models, we aimed to reveal (1) the formation process of meniscal tears secondary to ACLT and (2) the protective effects of ACLR on secondary meniscal tears. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 May;35(5):556-561

Department of Knee Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.

Objective: To investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries.

Methods: A clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Read More

Arthroscopy 2021 May 13. Epub 2021 May 13.

North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia; University of Notre Dame, School of Medicine, Sydney, Australia. Electronic address:

Purpose: The purpose of this study was to compare long-term patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction with untreated stable lateral meniscal posterior root (LMPR) tears to those with an intact meniscus.

Methods: Four hundred ninety-two subjects were followed for a minimum of 15-years post-ACL reconstruction and evaluated by an International Knee Documentation Committee questionnaire. The integrity of the meniscus was classified at surgery. Read More

Arthrosc Tech 2021 Apr 12;10(4):e1073-e1077. Epub 2021 Mar 12.

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Ramp injury, that is, injury to the peripheral attachment of the posterior horn of the medial meniscus, often requires additional surgery during anterior cruciate ligament (ACL) reconstruction. Diagnosis and treatment of ramp lesions are important because unrepaired ramp lesions could cause risk to the reconstructed ACL because of anteroposterior and external rotation laxity, whereas acute rupture or chronic deficiency of the ACL could also cause ramp lesions because of instability. Ramp lesions are difficult to diagnose and treat from the anterior compartment during arthroscopy. Read More

Knee Surg Sports Traumatol Arthrosc 2021 May 11. Epub 2021 May 11.

Sports Medicine Service, Beijing Jishuitan Hospital, No. 31, Xin Jie Kou East Street, Xi Cheng District, Beijing, China.

Purpose: This study aimed to compare the difference in posterior tibial slope (PTS) measurements based on the full-length and half-length tibial anatomic axes of the same group of patients. It was hypothesized that the obtained PTS values would be affected by the length of tibia chosen during the measurements.

Methods: Full-length true lateral tibia radiographs were obtained for each patient who underwent anterior cruciate ligament reconstruction (ACLR) in our department. Read More

JBJS Case Connect 2021 05 11;11(2). Epub 2021 May 11.

Rothman Orthopaedic Institute - Florida, Orlando, Florida.

Case: A 16-year-old football player presented with chronic ACL deficiency along with bicompartmental bucket handle meniscal tears.

Conclusion: We present a "triple cruciate" sign in addition to the triple posterior cruciate ligament (PCL) sign seen on Magnetic Resonance Imaging (MRI) to aid in diagnosing this injury. Read More

Orthop Surg 2021 May 6. Epub 2021 May 6.

Department of Sports Medicine, Beijing LUHE Hospital Capital Medical University, Beijing, China.

Objective: To investigate the manifestation, mechanisms, and treatment of isolated partial femoral avulsion fractures of the posterior cruciate ligament (PCL) in adults.

Methods: From January 2011 to December 2018, we retrospectively reviewed the clinical data of three patients with isolated partial femoral avulsion fractures of the PCL who were admitted to our institution. All of these patients were admitted to our emergency department within 24 h after injury. Read More

J Orthop Case Rep 2020 May-Jun;10(3):36-42

The Orthopaedic Speciality Clinic, Pune, Maharashtra, India.

Introduction: Injuries to the knee ligaments, menisci, and cartilage are possible in high-velocity trauma as in road traffic accidents. Similarly, these structures can be disrupted in proximal tibia fractures. We present a series of three cases which had a previously undescribed injury combination. Read More

Orthop J Sports Med 2021 Apr 16;9(4):2325967121998310. Epub 2021 Apr 16.

Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Québec, Canada.

Background: The mechanism for traumatic ruptures of the native anterior cruciate ligament (ACL) is frequently a noncontact injury involving a valgus moment with internal rotation of the tibia. The abnormal rotation and translation of the lateral femoral condyle posteroinferiorly relative to the lateral tibial plateau is thought to be related to the geometry of the tibial plateau.

Purpose/hypothesis: The purpose of the study was to mathematically model the posterior tibial plateau geometry in patients with ACL injuries and compare it with that of matched controls. Read More

Injury 2021 Apr 20. Epub 2021 Apr 20.

Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, China. Electronic address:

Objective: To compare the clinical effects of an inverted L-shaped postero-medial approach with a homemade hook plate and arthroscopic fixation with Endobutton for tibial avulsion fractures of the posterior cruciate ligament.

Methods: The clinical data of 36 patients with PCL tibial avulsion fractures from January 2012 to December 2019 were analyzed retrospectively. The fractures were classified into Meyers-McKeever types II and III. Read More

J Knee Surg 2021 Apr 30. Epub 2021 Apr 30.

Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, Illinois.

The purpose of this study was to define the diagnostic value of magnetic resonance imaging (MRI) and plain radiographs (X-ray [XR]) in identifying an osteochondral defect or loose body in patients undergoing operative treatment for patellar instability. A total of 87 patients treated operatively for patellar instability with medial patellofemoral ligament (MPFL) reconstruction between 2015 and 2019 were identified. Inclusion criteria were evidence of clinical patellar instability, preoperative XR and MRI studies, and concomitant diagnostic knee arthroscopy and MPFL reconstruction performed to address patellar instability. Read More

Indian J Orthop 2021 Apr 19;55(2):263-275. Epub 2021 Jan 19.

The Orthopaedic Speciality Clinic, 16 Status Chambers, 1221/A Wrangler Paranjpe Road, Pune, 411004 India.

Introduction: The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and so is the number of revision surgeries for a failed ACLR. The spectrum of ACL failure includes symptoms of recurrent instability, pain, and/or stiffness.

Discussion: Factors contributing to ACL failure may be classified as patient-related, surgeon-related, and biological factors. Read More

Arthroscopy 2021 05;37(5):1610-1611

Auckland, New Zealand.

The lateral tibial posterior slope (LTPS) and the lateral meniscal bone angle (MBA) are important geometrical features of the knee joint and have therefore been of interest in the setting of anterior cruciate ligament injury (ACL) and ACL reconstruction. An emerging body of evidence suggests that LTPS is an independent risk factor for primary and recurrent ACL injury. Furthermore, biomechanical and clinical evidence is emphasizing the crucial contribution of the lateral meniscus to rotatory knee stability. Read More

Arthroscopy 2021 05;37(5):1378-1380

Twin Cities Orthopedics, Edina-Crosstown. Edina, Minnesota, U.S.A.. Electronic address:

Patients with multiligament knee injuries require a thorough examination (Lachman, posterior-drawer, varus, valgus, and rotational testing). Diagnoses are confirmed with magnetic resonance imaging as well as stress radiographs (posterior, varus, and valgus) when indicated. Multiple systematic reviews have reported that early (<3 weeks after injury) single-stage surgery and early knee motion improves patient-reported outcomes. Read More

Arthroscopy 2021 Apr 20. Epub 2021 Apr 20.

Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.

Purpose: This study aimed to determine radiological findings associated with ramp lesions in knees with anterior cruciate ligament (ACL) injury.

Methods: This study included the primary ACL reconstructions from June 2011 to March 2019. The exclusion criteria were combined fractures and multiligament injuries. Read More

Orthop J Sports Med 2021 Apr 6;9(4):23259671211000038. Epub 2021 Apr 6.

Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada.

Background: A spectrum of anterolateral rotatory laxity exists in anterior cruciate ligament (ACL)-injured knees. Understanding of the factors contributing to a high-grade pivot shift continues to be refined.

Purpose: To investigate factors associated with a high-grade preoperative pivot shift and to evaluate the relationship between this condition and baseline patient-reported outcome measures (PROMs). Read More

Am J Sports Med 2021 Jun 21;49(7):1813-1821. Epub 2021 Apr 21.

Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Lyon, France.

Background: Ramp lesions are defined as a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments. Five subtypes have been described: type 1, meniscocapsular lesion; type 2, partial superior lesion; type 3, partial inferior lesion or hidden type; type 4, complete tear in the red zone; and type 5, complete double tear.

Purpose: (1) To determine the prevalence of different subtypes of ramp lesions in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). Read More

Am J Sports Med 2021 05 16;49(6):1470-1481. Epub 2021 Apr 16.

Department of Rehabilitation Sciences, Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium.

Background: Rates of reinjury, return to play (RTP) at the preinjury level, and hamstring strain injuries in male soccer players after anterior cruciate ligament reconstruction (ACLR) remain unsatisfactory, due to multifactorial causes. Recent insights on intramuscular hamstring coordination revealed the semitendinosus (ST) to be of crucial importance for hamstring functioning, especially during heavy eccentric hamstring loading. Scientific evidence on the consequences of ST tendon harvest for ACLR is scarce and inconsistent. Read More

J Exp Orthop 2021 Apr 15;8(1):28. Epub 2021 Apr 15.

University of Stirling, Stirling, UK.

Purpose: The posterior cruciate ligament (PCL) is an important stabilizer of the knee and can be damaged in up to 20% of ligamentous injuries. Numerous techniques for surgical treatment have been described in the literature with none shown to be clearly superior. The aim of this study was to assess the 2-year outcomes of PCL repair with suture tape augmentation. Read More