Evaluating the risk of popliteal artery injury in the all-inside meniscus repair based on the location of posterior meniscal lesions.

The 'all-inside' meniscus repair is extremely useful technique in addressing tears at the far posterior horn of meniscus. However, this procedure may place the popliteal neurovascular bundle at risk of injury. The purpose of this study was to evaluate the risk of popliteal artery injury by the trajectory of anchor delivery instruments inserted through standard knee arthroscopic portals for the repair of the far posterior horn of meniscus tears. Standard arthroscopic portals were marked on five human cadaveric knees which were subsequently disarticulated. Axial photographs were taken after marking the 5 10, and 15 mm points from the meniscal root on the posterior horns of the menisci. The unsafe zones for meniscus repair at each of these points were identified on the photographs of knees by first drawing two lines from the edges of the popliteal artery and crossing at the respective points at the posterior horns. The points at which these lines meet a circular protractor applied to the center of each meniscus in the knee photograph were recorded as a range. The range signifies the unsafe zone for each respective point on the posterior horn of meniscus. The anterolateral arthroscopic portal fell within the unsafe zone of the 5 mm point on the posterior horn of lateral meniscus in three of the five knees and within the unsafe zone of the 10 mm point on the posterior horn of lateral meniscus in another two knees. A cautious approach should be practiced during the repair of tears located at these two points. None of the other points' unsafe zones (lateral 15 mm, medial 5 mm, 10 mm and 15 mm points) coincided with the ipsilateral portal sites. Level of evidence 5 (Human cadaveric study).

Effect of the Timing of Anterior Cruciate Ligament Reconstruction on Clinical and Stability Outcomes: A Systematic Review and Meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the effect of the timing of anterior cruciate ligament (ACL) reconstruction on clinical and stability outcomes by analyzing high-quality studies that assessed timing as a primary objective. METHODS: The MEDLINE, EMBASE, and Cochrane database were systematically searched. The inclusion criteria were as follows: (1) English articles, (2) noncomparative study or relevant study reporting clinical and/or stability results, and (3) timing of the ACL reconstruction as a primary objective. Study type, level of evidence, randomization method, exclusion criteria, number of cases, age, sex, timing of ACL reconstruction, follow-up, clinical outcomes, stability outcomes, and other relevant findings were recorded. Statistical analysis of the Lysholm scores and KT-1000 arthrometer measurements after early and delayed ACL reconstruction was performed using R version 3.3.1. RESULTS: Seven articles were included in the final analysis. There were 6 randomized controlled trials and 1 Level II study. Pooled analysis was performed using only Level I studies. All studies assessed the timing of ACL reconstruction as a primary objective. The definition of early ranged broadly from 9 days to 5 months and delayed ranged from 10 weeks to >24 months, and there was an overlap of the time intervals between some studies. The standard timing of the delayed reconstruction was around 10 weeks from injury in the pooled analysis. After pooling of data, clinical result was not statistically different between groups (I2: 47%, moderate level of heterogeneity). No statistically significant difference was observed in the KT-1000 arthrometer measurements between groups (I2: 76.2%, high level of heterogeneity) either. CONCLUSION: This systematic review and meta-analysis performed using currently available high-quality literature provides relatively strong evidence that early ACL reconstruction results in good clinical and stability outcomes. Early ACL reconstruction results in comparable clinical and stability outcomes compared with delayed ACL reconstruction. LEVEL OF EVIDENCE: Level II, a systematic review and meta-analysis of Level I and II studies.

Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study.

INTRODUCTION: We conducted a study to elucidate the correlation between the anatomy of the shoulder joint with the development of rotator cuff tear (RCT) and glenohumeral osteoarthritis (GHOA) by using acromioglenoid angle (AGA). MATERIALS AND METHODS: The AGA is a new measured angle formed between the line from midglenoid to lateral end of the acromion with the line parallel to the glenoid surface. The AGA was measured in a group of 85 shoulders with RCT, 49 with GHOA and 103 non-RCT/GHOA control shoulders. The AGA was compared with other radiological parameters, such as, the critical shoulder angle (CSA), the acromion index (AI) and the acromiohumeral interval (AHI). Correlational and regression analysis were performed using SPSS 20. RESULTS: The mean AGA was 50.9° (45.2-56.5°) in the control group, 53.3° (47.6-59.1°) in RCT group and 45.5° (37.7-53.2°) in OA group. Among patients with AGA > 51.5°, 61% were in the RCT group and among patients with AGA < 44.5°, 56% were in OA group. Pearson correlation analysis had shown significant correlation between AGA and CSA ( r = 0.925, p < 0.001). It was also significant of AHI in RCT group with mean 6.6 mm (4.7-8.5 mm) and significant AI in OA group with mean 0.68 (0.57-0.78) with p value < 0.001 respectively. CONCLUSION: The AGA method of measurement is an excellent predictive parameter for diagnosing RCT and GHOA.