25-year trends in anterior cruciate ligament reconstruction: results from the biennial ACL Study Group survey from 1998 to 2023.

Traumatic meniscus tears requiring repair at the time of surgery are a marker of poorer outcome following Tibial plateau fracture at medium term follow up.

Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis: national utilization patterns and 2-year postoperative outcomes.

To evaluate the failure rates of all-inside meniscal repair based on tear morphology in stable knees (i.e., without concomitant anterior cruciate ligament reconstruction [ACLR]) and to assess the influence of failure. This retrospective cohort study included 1008 patients who underwent arthroscopic all-inside meniscal repair between 2015 and 2022 at Capio Artro Clinic, Stockholm, Sweden. Inclusion criteria were isolated medial or lateral meniscal repair with clearly documented tear morphology. Tears were categorised as longitudinal (LT), bucket-handle (BH), undersurface (US), radial (RT), horizontal (HT) or discoid (DT). The primary outcome was repair failure, defined as reoperation with partial or total meniscectomy within three years. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to identify factors associated with failure. The overall failure rate was 29.4% (296/1,008). Medial meniscus repairs demonstrated a significantly higher failure rate compared with lateral repairs (37.0% vs. 18.3%, p < 0.001). Among medial tears, LT had the highest failure rate (39.8%), followed by BH tears (35.5%) and unstable simple US tears (34.3%). In contrast, lateral LT and BH tears showed substantially lower failure rates (16.7% and 19.3%, respectively). Cox regression analysis identified medial meniscus repair as an independent risk factor for failure (hazard ratio 2.33, 95% confidence interval 1.78-3.05, p < 0.001), whereas tear type, age >30 years, and female sex were not independently associated with failure. Medial meniscus repairs in stable knees were associated with more than twice the hazard of failure compared with lateral repairs and the only significant predictor of failure. Tear morphology did not independently affect outcomes, highlighting meniscal laterality as the key factor influencing repair survival. Level III.

RAMP lesions are common meniscal injuries associated with anterior cruciate ligament (ACL) tears, and growing interest has focused on their impact on functional outcomes following surgical repair. This study evaluated the short-term effects of surgical repair of RAMP lesions in terms of balance, fall risk, and knee function scores in patients who have undergone anterior cruciate ligament reconstruction (ACLR). Seven patients who underwent RAMP lesion repair in addition to ACLR were included in the study. Balance parameters (OSI, Overall Stability Index; APSI, Anterior Posterior Stability Index; MLSI, Medial Lateral Stability Index) and fall risk (FRI, Fall Risk Index) were assessed using the Biodex Balance System, while knee function was evaluated using the Tegner Activity Level and Lysholm Knee Score preoperatively and at the 6th postoperative week. Six of the patients were male, one was female, and the mean age was 26.8 years (18-35). All followed the same postoperative rehabilitation protocol. OSI decreased from 0.48 (0.1-1.1) to 0.17 (0.1-0.3), APSI from 0.28 (0-0.5) to 0.11 (0.1-0.2), MLSI from 0.22 (0.1-0.5) to 0.12 (0.1-0.3), and FRI from 0.7 (0.4-1.3) to 0.48 (0.2-0.8) (all p < 0.05). Tegner score increased from 2.14 (0-4) to 4.14 (3-5), and Lysholm score from 48.85 (25-80) to 78.14 (64-95) (both p < 0.05). RAMP lesion repair was associated with significant improvements in postural stability during the early postoperative period, reduced fall risk, and improved knee function scores following ACLR.

ABSTRACT The study evaluated the effectiveness of different rehabilitation methods for young volleyball players aged 15–20 following knee arthroscopy for internal meniscus repair. The study, conducted in Moscow from March to September 2025, included 20 participants who were divided into two groups: one group received standard physiotherapy and exercise (Group A), and the other group received the same treatment plus massage therapy (Group B). Assessments were conducted three to four weeks post-surgery, focusing on knee flexion, extension, and pain levels measured using the Numerical Rating Scale (NRS). Significant differences were observed in knee extension as well, with Group A improving from 20 to 39 degrees, while Group B increased from 30 to 42 degrees. The results indicated P-values of 0.03 for flexion and 0.02 for extension, indicating the positive impact of incorporating massage therapy in the rehabilitation programme. The results also demonstrated a significant difference in pain intensity between the two groups (p = 0.01), highlighting the effectiveness of incorporating massage therapy in reducing early post-operative pain in young volleyball players following meniscus suture repair. Overall, the study revealed the importance of comprehensive rehabilitation strategies for enhancing recovery in young athletes post-surgery.

Meniscal repair is preferred over meniscectomy to preserve joint function, but failure leading to reoperation remains a concern, affecting both patient outcomes and healthcare resources. The purpose of this study was to determine the 5-year incidence of reoperation after meniscal repair in a large population-based cohort and to identify risk factors associated with failure. A total of 2390 meniscal repairs performed between 2010 and 2022 in the Central Denmark Region (six public hospitals) were analysed. Reoperation was defined as revision repair or meniscectomy on the same meniscus. Kaplan-Meier survival analysis was used to estimate cumulative reoperation risk. Independent risk factors were assessed using multivariable Cox regression including age, sex, body mass index (BMI), smoking status, meniscus laterality, time from injury to surgery, number of sutures, and concomitant anterior cruciate ligament (ACL) reconstruction. The 5-year cumulative reoperation risk was 32.7% (95% confidence interval [CI], 30.6-34.7). Risk of reoperation was not associated with age, sex, BMI, or injury chronicity. Smoking showed a trend towards increased risk (hazard ratio [HR] 1.19, 95% CI 0.99-1.43). Medial meniscus repairs had higher risk than lateral repairs (35.8% vs. 21.2%, p < 0.001). Concurrent ACL reconstruction was protective (HR 0.52, 95% CI 0.45-0.60). In this large, population-based cohort, including 2390 repairs, the 5-year reoperation risk after meniscal repair was 32.7%. Age, BMI, and injury chronicity were not predictive of failure. Smoking and medial meniscus repair increased risk, while concomitant ACL reconstruction was protective. These findings support broader indications for meniscal preservation and underscore the importance of realistic preoperative counselling of patients. Level III.

Effective post-operative pain management remains a challenge in the pediatric population, and opioids continue to be the mainstay of peri-operative pain management. There is limited literature on opioid prescription patterns and patient and surgical factors that affect postoperative pain in pediatric patients who undergo arthroscopic knee surgery. The objectives of this study were to perform a quantitative evaluation of peri-operative opioid administration and prescription patterns following arthroscopic knee surgery in the pediatric population and identify patient and surgical factors that affect postoperative pain control in the studied population. A retrospective chart review of patients aged 8 to 20 having undergone arthroscopic knee surgery for either meniscal repair and/or anterior cruciate ligament reconstruction over a 48-month period was conducted. Demographic data, discharge prescriptions, surgical information, and pain scores were collected. Patients/parents were called 48 hours post-operatively and asked whether their pain control was adequate or inadequate with the prescribed regimen. Patients were then separated into two groups for the statistical analysis, with the two groups being adequate pain control (pain controlled) or inadequate pain control (pain uncontrolled). One hundred and fifty-two patients (50 male) were available for phone follow-up 48 hours post-operatively and were included in the study. One hundred and twenty-three patients described their pain as controlled (PC), and 29 patients described their pain as uncontrolled (PU). Patients who described their pain as uncontrolled (PU group) were on average younger (p-value = 0.038) and lighter (p-value = 0.010) than the group who reported adequate pain control at follow-up (Table 1). There was no significant difference between the groups in opioid prescription dose at discharge (p-value = 0.065). Gender, tourniquet use, multimodal analgesia, and regional anesthesia did not significantly affect post-operative pain control at 48-hour follow-up. Isolated ACL procedures had the highest percentage of patients reporting adequate pain control at follow-up (88.9%) compared to isolated meniscus (71.4%) and concomitant ACL and meniscus procedures (78.3%) (p-value = 0.303) (Figure 1). In this study, exit opioid prescriptions (mg/dose) did not differ significantly based on age, weight, or surgery type. Identifying the factors that affect postoperative pain control in the pediatric population is essential to establish effective and evidence-based guidelines for opioid prescriptions. Patients may be receiving generic postoperative opioid prescriptions instead of prescriptions individualized to the patient. Higher doses of opioids following surgery were not associated with improved postoperative pain management. Postoperative opioid prescriptions should be tailored to individual patients and procedure types to optimize the dose of opioids prescribed to every patient. Further prospective research is warranted into multimodal pain management strategies targeting better postoperative pain control and decreased opioid use. For any figures or tables, please contact the authors directly.

To determine the proportion of patients and the factors associated with the achievement of a patient-acceptable symptom state (PASS) 5 years after primary anterior cruciate ligament reconstruction (ACLR). Patients who underwent primary ACLR between 2005 and 2018 at Capio Artro Clinic, Stockholm, Sweden, were eligible for inclusion. The primary outcome was the achievement of a PASS on each Knee injury and Osteoarthritis Outcome Score (KOOS) subscale at the 5-year follow-up. Multivariable logistic regression analyses were used to assess associations with age, sex, time from injury to surgery, pre-injury Tegner activity level, graft type, cartilage injury, meniscal resection or repair, and symmetrical 6-month limb symmetry index (LSI ≥ 90%) in isokinetic extension and flexion strength and single-leg-hop performance. A total of 2663 patients were analysed. The proportion of patients achieving a PASS varied between the KOOS subscales as follows: Pain 64.8%; Symptoms 93.8%; Activities of Daily Living (ADL) 49.1%; Sport and Recreation (Sport&Rec) 65.4% and Quality of Life (QoL) 73.5%. Age ≥30 years was positively associated with PASS across all subscales. Female sex reduced the odds of achieving a PASS on the Pain (OR 0.80; 95% confidence interval [CI] 0.65-0.99; p = 0.04), Symptoms (OR 0.57; 95% CI 0.36-0.90; p = 0.02) and Sport&Rec (OR 0.73; CI 95% 0.59-0.90; p = 0.004) subscales. A surgical delay of ≥3 months was negatively associated with the achievement of a PASS on the QoL (OR 0.71; 95% CI 0.51-0.99; p = 0.04) subscale. Medial meniscus (MM) repair reduced the odds of achieving a PASS on the Sport&Rec (OR 0.61; 95% CI 0.41-0.92; p = 0.02) and QoL (OR 0.56; 95% CI 0.37-0.86; p = 0.01) subscales. Hamstring tendon (HT) autograft rather than bone-patellar-tendon-bone autograft had increased odds of achieving a PASS on the Sport&Rec (OR 2.13; 95% CI 1.31-3.47; p = 0.002) subscale. Achieving a LSI ≥ 90% in isokinetic extension strength was associated with a PASS on ADL (OR 1.01; 95% CI 1.00-1.02; p = 0.02) and QoL (OR 1.01; 95% CI 1.00-1.02; p = 0.02) subscales, whereas an LSI ≥ 90% in single-leg-hop test was associated with a PASS on the Symptoms (OR 1.03; 95% CI 1.01-1.05; p < 0.001), ADL (OR 1.01; 95% CI 1.00-1.02; p = 0.02), Sport&Rec (OR 1.01; 95% CI 1.01-1.02; p = .003), and QoL (OR 1.01; 95% CI 1.00-1.02; p = 0.01) subscales. The achievement of a PASS was over 64% on at least four out of five KOOS subscales 5 years after ACLR. Older age (≥ 30 years) was consistently associated with higher odds of achieving a PASS, while female sex was associated with lower odds. MM repair was associated with reduced odds of achieving a PASS on the Sport&Rec subscale, whereas the use of HT grafts was associated with higher odds on the same subscale. Symmetrical isokinetic extension strength and single-leg-hop test performance at 6 months were associated with higher odds of achieving a PASS; however, the effect sizes were small, suggesting limited clinical relevance. Level III.

To assess the safety, effectiveness, and postoperative outcomes of medial collateral ligament (MCL) pie-crusting (PC) in arthroscopic meniscus surgery. This systematic review was conducted in accordance with PRISMA guidelines. Three databases (PubMed, EMBASE and MEDLINE) were searched from inception to 21 January 2025, for studies evaluating the use of MCL PC during arthroscopic meniscus or anterior cruciate ligament (ACL) surgery. Data on patient demographics, medial joint space measurements, postoperative instability, patient reported outcome measures (PROMs), and complications were extracted. Fifteen studies comprising 1009 patients were included, with 723 undergoing PC. PC significantly increased medial joint space width by a mean of 5.7 mm intraoperatively (p < 0.05), with no residual laxity reported at mean final follow-up of 16.5 months. The most common complications of PC were transient medial knee pain (12.7%) and ecchymosis (12.9%). There were five reports of saphenous nerve irritation (0.8%), all resolved by final follow-up of 31.6 months. In contrast, iatrogenic chondral injury was reported in 9.0% of patients undergoing meniscal repair without PC. MCL PC is a safe and effective technique to improve visualisation and outcomes in arthroscopic meniscus surgery. It is associated with improved joint access and low complication rates without long-term instability. While current evidence supports its use, further high-quality, long-term comparative studies are needed to validate its safety and efficacy, as this study primarily used retrospective data without long-term follow-up. Level IV.

Background:Multiligament knee injuries (MLKIs) are traumatic, limb-threatening injuries requiring surgical reconstruction, of which Schenck classification for knee dislocation (KD) 3 and 4 MLKIs are the most serious. Arthrofibrosis is a common complication of multiligament knee reconstruction (MLKR).Purpose:This study sought to identify risk factors for arthrofibrosis in Schenck KD 3 and 4 MLKI patients.Study Design:Case-control study; Level of evidence, 3.Methods:Patients with Schenck KD 3 or 4 MLKI who underwent MLKR with a single surgeon were identified retrospectively. Patient sociodemographics, injury characteristics, operative details, and postoperative courses were collected. Patients were divided into groups based on development of postoperative arthrofibrosis, defined as failure to reach a range of motion of 0° to 90° or extensor lag ≥10° by 6 weeks or as undergoing manipulation under anesthesia with or without lysis of adhesions. Univariate and chi-square analyses were used to identify associations with arthrofibrosis, and logistic regression was used to confirm risk factors. Statistical significance was defined as P < .05.Results:A total of 71 patients with a mean age of 31.5 ± 10.6 and mean follow-up time of 25.1 months were included. Of this total, 23 (32.4%) developed arthrofibrosis postoperatively. Characteristics and variables associated with arthrofibrosis were younger age (28.0 ± 10.4 vs 33.5 ± 10.4 years; P = .04), higher median household income by zip code ($107,066 ± $40,536 vs $83,911 ± $28,530; P = .007), worse preoperative flexion (98.1°± 30.5° vs 120.6°± 22.1°; P = .002), quicker time from injury to surgery (81.6 ± 74.2 days vs 232.5 ± 307.3 days; P = .03), and significantly longer time to return to weightbearing as tolerated (12.0 ± 9.0 weeks vs 7.0 ± 3.4 weeks; P = .005). There were no differences in race, sex, body mass index, insurance type, preoperative extension, use of external fixation, mechanism of injury, or concomitant meniscal repair (P > .05). Logistic regression identified younger age, preoperative flexion, and time to weightbear as risk factors for arthrofibrosis (P = .004, .014, .019, respectively).Conclusion:A third of MLKI KD 3 and 4 patients who underwent reconstruction developed arthrofibrosis. Younger patients, those with worse preoperative flexion, and those who take longer to return to weightbearing as tolerated are at risk of arthrofibrosis. Time to weightbearing and preoperative flexion may be modifiable by prehabilitation or manipulation under anesthesia at earlier stages.

To determine whether chondroplasty for isolated medial patellar facet lesions produces similar clinical outcomes compared to patients without patellofemoral cartilage lesions in the setting of medial patellofemoral ligament (MPFL) reconstruction for patellar instability. We retrospectively identified patients who underwent MPFL reconstruction with or without tibial tubercle osteotomy (TTO) from 2015 to 2020 with minimum 2-year follow-up. Operative reports detailed patellofemoral articular surfaces and Outerbridge grade. Exclusion criteria were: prior knee surgery, multiple lesions, concomitant cartilage repair, trochleoplasty, or meniscus repair. Patients with isolated medial facet lesions (case) were propensity matched to patients without patellofemoral cartilage injury (control) by age, sex, BMI, and concomitant TTO. Clinical outcomes were evaluated using the Kujala score, Tegner activity scale, and the Visual Analog Score (VAS) for pain. Of 79 eligible patients, 59 (74.7%) completed all surveys, and 40 patients (8 M and 32 F) were matched 1:1 with mean 4.1-year (range: 2.1-8.5) follow-up, including 20 patients with medial facet lesions (5 grade II, 6 grade III, and 9 grade IV). There were no significant differences between groups with respect to Kujala score (85.2 vs 84.6, p=0.906), Tegner (5.7±2.6 vs 4.9±3.0, p=0.924), or VAS pain score (12.4±20.1 vs 16.5±23.9, p=0.718). Chondral lesion size at the index procedure was not significantly correlated with pain (R=-0.06, p=0.816) or Kujala score (R=-0.67, p=0.779). Chondroplasty for isolated medial patellar facet lesions led to similar clinical outcomes to patients with intact patellofemoral articular cartilage at a minimum of 2years following MPFL reconstruction. These findings support conservative management of isolated medial facet lesions without need for cartilage restoration procedures. Retrospective comparative cohort study.

Comparison of the healing rate with meniscal repair concomitant with anterior cruciate ligament reconstruction and isolated meniscal repair based on magnetic resonance imaging signal intensity

Cyclops syndrome is a common yet poorly understood complication after anterior cruciate ligament (ACL) reconstruction (ACLR), resulting in loss of knee extension that sometimes requires revision surgery for debridement. Limited agreement in the literature exists on the risk profile of patients who develop cyclops syndrome. The purpose was to define a risk profile indicating which individuals are predisposed to reoperation for cyclops syndrome after primary ACLR. It was hypothesized that high posterior tibial slope (PTS), narrow notch, large grafts, and higher grades of remnant preservation would be associated with reoperation for cyclops syndrome. Case-control study; Level of evidence, 4. Primary ACLRs performed by academic sports medicine surgeons at a single large integrated health care network between 2014 and 2021 were included. Variables including patient characteristics, knee hyperextension, instability grade, graft type and diameter, meniscal procedures, femoral notch width, ACL remnant preservation, graft/tissue impingement, tunnel position, and PTS were collected. Univariate analyses and multiple regression were performed to identify risk factors associated with reoperation for cyclops syndrome within 24 months after ACLR. A total of 1163 consecutive primary ACLRs were included (mean age, 24.9 years). The overall rate of reoperation for cyclops syndrome was 5.5%. No statistically significant differences in rates of reoperation for cyclops syndrome were identified based on surgical timing, graft type, graft diameter, or meniscal repair. Additionally, ACL remnant grade, excessive graft anterior tissue coverage, and tibial tunnel position were not associated with the development of symptomatic cyclops syndrome. On univariate analyses, contralateral knee hyperextension (P = .04) and increased PTS >12° (P = .004) were found to be potential risk factors for cyclops syndrome. After controlling for PTS, narrow femoral notch, and femoral tunnel placement, stepwise subset multiple regression analysis (n = 351) identified knee hyperextension as an independent predictor of reoperation for cyclops syndrome (OR, 2.40; P = .049). After controlling PTS, narrow femoral notch, and proximal femoral tunnel placement, contralateral knee hyperextension was found to be an independent predictor for reoperation for cyclops syndrome necessitating surgical debridement after primary ACLR. Surgical delay, graft type, graft diameter, meniscal repair, remnant preservation, or excessive anterior graft tissue were not found to be associated with reoperation for cyclops syndrome.

To describe the nationwide population of anterior cruciate ligament (ACL) injured patients initially managed non-operatively, quantify the proportion undergoing delayed ACL reconstruction (ACLR) and describe both intraoperative findings and patient-reported outcomes. Primary ACL injuries treated non-operatively were prospectively registered in the Norwegian Knee Ligament Register (2017-2023). We collected baseline characteristics, injury details, surgical details if delayed ACLR was performed and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score, KOOS). Treatment survival was analysed with Kaplan-Meier curves, and factors associated with ACLR were assessed with Cox regression. Of 485 patients included (mean age at injury (SD) 35 (12), 25%<25 years), 93% (n=452) were physically active in sports preinjury. At 2 years, 63% remained non-operatively treated. Of the delayed ACLR patients (n=178), 56% underwent concurrent meniscal repair, and 18% partial resection. Instability was the main reason for ACLR (85%). Patients younger than 25 years, those active in pivoting sports preinjury and those with meniscal injuries at baseline were more likely to undergo delayed ACLR (HR (95% CI) 1.95 (1.2 to 3.2), 1.54 (1.1 to 2.2) and 1.63 (1.2 to 2.2), respectively. Both non-operative and delayed ACLR patients showed moderate impairment on KOOS Sport/Recreation and Quality of Life subscales at 2-year follow-up (mean scores 69.8 vs 61.0 and 68.6 vs 63.4), with no statistically significant between-group differences. In this active population of ACL injured patients treated non-operatively, two-thirds remained non-operatively treated at 2 years. Younger patients, those engaged in pivoting sports preinjury and those with baseline meniscal injuries had higher risks of undergoing delayed ACLR. KOOS scores were similar between non-operative and delayed ACLR patients.

BackgroundWhile the all-inside (AI) technique is widely preferred for its simplicity and efficiency, the outside-in (OI) method is less commonly used. Despite both techniques being effective, direct comparisons of their functional outcomes are limited. This study aims to compare the clinical efficacy of OI and AI repair techniques for zone-3 and zone-4 medial meniscus tears, emphasizing outcomes based on the Minimal Clinically Important Difference (MCID).We hypothesized that there would be no significant difference in outcomes between the two techniques.MethodsA retrospective cohort study was conducted on 93 patients (mean age: 37.6 ± 11.8 years) with isolated zone-3 or zone-4 medial meniscus tears treated between 2020 and 2023. Patients were divided into two groups: OI (n = 63) and AI (n = 30), with all surgeries performed by two experienced orthopedic surgeons. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner-Lysholm Knee Scoring Scale (TLKS) at a minimum follow-up of 6 months. The MCID was calculated using the 0.5 standard deviation method. Statistical analyses included ANCOVA to adjust for age-related differences, with significance set at p < 0.05.ResultsBoth OI and AI techniques resulted in significant improvements in IKDC, KOOS, and TLKS scores, surpassing MCID thresholds for all measures (p < 0.001). No significant differences were observed between the two groups in terms of functional outcomes (p > 0.05). The OI group utilized significantly fewer sutures (median: 1 [1–4] vs. 2 [1–7]; p < 0.001) and had a higher, though not statistically significant, complication rate (11% vs. 0%; p = 0.092). All complications were observed in the OI group, including saphenous nerve palsy and septic arthritis.ConclusionBoth outside-in and all-inside techniques offer comparable clinical improvements in the repair of zone-3 and zone-4 medial meniscus tears, achieving success defined by MCID thresholds. The outside-in group used fewer sutures and exhibited a slightly higher complication rate, although this difference was not statistically significant. These findings support similar clinical outcomes for both techniques and may help guide surgical decision-making based on individual cases and surgeon experience.

Donor-recipient sex mismatch for tissue and organ transplantation has been shown to negatively affect outcomes. To analyze the effect of sex mismatching on outcomes after meniscal allograft transplantation (MAT) and to determine if there is an association between the sex of the recipient and the sex of the donor and how this affects clinically significant outcome (CSO), reoperation, and failure rates after primary MAT. Case series; Level of evidence, 4. Between 2003 and 2022, patients who underwent MAT were prospectively followed, with the inclusion criteria of having undergone primary MAT and having a minimum of 2 years' follow-up. Patient characteristics and clinical data, as well as donor age, donor sex, and graft expiration date, were collected. Reoperation and failure data were also collected, and patients were evaluated for achieving CSOs for the International Knee Documentation Committee (IKDC) score. A reoperation was any surgical intervention involving the transplanted allograft, including second-look arthroscopic surgery in the setting of recurrent symptoms or functional deficits, meniscectomy, and meniscal repair. Failure was defined as revision MAT and unicompartmental or total knee arthroplasty. Survivorship was assessed with a Kaplan-Meier curve. Log-rank testing evaluated survivorship between groups. A total of 245 patients met the inclusion criteria and were followed for a mean of 8.4 ± 4.2 years (range, 2.0-19.1 years). Isolated MAT was performed in 73 of 247 knees (30%). There was a significantly greater prevalence of female knees (89/129 [69%]) than male knees (10/118 [9%]) that received a graft from the opposite sex (P < .001). On average, graft recipients were younger in the mismatch group than in the nonmismatch group (25.4 ± 8.5 vs 28.6 ± 8.8 years, respectively; P = .004). No donor variables were predictive of achieving CSOs for the IKDC score at 5 years. No difference in rates of survivorship from reoperations or failure was observed. Donor variables, including sex, age, and donor-recipient sex mismatch, did not negatively affect clinical outcomes. These findings suggest that sex matching is not necessary for graft selection, potentially increasing the availability of allografts and facilitating MAT in the setting of limited donor availability.

Allergic diseases are common in children and are risk factors for infections following orthopaedic surgery. However, their association with infection risk following knee surgery in pediatric populations is unknown. This study compared the risks of postoperative infection in children with and without a history of allergic disease (eczema [atopic dermatitis] or asthma) who underwent common orthopaedic sports knee surgeries. A retrospective cohort study was conducted using the TriNetX database. Patients aged 10 to 18 who underwent anterior cruciate ligament (ACL) reconstruction (ACLR) or meniscal surgery, including meniscectomy, meniscal repair, and meniscal transplant, were organized into separate cohorts based on prior history of asthma or eczema and matched based on demographics and comorbidities. Outcomes were 90-day postoperative superficial soft tissue infection (SSTI), deep soft tissue infection (DSTI), sepsis, wound complication, pneumonia, urinary tract infection (UTI), and emergency department (ED) visit risks. Tests of significance (alpha=0.05) were performed, and risk ratios (RRs) with 95% confidence intervals were calculated. Patients with allergic diseases were more likely to be African American and obese. The risks of SSTI (1.3% vs. 0.4%; RR=3.182; P=0.0004) and sepsis (0.4% vs. 0%; P=0.002) in ACLR patients, and risks of SSTI (1.0% vs. 0.3%; RR=3.2; P=0.0007) and pneumonia (0.4% vs. 0%; P=0.0005) in meniscus surgery patients, were higher in patients with a history of eczema than without. Asthma was associated with a greater likelihood of SSTI (1.1% vs. 0.5%; RR=2.067; P=0.02) and sepsis (0.4% vs. 0%; P=0.002) in patients undergoing ACLR but not meniscus surgery. Prior diagnosis of either disease was associated with increased risk for ED visits following both ACLR and meniscus surgery. No significant differences in risk rates were noted between cohorts for DSTI, wound complications, and UTI. Although overall risks were low, there were significantly greater risks of SSTI and ED visits following common knee sports surgeries in pediatric patients with a history of allergic disease than in those without. Level III.

Incidence of concomitant intra- and extra-articular lesions and procedures in patients undergoing primary and subsequent revision single-stage or 2-stage revision anterior cruciate ligament reconstruction: a matched retrospective cohort study.

Background: Optimized surgical fixation and meniscal stabilization during rehabilitation increase healing success. However, the latest generation of all-inside devices has not yet been biomechanically compared with inside-out suture tape (IO-ST) repair. Hypothesis: (1) The contact area of a suture anchor (SA) would compensate for a meniscal defect better than polyether ether ketone anchors (PA); (2) adjustable tensioning for all-inside meniscal repair fixation would result in higher initial load than IO-ST repair; and (3) stiffer constructs would decrease secondary displacement. Study Design: Controlled laboratory study. Methods: This study investigates human menisci (N = 39) via microscopic imaging and a biomechanical testing protocol. For the imaging protocol, needles of an all-inside SA or PA device and an IO-ST device were inserted after staining to measure the iatrogenic defect created by the needle insertion (n = 20) and the length, width, and meniscus contact area of deployed all-inside anchors (n = 6). For biomechanical testing, menisci with longitudinal bucket handle tears were prepared, and single stitches were repaired (each n = 9). After suture tensioning (50 N) and fixation, initial load, initial stiffness, and relief displacement were measured. Constructs underwent cyclic loading between 2 and 20 N, with 10,000 cycles (0.75 Hz), and stiffness and displacement were measured. Ultimate stiffness and load-to-failure were analyzed at 3.15 mm/sec. Results: All-inside needles created greater iatrogenic meniscal defects ( P &lt; .001) than IO-ST repair. While PAs were longer ( P &lt; .001), SAs were wider with a greater meniscal contact area (both P &lt; .001). IO-ST repair resulted in the lowest initial load ( P &lt; .001) and relief displacement ( P &lt; .001), whereas SA repair resulted in a higher initial load ( P &lt; .007) and stiffness ( P &lt; .023) than PA repair. The overall stiffer SA fixation ( P &lt; 001) significantly reduced cyclic displacement compared with other repairs ( P &lt; .044). The PA group failed due to an anchor fracture at a significantly lower load (84.3 ± 10.7 N; P &lt; .001) than the IO-ST (136.4 ± 10.5 N) and the SA repair (122.1 ± 17.5 N), with a suture-based failure mode. The ultimate stiffness of SA constructs was higher ( P &lt; .045) than that of other repairs. Conclusion: While all-inside devices showed improved primary stability, the IO-ST construct demonstrated the highest load-to-failure. In a human cadaveric model, meniscal repair with a more compact and conforming SA was stiffer and reduced cyclic displacement compared with PA and IO-ST repair. Clinical Relevance: All-inside SA repair improved primary stability. Future clinical series will define the overall significance of healing rates.