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Background: Lateral, All-Round and All-Inside (LARAI) portal is a viewing or working portal for observing and repairing the lesions of the lateral meniscus. However, there are safety concerns about popliteal artery (PA) injuries during the procedure. This study aimed to assess the safe distance between the trajectory of the LARAI portal and PA. Materials and methods: Both three-dimensional computed tomography (3D-CT) and cadavers were used to simulate the LARAI portal trajectory. In the 3D-CT study, between January 2020 and September 2020, 45 participants who underwent computed tomography angiography were included in the study. The shortest distance from the PA to the simulated trajectory needle (PS) was measured using 3D-CT. Mean −3SD −2 was calculated to assess the safety of the LARAI portal trajectory. If this value was more than zero, the trajectory was considered "safe." In the cadaveric study, lower limbs from seven fresh-frozen cadavers were used to establish the "safe" trajectories of the LARAI portal, and the PS was measured. Results: In the 3D-CT study, the longest PS (P < 0.001) was found 20 mm lateral to the edge of the patellar tendon trajectory at 0 mm from the posterior cruciate ligament (PCL). Safe trajectories were also found 10 mm, 15 mm, and 20 mm lateral to the edge of the patellar tendon at 0 mm from the PCL, as well as the 20 mm lateral to the edge of the patellar tendon at 3 mm from the PCL. The cadaveric study showed that the average PS of all safe trajectories closely adjoined to PCL was greater than 14 mm. Conclusions: The LARAI portal trajectory in the "figure of four" is safe, and the optimal insertion point is 10–20 mm lateral to the edge of the patellar tendon and closely adjoined to the posterolateral margin of the PCL at knee joint line level. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: Degeneration of the cartilage after anterior cruciate ligament reconstruction (ACL-R) is known, and further deterioration can be expected in patients with tunnel malplacement or partial meniscal resection. It was hypothesized that there is a significant increase in cartilage degeneration after failed ACL-R.Material and Methods: Isolated ACL revision surgery was performed in 154 patients at an interval of 46 ± 33 months (5-175 months) between primary and revision surgery. Cartilage status at the medial, lateral femorotibial, and patellofemoral compartments were assessed arthroscopically during primary and revision ACL-R in accordance with the Outerbridge classification. Tunnel placement, roof angle, and tibial slope was measured using anteroposterior and lateral radiographic views.Results: Cartilage degeneration increased significantly in the medial femorotibial compartment, followed by the lateral and patellofemoral compartments. There was a correlation between both cartilage degeneration in the patellofemoral compartment (PFC) (rs = 0.28, p = 0.0012) and medial tibial plateau (Rs = 0.24, p = 0.003) in relation to the position of tibial tunnel in the frontal plane. Worsening of the cartilage status in the medial femorotibial compartment, either femoral or tibial, was correlated with the tibial aperture site in the lateral view (Rs = 0.28, p < 0.001). Cartilage degeneration in the lateral compartment of the knee, on both femoral or tibial side, was inversely correlated with the femoral roof angle (Rs = -0.1985, p = 0.02). Meniscal tears, either at the medial or lateral site or at both, were found in 93 patients (60%) during primary ACL-R and increased to 132 patients (86%) during revision ACL-R.Discussion: Accelerated cartilage degeneration and high prevalence of meniscal lesions are seen in failed ACL-R. Tunnel placement showed significant impact on cartilage degeneration and may partially explain the increased risk of an inferior outcome when revision surgery is required after failed primary ACL-R.Level Of Evidence: Level IV-retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: To arthroscopically evaluate the incidence of lateral meniscal root avulsion (LMRA) and associated intra-articular injuries in patients undergoing anterior cruciate ligament (ACL) reconstruction.Materials and Methods: From April 2014 to March 2017, 532 consecutive patients were diagnosed as having an ACL injury and underwent arthroscopic ACL reconstruction. The diagnosis of LMRA was made arthroscopically. The effects of gender, activity, grade of laxity, time from injury, and concomitant meniscal lesions were analyzed.Results: Among 532 patients, 497 (93.4%) underwent primary ACL reconstruction and 35 (6.5%) underwent revision procedures. 383 were acute or subacute injuries (less than 6 months from injury to surgery) and 149 chronic (more than 6 months). Average age was 30.4 years (DS: ± 11.04); there were 422 (79.3%) males and 110 (20.6%) females. A LMRA associated with the ACL injury was detected in 72 cases (13.5%), with a significant prevalence observed in males ([Formula: see text] = 4.65; P = 0.031, statistically significant). In the 149 patients with a chronic injury, 27 patients had LMRA (18.1%), while 45 of the 383 patients with an acute or subacute injury had LMRA (11.7%). There was a tendency, albeit not significant ([Formula: see text] = 3.721; P = 0.054), for the prevalence to increase with time since the initial ACL injury. LMRA was significantly associated ([Formula: see text] = 7.81; P = 0.006) with a meniscocapsular tear of the posterior horn of the medial meniscus (ramp lesion). No other significant associations, such as with severity of A-P translation (as measured by KT-2000) or activity level, were detected.Conclusion: LMRA is a relatively common injury associated with both acute and chronic ACL tears. A relatively high incidence in cases of chronic ACL insufficiency suggests that LMRAs do not heal spontaneously or that they may appear with time, even when absent at the time of the initial injury.Level Of Evidence: Level III, cross-sectional study. [ABSTRACT FROM AUTHOR]

Background: Partial lesions of the anterior cruciate ligament (ACL) are more common than is generally thought, accounting for about 10-12% of ACL injuries. Selective reconstruction may be considered as an option in isolated bundle rupture. The purpose of this study is to evaluate both subjective and objective clinical results, as well as functional recovery time, after selective arthroscopic single-bundle reconstruction in a consecutive series of patients affected by partial ACL rupture.Materials and Methods: Thirty-six patients undergoing selective reconstruction of a single ACL bundle were retrospectively evaluated from a series of 354 ACL reconstructions performed over a 3-year period. Although the suspicion of partial lesions was present at clinical and magnetic resonance imaging (MRI) evaluation, final diagnosis was obtained during arthroscopy. All patients were operated using the same technique and type of fixation, and undergoing the same functional recovery protocol.Results: Mean follow-up was 64 months (48-84 months). All patients but one achieved good functional recovery and returned to their sports within a mean period of 6.1 months. A single patient complained of postoperative instability 1 year after the index operation and needed further surgery. No complications were recorded.Conclusions: Selective reconstruction of partial ACL injury is a method to bear in mind because it offers quick functional recovery. Specific technical and diagnostic steps should be performed and discussed with patients preoperatively.Level Of Evidence: Level 4, retrospective study. [ABSTRACT FROM AUTHOR]

Background: Meniscal injury is currently a well-recognized source of knee dysfunction. While it would be ideal to repair all meniscus tears, the failure rate is significantly high, although it may be reduced by careful selection of the patients. Our objective was to assess the outcome of meniscal repair surgery and the role of simultaneous reconstruction of the anterior cruciate ligament (ACL). Materials and methods: Retrospectively, all consecutive patients between January 2008 and 2011 who underwent meniscal repair were included. Patients were identified using the hospital database with diagnosis and procedure codes. Patient notes were reviewed, including details of the type of tear, chronicity, location, and surgery. We used symptomatic resolution as the outcome measure. Results: 136 Meniscal repairs were performed in 122 patients with a mean age of 26.8 years. Mean follow-up duration was 9 months. 63 % of the patients underwent medial and 37 % underwent lateral meniscal repair, with failure rates of 19 % for medial and 12 % for lateral menisci. Ligament injuries were found in 61 % of the patients ( n = 83). Failure of meniscal repair occurred in 14.5 % ( n = 12) of the patients who had early ACL reconstruction and in 27 % ( n = 22) of the patients who had delayed ACL reconstruction ( p = 0.0006). The failure rate was found to be 13 % in patients who were younger than 25 years (61 %) and 15 % in patients who were older than 25 years (39 %). Conclusion: The success rate of meniscal repair was found to be significantly better when ACL reconstruction was performed simultaneously with meniscal repair. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Abstract Meniscectomy can lead to degenerative joint changes in the knee. Collagen meniscus implantation is a tissue engineering technique designed to stimulate regeneration of meniscal tissue in case of irreparable tears or previous meniscectomy. The implant is composed of type I collagen derived from bovine Achilles tendon and enriched with glycosaminoglycans. Previous clinical trials demonstrated satisfactory medium-term results in patients who received a collagen meniscus implant (CMI). In this study, CMI structure was analysed by light microscopy and scanning electronic microscopy (SEM). The same morphological studies were performed on two implant biopsies, obtained from two patients who underwent a second arthroscopic look six months after implantation. The evolution of the implant was also investigated by magnetic resonance imaging, 6 and 12 months postoperatively. CMI presented a multilamellar structure, with inner lacunae allowing tissue ingrowth. The lamellae were made of collagen fibrils, randomly oriented and preserving the typical 64-nm period. At second arthroscopic look, the implant appeared in continuity to the native residual meniscus and parameniscus, and showed good consistency and stability at probing. The biopsy specimens demonstrated invasion of the scaffold by connective tissue and blood vessels. The newly synthesised collagen fibrils were clearly distinguishable from the scaffold ones. No phagocytomacrophagic cells nor inflammatory reactions were observed inside the implant. MRI findings confirmed CMI biocompatibility and highlighted the evolution of the integration process with time. The data achieved in this study support the hypothesis that CMI stimulates regeneration of meniscal-like tissue, which could prevent the development of degenerative changes after meniscectomy. [ABSTRACT FROM AUTHOR]