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Although anatomical anterior cruciate ligament reconstruction (ACLR) can provide satisfactory outcomes, little is known about how this procedure impacts patellar height. Since harvesting bone-patellar tendon-bone (BTB) autografts is a potential risk factor for decreased patellar height, we examined changes in patellar height after anatomical ACLR with BTB autograft with a focus on the size of the harvested graft.Subjects were 84 patients (49 males, 35 females; mean age, 23 years) who underwent primary anatomical ACLR with central third BTB autograft. Preoperative to postoperative Caton-Deschamps index (CDI) ratio was calculated using lateral knee radiographs before and 6 months after surgery. The length and cross-sectional area (CSA) of the graft were measured intraoperatively, and the CSA of the contralateral patellar tendon was measured by ultrasound 6 months postoperatively. The difference in graft CSA relative to the contralateral tendon CSA, expressed as a percentage (gCSA:ctCSA percentage), was also calculated.Patellar height decreased slightly after surgery (preoperative CDI: 0.856 ± 0.113; postoperative CDI: 0.841 ± 0.113), with a mean difference between preoperative and postoperative CDIs of -0.015 (range: -0.293 to 0.101). Although the CDI of male subjects significantly decreased after surgery (preoperative: 0.852 ± 0.117; postoperative: 0.827 ± 0.115), no significant changes were noted in female subjects (preoperative: 0.862 ± 0.108; postoperative: 0.861 ± 0.108). Graft length and CSA did not significantly impact the CDI ratio (r = -0.138 and r = -0.038, respectively). Moreover, no significant relationship was observed between the gCSA:ctCSA percentage and CDI ratio (r = 0.118).Although patellar height slightly, but significantly, decreased at 6 months after anatomical ACLR with BTB autograft, it was not affected by the length and CSA of harvested grafts. The decrease in postoperative patellar height was observed only in male subjects, suggesting the potential importance of sex differences in soft tissue healing during the postoperative period.

Posterior ankle impingement syndrome is mainly seen in ballet dancers and frequently associated with specific movements in ballet such as pointe and demi pointe in which the whole-body weight is applied to the maximally plantar flexed ankle. We performed arthroscopic debridement for 2 dedicated ballet dancers on the intervening soft tissue causing posterior ankle impingement syndrome (PAIS). In both cases, T2-weighted magnetic resonance imaging (MRI) revealed low-signal intensity of meniscus-like soft tissue without abnormal osseous findings, connecting from the posterior side of the talus to Kager's fat pad. To examine the intervening soft tissue in detail, we performed histological evaluation by hematoxylin and eosin staining, Safranin O fast green staining, and immunohistochemistry for type I collagen and type II collagen. Hematoxylin and eosin staining showed that there was cartilage-like tissue including chondrocyte-like cells in contact with fibrous tissue. The extracellular matrix in the cartilage zone was consistently stained by Safranin O staining and type II collagen without any staining with type I collagen. These findings suggested that the meniscus-like soft tissue appearing as low-signal intensity on MRI at the posterior side of talus included hyaline-like cartilage. To the extent of our knowledge, these were rare cases of hyaline-like cartilage generation causing PAIS in ballet dancers, which might be associated with ballet specific movements resulting in chondrogenesis.

Purpose Second-look arthroscopy is invasive but still one of the most useful postoperative evaluation methods since graft morphology including graft tension, graft tear, and synovial coverage can be directly evaluated. However, only a few studies have evaluated transplanted posterior cruciate ligament (PCL) grafts. This study aimed to clarify the PCL graft morphology and chondral damages at second-look arthroscopy after double-bundle PCL reconstruction (PCLR) and to investigate the effects of patient age on these arthroscopic findings. Methods This study retrospectively included 26 patients who underwent second-look arthroscopy at the time of hardware removal 14 months after double-bundle PCLR for isolated PCL injury from January 2007 to December 2020. The patients were divided into two groups: group A, 39 years or younger (n = 14); and group B, 40 years or older (n = 12). At second-look arthroscopy, the grafts were evaluated based on tension (taut, graft tension as tense as a normal PCL; lax, graft tension looser than a normal PCL, unclassified, completely torn graft), tear (one or more tendon strands torn), and synovial coverage (good, synovial coverage greater than 80% around the graft; fair, synovial coverage greater than 50%; and poor, synovial coverage less than 50%). The chondral damages were evaluated using the Outerbridge classification system. Radiographic posterior tibial translation with gravity sag view as well as clinical outcomes were also evaluated. Results Anterolateral (AL) graft tension was lax in 8% of the patients, whereas posteromedial (PM) graft tension was lax or unclassified in 24% (p = 0.043). Graft tear was observed only in the PM graft of 19% patients (p = 0.022). Synovial coverage of AL grafts was good or fair in all cases, whereas that of PM grafts was poor in 28% cases (p, Highlights • Second-look arthroscopy is a direct evaluation of the transplanted graft. • There are very few studies of second-look arthroscopy of transplanted PCL grafts. • Arthroscopic findings in the PM graft were inferior to those in the AL graft. • Poorer synovial coverage in the PM graft was observed in the patients ≥40 years.

Lateral patellar dislocation is a relatively common knee injury in children and adolescents (Nietosvaara et al., J Pediatr Orthop 14(4):513–5, 1994; Fithian et al., Am J Sports Med 32(5):1114–21, 2004), and it may lead to recurrent patellar instability and functional disability (Macnab, J Bone Joint Surg Am 34:957–67, 1952; Hawkins et al., Am J Sports Med 14(2):117–20, 1986). Furthermore, most patients tend to have articular cartilage lesions in their patellofemoral (PF) joint (Nomura et al., Arthroscopy 19(7):717–21, 2003); these lesions get worse with time and lead to patellofemoral osteoarthritis (PFOA) (Nomura and Inoue, Osteoarthr Cartil 13(11):1029–36, 2005; Salonen et al., Am J Sports Med 45(6):1376–82, 2017). The therapeutic objectives would be preventing further dislocation, improving subjective apprehension, and reducing the risk of future osteoarthritis (OA). Numerous surgical procedures for stabilizing an unstable patella have been reported for over a hundred years. However, few procedures have demonstrated the prevention of further aggravation of osteoarthritis. The medial patellofemoral ligament (MPFL) has been regarded as a primary restraint for lateral displacement of the patella, and reconstructing an MPFL has become the first choice of treatment in patellar instability. The present chapter focuses on the current status of MPFL reconstruction, especially from a viewpoint of its possibility for preventing future OA.

The aim of this study was to assess early graft failure after anterior cruciate ligament (ACL) reconstruction according to chronicity of ACL deficiency (ACLD) and clarify predisposing factors.A total of 731 patients who underwent anatomic ACL reconstruction were divided into 3 groups based on chronicity of ACLD:6 months (Group 1), 6 months to 2 years (Group 2), and2 years (Group 3). Types of ACL grafts used included single-bundle hamstring tendon (HT), multiple-bundle HT, and rectangular bone-patellar tendon-bone (BTB) grafts. Preoperatively and immediately postoperatively, lateral radiographs in full extension were taken to examine anterior tibial subluxation (ATS). All ACL grafts were evaluated by MRI at 6 months to identify graft failure. The group with the highest failure rate was further examined to compare possible risk factors between the intact and failure subgroups, followed by multivariate logistic regression analysis to identify predisposing factors.Early graft failure on MRI without any episode of postoperative trauma was observed in 7 (1.4%), 2 (1.8%), and 11 (9.2%) patients in Groups 1, 2, and 3, respectively, with a significantly higher rate in Group 3 (P 0.001). Of the 119 patients in Group 3, significant differences were observed between intact and failure subgroups with regard to surgical procedure (P = 0.03), chondral lesions (P 0.01), and preoperative ATS (P 0.01). Multivariate logistic regression analysis revealed that surgical procedures (odds ratio, 3.8; 95%CI, 1.16-12.59) and preoperative ATS (odd ratio, 2.4; 95%CI, 1.26-4.38) were predisposing factors of early graft failure.Patients with ACLD for2 years experienced early graft failure with an incidence rate of 9.2%. Predisposing factors of early graft failure in these patients included the use of single-bundle HT grafts and preoperative ATS. The use of rectangular BTB grafts resulted in a lower graft failure rate.Case Series.

Introduction There was little information about the isolated medial meniscal tears in the anterior–middle segment. This study aimed to report the infrequent cases of the isolated medial meniscal tears in the anterior–middle segment related to kicking motion among young soccer players with a short-term postoperative outcome. Presentation of case In the retrospective review of the surgical records from 2000 to 2018, there were 15 cases with the corresponding tear. They were all young male soccer players with a mean age of 16.7 years (range: 10–23 years). The cause of injury was kicking motion during playing soccer in all the patients. The most frequent symptom was locking in 80% of the cases. In the arthroscopic evaluation, all the cases presented with a longitudinal (bucket-handle) tear in the anterior–middle segment in the peripheral zone with a length of 25 to 30 mm, while the posterior segment and the cruciate ligaments were intact. Meniscal repair was performed for all the cases. At one year, all the patients could return to play soccer with a pre-injury level without any symptoms. In the second-look arthroscopy at six months among four cases, all meniscal tears healed completely. Discussion and conclusion Clinicians should be aware of the possibility of isolated peripheral longitudinal tear in the anterior–middle segment of the medial meniscus, which is related to the kicking motion among young soccer players and mainly causes locking., Highlights • Isolated medial meniscal tears in anterior–middle segment are relatively infrequent. • These tears cause after kicking motion among young soccer players. • Longitudinal (bucket-handle) tears are observed in the periphery. • Clinical outcomes after repair are good.