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Background: Meniscal extrusion, referred to as an external displacement of the meniscus, is a commonly encountered but often overlooked magnetic resonance imaging finding in the knee joint. Meniscal extrusion alters the biomechanical properties of the meniscus, leading to accelerated cartilage degeneration and early osteoarthritic changes. The literature contains discrepancies about meniscal extrusion on topics ranging from definition to diagnosis. This narrative review outlines the pathogenesis, natural history, diagnosis, and treatment of meniscal extrusion. Purpose: To review the current literature on meniscal extrusion, from pathogenesis to treatment, and to provide recommendations for future research. Study Design: Narrative review. Methods: A computer-based search of the PubMed, Ovid Medline, and Cochrane Library databases was used to perform a comprehensive literature review on meniscal extrusion. A total of 81 studies was ultimately included in the review. Results: The literature review highlighted the current ambiguity in definition, difficulty in clinical diagnosis, and low level of awareness of this condition. This review covers all aspects related to meniscal extrusion and identifies many of its lesser known aspects. Conclusion: In the current literature, meniscal extrusion remains a lesser known albeit common condition because of its relatively silent nature along with lack of knowledge among orthopaedic surgeons. Further studies are warranted to provide better understanding and management of this condition.

Background: The anterior cruciate ligament (ACL) is the most commonly operated ligament of the knee. Details on the top journals, universities, and authors on the topic would be helpful to identify the sources of information for clinical and research queries as well as to observe trends for future research and identify universities/authors of particular interest for training or to follow their research. Purpose: To consolidate information from PubMed on the ACL from 1979 to 2018, spanning 40 years. Study Design: Cross-sectional study. Methods: A search of the PubMed database was conducted for the ACL, and 18,696 articles published over the past 40 years were analyzed for further details. These details included the number of publications per year, top 10 journals publishing on the ACL, top 10 first authors publishing articles on the ACL, and number of articles published with specific keywords. Data were also sought from the Scopus database regarding the top universities and countries publishing on the ACL. The coauthorship of articles and co-occurrence of terms in titles were also analyzed using VOSviewer. Results: There was a steady increase in the yearly average number of publications from 1979 to 2018. The top journal and top author publishing on the ACL were The American Journal of Sports Medicine and Freddie H. Fu, respectively. The most articles published by a first author were by K. Donald Shelbourne. Time-based links of Dr Fu to other authors were represented as VOSviewer output. Most occurrences of specific keywords in the title were also studied and listed. The United States was the most published country, and 8 of the top 10 universities that published were from this country. Conclusion: There has been a steady increase in the number of articles published in PubMed since 1979. It appears that interest on the topic of the ACL has not decreased or stabilized but rather increased significantly over the past few years. This article quantifies the increased interest and could act as a baseline for future studies to compare.

Cyclops lesion is a known complication of anterior cruciate ligament reconstruction (ACLR). Although the incidence of cyclops lesion appears to be decreasing, it remains an important cause of restriction of extension after ACLR. We reviewed the available literature regarding the cyclops lesion and syndrome and cyclops-like lesions to analyze available evidence on cyclops lesions and variants of cyclops lesions. A keyword search in PubMed, Scopus, Web of Science, and EMBASE, Ovid Medline, and Ovid journals provided 47 relevant articles in the English literature, which were used to create this review. We classified cyclops lesions based on clinical presentation, pathology, and location. Risk factors, management options, tips to reduce the condition, and controversies related to the condition have been discussed. Female sex, greater graft volume, bony avulsion injuries, excessively anterior tibial tunnel, double-bundle ACLR, and bicruciate-retaining arthroplasty appear to predispose patients to cyclops lesions. Cyclops syndrome is a cyclops lesion that causes a loss of terminal extension. Arthroscopic debridement is an effective treatment for cyclops syndrome, whereas cyclops lesions are usually managed conservatively. It is important to distinguish between cyclops lesion and cyclops syndrome, as management differs based on symptoms. Cyclops lesion is diagnosed using magnetic resonance imaging. The management of choice for symptomatic lesions is surgical excision. Outcomes after excision are very good, and recurrence is rare.

Purpose No systematic review has compared the clinical outcome of anterior stabilized ultra-congruent and standard cruciate-retaining inserts in fixed-bearing primary total knee arthroplasty. This study aimed to compare the outcomes and establish the superiority or equivalence of these inserts. Methods Pubmed, EMBASE, Medline, AMED, ERIC, and Proquest databases were searched electronically. PRISMA guidelines were followed in the conduct of the study. The clinical outcomes compared in the meta-analysis were overall knee score, WOMAC, score for knee function, score for knee pain, SF-12 PCS, knee flexion, manipulation under anaesthesia for postoperative knee stiffness, revision total knee arthroplasty or change of polyethylene insert for post-operative instability (relative risk [RR]) and survivorship. Study quality was evaluated using the Newcastle Ottawa Scale and the Modified Jadad scale. Results Fourteen studies comprising 9989 knees (three RCTs and 11 comparative case-cohort studies) were included for qualitative and quantitative analysis. The pooled analysis of the ultracongruent insert and the standard cruciate retaining insert was based on a cohort of 2860 and 7129 TKA, respectively. Knee pain was significantly better in patients that had standard inserts ( p  = 0.02; 95% CI − 1.06 to − 0.10), and the physical component of health-related quality of life was also significantly better in patients that had standard inserts ( p  = 0.02; 95% CI − 6.43 to − 0.64). There was a 72% lesser chance of revision TKA or change of insert for postoperative instability in knees that had been implanted with ultracongruent inserts (RR = 0.28; p  = 0.0002; 95% CI 0.15–0.55). There was no difference in the otheroutcome measures. There was no significant difference between the two inserts, considering the minimal clinically important difference or absolute ratio. Conclusion Differences observed between the two types of inserts were not clinically significant. Therefore, based on current evidence, arthroplasty surgeons can use either of these inserts with cruciate-retaining knee prosthesis. Level of evidence Therapeutic study, Level II.

A method to draw a Pedotti or butterfly diagram is described using Microsoft Excel spreadsheets and charts without the need for knowledge in programming or special software.A method to draw a Pedotti or butterfly diagram is described using Microsoft Excel spreadsheets and charts without the need for knowledge in programming or special software.

Purpose The purpose of this study was to analyze the trends in publications on ramp lesions of the meniscus in the current literature. We hypothesized that publications on ramp lesions have increased rapidly in recent years due to increased knowledge of both clinical and radiological pathology. Methods A Scopus search performed on 21/01/23 retrieved 171 documents. A similar search strategy was employed to carry out a search for ramp lesions on PubMed with no time filters and only English articles. The articles were downloaded into Excel software, and citations for PubMed articles were determined from the iCite website. Analysis was performed using Excel. Using Orange software, data mining was performed from the titles of all articles. Results There are a total of 126 publications from 2011 to 2022 with a total of 1778 citations in PubMed. Of all publications, 72% were published in the last 3 years, from 2020 to 2022, indicating an exponential increase in interest in this subject in recent years. Similarly, 62% of the citations were aggregated by the years 2017–2020, both years included. When the journals were analyzed according to the number of citations, the American Journal of Sports Medicine (AJSM) topped with 822 citations (46% of all citations) and 25 publications, followed by Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) with 27 articles and 388 citations (22% of all citations). When analyzed by citations per publication for different types of studies, randomized clinical trials (RCTs) were the most cited, with 32 citations per publication, followed by basic science articles with 31.5. Most of the basic science articles were cadaver studies examining anatomy, technique, and biomechanics. Technical notes were the third most cited at 18.64 per publication. While the USA is the country that leads publications, France is in a significant second position contributing to research on this topic, followed by Germany and Luxembourg. Conclusions Global trend analysis suggests that ramp lesion research has significantly increased and that the number of papers on the topic is steadily increasing. We found that the publications and citations presented a rising trend, the majority of the highly cited papers were contributed by a few centers, and the most cited were randomized clinical trials and basic science studies. The long-term outcomes of conservatively and surgically treated ramp lesions have attracted the most research interest.

Background: As information on the meniscus accumulates in PubMed, it is possible to evaluate the trends in research on the topic over time. Purpose: To evaluate the major trends in meniscus-related publications in PubMed from the earliest publication to the present day. Study Design: Cross-sectional study. Methods: PubMed was searched on January 3, 2023, using the search strategy “menisc *”[All Fields] AND (“knee”[MeSH Terms] OR “knee”[All Fields] OR “knee joint”[MeSH Terms] OR (“knee”[All Fields] AND “joint”[All Fields]) OR “knee joint”[All Fields]) AND 1900/01/01:2022/12/31[Date - Publication]. This retrieved 15,569 human and animal studies. We determined the top 10 meniscus-related publications in terms of overall citations and citations per year, as well as the top 10 authors, journals, countries, and institutions of cited publications on the meniscus. In addition, we performed word-cloud analyses based on meniscus-related terms from different periods (before 1981, before 2000, after 2005, and in the past 5 years [2018-2022]), including the year of first appearance and the number of publications featured. Results: Since the first recorded publication on the meniscus in 1928, there was a steady growth in the number of articles until 2005, when there was an upsurge in publications from 254 in 2005 to 955 in 2022. Noyes was the author with the most citations (n = 3314), and a 2006 study by Caplan and Dennis had the most citations per year (n = 125). Arthroscopy published the most articles on the meniscus with 1118, whereas the Journal of Cellular Biochemistry had the most citations per article with 125.69. The most published countries and institutes were the United States and the Hospital for Special Surgery, respectively. Word-cloud analysis of article titles showed that “meniscectomy” had become less prominent, and “root,”“ramp,”“transplantation,” and “slope” had become more prominent. Conclusion: There has been an upsurge in publications on the meniscus since 2005, with word-cloud analysis indicating shifting interests in meniscus-related research.

Background: Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature. Purpose: To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies. Study Design: Scoping review; Level of evidence, 4. Methods: The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords “ALPSA,”“anterior labrum periosteal sleeve avulsion,”“anterior labral periosteal sleeve avulsion,” and “anterior labroligamentous periosteal sleeve avulsion” lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation. Results: This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures. Conclusion: There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.

Proximal fibular osteotomy has been proposed as a simple and inexpensive alternative to high-tibial osteotomy and unicondylar knee arthroplasty and may be useful for low-income populations that cannot afford expensive treatment methods. However, there is no consensus existing regarding the mechanism by which it acts nor the outcome of this procedure. This study was performed to analyze the available evidence on the benefits of proximal fibular osteotomy and to understand the possible mechanisms in play. There are various mechanisms that are proposed to individually or collectively contribute to the outcomes of this procedure, and include the theory of non-uniform settlement, the too-many cortices theory, slippage phenomenon, the concept of competition of muscles, dynamic fibular distalization theory and ground reaction vector readjustment theory. The mechanisms have been discussed and future directions in research have been proposed. The current literature, which mostly consists of case series, suggests the usefulness of the procedure in decreasing varus deformity as well as improving symptoms in medial osteoarthritis. However, large randomised controlled trials with long-term follow-up are required to establish the benefits of this procedure over other established treatment methods.

Purpose Arthroscopy is an established sub-speciality in orthopaedics. With advancing technology, instrumentation and implants, this sub-speciality has seen an explosion of knowledge and techniques since its inception. The indications for arthroscopic management are increasing and, hence, the number of publications on this topic. There has been no study looking into the bibliometrics of all publications within this speciality. The purpose of this study was to look into the trends of published articles on arthroscopy from PubMed and Scopus including studying their citation numbers. Materials and methods We set out to look into the number of publications from the earliest up to 2019 and their trends and citation numbers in PubMed and Scopus. We also performed a VOS viewer analysis of MeSH terms and titles of publications to look at research trends over time. Results There were 41,149 articles published on PubMed since 1955 and 50,373 articles on Scopus since 1939. The total number of citations were 912,630 for 38,338 cited articles. With 2864 publications in 2019, there was a more than four-fold increase from the number published in the year 2000. The knee joint was the most frequently published joint with an increasing trend in hip arthroscopy. Cohort studies were the most common with 13,180 articles followed by Reviews with 5746 articles. The top 10 authors, universities and journals were listed along with citation numbers. We analysed the trends of publications for each joint and compared them. Yearly citations have progressively increased to reach a maximum of 45,407 in 2007. Arthroscopy was the most published and cited journal on this topic. The Journal of Bone and Joint Surgery ( JBJS ) (Am) had the most citations per article. The USA and Hospital for Special Surgery, New York were the most published country and university, respectively. Conclusions There is a healthy growth of publications on the subject of arthroscopy with a steep increase in the number of publications and citations in recent years. VOS Viewer analysis showed an evolution of research and practice in the field of arthroscopy. Recommendations were made for databases and search engines to improve on the search and analysis of such studies in the future. Level of evidence 4