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Purpose The purpose of this review is to perform a meta-analysis of studies reporting meniscus repair outcomes. Pooled analyses of such studies will provide an accurate estimate of the outcomes that can be expected following meniscal repair at various postoperative time points. Methods A meta-analysis of meniscal repair failure (defined as persistent symptoms, lack of healing on magnetic resonance imaging or revision surgery) and other clinical outcomes was performed following meniscal repair. Patients included had traumatic, nondegenerative meniscal tears, were skeletally mature, and had specific time-points after surgery. Repairs included were performed either in isolation, or with concomitant ACL reconstruction. Because of the inherent heterogeneity of single-arm meta-analyses, pooled analyses were performed using a random-effects model. Results Rates of all-cause meniscal repair failure was pooled to be 12% at 0-1 years (95% CI: .09-.16), 15% at 2-3 years (95% CI: .11-.20), and 19% at 4-6 years (95% CI: .13-.24). Sensitivity analysis for studies performing meniscal repair entirely on patients with concomitant ACL reconstruction (ACLR) showed comparable rates of failure at similar time intervals. Development of osteoarthritis, in patients with knees previously free from articular pathologies, was 4% at 2-3 years (95% CI: .02-.07), and 10% at 4-6 years (95% CI: .03-.25). Conclusion Meniscus repair for traumatic injuries have an all-cause failure rate that increases from 12% to 19% through a time period ranging from 1-6 years following surgery. The failure rates were comparable for patients with meniscal repairs performed with concomitant ACLRs. Level of Evidence IV; Systematic Review of Level II-IV Studies.

José Martins Juliano Eustaquio,1,2 Alberto Martins Fontoura Borges,2 Lorena Souza Vilela,2 Matheus Pizarro Carvalho Gouveia,2 Amanda Laruzo Rabelo,2 Camila Cohen Kaleka,3 Pedro Debieux,3,4 Octávio Barbosa Neto1 1Exercise Science, Health and Human Performance Research Group, Graduate Program in Physical Education, Federal University of Triângulo Mineiro (UFTM – Universidade Federal do Triângulo Mineiro), Uberaba, MG, Brazil; 2Department of Orthopedics and Traumatology, Mário Palmerio Hospital, University of Uberaba (UNIUBE – Universidade de Uberaba), Uberaba, MG, Brazil; 3Knee Surgery Group, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; 4Knee Surgery and Arthroscopy Group, Federal University of São Paulo (UNIFESP – Universidade Federal de São Paulo), São Paulo, SP, BrazilCorrespondence: José Martins Juliano EustaquioMário Palmerio Hospital, University of Uberaba (UNIUBE – Universidade de Uberaba), Av. Cecília Palmerio, s/n, Uberaba, MG, CEP: 38050175, BrazilEmail zemartinsjuliano@hotmail.com; octavio.neto@uftm.edu.brPurpose: To evaluate the prevalence and characteristics of orthopedic injuries associated with the technical-tactical profiles of Brazilian Jiu-Jitsu (BJJ) fighters, according to the fighters’ graduation level (beginner and advanced).Patients and Methods: Cross-sectional study, which included the participation of amateur and professional BJJ athletes, aged between 18 and 60 years and practitioners of the sport for at least six months. All answered a mixed self-reported morbidity questionnaire. Participants were divided into four groups, according to the technical-tactical profile in the fight (keeper and passer) and the fighter’s graduation level (beginner and advanced), and also into four subgroups, divided by joining the groups in pairs above. Descriptive and analytical statistical procedures were used, with a level of statistical significance set at 5% (p < 0.05).Results: A total of 198 participants were included in the study. There was a higher prevalence of musculoskeletal injuries in advanced fighters (p< 0.001), with no significant difference between the profiles of guard and passer fighters. Sprains were the most common type of injury in all studied groups and subgroups. The anatomical segments knee and shoulder, respectively, were the most affected in all groups, and both segments showed significant associations of the athletes in the advanced and guard groups.Conclusion: The study showed important data for creation of specifics injury prevention protocols, through the higher prevalence of injuries in athletes of the advanced profile and in the segments of the knee and shoulder, with emphasis on the guard fighters.Keywords: martial arts, sports injuries, orthopedics

Objective: To evaluate the epidemiological and clinical characteristics of knee injuries in Brazilian Jiu-Jitsu (BJJ) practitioners. Methods: Cross-sectional study, using a mixed questionnaire, based on the Referred Morbidity Index. Results: 198 amateur and professional BJJ fighters, of both sexes, aged between 18 and 60 years, participated in the study. The majority (88%) of the fighters had only one knee injury (p < 0.001). In total, 29.8% proportion of knee injuries (p < 0.001) was identified, which were mainly from the medial collateral ligament (38%), caused by a sprain mechanism (86%) and conservative treatment (65%). Conclusion: A high prevalence of knee injuries in JJB fighters was found, compared to other sports that also perform rotational movements and have great body contact, such as mixed martial arts (MMA), judo, soccer, basketball and handball. Some JJB strikes, such as the key and the projection, can cause greater knee joint stress, both in the attacking fighter and in the opponent. The knowledge of the epidemiological characteristics of sports injuries is important in the elaboration of prevention and training protocols more specific to the sport and for the understanding of the complex mechanisms involved with this outcome in sport. Level of Evidence IV, Case Series. RESUMO Objetivo: Avaliar as características epidemiológicas e clínicas das lesões no joelho de praticantes de jiu-jitsu brasileiro (JJB). Métodos: Estudo de desenho transversal, por meio de questionário do tipo misto, baseado no Índice de Morbidade Referida. Resultados: Participaram 198 lutadores amadores e profissionais de JJB, de ambos os sexos, com idades entre 18 e 60 anos. A grande maioria (88%) dos lutadores apresentou apenas uma lesão no joelho (p < 0,001). Observou-se proporção de 29,8% de lesões no joelho (p < 0,001), que foram principalmente do ligamento colateral medial (38%), causadas por mecanismo de entorse (86%) e de tratamento conservador (65%). Conclusões: Observou-se alta prevalência de lesões no joelho em lutadores de JJB, comparativamente a outros esportes que também realizam movimentos rotacionais e têm grande contato corporal, como as artes marciais mistas (MMA), o judô, o futebol, o basquetebol e o handebol. Alguns golpes do JJB, como a chave e a projeção, podem causar maior estresse articular no joelho, tanto no lutador que ataca quanto no oponente. O conhecimento das características epidemiológicas das lesões esportivas é importante na elaboração de protocolos de prevenção e treinamento mais específicos à modalidade e também para a compreensão dos mecanismos complexos envolvidos com esse desfecho no esporte. Nível de Evidência IV, Série de Casos.

The aim of this study was to retrospectively compile normative data on the anterior cruciate ligament (ACL) in the paediatric population with magnetic resonance imaging, emphasizing the differences between men and women. In this retrospective study, musculoskeletal radiologists evaluated length, area, coronal and sagittal inclination of the ACL and inclination of the intercondylar notch. A total of 253 MR examinations (130 males and 123 females between 6 and 18 years of age) were included. The association between measurements, sex and age was considered. Linear and fractional polynomial regression models were used to evaluate the relationships between measurements. ACL length showed significant progressive growth (p

To evaluate the regenerative capacity of gracilis (G) and semitendinosus (ST) tendons, to examine the sensitivity and specificity of signs and symptoms in the assessment of hamstring tendons, and to assess the thickness and insertion site of regenerated tendons.Thirty sequential knees were subjected to anterior cruciate ligament reconstruction with semitendinosus and gracilis tendons. After surgery, the patients were followed up clinically with physical examination and magnetic resonance imaging (MRI).Overall, 36.66% of the tendons were visible on MRI, whereas 83.33% were palpable. On MRI, the distal insertion site of the regenerated semitendinosus tendon was visible proximal to the landmark of the medial femoral condyle in 28%, at the same level in 16%, and distally in 56% of the cases. Gracilis tendon insertion was visible proximally in 36.66% of cases, at the same level in 10%, and distally in 53.33%. Eleven knees exhibited complete regeneration.Partial or total regeneration of the ST and G tendons was apparent on MRI. Palpation is effective for evaluating regeneration of the ST and G tendons; however, MRI is still the gold standard. ST and G tendons regenerated completely in only a small percentage of patients, limiting reuse as a graft in cases with new ligament injuries of the knee.Avaliar a capacidade de regeneração dos tendões Grácil e Semitendíneo; Identificar a sensibilidade e especificidade da manobra semiológica para detecção da presença dos tendões isquiotibiais; verificar espessura e região de inserção dos tendões regenerados.30 pacientes foram submetidos à cirurgia para reconstrução do LCA, com retirada dos tendões do semitendíneo e grácil. Após a cirurgia, os pacientes foram acompanhados clinicamente por exame físico e por RM.Observou-se que em 36,66% eles se apresentavam visíveis, enquanto 83,33% os tendões estavam palpáveis. Observou-se à RM, quanto a região da inserção distal dos tendões regenerados: Semitendíneos, 28% proximal ao ponto padronizado do MFC, 16% se apresentaram ao nível e 56% distal. Já quanto aos tendões do Grácil, 36,66% apresentavam-se proximais, 10% ao nível e 53,33% distal. Onze tendões do ST e do G tiveram regeneração completa.Ficaram caracterizadas, por RM, as regenerações parciais ou totais dos tendões ST e G;a palpação, é eficaz para avaliar a regeneração dos tendões, porém RM mantem-se como padrão ouro; apenas parte dos pacientes os tendões ST e G se regeneraram de maneira completa, limitando a sua reutilização como enxerto nos casos de nova lesão ligamentar.

To determine a relationship between smoking, alcohol abuse and anabolic steroids and meniscoligamentous injuries.A total of 239 patients underwent surgical treatment of isolated anterior cruciate ligament (ACL) lesion, ACL associated with meniscal injury and isolated meniscal injury, and were inquired by a single team of surgeons about their habits: smoking, alcoholism and use of artificial anabolic agents. In addition, quality of life was assessed using the SF-36 questionnaire.It was not possible to establish a direct relationship between habits and meniscal and ligamentous injuries, despite the finding that patients with ACL-associated lesions were more frequently smokers, and that patients with isolated meniscal injuries used more artificial anabolic agents. Regarding quality of life, there were no statistical differences in the habits between the groups; however, except for smokers with isolated meniscal injury, all patients who did not have the habits analyzed presented a better score in the SF-36 questionnaire.There were no significant findings correlating smoking, alcohol abuse and artificial anabolic agents with the presence of injuries. In addition, six months after the surgical treatment, there was no difference in the quality of life between the groups evaluated.Determinar uma relação entre hábito de fumar, abuso de álcool e anabolizantes artificiais com lesões menisco-ligamentares do joelho.Um total de 239 pacientes foi submetido ao tratamento cirúrgico de lesão isolada do ligamento cruzado anterior (LCA), do LCA associada à lesão meniscal e lesão meniscal isolada e foi indagado, por uma única equipe de cirurgiões, sobre seus hábitos: tabagismo, alcoolismo e uso de anabolizantes artificiais. Além disso, foi avaliada a qualidade de vida com o questionário SF-36.Não foi possível estabelecer uma relação direta entre os hábitos e as lesões menisco-ligamentares, apesar da constatação de que os pacientes com lesões associadas ao LCA eram, com maior frequência, tabagistas e que os pacientes com lesão meniscal isolada usavam mais anabolizantes artificiais. Com relação à qualidade de vida, não houve diferença estatística quanto aos hábitos entre os grupos, porém, exceto tabagistas com lesão meniscal isolada, todos os pacientes que não tinham os hábitos analisados apresentaram pontuação melhor no questionário SF-36.Não houve achados significativos que correlacionassem os hábitos de fumar, abuso de álcool e anabolizantes artificiais com a presença de lesão. Além disso, seis meses após o tratamento cirúrgico, não houve diferença na qualidade de vida entre os grupos avaliados.

The treatment approach for a patient with knee joint focal cartilage lesion is a difficult decision. To date, there has been no randomized clinical trial involving Hydrogel (Cartiva™). This study evaluated and compared the results of a hydrogel implant (Cartiva™) with autologous osteochondral transplantation (AOT) for treating knee joint focal cartilage lesions. Thirty-eight symptomatic patients, with a focal cartilage lesion of Outerbridge grades III or IV, were randomized into one of two groups according to the inclusion and exclusion criteria. Group I underwent AOT, and Group II was treated with a Hydrogel implant. Patients were evaluated preoperatively and again postoperatively at 6, 12, and 24 months using the subjective International Knee Documentation Committee (IKDC) scores, Visual Analog Scale for Pain (VAS Pain), Activities of Daily Living Scale (ADLS) and Lysholm score. Both groups showed significant improvements from baseline (pre-surgery) to post-surgery (6, 12, and 24 months; p

To evaluate the graft diameter size after one-year follow-up or more of patients Tanner II, III, and IV who were submitted to anterior cruciate ligament reconstruction. Ten patients [five males (mean age: 14.4 years) and five females (mean age: 13.6 years)] with open physis and anterior cruciate ligament tear were submitted to transphyseal anterior cruciate ligament reconstruction with quadruple hamstrings graft. During the procedure, graft and tunnel size were recorded. After last clinical follow-up (range 1–11 years), an MRI study was requested and their measurements near the tibial tunnel were compared with the graft diameter measured and used during primary procedure. Four patients had Tanner stage II, four patients Tanner stage III, and two Tanner IV. There were statistically significant decreases in the quadruple hamstrings graft diameter size (average of 25.3 %). Mean size at time of surgery was 7.9 mm (±0.87), and mean size measured at different points of follow-up evaluation was 5.9 mm (±0.65). Diameter size of hamstring graft in skeletally immature patients is smaller in most cases. If there is a decrease in the diameter of the graft along postoperative time, the risk of a re-rupture is theoretically further increased. Quadruple hamstring graft decreases a mean 25.3 % in diameter from time of anterior cruciate ligament reconstruction surgery until reassessment period in skeletally immature patients. IV.

Objective To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. Methods We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. Results Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. Conclusion There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.

Avulsion fractures of the posterior cruciate ligament (PCL) are usually found in pediatric populations. This study investigated which of 2 approaches—posteromedial or direct posterior—enables easier PCL reinsertion. Ten fresh cadavers were studied using direct posterior (10 knees) and posteromedial (10 knees) approaches. In both, a guidewire was inserted into the tibial insertion of the PCL as perpendicular as possible to the coronal knee axis. Then, the angle between the guidewire and the horizontal plane of the table was measured. The mean angle of the guidewire was 8.6° (SD=7.3°) with the direct posterior approach and 36.6° (SD=14.3°) with the posteromedial approach ( P =.005). The direct posterior approach allows a greater degree of freedom compared with the posteromedial approach to reach the PCL tibial insertion. [ Orthopedics. 2016; 39(5):e1024–e1027.]

The aim of this study was to compare the sagittal and rotational stability of anterior cruciate ligament (ACL) reconstructions with anatomic double-bundle and single-bundle techniques. Twenty consecutive patients undergoing ACL reconstruction were randomized into two groups. One group was reconstructed with a single bundle in the anatomical position, while the other group was treated with an anatomical double-bundle technique. In both groups, the navigation equipment was used to measure the anterior tibial translation, internal tibial rotation, and external tibial rotation in 30° of flexion preoperatively and postoperatively. Both groups showed a significant reduction in anterior tibial translation, tibial internal rotation, and tibial external rotation from preoperative to postoperative (p

The purposes of this study are to describe an ACL femoral tunnel classification system for use in planning revision ACL reconstruction based on 3-D computed tomography (CT) reconstructions and to evaluate its inter- and intra-rater reliability.A femoral tunnel classification system was developed based on the location of the femoral tunnel relative to the lateral intercondylar ridge. The femoral tunnel was classified as Type I if it was located entirely below and posterior to the ridge as viewed from distally, Type II if it was slightly malpositioned (either vertically, anteriorly, or both), and Type III if it was significantly malpositioned. To evaluate the reproducibility of the classification system, CT scans of 27 knees were obtained from patients scheduled for revision ACL reconstruction, and 3-D reconstructions were created. Four views of the 3-D reconstruction of each femur were then obtained, and inter- and intra-observer reliability was determined following classification of the tunnels by eight observers.Twenty-five tunnels were classified as Type I (5 tunnels), Type II (9 tunnels), or type III (11 tunnels) by at least 5 of 8 observers, while insufficient agreement was noted to classify two tunnels. The interobserver reliability of tunnel classification as type I, II, or III yielded a κ coefficient of 0.57, while intra-observer reliability yielded a κ coefficient of 0.67. Subclassification of type II femoral tunnels into the subgroups anterior, vertical, and both was possible in four of the nine type II patients. The interobserver reliability of the complete classification system yielded a κ coefficient of 0.50, while the intra-observer reliability yielded a κ coefficient of 0.54.Classification of the location of ACL femoral tunnels utilizing 3-D reconstructions of CT data yields moderate to substantial inter- and intra-observer reliability.Diagnostic Level III.

The preservation of meniscal tissue is paramount for long-term joint function, especially in younger patients who are athletically active. Many studies have reported encouraging results following the repair of meniscus tears, including both simple longitudinal tears located in the periphery and complex multiplanar tears that extend into the central third avascular region. However, most types of meniscal lesions are managed with a partial meniscectomy. Options to restore the meniscus range from an allograft transplantation to the use of synthetic and biological technologies. Recent studies have demonstrated good long-term outcomes with meniscal allograft transplantation, although the indications and techniques continue to evolve, and the long-term chondroprotective potential of this approach has yet to be determined. Several synthetic implants, most of which are approved in the European market, have shown some promise for replacing part of or the entire meniscus, including collagen meniscal implants, hydrogels, and polymer scaffolds. Currently, there is no ideal implant generated by means of tissue engineering. However, meniscus tissue engineering is a fast developing field that promises to develop an implant that mimics the histologic and biomechanical properties of a native meniscus.

Leonardo Jose Bernardes Albertonia, Felipe C Matheus Henrique Araujo Venturab, Carlos Pedro Debieuxd, Marcelo Seiji Kubotaa, Gera Marcus Vinicius Malheiros Luzoe, Antonio A Filhof a MSc, Physician in the Knee Group, Department of Orthopedics and Sao Paulo (EPM-UNIFESP), Sao Paulo, SP, Brazil b Third-year Resident Physician in the Department of Orthopedics an c PhD, Physician in the Knee Group, Department of Orthopedics and d Physician in the Knee Group, Department of Orthopedics and Trau e PhD, Affiliated Professor and Physician in the Knee Group, Departm Brazil f PhD, Affiliated Professor and Head of the Knee Group, Department Brazil