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Parrot beak tear is a white-white meniscal injury that often occurs in isolated injuries. Partial meniscectomy for parrot beak tears is often recommended, owing to the avascular zone; however, partial meniscectomy, especially with the lateral meniscus, has a high failure rate for return to sports, leading to residual meniscus extrusion and lateral compartment osteoarthritis. Thus, we have developed a repair technique to preserve the parrot beak tear of the avascular zone. This is a modification of the inside-out repair with additional reduction sutures. We recommend this procedure as a technique for repairing avascular parrot beak tears of the lateral meniscus., Technique Video Video 1 We demonstrate a technique for a parrot beak tear of the lateral meniscus of the avascular zone, in which we present the modification of the inside-out repair with additional reduction sutures and bone marrow-derived fibrin clot, based on “ABCs” theory of meniscal repair: anatomic reduction, biologic augmentation, and circumferential compression across the tear site. This case involved the right knee of a 21-year-old professional soccer player who had a parrot beak tear of the lateral meniscus. From the anterolateral portal view, a parrot-beak tear was observed in the lateral meniscus in the figure-four position. This tear started from the anterior to the posterior portion of the white-white zone of the lateral meniscus. The residual meniscus had a horizontal tear. After meniscal instability was confirmed by a probe, an arthroscopic rasp was used to freshen the sites of the tears in the meniscus and to promote healing through the anteromedial portal. Reduction sutures were then placed on the body of the parrot beak tear using a Scorpion suture passer through the anterolateral portal viewing from anteromedial portal. A NanoPass was inserted into the joint below the anterior horn of lateral meniscus and the reduction suture was retrieved through the capsule in the far anterolateral portal without damaging the articular cartilage of the tibial plateau viewing from anteromedial portal. We confirm the reduction suture work for this parrot beak tear viewing from anteromedial and anterolateral portal. The 11-G bone marrow harvest needle was used to harvest 10 mL of bone marrow aspirate from the lateral side of the intercondylar notch of the right knee through the anteromedial portal viewing from the anterolateral portal, which is positioned in the deep flexion position without a tourniquet. Dual meniscal repair needles loaded with 2-0 braided polyester sutures with clots are inserted into the injured site through a cannula positioned in the anteromedial portal viewing from the anterolateral portal. The suture needles are retrieved under direct visualization through a previously prepared lateral incision. After inserting the clot, needles loaded with 2-0 sutures alone are penetrated through the unstable portion of the meniscus through the anteromedial portal viewing from the anterolateral portal. Stitches were placed at 3-mm intervals. The repaired meniscus covers the articular surface of lateral compartment viewing from the anterolateral portal.

Restrictions during the coronavirus disease 2019 (COVID-19) pandemic have decreased physical activity levels, which may result in locomotive syndrome. This study evaluated the change in locomotive syndrome prevalence and associated risk factors among an elderly population before and after a coronavirus outbreak.This written self-administered cross-sectional survey was conducted in conjunction with the coronavirus disease vaccination program in Habikino City, Japan. Participants who were aged ≥65 years completed the five-question Geriatric Locomotive Function Scale before and during the pandemic. The diagnosis of locomotive syndrome and its stage was based on the Geriatric Locomotive Function Scale score: stage 1 (2-3 points), 2 (4-5 points), and 3 (≥6 points). Data on lifestyle changes, including regular exercise, during the pandemic were collected.This study included 12,197 participants (36.7% of the city's total elderly residents). The prevalence of locomotive syndrome increased from 41.3% to 47.1% after the outbreak. In total, 765 (6.3% of overall population) and 295 (9.5% of the participants who had stages 1-2 before the pandemic) participants developed locomotive syndrome and stage 3 locomotive syndrome, respectively. The multivariate logistic regression analysis indicated that a decrease in exercise was significantly associated with the onset of locomotive syndrome (all stages) (odds ratio = 2.5, p 0.001) and locomotive syndrome stage 3 (odds ratio = 2.6, p 0.001).Extrapolation of the study's findings to the entire population of Japan suggests that approximately 2 million elderly individuals might develop locomotive syndrome after the coronavirus outbreak. Additionally, 10% of the participants with mild-moderate locomotive syndrome before the pandemic may develop severe locomotive syndrome after the outbreak. The greatest risk factor for new-onset or worsening locomotive syndrome was a decrease in daily exercise. Thus, there is an urgent need for adequate exercise guidelines during the coronavirus pandemic, especially for the elderly population.

Background: Osteochondral autograft transplantation (OAT) for capitellar osteochondritis dissecans (OCD) requires harvesting of tissue from the asymptomatic knee joint. However, donor site morbidity (DSM) in such cases remains unclear. Purpose: To evaluate DSM and postoperative radiographic findings in patients undergoing OAT for advanced capitellar OCD. Study Design: Case series; Level of evidence, 4. Methods: Eighty-six juvenile athletes underwent OAT for advanced capitellar OCD. The 2000 International Knee Documentation Committee subjective score, rate of return to sports, and symptoms in the donor knee were assessed at a mean follow-up of 86 months (range, 28-185 months). Additionally, 49 of the 86 patients were assessed by radiographic and magnetic resonance imaging (MRI) findings of the knee donor site. DSM was defined according to the usual criterion (persistent symptoms for >1 year or the need for subsequent intervention) and a stricter criterion (the presence of any symptoms, such as effusion, patellofemoral complaints, crepitation, unspecified disturbance, stiffness, pain/instability during activities, and osteoarthritic change). The stricter criterion was also used to allocate patients into a DSM group and a no-DSM group. Results: Two and 11 patients were determined to have DSM according to the usual and stricter criteria, respectively. All patients returned to the competitive level of their sports. The mean International Knee Documentation Committee score was 99.0. MRI findings showed abnormal signal intensity in 17 patients (35%) and hypertrophic changes in 11 patients (22%) at the donor harvest sites. The MOCART (magnetic resonance observation of cartilage repair tissue) score was higher in the no-DSM group (mean, 68.2) than in the DSM group (mean, 52.9) ( P = .027). Conclusion: OAT for juvenile athletes with advanced capitellar OCD provided good clinical outcomes. The DSM rate was relatively low (2.3%) with the usual criterion but high (12.8%) with the stricter criterion. MRI showed an abnormal signal intensity and hypertrophy in some cases.