Tibial sided Anterolateral Ligament Injuries are Associated with Poor Healing and Residual Pivot Shift Testing Following Anterior Cruciate Ligament Reconstruction.

PURPOSE: ; to investigate if tibial sided anterolateral ligament (ALL) injuries are associated with poor healing and residual pivot shift. METHODS: ; Patients who underwent anterior cruciate ligament reconstructions within postinjury 6 weeks from January 2008 to March 2021 were included. They had concomitant ALL injury confirmed by preoperative magnetic resonance imaging (MRI) and were followed minimum 20 months. Preoperative ALL injury was graded by the Muramatsu classification and postoperative ALL healing were graded by a modification of the Lee classification (good, partial, and non-visualized). The patients were allocated to an improved group (IG) and an unimproved group (UG) based on a comparison of pre- and postoperative MRI. ALL tear site, postoperative knee stability, Lysholm score, and Tegner activity scale (PROs) were compared between the two groups. RESULTS: ; 128 patients were enrolled. 94.5 % patients achieved the minimal clinically important difference (MCID) for PROs, respectively. The ALL was torn at the femoral side in 46.9% patients, at mid-substance in 31.2.%, and at tibial side in 21.9%, Preoperatively, 86 (67.2%) patients had a partial tear and 42 (32.8%) patients had a complete tear. Based on the postoperative MRI appearances, 38 (29.7%) and 90 (70.3%) patients were allocated to the IG and UG, respectively. The tibial side tears were significantly frequent in UG (p= .032). Pivot shift showed a significantly higher incidence in UG than IG (p=.004). Lachman test and PROs did not differ between the two groups. CONCLUSIONS: ; Tibial-sided ALL tears occurred in 18.7% of the UG compared to 3.2% of the IG, and 45.6% of the UG had a postoperative grade 1 or 2 pivot shift, compared to 15.8% of the IG. Percentages of patients with the MCID for PROs did not differ between the two groups. However, the clinical relevance is limited by a high transfer bias.

Association of Increased Lateral Femoral Condylar Ratio With Lateral Meniscus Posterior Root Tear in Noncontact ACL Injury.

Background: In the setting of anterior cruciate ligament (ACL) injury, lateral meniscus posterior root tears (LMPRTs) are less readily diagnosed on preoperative magnetic resonance imaging (MRI). Therefore, to predict LMPRTs in ACL injuries, it is necessary to understand the risk factors associated with them. Purpose/Hypothesis: The purpose of this study was to investigate the association of lateral femoral condylar ratio (LFCR) with LMPRTs in ACL injuries. It was hypothesized that an increased LFCR would be associated with LMPRTs in noncontact ACL injuries. Study Design: Cohort study; Level of evidence, 3. Methods: Enrolled were consecutive patients who underwent primary acute (<6 weeks from injury) ACL reconstruction after noncontact injury and had LMPRT confirmed on preoperative MRI and arthroscopically (combined group; n = 62) as well as patients who underwent isolated acute ACL reconstruction (isolated group; n = 80) who were matched to the combined group by age, height, and body mass index (BMI). All patients underwent surgery between January 1999 and November 2021. LFCR and posterior tibial slope (PTS) were measured and compared between the isolated and combined groups. The area under the receiver operating characteristic curve (AUC) was calculated to determine the cutoff for detecting increased risk of LMPRTs. Results: The demographic characteristics of the 2 groups did not differ significantly, nor did the PTS. The LFCR was a significant factor (odds ratio [OR], 1.23; P = .001) associated with LMPRT. Patient age, height, BMI, and PTS were not associated with LMPRT. The AUC (0.66; 95% CI, 0.57-0.75) for LFCR had a sensitivity of 39% and specificity of 90% to predict LMPRT. The calculated cutoff associated with an increased risk for LMPRT when compared with the isolated group was 67.0% (OR, 4.98; 95% CI, 2.10-11.79). Conclusion: Increased LFCR was associated with the presence of LMPRTs in patients with acute ACL injuries. The LFCR may provide surgeons with additional information regarding the risk of having a concomitant LMPRT when planning ACL reconstructions.

Editorial Commentary: Increased Lateral Femoral Condyle Ratio, Increased Posterior Tibial Slope, and Narrow Notch Width Are all Risk Factors for Anterior Cruciate Ligament Tear, and Anterior Cruciate Ligament Graft Tear.

Bony risk factors for anterior cruciate ligament (ACL) injuries have been investigated during past 2 decades. Deep posterior femoral condylar depth, measured by the lateral femoral condyle ratio, influences anterolateral instability and the graft survival following ACL reconstructions. Before planning of revision ACL reconstruction, other bony risk factors, including the posterior tibial slope and intercondylar notch width, should be carefully evaluated to protect the ACL graft.

Bone Morphological Characteristics as Risk Factors for Anterior Cruciate Ligament Injury: Comparison Between Contact and Noncontact Injury.

Background: Altered bone morphologies are considered risk factors for noncontact anterior cruciate ligament (ACL) injuries. Purpose/Hypothesis: This study aimed to investigate bone morphological characteristics as risk factors for ACL tears in contact injuries and compare these factors with those for noncontact ACL injuries. We hypothesized that altered bone morphologies would also be risk factors for contact ACL injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled were patients who underwent primary ACL reconstructions between January 2000 and December 2021 within 6 weeks after injury. Patients in the ACL group were classified according to injury mechanism (contact vs noncontact). During the same period, a control group of patients matched by age, height, and body mass index to the ACL group was selected. The lateral femoral condylar ratio (LFCR), notch width index (NWI), and lateral posterior tibial slope (PTS) were measured. Measured parameters were compared between the control, contact, and noncontact groups using analysis of variance. Results: There were 86 patients in the control group, 102 patients in the contact ACL group, and 105 patients in the noncontact ACL group. The demographic characteristics of the 3 groups did not differ significantly. The contact group had significantly higher LFCRs and lower NWIs compared with the control group (P < .001 and P = .001, respectively). The noncontact group had significantly higher LFCRs and PTSs and lower NWIs compared with the control group (P = .031; P < .001; and P < .001, respectively). The noncontact group had significantly higher PTSs and lower NWIs compared with the contact group (P = .003 and P =.014, respectively). In the contact group, the LFCR, PTS, and NWI were significant risk factors for ACL tears (odds ratio [OR], 1.25 [P < .001]; OR, 1.16 [P = .008]; and OR, 1.27 [P = .001], respectively), and in the noncontact group, the PTS and NWI were significant risk factors for ACL tears (OR, 1.20 [P < .001]; OR, 1.59 [P < .001], respectively). Conclusion: Altered bone morphological characteristics of the knee were found to be risk factors for ACL tears in contact injuries as well as noncontact injuries. Altered morphology has a more significant effect in noncontact ACL injuries.

Clinical and Magnetic Resonance Imaging Outcomes After Human Cord Blood-Derived Mesenchymal Stem Cell Implantation for Chondral Defects of the Knee.

Background: There is a paucity of literature reporting clinical and magnetic resonance imaging (MRI) outcomes after allogeneic umbilical cord blood-derived mesenchymal stem cell (UCB-MSC) implantation for chondral defects of the knee. Purpose: To report clinical and MRI outcomes after UCB-MSC implantation for chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: Inclusion criteria were patients aged between 40 and 70 years with focal chondral lesions of grade 3 or 4 on the medial femoral condyle, defect sizes >4 cm2, and intact ligaments. Exclusion criteria were patients who required realignment osteotomy or who had a meniscal deficiency, ligamentous instability, or a concomitant full-thickness chondral defect in the lateral or patellofemoral compartment. A mixture of human UCB-MSCs and sodium hyaluronate was implanted into the chondral defect through mini-arthrotomy. MRI at 1-year follow-up was performed to evaluate repaired cartilage hypertrophy. Repaired cartilage thickness was measured, and hypertrophy was classified as grade 1 (<125%), grade 2 (<150%), or grade 3 (<200%). Patient-reported outcomes (PROs; International Knee Documentation Committee, visual analog scale for pain, and Western Ontario and McMaster Universities Osteoarthritis Index) were evaluated preoperatively and at 1, 2, and 3 years postoperatively. Repaired cartilage hypertrophy was evaluated for a correlation with PRO scores. Results: Enrolled were 85 patients with a mean age of 56.8 ± 6.1 years and a mean chondral defect size of 6.7 ± 2.0 cm2. At follow-up, a significant improvement in all PRO scores was seen compared with preoperatively (P < .001 for all). MRI at 1-year follow-up demonstrated that 28 patients had grade 1 repaired cartilage hypertrophy, 41 patients had grade 2, and 16 patients had grade 3. MRI performed in 11 patients at 2 years after surgery indicated no difference in repaired cartilage hypertrophy between the 1- and 2-year time points. The grade of repaired cartilage hypertrophy did not correlate with PRO scores. Conclusion: Clinical outcomes improved significantly at short-term follow-up after UCB-MSC implantation. Although all patients showed repaired cartilage hypertrophy, it did not correlate with clinical outcomes.

Editorial Commentary: Determinants of Outcome After Repair of Knee Medial Meniscus Posterior Root Tear Are Multifactorial.

Medial meniscus posterior root tears alter tibiofemoral contact, leading to medial knee osteoarthritis. Repair can restore kinematics and biomechanics. Female sex, age, obesity, high posterior tibial slope, varus malalignment >5°, and Outerbridge grade ≥3 chondral lesions in the medial compartment are associated with risk for medial meniscus posterior root tears and poor healing after repair. Extrusion, degeneration, and tear gap may increase tension across the repair site, resulting in poor outcome.

Combined Anterolateral Ligament and Anterior Cruciate Ligament Injury Is Associated With Increased Lateral Femoral Condyle Ratio.

PURPOSE: to investigate the association between the lateral femoral condylar ratio (LFCR), the posterior tibial slope (PTS), and injury of the anterolateral ligament (ALL). METHODS: Inclusion criteria were patients with acute anterior cruciate ligament (ACL) tear after noncontact injury during sports from October 1997 to May 2021. The LFCR and PTS were measured, and injury of the ALL was evaluated. Patients were divided into 2 groups: isolated ACL tear (isolated group) and combined ACL with ALL tear (combined group). The LFCR and PTS were compared between the isolated and combined groups. For each risk factor, the receiver operating characteristic curve, the area under the curve (AUC), and its 95% confidence interval (CI) were calculated to determine the cutoff for detecting increased risk of ALL injury. RESULTS: There were 83 patients in the isolated group and 176 patients in the combined group. Demographics of the 2 groups did not differ significantly. The LFCR was significantly larger in the combined group than in the isolated group (P = .000). The PTS did not differ between the two groups (P = .405). The LFCR (odds ratio [OR] = 1.58; P = .000) was a significant factor. Age, body mass index, and PTS were not associated with an ALL injury. The AUC (0.79; 95% CI, 0.74-0.85) for the LFCR had a sensitivity of 73% and specificity of 76% to predict an ALL rupture. The calculated cutoff of 64.5 was associated with an increased risk for ALL rupture (OR = 8.65; 95% CI, 4.73-15.81) when compared with the isolated group. CONCLUSIONS: An increased LFCR was associated with the ALL injury. However, increased PTS was not associated with ALL injury. These findings need to be considered for clinicians in treating ACL tear patients at risk for an ALL injury. LEVEL OF EVIDENCE: III, retrospective comparative prognostic trial.

Correlation Between Anatomic Landmarks and Bony Trough Position in Lateral Meniscal Allograft Transplant.

Background: Determining the rotational axis of the bony trough during lateral meniscal allograft transplant (MAT) is difficult. The use of anatomic landmarks may help a surgeon determine the rotational alignment of the graft during the procedure. Purpose: To investigate the association between the knee's anatomic landmarks and the position of the bony trough to prevent extrusion after lateral MAT. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled were 44 patients who underwent lateral MAT between July 2000 and February 2011. The patients' mean age at the time of surgery was 30.8 years. Extrusion was measured on magnetic resonance imaging (MRI) scans at a mean of 3.6 months postoperatively, and patients were divided into an extrusion group (n = 15) and a no-extrusion group (n = 29). Three coronal MRI scans from each patient were selected, each from the region at the level of the tibial tuberosity (TT), the anterior bony trough, and the posterior bony trough. We measured the distance between the center of the anterior bony trough and the center of the TT (the TT distance) and the distance between the center of the posterior bony trough and the medial border of the lateral femoral condyle (LFC) (the LFC distance). Results: The mean center of the anterior bony trough was in a more medial position relative to the center of the TT in the no-extrusion group (-2.9 ± 4.8 mm) compared with the extrusion group (1.3 ± 4.9 mm; P = .010). The mean center of the posterior bony trough was in a more medial position relative to the medial border of the LFC in the no-extrusion group (-1.7 ± 3.9 mm) compared with the extrusion group (1.0 ± 3.2 mm; P = .027). Both TT distance and LFC distance were significantly correlated with extrusion (P = .005 and .025, respectively). The cutoff value was -0.24 mm for the anterior bony trough and -0.58 mm for the posterior bony trough (negative values indicate that the trough was medial to the respective landmarks). Conclusion: To prevent extrusion of the allograft, the center of the anterior bony trough needs to be aligned with the center of the TT, and the center of the posterior bony trough needs to be aligned with the medial border of the LFC.

Erratum to "Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation".

[This corrects the article on p. 128 in vol. 14, PMID: 35251550.].

Editorial Commentary: Knee Preoperative Medial Laxity May Result in Overcorrection or Varus Recurrence After Open-Wedge High Tibial Osteotomy.

The long-term results of high tibial osteotomy (HTO) depend mainly on postoperative alignment. However, under- or overcorrection can occur during and after surgery. Biomechanically, excessive overcorrection after HTO can potentially lead to unfavorable knee kinematics and increased shear stress at the joint surface. Fine tuning of the medial soft tissue during open wedge HTO is necessary for a satisfactory limb alignment.

Accuracy of the Arthroscopic Location of the Center of the Anterior Horn During Lateral Meniscal Allograft Transplantation.

Background: Anatomic placement of the meniscal allograft is imperative to achieve satisfactory outcomes after meniscal allograft transplantation (MAT). Few studies have reported on the accuracy of the provisional location of the center of the anterior horn of the lateral meniscus (AHLM). Hypothesis: The authors hypothesized that the provisional center would not coincide with the anatomic center of the AHLM. Study Design: Descriptive laboratory study. Methods: Tibial plateaus were retrieved from 93 consecutive patients who underwent total knee arthroplasty. A complete radial cut was made 2 cm lateral to the insertion of the AHLM on the retrieved tibial plateau. While moving the stump of the anterior horn with forceps, the center of the insertion was determined, and a Kirschner wire (provisional wire) was drilled into the location. The insertion area of the AHLM was dissected carefully, and the periphery of the insertion area of the anterior horn was marked. Another Kirschner wire (anatomic wire) was drilled into the center of the dissected anterior horn. The resected tibial plateau was positioned so that the longitudinal line of the tibial plateau was aligned on a plastic ruler. The distance between the provisional and anatomic wires was measured by a digital caliper along the longitudinal and vertical axes. Results: The mean distance between the provisional and anatomic wires was 2.5 ± 1.2 mm. The provisional wire in 14 patients (15%) was placed at the anatomic center. In 36 patients (39%), the provisional wire was drilled anterolateral to the anatomic center, and in 18 patients (19%), the wire was drilled anteromedial to the anatomic center. In 21 patients (23%), the provisional wire was located within 2 mm of the anatomic center, and in 62 patients (67%), the wire was located within 3 mm of the anatomic center. Conclusion: The provisional wire was located a mean of 2.5 mm from the anatomic center, and only 23% of patients had wires that were located within 2 mm of the anatomic center. In 39% of patients, the provisional wire was drilled anterolateral to the anatomic center. This finding needs to be considered during lateral MAT. Clinical Relevance: Without dissection of the AHLM, the determination of the anatomic center of the anterior horn is not accurate during lateral MAT.

Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation.

BACKGROUND: The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group. METHODS: This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score. RESULTS: The mean follow-up period was 17.5 months (range, 11-38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016). CONCLUSIONS: Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.

An Increased Lateral Femoral Condyle Ratio in Addition to Increased Posterior Tibial Slope and Narrower Notch Index Is a Risk Factor for Female Anterior Cruciate Ligament Injury.

PURPOSE: To investigate the relationship between the lateral femoral condyle ratio (LFCR) among osseous morphologic characteristics of the knee and anterior cruciate ligament (ACL) injury in female patients. METHODS: Inclusion criteria were female patients (ACL group, n = 59) undergoing primary ACL reconstruction from 2012 to 2018. Control female patients (control group, n = 58) were matched by age, height, and body mass index to ACL group. They had no meniscal or ligament tear, and no trochlear dysplasia on magnetic resonance imaging. The LFCR, notch width index (NWI), and posterior tibial slope (PTS) were measured and compared between the ACL and control groups. For each risk factor, the receiver operating characteristic curve and the area under the curve and its 95% confidence interval (CI) was calculated to determine the cutoff for detecting increased risk of ACL injury. RESULTS: The LFCR was significantly larger in the knees in the ACL group than in the control group (P = .001). The NWI was significantly smaller and the PTS was significantly larger in the knees in the ACL group than in the control group (P = .000, P = .000, respectively). The NWI (odds ratio [OR] 1.41; P = .000) was the most significant factor, followed by the PTS (OR 1.29; P = .003) and the LFCR (OR 1.26; P = .001). The area under the curve (0.67, 95% CI 0.58-0.77) for the LFCR had a sensitivity of 66% and specificity of 66% to predict an ACL injury. The cutoff of 63.9 was associated with an increased risk for ACL injury (OR 3.71; 95% CI 1.73-7.95). CONCLUSIONS: An increased LFCR was associated with female ACL injury. The LFCR, NWI, and PTS are predictive risk factors for an ACL injury. These findings need to be considered for clinician in identifying female patients at risk for an ACL injury. LEVEL OF EVIDENCE: III, retrospective comparative prognostic trial.

Lateral Capsular Stabilization in Lateral Meniscal Allograft Transplantation.

BACKGROUND: Stabilization of the lateral capsule to the tibial plateau may decrease midbody extrusion after lateral meniscal allograft transplantation (MAT). However, there is a paucity of literature reporting on postoperative magnetic resonance imaging (MRI) findings after lateral capsular stabilization (LCS) at the time of lateral MAT. PURPOSE/HYPOTHESIS: The purpose was to describe MRI findings after LCS and compare postoperative extrusion between isolated lateral MAT and lateral MAT with LCS. It was hypothesized that allograft extrusion would be reduced after MAT with LCS but that the stabilized capsule would increase the risk of tears to the capsule or allograft. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Included were patients who underwent lateral MAT with 6-month follow-up MRI. Concomitant LCS was performed for patients with redundant lateral capsule displaced from the lateral tibial plateau as evident on coronal MRI or arthroscopic examination (MAT+LCS group); otherwise, patients underwent MAT only (isolated MAT group). The Lysholm score, Tegner score, and lateral joint space on radiographs were compared between the 2 groups at 2 years postoperatively, and the stabilized lateral capsule and allograft were evaluated using 6-month follow-up MRI. Extrusion, rotation, and position of the allograft bridge were compared between the 2 groups. Regression analysis was performed to identify factors predictive of degree of extrusion. RESULTS: There were 10 patients in the MAT+LCS group and 13 patients in the isolated MAT group. No significant differences were found between groups in preoperative patient characteristics or postoperative Lysholm score, Tegner score, lateral joint space, or MRI parameters. Postoperative extrusion was not related to obliquity angle, position of the bony bridge, or presence of LCS. In the MAT+LCS group, 1 patient showed a tear of the lateral capsule and a radial tear of the allograft, and 3 patients had a meniscocapsular separation at the midbody of the allograft. In the isolated MAT group, 1 patient had a peripheral tear at the midbody, but there was no tear of the allograft in the other patients. CONCLUSION: LCS did not decrease extrusion of lateral meniscal transplantation, but it can lead to increased risk for graft or capsule tear.

Comparison Between Early and Late Retensioning of an Adjustable-Loop Cortical Suspension Device During Hamstring ACL Reconstruction.

BACKGROUND: Biomechanical studies have demonstrated significant loosening of the adjustable-loop device as compared with the fixed-loop device used in anterior cruciate ligament reconstruction. Retensioning of the adjustable loop has been recommended; however, the timing of the retensioning is unknown. HYPOTHESIS: Early (ER) and late retensioning (LR) will show similar gapping between the femoral tunnel and graft on follow-up magnetic resonance imaging (MRI) and similar clinical outcomes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This study included 101 patients who underwent hamstring anterior cruciate ligament reconstruction using the adjustable-loop device for femoral fixation between June 2016 and January 2018. All patients a had follow-up MRI on postoperative day 1. Patients with revision surgery and those with reinjury after reconstruction were excluded. In the ER group, retensioning and knot tying of the initially tightened adjustable loop were performed after the flip of the button and before the graft was fixed at the tibia. In the LR group, retensioning and knot tying were performed after initial tightening of the adjustable loop and graft fixation at the tibial side. The tunnel-graft gap measured on multiplanar reformatted images of MRI scans was compared between the groups, as were clinical outcomes. RESULTS: The mean age of the patients at the time of surgery was 30.3 years (range, 14-61 years). ER and knot tying were performed in 56 patients and LR and knot tying in 45. Preoperative characteristics of the 2 groups showed no significant differences. The mean ± SD tunnel-graft gap was 1.5 ± 2.0 mm in the ER group and 5.4 ± 4.0 mm in the LR group (P < .001). There were no significant differences in clinical outcomes between the groups. CONCLUSION: ER and knot tying demonstrated less tunnel-graft gap than that of LR. However, there were no differences in clinical outcomes according to the timing of retensioning.

Human umbilical cord blood-derived mesenchymal stem cell implantation for osteoarthritis of the knee.

INTRODUCTION: This study aimed to investigate the clinical outcomes after human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) implantation for medial compartment (MC) osteoarthritis of the knee. MATERIALS AND METHODS: Inclusion criteria were patients older than 60 years, with a kissing lesion of the MC, a full-thickness chondral defect ≥ 4 cm2 of the medial femoral condyle (MFC), and a varus deformity ≥ 3° on a long cassette scanogram. The mean age was 64.9 ± 4.4 years and the mean chondral defect of the MFC was 7.2 ± 1.9 cm2. A mixture of sodium hyaluronate and hUCB-MSC was implanted into the chondral defect and a high tibial osteotomy was performed in all patients. International Knee Documentation Committee (IKDC), visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and 1 year and 2 years postoperatively. Cartilage regeneration was evaluated in 14 (56%) patients by second-look arthroscopy at 1 year postoperatively. RESULTS: Twenty-five patients underwent hUBC-MSC implantation. IKDC, VAS, and WOMAC scores at 1 year and 2 years improved significantly compared to preoperative scores. These scores at 1 year and 2 years were not significantly different between the body mass index (BMI) < 25 group and BMI ≥ 25 group. However, the < 65-year-old group showed superior IKDC scores at 1 year and 2 years and VAS score at 2 years than the ≥ 65-year-old group. Younger age and larger size of the chondral defect were associated with a significantly greater improvement in IKDC, VAS and WOMAC scores at 2 years. Second-look arthroscopy demonstrated International Cartilage Repair Society-Cartilage Repair Assessment grade I in six (42.9%) patients and grade II in eight (57.1%). CONCLUSIONS: hUCB-MSC implantation regenerated cartilage satisfactorily and showed satisfactory clinical outcomes in patients older than 60 years who had MC osteoarthritis.

Hamstring Anterior Cruciate Ligament Reconstruction Using an Adjustable-Loop Cortical Suspension Device: Immediate Postoperative Magnetic Resonance Imaging.

The purpose of this study is to determine whether the hamstring grafts are fully inserted into the femoral tunnel with the adjustable loop using immediate postoperative magnetic resonance imaging (MRI) after anterior cruciate ligament (ACL) reconstructions. A total of 62 consecutive patients underwent hamstring ACL reconstruction using an adjustable-loop cortical suspension device for the femoral fixation and the Intrafix sheath and screw for the tibial fixation. Multiplanar reformatted images of 3-T MRI scans were obtained at the 1st postoperative day before weight bearing is initiated in all patients to evaluate the gap (the tunnel-graft gap) between the top of the hamstring graft and top of the femoral tunnel. Postoperative MRI scans showed that the tunnel-graft gap was 1.5 ± 2.7 mm (range, 0-12 mm). In 43 (69.4%) patients, there was no gap between the top of the femoral tunnel and hamstring graft. In 19 (30.6%) patients, there was a gap between the tunnel and graft, and nine patients demonstrated a tunnel-graft gap greater than 5 mm. Immediate postoperative MRI scans demonstrated that an adjustable-loop cortical suspension device may not pull the hamstring graft completely into the femoral tunnel.

Ring-shaped lateral meniscus combined with an accessory meniscus: A rare anatomical variant.

A ring-shaped meniscus is a very rare anatomical variant among all meniscal abnormalities. Additionally, an accessory meniscus is extremely rare, and only a few cases have been reported. We herein report a case involving the combination of these two features in a single lateral meniscus. These abnormalities were found during arthroscopic surgery for removal of an osteochondral fragment that had detached from the patellar bone and plication of the medial patellofemoral ligament in a patient with acute patellar dislocation. To our knowledge, each variant is extremely rare and the combination of the two variants has not been reported.

Comparison of Postoperative Tunnel Widening After Hamstring Anterior Cruciate Ligament Reconstructions Between Anatomic and Nonanatomic Femoral Tunnels.

PURPOSE: To evaluate the effect of the location of the femoral tunnel on 3-dimensional (3D) computed tomography (CT) upon the postoperative tunnel widening after anterior cruciate ligament (ACL) reconstructions. METHODS: Inclusion criteria were patients who underwent hamstring ACL reconstructions using an adjustable-loop cortical suspension device, underwent 3D CT at the day after surgery, and were followed for a minimum of 2 years after surgery. Exclusion criteria were patients with combined ligament injury and reinjury after reconstruction. Using 3D CT, the center of the femoral tunnel aperture was located on a standardized grid system. The center of the ACL footprint was defined from the literature. The femoral tunnel location was classified as anatomic if it located within 2 standard deviations of the center position. If it was outside the 2 standard deviations, the tunnel was classified as nonanatomic. The patients were divided into either anatomic or nonanatomic groups. Femoral tunnel angles on both sagittal and coronal planes were measured. Both femoral and tibial tunnels measured on anteroposterior and lateral radiographs at immediate postoperative day and at 2 years after surgery. Postoperative knee stability and patient-reported outcomes were evaluated. RESULTS: There were 37 patients in anatomical group and 52 patients in nonanatomical group among enrolled 87 patients. There were no differences in demographics between the 2 groups. There were no differences in the femoral tunnel angles and postoperative tunnel widening between the 2 groups. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. Postoperative knee stability and patient-reported outcomes showed no statistically significant differences between the 2 groups. CONCLUSIONS: There was no significant difference in postoperative tunnel widening or clinical outcomes between anatomic and nonanatomic femoral tunnel location after hamstring ACL reconstructions. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.