To describe the patient-reported clinical outcomes following medial meniscus root repair with meniscus centralization and to identify common complications and detail provisional results.
Patients ...undergoing medial meniscus root repair with meniscus centralization from 2020 to 2022 were identified using an institutional database. Patients were followed prospectively using postoperative Tegner Activity Scale, visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, International Knee Documentation Committee score, and a Likert score for improvement, surgery satisfaction, and subsequent surgeries at minimum 1-year follow-up with mean 2-year follow-up. Demographics, injury characteristics, and surgical details were also collected.
Twenty-five patients (age: 50 ± 11 years; sex: 76% female; body mass index: 33 ± 8) were included in this study. Postoperative Tegner score was maintained at preoperative levels (P = .233), and VAS at rest, VAS with use, Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, and International Knee Documentation Committee improved significantly postoperatively (P = .003; P < .001, P < .001, P = .023, respectively). Eighty-eight percent of patients reported subjective improvement in their knee at final follow-up. Postoperative radiographs did not show any significant osteoarthritis progression, and no patients had undergone a revision meniscus surgery or total knee arthroplasty at the time of follow-up.
At minimum 1-year follow-up and mean 2-year follow-up, patients undergoing medial meniscus root repair with meniscus centralization demonstrated significant postoperative improvements in pain, function, and quality of life and reported high rates of surgery satisfaction. There was no evidence of significant arthritic progression on postoperative imaging, and no patients underwent revision meniscus surgery or total knee arthroplasty.
Level IV, case series.
To describe the clinical history of a series of primary, lateral patellar dislocations and determine long-term predictors of recurrent instability while accounting for patients undergoing early ...operative management.
A large geographic database of more than 500,000 patients was used to identify patients who sustained a first-time lateral patellar dislocation between 1990 and 2010. Charts were individually reviewed to document demographics, radiographic measures including tibial tubercle to trochlear groove distance (TT-TG) and patellar length (PL), recurrent episodes of instability, and patellar stabilization surgery. A risk score that accounted for early surgical management was calculated using Fine and Gray competing risk regression, and its ability to stratify patients was examined using cumulative incidence curves.
Eighty-one patients (mean age 19.9 ± 9.4 years, 38 male, 43 female) were identified and followed for a mean of 10.1 years (range 4.1-20.2). Thirty-eight patients (46.9%) experienced an episode of recurrent instability and 30 (37.0%) underwent patellar stabilization surgery, including 7 who did so before recurrent dislocation. A multivariate, statistically derived scoring system, the Recurrent Instability of the Patella Score (RIP Score), that employed age, skeletal maturity, trochlear dysplasia, and TT-TG/PL ratio to predict recurrent instability while accounting for patients managed surgically, was generated. The resulting RIP score stratified patients into low-, intermediate-, and high-risk categories, with 0.0%, 30.6%, and 79.2% 10-year recurrent instability rates, respectively (P = .000004), and an area under the curve of 0.875 (P = .00002).
Patients who sustain a first-time, lateral patellar dislocation can be readily classified into low-, intermediate-, and high-risk categories employing the RIP score based on age, skeletal maturity, trochlear dysplasia, and TT-TG/PL ratio. This long-term risk stratification holds significant potential clinical utility for determination of patients who are at high risk for recurrent instability after primary patellar dislocation.
Level III, retrospective comparative study.
Purpose
Medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy are commonly used to treat recurrent lateral patellar instability, yet there are limited available data on ...return to sport (RTS) following these procedures. The purpose of this study is to evaluate patient factors associated with excellent functional outcomes, including successful RTS, following surgical stabilization including MPFL reconstruction in competitive athletes with recurrent lateral patellar instability.
Methods
Athletes undergoing primary MPFL reconstruction for recurrent lateral instability from 2005 to 2013 were identified at a single institution. Concomitant procedures, such as tibial tubercle osteotomy (TTO), were included. Patient demographic information, including BMI, gender, age, and pre-injury Tegner score, was recorded. In addition, radiographs were reviewed for pre-operative patellar height (Caton–Deschamps index) and trochlear dysplasia (Dejour classification). All patients underwent a standardized rehabilitation/post-operative protocol, with isokinetic strength and functional testing being performed at 6 months post-operatively. Final Tegner scores, RTS status, subjective instability ratings, and Kujala scores were collected at a minimum of 2 years. Chi-squared analysis for categorical variables and Wilcoxon rank-sum analysis for continuous variables were used to determine the relationship between the previously mentioned patient and knee characteristics with isokinetic data, RTS status, or Kujala scores.
Results
Thirty-nine athletes (23 male, 16 female) at a mean age of 17.5 ± 2.9 years (range, 13–26) underwent primary MPFL reconstruction (32 autografts, seven allografts) for recurrent patellar instability with a mean follow-up of 47.0 ± 16.4 months. Sixteen patients (41%) underwent concomitant tibial tubercle osteotomies. Isokinetic data collected at 6 months post-operatively demonstrated mean knee flexion and extension strength deficits of 15.8 ± 10.1% and 21.4 ± 14.3%, respectively, compared to the contralateral leg (
p
< 0.001 for both). Patients who underwent concomitant tibial tubercle osteotomy (
p
= 0.04), males (
p
= 0.01) and those with patella alta (
p
= 0.04) had weaker 6-month isokinetic testing. Thirty-three of the thirty-nine (85%) athletes were able to RTS at a mean of 8.1 ± 3.9 months. Patients undergoing MPFL with concomitant TTO (
p
= 0.02) returned to sport at a slower rate. One patient (3%) reported an episode of recurrent dislocation requiring revision surgery. Kujala and Tegner scores at final follow-up were 91.1 ± 6.3 and 6 (range, 4–9), respectively.
Conclusion
Surgical stabilization including MFPL reconstruction for recurrent lateral patellar instability is an effective procedure for returning athletes to competitive sports. However, strength deficits persist at 6 months after surgery, especially in those undergoing concomitant TTO, which may delay return to sport. Physicians can use these results to counsel patients that return to competitive sports is safe with good clinical outcomes and low rate of recurrence at 4-year follow-up; however, predisposing factors, like a lateralized tibial tubercle, should be addressed if necessary, but athletes should be counselled that a slower recovery and longer return to sport time may be expected.
Level of evidence
IV.
Background: Fresh-stored osteochondral allografts have been used successfully to resurface large chondral and osteochondral defects of the knee. However, there are limited data available for the ...return to athletic activity.
Purpose: To review the rate of return to athletic activity after osteochondral allograft transplantation in the knee and to identify any potential risk factors for not returning to sport.
Study Design: Case series; Level of evidence, 4.
Methods: Forty-three athletes were treated with fresh-stored osteochondral allograft transplantation for symptomatic large chondral or osteochondral defects of the knee from 2000 to 2010. The average age of the athletes (30 men, 13 women) was 32.9 years (range, 18-49 years). Patients were prospectively evaluated by International Knee Documentation Committee (IKDC), activities of daily living scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, and Cincinnati Sports Activity Scale scores. A multivariable regression analysis was performed to identify potential risk factors for failure to return to sport at the preinjury level.
Results: At an average 2.5-year follow-up, limited return to sport was possible in 38 of 43 athletes (88%), with full return to the preinjury level achieved in 34 of 43 athletes (79%). In these 34 athletes, time to return to sport was 9.6 ± 3.0 months. Age ≥25 years (P = .04) and preoperative duration of symptoms greater than 12 months (odds ratio, 37; P = .003) negatively affected the ability to return to sport. In the athletes who returned to their previous level of competition, IKDC (P < .001), KOOS (P = .02), and Marx Activity Rating Scale (P < .001) scores were all significantly greater than in those athletes who did not return to sport.
Conclusion: Osteochondral allograft transplantation in an athletic population for chondral and osteochondral defects in the knee allows for a high rate of return to sport. Risk factors for not returning to sport included age ≥25 years and preoperative duration of symptoms ≥12 months.
Context:
Articular cartilage injuries are common in patients presenting to surgeons with primary complaints of knee pain or mechanical symptoms. Treatment options include comprehensive nonoperative ...management, palliative surgery, joint preservation operations, and arthroplasty.
Evidence Acquisition:
A MEDLINE search on articular cartilage restoration techniques of the knee was conducted to identify outcome studies published from 1993 to 2013. Special emphasis was given to Level 1 and 2 published studies.
Study Design:
Clinical review.
Level of Evidence:
Level 3.
Results:
Current surgical options with documented outcomes in treating chondral injuries in the knee include the following: microfracture, osteochondral autograft transfer, osteochondral allograft transplant, and autologous chondrocyte transplantation. Generally, results are favorable regarding patient satisfaction and return to sport when proper treatment algorithms and surgical techniques are followed, with 52% to 96% of patients demonstrating good to excellent clinical outcomes and 66% to 91% returning to sport at preinjury levels.
Conclusion:
Clinical, functional, and radiographic outcomes may be improved in the majority of patients with articular cartilage restoration surgery; however, some patients may not fully return to their preinjury activity levels postoperatively. In active and athletic patient populations, biological techniques that restore the articular surface may be options that provide symptom relief and return patients to their prior levels of function.
Purpose
Medial meniscus posterior root tears (MMPRTs) are recognized as a source of pain and dysfunction, but treatment options remain a challenge. The purpose of the study was to determine (1) the ...efficacy of partial meniscectomy to treat MMPRTs compared to a matched group of non-operatively treated MMPRTs, and (2) risk factors for worse clinical and radiographic outcome.
Methods
This retrospective comparative study was performed to include patients with complete, isolated MMPRTs with documented clinical symptoms and were treated with arthroscopic partial meniscectomy (PMM) and a minimum 2-year follow-up. These patients were then matched by age, gender, and BMI to patients with the same diagnosis who were treated non-operatively. Clinical and radiographic outcomes were compared between the two groups. Analysis was performed to determine risk factors for worse clinical and radiographic outcome in the PMM group alone.
Results
Overall, 52 patients were included in the study. Twenty-six patients (9M:17F) with a mean age of 55 ± 9 and a mean BMI of 32.8 ± 5.3 were treated with PMM and followed for 5.5 ± 2.0 years (range 2.3–9.3 years). In the PMM group, final median Tegner score was 3, mean IKDC score was 67.8 ± 20, and more patients had grade II or higher arthritis at final follow-up than baseline (91.3 vs. 36%,
p
< 0.01). Overall, 14 of the 26 patients (54%) treated operatively progressed to total knee arthroplasty at a mean of 54.3 months. There was no significant difference in final Tegner scores, IKDC, K-L grades, progression to arthroplasty, or overall failure rate between the PMM group and non-operative group. Following PMM, female patients had lower final IKDC scores (44.0 ± 2.8 vs. 74.6 ± 16.7,
p
= 0.02) compared to males, as well as a higher rate of arthroplasty (70.6 vs. 20.0%,
p
= 0.009). Higher BMI correlated with lower IKDC scores (
r
= −0.91,
p
= 0.01) and meniscal extrusion was associated with higher rate of arthritis at final follow-up (
p
= 0.02).
Conclusion
Partial meniscectomy for a complete MMPRT provides no benefit in halting arthritic progression. Patients who undergo PMM for MMPRTs still progress to significant arthritis, poor clinical outcomes and a high arthroplasty rate (54%) at over 5-year follow-up. Female gender, increased BMI, and meniscus extrusion were associated with worse outcome.
Study design
Level III.
Background:
The rate of patellofemoral arthritis after lateral patellar dislocation is unknown.
Purpose/Hypothesis:
The purpose of this study was to compare the risk of patellofemoral arthritis and ...knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined.
Results:
At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio HR, 7.8; 95% CI, 3.9-17.6; P < .001) than individuals without a patellar dislocation. However, the risk of knee arthroplasty was similar between groups (HR, 2.8; 95% CI, 0.6-19.7; P = .2). Recurrent patellar dislocations (HR, 4.5; 95% CI, 1.6-12.6), osteochondral injury (HR, 11.3; 95% CI, 5.0-26.6), and trochlear dysplasia (HR, 3.6; 95% CI, 1.3-10.0) were associated with arthritis after patellar dislocation.
Conclusion:
Patellar dislocation is a significant risk factor for patellofemoral arthritis, as nearly half of patients have symptoms and radiographic changes consistent with arthritis at 25 years after lateral patellar dislocation. Osteochondral injury, recurrent patellar instability, and trochlear dysplasia are associated with the development of arthritis.
Purpose
Patellar dislocation can occur in isolation or be associated with chronic instability. The goals of this study are to describe the rate and factors associated with additional patellar ...instability events (ipsilateral recurrence and contralateral dislocation), as well as the development of patellofemoral arthritis in patients who are skeletally immature at the time of first patellar dislocation.
Methods
The study included a population-based cohort of 232 skeletally immature patients who experienced a first-time lateral patellar dislocation between 1990 and 2010. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. Subjects were followed for a mean of 12.1 years to determine the rate of subsequent patellar dislocation (ipsilateral recurrence or contralateral dislocation) as well as clinically significant patellofemoral arthritis.
Results
104 patients had ipsilateral recurrent patellar dislocation. The cumulative incidence of recurrent dislocation was 11% at 1 year, 21.1% at 2 years, 37.0% at 5 years, 45.1% at 10 years, 54.0% at 15 years, and 54.0% at 20 years. Patella alta (HR 10.6, 95% CI 3.6, 36.1), TT-TG ≥ 20 mm (HR 18.7, 95% CI 1.7, 228.2), and trochlear dysplasia (HR 23.7, 95% CI 1.0, 105.2) were associated with recurrence. Similarly, 18 patients (7.8%) had contralateral patellar dislocation. The cumulative incidence of patellofemoral arthritis was 0% at 2 years, 1.0% at 5 years, 2.0% at 10 years, 10.1% at 15 years, 17% at 20 years, and 39.0% at 25 years. Osteochondral injury was associated with arthritis (HR 25.7, 95% CI 6.2, 143.8). There was no association with trochler dysplasia (HR 1.2, 95% CI 0.2, 5.0), recurrent patellar instability (HR 1.2, 95% CI 0.2, 7.2), gender (HR 1.3, 95% CI 0.3, 5.6), or patellar-stabilizing surgery (HR 0.7, 95% CI 0.2, 3.5) and arthritis.
Conclusion
Skeletally immature patients had a high rate of recurrent patellar instability that was associated with structural abnormalities such as patella alta,TT-TG ≥ 20 mm, and trochlear dysplasia. Approximately 10% of patients experienced a contralateral dislocation and 20% of patients developed arthritis by 20 years following initial dislocation. Osteochondral injury was associated with arthritis.
Level of evidence
Retrospective case series, Level IV.
Abstract Patient satisfaction following hip arthroscopy is currently underreported and lacks uniformity when published. While current patient reported outcomes are important, they may not reflect ...overall patient satisfaction because it is complex and multifactorial. However, assessment and documentation of patient satisfaction following hip arthroscopy is critical to demonstrating value and quality. Therefore, it is of pressing importance that the hip arthroscopy community develops an accurate score that is consistent, valid, and reliable.
Purpose
The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. ...The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection.
Methods
The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model.
Results
Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (
P
< 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection,
P
< 0.001).
Conclusion
Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates.
Level of evidence
III.
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