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Introduction: Accurate assessment of anterior cruciate ligament (ACL) function is vital for guiding treatment. Nevertheless, the presence of tibial subluxation in the neutral position of a patient with an ACL injury may potentially introduce a confounding factor. This study aims to investigate whether tibial subluxation in the neutral position affects the diagnosis of anterior instability in patients with ACL injuries, potentially impacting the reliability and diagnostic accuracy of stress radiography. Methods: This study included 88 patients: 30 with acute complete ACL tears (acute group), 28 with chronic complete ACL tears (chronic group), and 30 patients who underwent knee arthroscopic surgery other than ACL reconstruction (control group). Side-to-side differences (SSD) in stress radiography were measured using the Telos load status and the SSD of the gap between the Telos load and unload statuses. Diagnostic accuracy of the two methods was assessed using areas under the receiver operating characteristic curves (AUCs). Results: The load SSD (5.92 ± 5.28 mm) was higher than the load-unload SSD (4.27 ± 5.99 mm) in the chronic group (P = 0.017). The load SSD demonstrated a significantly higher diagnostic value than that of the load-unload SSD in the combined group (AUC = 0.920 vs. 0.830; P = 0.012) and chronic group (AUC = 0.913 vs. 0.754; P = 0.002). After adjusting the symptoms for radiographic duration from 6 to 3 months in the chronic group, the load SSD exhibited a significantly higher diagnostic value (AUC = 0.902) than that of the load-unload SSD (AUC = 0.740; P < 0.001). Conclusion: The load SSD provides superior diagnostic accuracy compared to the load-unload SSD in ACL tear cases, where static anterior tibial subluxation may result in false negatives. Although load-unload SSD may have diagnostic value within the first 3 months post-injury, the load SSD method provides a reliable assessment of ACL function for patients beyond this timeframe. [ABSTRACT FROM AUTHOR]

Among the graft options for anterior cruciate ligament reconstruction (ACLR), hamstring autografts are widely regarded as the preferred choice for primary ACLR among orthopedic surgeons worldwide. However, concerns persist regarding postoperative knee flexor weakness. We aimed to compare knee extensor and flexor strengths between hamstring autograft and tibialis anterior allograft groups in ACLR patients, who were propensity score-matched based on baseline characteristics. A retrospective analysis included 58 matched pairs who underwent isokinetic strength tests at 6 and 12 months post operation. Isokinetic muscle strength tests found no significant difference in knee extensor and flexor strength at 6 months post operation between the hamstring autograft and tibial anterior allograft groups. At 12 months, the hamstring autograft group exhibited significantly greater knee flexor deficit (total work and average power) compared to the allograft group, despite no differences in extensor strength or patient-reported outcomes. This study highlights the impact of hamstring autograft harvesting on muscle strength and recovery following ACLR in short-term period. [ABSTRACT FROM AUTHOR]

Background: Consensus has not yet been reached regarding combined anterior cruciate ligament reconstruction (ALLR) with revisional anterior cruciate ligament reconstruction (RACLR). We aimed to compare the clinical outcomes between patients who underwent isolated RACLR and those who underwent RACLR combined with ALLR. Methods: Between June 2010 and June 2021, 49 patients who underwent RACLR were retrospectively reviewed over a 24-month follow-up. Patients were categorized into the isolated RACLR (n = 37, group 1) or combined ALLR group (n = 12, group 2). Clinical outcomes were evaluated with several patient-reported outcome measures (PROMs) and minimal clinically important differences (MCIDs) for each PROM. The side-to-side difference (SSD) of the anterior instability was measured. The pivot-shift test was performed. Results: Baseline characteristics showed no differences between the groups. PROMs showed no significant differences between the groups at the 2-year follow-up. Group 2 was superior to group 1 in the MCID achievement rate for Lysholm knee and International Knee Documentation Committee (IKDC) subjective scores at 24 months postoperatively. At the final follow-up, the proportion of IKDC grade A in SSD for anterior laxity was higher in group 2 than in group 1 (58.3% versus [vs.] 18.3%, p = 0.009), and the proportion of pivot-shift grade 0 was also higher in group 2 (66.7% vs. 27.0%, p = 0.013). The "near return to activity" rate was also higher in group 2 than in group 1 (83.3% vs. 45.9%, p = 0.043). Conclusions: Combining ALLR with RACLR in non-athletes results in a higher proportion of patients with less mechanical graft failure and satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To analyse whether valgus laxity and clinical outcomes differ depending on whether the superficial medial collateral ligament (sMCL) is released or transected during medial open‐wedge high tibial osteotomy (MOWHTO). Methods: Consecutive patients who underwent MOWHTO and subsequent radiological follow‐up for at least 2 years were retrospectively evaluated. The patients were divided into release and transection groups, according to the sMCL manipulation technique. Each patient was assessed for the following variables on valgus stress radiographs taken before surgery and at the 12‐ and 24‐month follow‐ups: the absolute value of valgus (ABV) and side‐to‐side difference (SSD) between the affected and normal sides. The differences between preoperative SSD and those at 12 and 24 months were respectively calculated and defined as delta SSD (ΔSSD). The Visual Analogue Scale, Lysholm knee, International Knee Documentation Committee subjective, and Knee Injury and Osteoarthritis Outcome scores were used to evaluate patient‐reported outcomes. Results: Eighty‐five patients were included in the study. Forty‐two patients (49.6%) underwent sMCL release, and the remaining 43 patients (50.4%) underwent sMCL transection. No significant differences were observed in the ABV and SSD of valgus laxity at the different time points between the two groups (n.s.). Furthermore, no significant differences were observed in the ΔSSD at the 12‐ and 24‐month follow‐ups between the two groups (n.s.). Significant improvement from preoperative values was observed in all patient‐reported outcomes (p < 0.001), with no significant differences between the two groups at any time point (n.s.). Conclusion: Significant improvements in clinical outcomes were observed, regardless of the technique used. Postoperative valgus laxity did not occur with either technique. The transection technique, which can be performed more simply and quickly, demonstrated similar clinical outcomes and valgus laxity to the release technique. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Despite the clinical benefits over nonoperative treatment or meniscectomy, the clinical outcomes of surgical repair for medial meniscus posterior root tear (MMRT) remain suboptimal, which may be attributed to the insufficient restoration of meniscal hoop tension during surgery.To analyze the clinical outcomes of surgical repair of MMRT based on the appearance of the meniscal tension observed immediately after surgery.Cohort study; Level of evidence, 3Electronic medical records of patients who underwent arthroscopic transtibial pull-out repair of MMRT between 2010 and 2021 were retrospectively reviewed. Patients with at least a 2-year follow-up and whose overall meniscal status after the surgical repair could be evaluated via arthroscopic images or videos were eligible to be included. Patients were classified based on the presence of the curtain-cliff sign, potentially implying insufficient postoperative meniscal hoop tension (group 1, patients without the curtain-cliff sign; group 2, patients with the curtain-cliff sign). Regression analysis was performed to evaluate whether the curtain-cliff sign reflects postoperative meniscal extrusion. Subsequently, comparative analyses were conducted between the 2 groups regarding baseline demographic data, clinical scores, intraoperative data, and radiologic parameters.A total of 79 patients were included (group 1, 59 patients; group 2, 20 patients). Regression analysis revealed a significant association between the curtain-cliff sign and postoperative meniscal extrusion, suggesting its potential to reflect the postoperative meniscal tension. In the between-group comparisons, there were no differences in baseline demographic data, preoperative clinical scores, and preoperative radiologic variables. However, at the final follow-up, group 2 showed a significantly lower International Knee Documentation Committee subjective score compared with group 1 (group 1, 61.7 ± 14.4; group 2, 52.9 ± 12.5; P = .017), while no significant differences were found in the visual analog scale for pain score and Lysholm score. Additionally, group 2 exhibited significantly higher postoperative meniscal extrusion compared with group 1, which was measured at both the midpoint of the medial femoral condyle (group 1, 4.0 ± 1.1 mm; group 2, 5.1 ± 1.5 mm, P = .004) and the posterior border of the medial collateral ligament (group 1, 4.4 ± 1.2 mm; group 2, 5.7 ± 1.5 mm; P = .004), with more pronounced progression compared with the preoperative status at these sites. Consistently, the progression of both the osteoarthritis grade and the hip-knee-ankle angle compared with preoperatively was significantly greater in group 2.In patients in whom the restoration of meniscal tension appears insufficient immediately after surgical repair of MMRT, relatively poor clinical outcomes can be anticipated. The findings of this study suggest that efforts to reinforce meniscal tension may be required during surgical repair of MMRT in some cases, especially those showing the curtain-cliff sign. [ABSTRACT FROM AUTHOR]

Plate fixation has recently gained popularity among the various surgical methods used to treat Neer type II distal clavicle fractures. The use of a low‐profile distal clavicle locking plate is logically considered a better option when there is no significant difference in the fixation strength between insertions of 3.5‐ and 2.7‐mm diameter screws. Therefore, the purpose of this biomechanical study was to investigate any differences in fixation strength among varying sizes of screws that are used to treat distal clavicle fractures. The study was performed with 20 paired shoulder girdles from 10 fresh frozen cadavers. To create a type IIA fracture of Neer classification, osteotomy was performed perpendicularly to the longitudinal axis of the clavicle at the medial end point of the conoid ligament. Two custom‐made fixtures designed to be attached to both upper and lower sides of the Instron were fabricated for the evaluation. The mean maximum pull‐out strength for fixation using 3.5‐mm diameter screws was 241.9 ± 67.8 N, whereas the mean pull‐out strength in fixation with 2.7‐mm diameter screws was 228.1 ± 63.0 N. There was no statistically significant difference between the two groups. Distal fragment fixation with distal clavicle locking plates using two 2.7‐mm diameter screws showed comparable biomechanical pull‐out strength at the time‐zero setting to fixations with a hook plate using two 3.5‐mm diameter screws. Therefore, the fixation of the distal fragment with a low‐profile plate and 2.7‐mm screws may be preferred as an alternative option if the distal fragment of the fractured clavicle is not extremely small. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) poses a significant global burden, with conventional treatments like corticosteroid and hyaluronic acid (HA) injections commonly used. Emerging injectable biologics, including bone marrow aspirate concentrate (BMAC), show promise in OA management., Purpose: To investigate the clinical efficacy of BMAC injection compared with other injection treatments for knee OA., Study Design: Systematic review; Level of evidence, 1., Methods: A systematic review was conducted using PubMed, Embase, Cochrane Library, and Google Scholar to identify randomized controlled trials with Level 1 evidence that compared the clinical efficacy of BMAC with other injections. The visual analog scale for pain and the Pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) were used as clinical scores representing pain. For functional assessment, the Western Ontario and McMaster Universities Osteoarthritis Index and the International Knee Documentation Committee subjective form were used. For studies comparing BMAC with HA, each clinical score was standardized to pain and function scales based on the minimal clinically important difference (MCID)., Results: Eight studies, consisting of a total of 937 patients, were included. Patients treated with BMAC showed a significant improvement in clinical scores compared with baseline, starting at 1 month postinjection. For pain scores at 6-month ( P = .033) and 12-month follow-up ( P = .011), BMAC demonstrated favorable results over HA, with a statistically significant difference. However, these differences did not exceed the MCID. When BMAC was compared with other injections, no significant differences were observed in the degree of clinical score improvement. No serious adverse events or events significantly associated with BMAC compared with other treatments were reported., Conclusion: BMAC injections demonstrated effectiveness in providing pain relief and functional improvement for patients with knee OA. When BMAC was compared with other intra-articular injection options, distinct differences surpassing the MCID were not evident. Further research is deemed necessary to investigate the role of BMAC in the treatment of knee OA., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Purpose: To analyze cartilage regeneration and clinical outcomes after human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) implantation based on the distribution and location of medial femoral condyle (MFC) cartilage defects., Methods: Patients who underwent hUCB-MSC implantation for MFC cartilage defects involved in isolated medial compartment osteoarthritis were included. The patients were divided into two groups: those with MFC defects located within the anterior-central portion (Group A) and those with MFC defects extending to the posterior portion (Group P). Cartilage regeneration was assessed using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scores. MFC cartilage defects were subdivided into anterior, central, and posterior regions. The total, regional MOCART scores, and patient-reported outcomes (PROs) were evaluated., Results: Overall, 43 patients were included in this study (Group A: 31 patients, Group P: 12 patients), with 30/43 undergoing combined high tibial osteotomy. Cartilage defect size was significantly larger in Group P than in Group A (7.8±1.9 cm 2 vs. 5.7±2.4 cm 2 , P=0.009). Group A demonstrated a significantly higher total MOCART score compared to Group P (55.0±12.3 vs. 40.4±9.2, P=0.001). PROs at final follow-up showed significant improvement compared to preoperative values in both groups (all P<0.001), with no significant differences in PROs between groups. The mean follow-ups for each group were 29.7 and 32.5 months, respectively. Defect size were significantly associated with the total MOCART score (P=0.026) and unsatisfactory outcome (MOCART < 60) (P=0.012, odds ratio 2.674). The cut-off value for defect size was 6.3 cm 2 (area under the curve, 0.905; P<0.001). In the comparison of regional MOCART scores within each patient, the anterior MOCART score was significantly higher than the central and posterior MOCART scores (P<0.001 and P=0.004, respectively)., Conclusion: Cartilage defects with osteoarthritis, which is smaller and primarily limited to the anterior-to-central portion showed better MOCART scores after hUCB-MSC implantation., (Copyright © 2024. Published by Elsevier Inc.)