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Purpose The purpose of the current study was to evaluate the short-term results of meniscal root repair surgery, assessing clinical and radiographic outcomes, utilizing MRI to assess root healing and extent of post-operative extrusion. Methods This was a single-center, retrospective study evaluating patients who had undergone a medial meniscus posterior root repair using a transtibial pullout technique with two locking cinch sutures. Demographic data were collected from patient charts. Clinical outcomes were assessed with pre- and post-operative IKDC and Lysholm scores. Pre-op scores were taken at the patients’ initial clinical visit, mean 1.55 months prior to surgery (± 1.8 months, min 0.3, max 7.3). Radiographic outcomes were assessed with MRI evaluation of root healing, meniscal extrusion, and cartilage degeneration using ICRS criteria. Tunnel placement was evaluated and compared to the anatomic footprint. Results Eighteen patients (47.2 years ± 11.9) were evaluated at mean follow-up of 24.9 months (± 7.2, min 18.4, max 35.6). The IKDC score significantly increased from 45.9 (± 12.6) pre-operatively to 76.8 (± 14.7) post-operatively ( p  < 0.001). Lysholm scores also increased from 50.9 (± 7.11) to 87.1 (± 9.8) ( p  < 0.001). Mean tunnel placement was 5.3 mm (± 3.5, range 0–11.8) away from the anatomic footprint. Mean extrusion increased from 4.74 mm (± 1.7) pre-operatively to 5.98 (± 2.8) post-operatively ( p  < 0.02). No patients with > 3 mm of extrusion on pre-operative MRI had < 3 mm of extrusion on post-operative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades worsened significantly ( p  < 0.02 and p  < 0.01, respectively). On MRI, one root appeared completely healed, 16 partially healed, and one not healed. Conclusion Patients treated with the transtibial suture pull-out technique with two locking cinch sutures had improved clinical outcomes, but only partial healing in the majority of cases, increased extrusion, and progression of medial compartment cartilage defect grade on follow-up MRI. Patients should be counseled that although clinical outcomes in the short term may be optimistic, long-term outcomes regarding progression to degenerative arthritis may not be as predictable. Clinical level of evidence III.

Purpose Recent evidence has found the antero-lateral ligament (ALL) may play a role in stabilizing the knee, but its role in anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of the current study is to systematically review and meta-analyze the current evidence in the literature to ascertain whether ACL reconstruction combined with ALL reconstruction affects knee stability, re-rupture rates and patient-reported outcomes compared to ACL reconstructions performed alone. Methods A literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL + ALL reconstruction and ACL reconstruction alone were included. Results Six clinical trials (LOE I: I, LOE II: 2, LOE III: 3) with 729 patients were included, with a mean follow-up time of 34.2 (24–54.9) months. There was a significant difference in favor of combined ACL + ALL reconstruction for reduced re-rupture rate (2.4% vs 7.3%, p  < 0.01), residual positive pivot shift rate (33.3% vs 11.4%, p  < 0.01), and reduced KT-arthrometer evaluation (1.6 vs 2.6, p  < 0.01). Combined ACL + ALL reconstruction resulted in improved IKDC scores (92.5 vs 87.8, p  < 0.01), Lysholm scores (95.7 vs 91.2, p  < 0.01) and Tegner scores (6.7 vs 5.7, p  < 0.01). There was no significant difference in rate of return to play at the same level (54.3% vs 46.0%, n.s.). Conclusion The current evidence suggests alongside soft tissue graft ACL reconstruction that concomitant ALL reconstruction improves clinical outcomes, with improved knee stability and lower re-rupture rates. Level of evidence III.

Background Recent interest has surged in the anterolateral ligament (ALL) and complex (ALC) of the knee. Its existence and role in rotary stability of the knee, particularly in the setting of anterior cruciate ligament (ACL) reconstruction, remains a contentious and controversial topic. Understanding the ALC We must review our history and recognize the pioneers who pushed our understanding of the ALL forward before it was popularly recognized as a discrete structure. Additionally, given that many eponyms remain in common use related to the ALC, we must standardize our nomenclature to prevent misuse or misunderstanding of terms in the literature. In this review, modern understanding of the anterolateral ligament complex (ALC) is traced to 1829 by exploring eponymous terms first in anatomy and then in surgical technique. Understanding our history and terminology will allow us to better understand the ALC itself. Conclusion This review aims to provide historical context, define terminology, and provide insight into the clinical relevance of the ALC.

Background Patient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR. Methods We conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p -values less than 0.05 were considered significant. Results The cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12–56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p  > 0.05). Absence of antibiotic PRAs was predictive of higher VAS ( p  < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p  > 0.05). Conclusions In conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.

Background Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT. Methods We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients’ functional status relative to the US population. P -values < 0.05 were considered significant. Results The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19–49 years) and mean body mass index (BMI) of 27.9 kg/m 2 (range 22.5–53.3 kg/m 2 ). Mean follow-up time was 56.8 months (range 13–106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction ( p  < 0.05). Conclusions The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low. Level of evidence : IV.

Background The purpose of this study was to identify socioeconomic predictors of time to initial evaluation, time to surgery, and postoperative outcomes among lateral patellar instability patients undergoing medial patellofemoral ligament reconstruction (MPFLR). Methods We conducted a retrospective review of patients at our institution who underwent primary MPFLR with allograft from 2011 to 2019 and had minimum 12-month follow-up. Patients were administered an email survey in January 2022 to assess symptom history, socioeconomic status, and postoperative outcomes including VAS satisfaction and Kujala score. Predictors of time to initial evaluation, time to surgery, and postoperative outcomes were identified using multivariable linear and logistic regression with stepwise selection. Results Seventy patients were included in the cohort (mean age 24.8 years, 72.9% female, mean follow-up time 45.7 months). Mean time to evaluation was 6.4 months (range 0–221) and mean time to surgery was 73.6 months (range 0–444). Having a general health check-up in the year prior to surgery was predictive of shorter time to initial evaluation (β = − 100.5 [− 174.5, − 26.5], p  = 0.008). Home ownership was predictive of shorter time to surgery (β = − 56.5 [− 104.7, 8.3], p  = 0.02). Full-time employment was predictive of higher VAS satisfaction (β = 14.1 [4.3, 23.9], p  = 0.006) and higher Kujala score (β = 8.7 [0.9, 16.5], p  = 0.03). Conclusion Markers of higher socioeconomic status including having a general check-up in the year prior to surgery, home ownership, and full-time employment were predictive of shorter time to initial evaluation, shorter time to surgery, and superior postoperative outcomes. Level of evidence : IV, retrospective case series.

Background: Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have been widely accepted because of their superior biomechanical properties when compared with arthroscopic single-row repair. Concerns regarding repair overtensioning with medial-row knot tying have led to increased interest in knotless repair techniques; however, there is a paucity of clinical data to guide the choice of technique. Hypothesis: Arthroscopic TOE repair techniques using knotless medial-row fixation will demonstrate lower retear rates and greater improvements in the Constant score relative to conventional knot-tying TOE techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Inclusion criteria were English-language studies that examined repair integrity or Constant scores after arthroscopic rotator cuff repair with TOE techniques. Two investigators independently screened results for relevant articles. Data regarding the study design, surgical technique, retear rate, and Constant shoulder score were extracted from eligible studies. A quality assessment of all articles was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The systematic review identified a total of 32 studies (level of evidence, 1-4) that met inclusion and exclusion criteria. Of the 32 studies, 5 reported on knotless TOE techniques, 25 reported on knot-tying TOE techniques, and 2 reported on both. In the knotless group, retear rates ranged from 6% to 36%, and Constant scores ranged from 38-65 (preoperative) to 73-83 (postoperative). In the knot-tying group, retear rates ranged from 0% to 48%, and Constant scores ranged from 42-64 (preoperative) to 55-96 (postoperative). Conclusion: Despite several theoretical advantages of knotless TOE repair, both knotless and knot-tying techniques reported considerable improvement in functional outcomes after rotator cuff repair. Although tendon failure rates showed a downward trend in knotless studies, additional prospective studies are warranted to better understand the role of medial-row fixation on tendon repair integrity and postoperative clinical outcomes.

Category: Sports; Ankle Introduction/Purpose: The World Health Organization declared the outbreak of COVID-19 a pandemic on March 11, 2020, leading to lockdowns, quarantines, and increased sedentary behaviors. As the general population as well as athletes returned to their normal physical activities or sport in 2021, the risk for musculoskeletal injury increases after inactivity. Thus, the purpose of this study was (1) to investigate the rates of AATR requiring repair in a single academic center in NYC, and (2) see if a corollary exists in the NFL. Our hypothesis is that after a decrease in AATRs in 2020 from decreased physical activity due to a combination of lockdown sanctions and COVID pandemic-induced fears, there is a rebound increase in AATRs in 2021, possibly even to greater than pre-pandemic levels. Methods: All study protocols were approved by the Institutional Review Board at the senior author's institution. A retrospective search was conducted using current procedural terminology to identify the total number of Achilles acute primary repair surgeries performed from years 2017 to 2021 at a sincle academic center. NFL data was obtained from publicly available sites according to previously validated studies. Chi-square analysis was conducted between proportion of Achilles surgeries performed in 2021 and 2017-2020 at a single academic center. Additional Chi-square analysis was performed in a similar manner, however between each year and 2021. Results: A total of 588 patients who sustained AATRs and underwent primary surgical repair were identified, primarily men (75.7%, n = 445), with an average age of 43.22+-14.4 years. The incidence of the total number of AATR repairs per year was: 2017: 21.1% (n = 124), 2018: 18.7% (n = 110), 2019: 22.1% (n = 130), 2020: 14.6% (n = 86), 2021: 23.5% (n = 138), indicating a 7.5% decrease in rate of AATRs from 2019 to 2020, followed by an 8.9% increase in incidence from 2020 to 2021. Within the NFL, the number of AATRs resulting in an IR stint increased every regular season from 2019-2020: 21.2% (n = 11), to 2020-2021: 32.7% (n = 17), to this past 2021-2022 season: 46.2% (n = 24). Conclusion: The main finding of our study is a decrease in the incidence of AATRs during the height of the COVID pandemic quarantine in 2020, with a 8.9% increase in 'post-COVID' 2021 at a single academic institution. There was also a 2.9% higher incidence of AATR in 2021 compared to 'pre-COVID' normal levels when averaged between 2017 to 2019, findings that are mirrored in the NFL. This information provides important information for providers when counseling patients and athletes on return to sport in this current pandemic, especially with possible future lockdowns or quarantines due to new variants such as Omicron.

ObjectiveConcerns regarding patient safety and image quality have made the use of knee-spanning external fixators in MRI a challenging clinical scenario. The purpose of our study was to poll practicing musculoskeletal radiologists on their personal experiences regarding the use of knee-spanning external fixators in MRI in an effort to consolidate practice trends for the radiologists’ benefit.MethodsA 27-item survey was created to address the institutional use, safety, adverse events, quality, and perspectives of the radiologist related to MRI of an externally fixated knee. The survey was distributed to 1739 members of the Society of Skeletal Radiology.ResultsA total of 72 members of the Society of Skeletal Radiology completed the survey. Most notably, 40 of 72 (55.56%) respondents are permitted to place a knee-spanning external fixator inside the MR bore at their institution, while19 of 72 (26.39%) respondents are not permitted to do so. Fourteen of 32 (43.75%) respondents have institutional guidelines for safely performing an MRI of an externally fixated knee. Twenty-five of 32 (78.13%) respondents are comfortable permitting an MRI of an externally fixated knee.ConclusionWe found a general lack of consensus regarding the decision to scan a patient with a knee-spanning external fixator in MRI. Many institutions lack safety guidelines, and providers rely upon a heterogeneous breadth of resources for safety information. A re-examination of the FDA device labeling nomenclature and expectations of the individual manufacturers may be needed to bridge this gap and help direct management decisions placed upon the provider.

Purpose The purpose of this study was to evaluate the mid-term results of posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and magnetic resonance imaging (MRI). Methods This was a single-center, retrospective study evaluating patients that had undergone a PMMRT. This was a follow-up to a previously published 2-year outcome study (all original patients were invited to participate). Clinical outcomes included pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores. Root healing, meniscal extrusion, and cartilage degeneration via International Cartilage Repair Society Scale (ICRS) grades were assessed on MRI by two musculoskeletal fellowship-trained radiologists. Results 10 of the original study’s 18 patients were able to participate. Mean age and BMI was 48.4 ± 12.0 years and 29.5 ± 4.5, respectively, with mean follow-up 65.5 ± 8.3 months (range 52.0–75.8) (60% female). The IKDC significantly increased from 43 ± 13 preoperatively to 75 ± 16 at 5-year follow-up ( p  < 0.001). There was no significant change in IKDC score between 2-year and 5-year follow-up [75 ± 16 vs 73 ± 20, (n.s)]. The Lysholm also significantly increased between preoperative and 5-year follow-up (49 ± 7 vs 84 ± 11, p  < 0.001). There was no significant change between Lysholm score at 2-year and 5-year follow-up [84.0 ± 11 vs 82 ± 13, (n.s)]. Mean extrusion did not significantly change from the preoperative state to 5-year follow-up [4.80 mm ± 1.9 vs 5.0 mm ± 2.5, (n.s.)]. Extrusion also did not significantly change between 2-and 5-year follow-up [6.1 ± 3.2 mm vs 5.0 mm ± 2.5, (n.s.)]. No patients with > 3 mm of extrusion on preoperative MRI had < 3 mm of extrusion on postoperative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades significantly increased from preoperative to 2-year follow-up ( p  = 0.038, p  = 0.023, respectively). Medial femoral condyle and medial tibial plateau ICRS grades again significantly increased between 2-year and 5-year follow-up ( p  = 0.014, p  = 0.034). Conclusion Patients treated with the transtibial suture pullout technique with two locking cinch sutures had maintenance of clinical outcome improvements at 5-year follow-up. However, extrusion was widely prevalent, with worsening progression of femoral and tibial chondral disease. Level of Evidence Level 4.