Is Venous Thromboembolism Prophylaxis Needed in Patients Undergoing Knee Arthroscopy? A Prospective Observational Study.

BACKGROUND: Although rare, deep vein thrombosis is a potentially life-threatening complication of knee arthroscopy. There are scanty literature analysing deep vein thrombosis after arthroscopy in Nepal. This study aimed to identify the prevalence of deep vein thrombosis in patients undergoing knee arthroscopy without chemoprophylaxis postoperatively at 2 weeks and 6 weeks, respectively. The study also aimed to estimate the risk of deep vein thrombosis in these patients by using Caprini Risk Assessment Model. METHODS: This prospective observational study was conducted at AKB center, B and B Hospital, Gwarko, Lalitpur, over a period of 16 months. All patients who underwent arthroscopy knee surgeries fulfilling the inclusion criteria were included in the study. The primary outcome measure was the prevalence of deep vein thrombosis as diagnosed by compression color-coded ultrasonography of the popliteal vein and calf vein at 2 weeks and 6 weeks postoperatively. The secondary outcome measure was the prevalence of deep vein thrombosis in the risk groups according to Caprini Risk Assessment Model. RESULTS: Out of 612 patients who underwent arthroscopic knee surgeries during the study period, 2 patients (0.33%) developed deep vein thrombosis at 6 weeks follow-up as diagnosed with ultrasonography of the popliteal and calf veins. The prevalence rate in high-risk group was 0.33% (1 in 307) and in very high-risk group was 5.88% (1 in 17). CONCLUSIONS: There was a low prevalence of deep vein thrombosis without chemoprophylaxis following knee arthroscopy in our study. There was higher prevalence of deep vein thrombosis in very high-risk group patients, so close monitoring of such patients during follow-up is recommended.

Semitendinosus Autograft Transplant for Medial Meniscus.

Treatment of meniscal tears has evolved over the last few decades, and preservation has now become the gold standard of treatment. Advancements in repair technique have extended the indication of repair. However, meniscectomy has to be performed in some situations. In these situations, meniscal allograft transplantation is considered the gold standard. But allografts are not available in every part of the world. Collagen implants and synthetic polymers are also advocated. But again, its limited research, availability, and high cost have restricted its widespread use. Many authors have advocated autograft transplantation, but there are no long-term results, and there is a lack of uniform surgical techniques. There is a technique described for lateral meniscus, but a medial meniscus autograft transplant technique is not very well elaborated. In this report, we aimed to describe a medial meniscus replacement technique using a hamstring autograft.

Implantless Supplementary Fixation of Anterior Cruciate Ligament in Tibia with "Make and Use" Anchor.

Supplementary fixation after anterior cruciate ligament reconstruction may be necessary in some situations. There are several methods described for supplementary fixation with their advantages and disadvantages. Anchor fixation is preferred by many because it does not require a second surgery for removal. However, anchors are costly. We described the "make and use" all-suture anchor, which can be made instantly whenever required. We modified "make and use" all-suture anchors for supplementary fixation after ACL reconstruction. This technical note aims to describe the method of supplementary fixation using the "make and use" all-suture anchor.

"Make and Use" All Suture Anchor-A Cost-Effective Method of Making an All-Suture Anchor.

All-suture anchors (ASA) are newer anchors that anchor soft tissues to the bone. It has several biomechanical and clinical advantages; however, the high cost of this anchor limits its use in low socioeconomic countries. The cost of the anchor dramatically increases the cost of surgery; hence, acceptance of surgery is also affected if patients have to pay their expenditure from their pocket. We have designed a simple, cost-effective method of making an ASA, which can be made instantly and used during surgery; hence, the name "make-and-use anchor." To make this anchor, few high-strength sutures are required. Over the suture, a sleeve of suture was created using an Ethibond. This sleeve will create a "ball" after deployment under the cortical bone, which provides anchorage to the sutures serving as an anchor. This anchor can be deployed both in the pull-in and push-in methods. This technical note aims to share the technique of making this cost-effective anchor, which is made instantly using locally available suture materials and can be used in various surgeries requiring anchors.

Positive Pivot Shift Test among Patients with Displaced Anterior Tibial Spine Fractures Undergoing Arthroscopic Fixation in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Understanding of displaced anterior tibial spine fractures has evolved over the years and is now considered to be anterior cruciate ligament avulsion injuries rather than intra-articular fractures. However, there are very few studies available evaluating the presence or absence of a pivot shift test, which is specific in diagnosing anterior cruciate ligament insufficiency, in patients with anterior tibial spine fractures. This study aimed to find out the prevalence of the positive pivot shift test among patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients presented with displaced anterior tibial spine fractures undergoing arthroscopic fixation. The data were collected between 1 January 2020 and 30 May 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: IRC_2019_11_09_1). All patients who presented with displaced anterior tibial spine fractures undergoing arthroscopic fixation were included in the study and those who did not provide consent were excluded. The pivot test was performed under anaesthesia. Point estimate and 90% Confidence Interval were calculated. Results: Among 48 patients, pivot shift was positive in 36 (75%) (64.75-85.25, 90% Confidence Interval). The mean age of the participants was 28.97±11.16 years, 21 (58.33%) were males and 15 (41.66%) were females. Conclusions: The prevalence of positive pivot shift test under anaesthesia in patients with displaced anterior tibial spine fractures undergoing arthroscopic fixation was higher than other studies done in similar settings. Keywords: anterior cruciate ligament; arthroscopy; knee fractures; physical examination.

Ramp Tear among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction in a Tertiary Care Centre.

Introduction: Ramp tear is a specific injury that affects the posterior horn of the medial meniscus and its meniscosynovial or meniscocapsular attachments. The actual prevalence of ramp lesion is unknown due to the high probability of misdiagnosis or underdiagnosis caused by the low sensitivity of imaging modalities and poor visualization during arthroscopy. This study aimed to find out the prevalence of ramp tear among patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing arthroscopic anterior cruciate ligament reconstruction after getting ethical approval from the Institutional Review Committee. Data from 1 March 2019 to 31 December 2022 was collected between 1 May 2023 to 30 May 2023 from medical records. The study included all patients who underwent arthroscopic anterior cruciate ligament reconstruction. Patients with a previous history of medial meniscus injury or repair and undergoing revision anterior cruciate ligament reconstruction were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 412 patients who underwent arthroscopic anterior cruciate ligament reconstruction, 53 (12.86%) (9.63-16.09, 95% Confidence Interval) had ramp tears. The mean age of patients with ramp tears was 28.64±7.57 years. Among 53 patients, 42 (79.24%) were male and 11 (20.75%) were female. Conclusions: The prevalence of ramp tears in patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre was found to be lower than other studies done in other international studies. Keywords: anterior cruciate ligament injuries; anterior cruciate ligament reconstruction; arthroscopy.

Epidemiological profile of anterior cruciate ligament injuries in a tertiary referral trauma center of Nepal.

BACKGROUND: Sports related injuries are the leading cause of Anterior Cruciate Ligament (ACL) tear in the Western world. Although professional and recreational sporting activities are increasing in Nepal, they are not as common and prevalent in comparison to western world. In contrast, Road Traffic Accident (RTA) is a very common cause of knee injuries in Nepal. Although there are some studies from Nepal mentioning Road Traffic Accidents (RTAs) as the most common cause of ACL injury, no specific studies have primarily investigated the epidemiological and demographic profile of ACL injured patients from this region. we aimed to understand the epidemiological and demographic profile of ACL injured patients and evaluate the mode of injury in a tertiary referral trauma center of Nepal. METHODS: This was a retrospective descriptive study of a hospital cohort conducted from February 2018 to January 2020. Electronic details were retrieved, telephone interviews conducted and data analysis was done using descriptive analysis on the patients from the fore mentioned dates to complete demographic and epidemiological information. RESULTS: A total of 237 patients were enrolled in this study. Among these, 120 patients (50.6%) fell into the age group of 15-30 years with a male to female ratio of 2.7:1. A RTA was the most common cause of ACL injury (38.8%), followed by sports-related injuries in 33.3% and falls in 16.5% of patients. The most common mode of RTA was a two-wheeler accident, and football was the most common sport causing ACL injuries. Sports injury was more common in patients below 30 years of age (OR = 3.5, 95% CI [2.2, 5.7]), whereas RTA was more common in patients above 30 years of age. Sports was the cause of ACL injury in 55.5% of students and RTAs was the commonest cause of ACL injury in office workers. CONCLUSION: Overall males were more frequently injured than females. Road traffic accidents were the most common cause of ACL injury in our subset of patients. Two-wheeler riders were the most commonly injured patients. Sport was the commonest cause of ACL injury in patients below 30 years, and RTA was common in patients above 30 years of age. Sports were the commonest cause of ACL injury in students, while RTA was the most common cause in office workers.

Variations in common operations in athletes and non-Athletes.

Background: Achieving pre-injury activity level after an injury is the fundamental goal of any orthopedic treatment for an athlete. Unfortunately, pre-injury activity levels differ significantly in different patient categories, especially in athletes and non-athlete. Hence, an outcome suitable to a non-athlete may not be adequate for an athlete. This has led to variations in the surgical approach to the same injury in an athlete and non-athlete.There is plenty of literature published comparing the outcome in athletes and non-athletes after a particular surgery. Scattered discussion about variations in these surgeries based on functional demand was done in many publications. But there was a lack of a comprehensive narrative review summarizing variations in common operations among athletes and non-athletes. Aim: This review attempted to summarize variations in common sports operations between high functional demand patients and low demand patients and discuss the variations from the author's perspective. Methods: A review of all the relevant papers were conducted focusing on athletes and non-athletes. Most commonly performed sports surgeries were ACL reconstruction, Meniscal repair, PCL reconstruction, and Shoulder instability surgery. A literature search was done for each commonly performed surgery using relevant keywords in PubMed and Google Scholars. Summary of papers pertinent to athletes and non-athletes were compiled to prepare this narrative review. Results: There is a lack of papers directly comparing results in athletes and non-athletes. However, many research papers discussed surgical variations in athletes (high demand) and non-athletes (low demand) patients. There are controversies in all commonly performed surgeries, and none of the papers gives a definitive guideline on the approach to athletes and non-athlete. Conclusion: Rather than a common suggestion on surgical variation, an individualized approach would be appropriate to decide on variation in particular surgery in both athletes and non-athletes.

Mean Tip Apex Distance in Patients undergoing Dynamic Hip Screw Fixation for Pertrochanteric Fractures without using Traction Table: A Descriptive Cross-sectional Study.

Introduction: Dynamic Hip Screw fixation has shown to be equally effective compared to cephalomedullary nailing. The effectiveness of dynamic hip screw fixation for pertrochanteric fractures without using traction table is not well investigated. This study aimed to find out the mean tip apex distance in patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table. Methods: A descriptive cross-sectional study was conducted among patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table between 1 September 2021 and 30 June 2022, after getting approval from institutional review committee (Reference number: IRC-2021-08-23-02). All patients undergoing dynamic hip screw fixation for pertrochanteric fractures without using traction table were included in the study. Patients with pre-existing ipsilateral or contralateral hip deformity, contra-lateral hip prosthesis, bilateral hip fractures, and history of prior ipsilateral hip surgeries were excluded. Point estimate and 95% confidence interval were calculated. Results: Among 45 patients, the mean tip apex distance was 20.45±6.13 mm (18.66-22.24 mm, 95% Confidence Interval). Among 45 patients, 24 (53.33%) were males and 21 (46.66%) were females. The average age of the participants was 67.75±21.33 years. Conclusions: The mean tip apex distance in patients undergoing dynamic hip Screw fixation for pertrochanteric fractures without using traction table was similar to that reported in other international studies. Keywords: fracture fixation; hip fractures; operating tables.

Positive Bacterial Culture among Suspected Orthopedic Infections in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: A hospital-based investigation of bacteriological isolates helps to identify common causative bacteria and their antibiotic sensitivity patterns. This helps in formulating presumptive antibiotic therapy and in reducing antibiotic misuse. The aim of this study was to find out the prevalence of positive bacterial culture isolates among suspected orthopaedic infections in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from the electronic data record of the Department of Microbiology of a tertiary care centre from 1 January 2017 to 31 December 2021. The study was conducted following ethical approval from the Institutional Review Committee (Reference number: IRC-2021-11-09-1). Culture reports of suspected orthopaedic infections were evaluated, and those with missing data were excluded. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 6201 specimens, positive bacterial culture were found in 2957 (47.69%) (46.45-48.93, 95% Confidence Interval). Among them, 1561 (56.01%) were gram-negative organisms and 677 (24.29%) were gram-positive. A total of 2787 (94.25%) were wound/pus swab cultures and 170 (5.74%) were tissue cultures. Conclusions: The prevalence of positive bacterial culture among suspected orthopaedic infections was lower than in other international studies. Among bacteriological isolates, gram-negative organisms are more than gram-positive organisms. Keywords: culture techniques; infections; microbial sensitivity tests; prevalence.

Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction.

Even after anterior cruciate ligament (ACL) tear, its remnant retains the vascularized synovial sheets, fibroblasts, myofibroblasts, and various mechanoreceptors within it. The aim of preserving the remnant is to retain these components during ACL reconstruction. In the recent past, there has been an increasing trend towards preserving remnants during ACL reconstruction. Although preserving remnants have physiological advantages, cyclops lesion and extension loss were among the most feared complications. Cyclops and loss of extension are due to the fallback of the remnant into the notch. Moreover, the mechanoreceptors present in the remnant are not active when the remnant is lax. These mechanoreceptors are active when the remnant is in tension. Thus, rather than merely preserving the remnant, it is essential to tension it for more physiological functions. Although there are various techniques of remnant tensioning described in the literature, these techniques require tampering of the fixation devices or an extra fixation device adding to the cost of surgery. We describe our modification of the remnant-tensioning method during anatomic ACL reconstruction. In this technique, the sutures holding the remnant are pulled out through the anatomic femoral tunnel and fixed with an interference screw along with the hamstring graft. This technique is cost-effective, reproducible, and does not require tampering with the fixation devices. Moreover, the direction of remnant pull will be the same as that of the reconstructed graft making both the graft and remnant anatomical in orientation. Suture management and visibility of the intraarticular structures during this procedure are a few downsides of this technique. The only prerequisite of this technique is a good quality remnant to hold the sutures.

Arthroscopy-Assisted All-Suture Coracoclavicular and Acromioclavicular Joint Stabilization in Acute Acromioclavicular Joint Injuries.

The existing literature agrees on surgical management for Rockwood grade IV and V injuries, but there is no consensus which type of surgery is the most appropriate one. More than 150 surgeries have been described for this condition in the literature. In an injury of less than 3 weeks, most surgeons prefer suture-button devices for coracoclavicular stabilization. Recent biomechanical studies have demonstrated that coracoclavicular stabilization provides good vertical stability but poor horizontal stability of acromioclavicular joint. Hence, they recommend acromioclavicular stabilization along with coracoclavicular stabilization. The use of a suture-button device for coracoclavicular stabilization requires special implants and instruments along with high surgical skills to drill precisely placed holes in the clavicle and the coracoid in order to avoid fractures from the drill hole. Due to relatively smaller clavicle and coracoid in Asian population, making holes in the clavicle and the coracoid has increased risk of fracture. We describe a technique in which no drill holes are made in the clavicle or the coracoid. In our technique, suture tape is used, which is looped around the coracoid and the clavicle, and the limbs are tied over the clavicle to maintain the coracoclavicular distance. The remaining limbs of suture tape is further looped through the tunnels made in acromion and tied over the acromion to augment the acromioclavicular ligament. The potential advantages of this technique are no costly implant and instruments are required, avoidance of complications associated with drill holes in coracoid and clavicle, both coracoclavicular and acromioclavicular joints are stabilized, direct repair of the acromioclavicular ligament can be performed, and no need of second surgery for implant removal.

Predictive Accuracy of Blumensaat Line Angle and Its Apex along with Anterior Cruciate Ligament Inclination Angle for Diagnosis of Anterior Cruciate Ligament Tear with Abundant Remnant.

BACKGROUND: Anterior Cruciate Ligament Blumensaat line angle and Anterior Cruciate Ligament Inclination angle can be measured when Anterior Cruciate Ligament is visualized on Magnetic Resonance Imaging. Both these angles can be helpful to determine the intactness of Anterior Cruciate Ligament. The aim of this study was to evaluate the diagnostic accuracy of Anterior Cruciate Ligament - Blumensaat line angle, apex of Anterior Cruciate Ligament - Blumensaat line angle and Anterior Cruciate Ligament - Inclination angle to determine the status of Anterior Cruciate Ligament in terms of tear or no tear. METHODS: We conducted a prospective observational study with Magnetic Resonance Imagings of knees of 71 patients, who were divided into Anterior Cruciate Ligament tear and Anterior Cruciate Ligament intact groups based on Anterior Cruciate Ligament - Blumensaat line angle (<150- intact; ? 150 - torn Anterior Cruciate Ligament), Anterior Cruciate Ligament - Inclination angle (>450 - intact ACL; ? 450 - Anterior Cruciate Ligament tear) and apex of Anterior Cruciate Ligament - Blumensaat line angle ( apex towards femur - Intact Anterior Cruciate Ligament; apex towards tibia or parallel lines- Anterior Cruciate Ligament Tear) measured on MRI study. Diagnostic accuracy was calculated in terms of sensitivity, specificity, positive predictive value and negative predictive value of Anterior Cruciate Ligament - Blumensaat line angle, Anterior Cruciate Ligament - Inclination angle and apex of Anterior Cruciate Ligament - Blumensaat line angle. RESULTS: The sensitivity and specificity of Anterior Cruciate Ligament - Blumensaat line angle to detect Anterior Cruciate Ligament status was 95.83% and 95.35% respectively. Similarly, the sensitivity of Anterior Cruciate Ligament - Inclination angle was 95.83% and specificity was 95.35%. The sensitivity of Apex Anterior Cruciate Ligament - Blumensaat line angle to detect Anterior Cruciate Ligament tear on MRI was calculated to be 95.74% and a specificity of 87.5% Conclusions: Anterior Cruciate Ligament - Blumensaat line angle and Anterior Cruciate Ligament - Inclination angle is highly sensitive and specific for the diagnosis of Anterior Cruciate Ligament tear. Apex of Anterior Cruciate Ligament - Blumensaat line angle is also helpful in determination of Anterior Cruciate Ligament tear.

Implant-Free, Transtibial, Bone Bridge Fixation for Knee Surgery Including Tibial Spine and Meniscal Root Fixation.

Fixation over bone bridge is commonly performed during transosseous pullout knee surgeries. This technique requires the drilling of 2 bony tunnels separately. Herein, we describe our technique in which bone bridge fixation is performed with a single bony tunnel. Our technique is described in 4 simple steps. Step 1: A short accessory tunnel is created from a point at least 1 cm away from the aperture of primary bone tunnel and opening into the lumen of the primary tunnel. Step 2: A shuttle suture (PROLENE) loop is passed from the accessory tunnel to the primary tunnel, and the loop is retrieved out of the primary tunnel using an 18-G epidural needle and arthroscopy probe. Step 3: Complimentary limbs of the pullout suture is then shuttled through the accessory tunnel using shuttle suture loop. Step 4: The knots are tied over the intervening bone bridge. Since the sutures are tied over the bone bridge, it has to be strong enough to provide support. This method of fixation is contraindicated when there is severe osteoporosis or if the tunnels are located in metaphysis. A supplemental video demonstration of the technique is included with this article.

Outside-In Repair of Longitudinal Tear of Medial Meniscus: Suture Shuttle Technique.

Meniscal tears are commonly encountered conditions of the knee. In the past, torn menisci were treated by excision of the loose flap. A better understanding of the meniscus anatomy and its biomechanical characteristics has led to the concept of meniscus preservation in eligible cases. Several suture-based repair techniques have been described in literature, including the outside-in technique. Although the outside-in technique of meniscus repair is commonly indicated for the anterior two-thirds of the meniscus, it can be used to repair the posterior part of the meniscus as well. Several modifications of this technique have been described in the literature. We hereby describe our modification of the outside-in technique of meniscus repair with the help of an epidural needle and high-strength sutures that is readily available in operating rooms. The advantages of our technique are that no large incision is required around knee joint, it's inexpensive, it can be performed with basic instruments, and even the tear of meniscus extending up to the posterior horn can be repaired. A supplemental video demonstration of the technique is included with this article.

The Effect of the Intercondylar Notch Shape and Notch Width Index on Anterior Cruciate Ligament Injuries.

BACKGROUND: Anterior cruciate ligament is one of the commonly injured ligaments in knee. The shape and dimension of the femoral notch has been linked with the risk of anterior cruciate ligament injury. The aim of this study was to study the risk of Anterior cruciate ligament injury with notch morphology in the Nepalese population. METHODS: This study is a case control study. Cases undergoing arthroscopic surgery at 2 tertiary level centers were enrolled. Patients with arthroscopic confirmation of Anterior cruciate ligament tear were taken as case and those without tear were taken as control. Axial Magnetic resonance Imaging sequence was used to study notch. Sections at the level of popliteal groove was taken for study and shapes were identified as A, U and W type, and notch width index was calculated. These variables were correlated with presence or absence of Anterior cruciate ligament tear. RESULTS: Out of 118 cases, 59 had tear, and 59 had no tear. Tear was found in 74% of Type A notch compared to 30.15% in Type U notch. The femoral notch width index was low in 42.59% of A type notch patients compared to 20.63% with U type notch. Analysis of notch width index among patients with Anterior cruciate ligament tears, showed that 40.67% of Anterior cruciate ligament torn knee had narrow notch compared to 22% in non- injured group, which was statistically significant. CONCLUSIONS: Type A notch and narrow notch both are risk factors for Anterior cruciate ligament tear.

Pseudoaneurysm of the Popliteal Artery Leading to Foot Drop After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Rare Complication: A Case Report.

CASE: A 32-year-old man underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft. He complained of persistent posterior knee pain in the postoperative period and at 4 weeks postsurgery developed foot drop and intense posterior knee pain. On clinicoradiological evaluation, a popliteal pseudoaneurysm (PSA) was diagnosed. The patient underwent surgical exploration, excision of the PSA, and primary repair of the popliteal artery. The foot drop recovered at 3 months post-second surgery follow-up. CONCLUSIONS: Persistent posterior knee pain and popliteal fossa swelling in a patient after ACLR should raise a suspicion of popliteal PSA. Identifying these lesions early can prevent further complications such as common peroneal nerve palsy.

A Definition of Significant Instability and a Scoring System for Predicting Meniscal Tears in ACL-Deficient Knees.

BACKGROUND: Patients with anterior cruciate ligament (ACL)-deficient knees risk recurrent instability of the affected knee, which may predispose to meniscal injuries. Various studies have correlated the incidence of meniscal tear with elapsed time from ACL tear and number of instability events. However, it is not clear how significant an instability event needs to be to contribute to a meniscal tear. PURPOSE/HYPOTHESIS: The purpose of this study was to (1) define a significant instability episode and (2) develop a checklist and scoring system for predicting meniscal tears based on significant instability episode. We hypothesized that patients with ACL-deficient knees who met the scoring threshold for a significant instability episode would have a higher incidence of meniscal tears compared with those who did not meet the threshold. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: This retrospective study included patients with magnetic resonance imaging (MRI)-confirmed isolated ACL tear for longer than 3 months. We determined parameters for assessing instability episodes and defined any instability events between the MRI and ACL reconstruction as significant or insignificant. Patients were then grouped into a significant instability group (≥1 significant episode) and an insignificant instability group, and the incidence and types of meniscal tears found during surgery were compared between groups. RESULTS: There were 108 study patients: 62 in the significant instability group and 46 in the insignificant instability group. During surgery, 58 meniscal tears (46 medial, 12 lateral) were recorded, for an overall meniscal injury rate of 53.70%. In the significant instability group, 47 patients (75.81%) had a meniscal tear and 15 (24.19%) had intact menisci (P < .001). In the insignificant instability group, 11 patients (23.91%) had a meniscal tear and 35 (76.08%) had intact menisci (P < .001). Regarding the 58 patients with a meniscal tear, 47 (81.03%) had ≥1 significant episode of instability before surgery, as compared with 11 (18.97%) who had insignificant or no instability. The odds of having a medial meniscal tear at ACL reconstruction was 10 times higher in the significant instability group versus the insignificant instability group. CONCLUSION: The incidence of a medial meniscal tear was 10 times greater in patients with a significant episode of instability versus those with insignificant instability, as defined using a predictive scoring system. The incidence of lateral meniscal tear did not change with instability episodes.

Weave Technique for Reconstruction of Medial Collateral Ligament and Posterior Oblique Ligament: An Anatomic Approach Using Semitendinosus Tendon.

Medial collateral ligament (MCL) is the most commonly injured ligament in knee. The majority of MCL tears can be managed conservatively, and reconstruction or augmentation is required in few selected cases. Anatomic MCL and posterior oblique ligament reconstruction have good functional outcome, but it requires 2 tunnels each in the tibia and femur, which may be a limitation in cases in which multiligament reconstruction is required. Several studies report the use of semitendinosus tendon with intact tibial attachment for MCL reconstruction. Since the attachment of semitendinosus is anterior to MCL footprint, it is non-anatomic and anisometric, which may lead to increased laxity of the reconstructed ligament in due course of time. To prevent the laxity in long term, the reconstruction has to be isometric and anatomic. We, hereby, are reporting our unique technique of MCL and posterior oblique ligament reconstruction using intact semitendinosus at tibial attachment and re-routing to the MCL which makes the reconstruction anatomic and isometric. A supplemental video demonstration of the technique is attached with this article.