Citations

Abstract The lateral and medial meniscus play vital roles in load distribution across the knee joint and in the prevention of knee osteoarthritis. As such, every effort should be made to save and repair the meniscus when possible, as partial and total meniscectomies have been shown to impair the meniscus’ ability to effectively dissipate shock. Recently, an algorithm—coined the “ABCs of meniscal repair”—has emerged as a blueprint for optimizing the success of a meniscal repair. The “ABCs of meniscal repair” refer to anatomic reduction, biologic augmentation, and circumferential compression across the meniscus tear, respectively. In this technique, we describe a modified use of the arthroscopic skid that allows for access to difficult‐to‐reach peripheral meniscal tears while simultaneously aiding in the anatomic reduction of the tear.

Abstract Femoroacetabular impingement with cam morphology that fails nonoperative management can be addressed with hip arthroscopy and cam resection. There exists a wide variation of cam morphology due to various etiologies that can make some cam lesions more challenging to address. A thorough preoperative evaluation and the utilization of a variety of intraoperative techniques can allow for adequate arthroscopic resection of these otherwise challenging cam lesions. In this technique video, we describe a systematic approach for the preoperative assessment of femoroacetabular impingement due to a cam lesion and consideration of different approaches for arthroscopic resection based on cam‐specific morphology.

Background: Complex repairs of radial meniscal tears have shown increased fixation strength compared to conventional sutures. A simplified 2-suture hybrid and a novel dual tie-grip repair with interconnected vertical mattress sutures spanning the tear were tested and compared to all-inside double-horizontal and tie-grip repairs. Hypothesis: The dual tie-grip repair would increase the initial compression load across the tear and show the least cyclic displacement and highest failure strength. Study Design: Controlled laboratory study. Methods: A total of 40 porcine medial menisci were assigned to 4 repair groups: double-horizontal, hybrid, tie-grip, and dual tie-grip (10 per group). Results from tie-grip repairs were used to assess the effect of vertical mattress suture interconnection. After suture placement according to the described technique and fixation, the initial compressive load, stiffness, and relief displacement were measured. The repaired specimens underwent cyclic loading between 5 and 30 N over 1000 cycles (0.75 Hz), while cyclic stiffness and displacement were measured. Ultimate stiffness and load-to-failure were analyzed at 3.15 mm/s. Results: Analysis of variance revealed that dual tie-grip and hybrid repairs showed higher initial compressive load and relief displacement than the other techniques, with dual tie-grip repair reaching the highest values for both metrics (load: 19.3 ± 2.3 N [ P < .001]; displacement: 0.75 ± 0.19 mm [ P < .001]). The double-horizontal repair had the lowest initial stiffness ( P < .001). Cyclic displacement was lowest for the dual tie-grip repair and highest for the double-horizontal repair (both P < .001). All repaired specimens stiffened during cycling without intergroup differences. Analysis of covariance for stiffness over displacement revealed higher stabilization ( P < .040) with dual tie-grip repair and reduced stabilization ( P < .001) with double-horizontal repair. Despite comparable ultimate stiffness across groups, the dual tie-grip repair failed predominantly by suture rupture at the highest ultimate load (275.5 ± 26.2 N; P < .001), whereas the double-horizontal repair failed by tissue rupture the earliest (127.2 ± 15.9 N; P < .001). Conclusion: The dual tie-grip repair provided the highest initial compression across the radial meniscal tear, the lowest cyclic displacement, and the greatest load-to-failure among all techniques in a porcine cadaveric model. The simplified 2-suture hybrid repair showed higher initial compression than other repairs and comparable cyclic stability to the tie-grip repair. Clinical Relevance: The dual tie-grip repair provided high compression across the radial tear and strong resistance to cyclic displacement. Future clinical series assessing differences in healing rates among different repair groups are warranted.

Abstract Medial meniscus root tears are among the most painful and disabling injuries in knee preservation practice, frequently presenting with substantial functional decline, particularly in female patients. Recent research associates increased posterior tibial slope with both root tears and worse pain scores. Although biomechanically plausible, posterior tibial slope should be interpreted as an association rather than a primary causal driver, as small variations in slope alone are unlikely to fully account for symptom burden or structural progression. Pain and functional decline in this population more likely reflects a multifactorial mechanical environment, in which posterior tibial slope interacts with other determinants of joint loading, including meniscal extrusion, limb alignment, cartilage health, body mass index, subchondral bone response, and degenerative meniscal changes. In our view, posterior tibial slope is one contributor within a broader mechanical environment rather than the primary driver. However, the key clinical message is clear: root tears represent a critical joint‐failure event that demands early recognition and treatment.

Abstract A posterior tibial slope (PTS) greater than 12° is an established risk factor for anterior cruciate ligament graft reconstruction failure. Reducing PTS is thus considered protective to the anterior cruciate ligament graft, and it can be achieved through an anterior closing‐wedge osteotomy. Prior to the procedure, PTS should be accurately measured to determine the amount of correction that is needed. Radiographic films remain the gold standard for measuring PTS. The purpose of this presentation is to show validated and reproducible step‐by‐step techniques for measuring PTS and anterior tibial translation for anterior closing‐wedge osteotomy using monopedal full‐length weight‐bearing tibia standing radiographs.

Abstract Tunnel convergence in multiligament knee surgery remains a technical challenge. Anterior cruciate ligament (ACL) femoral sockets/tunnels and lateral collateral ligament (LCL) femoral sockets/tunnels during anatomic posterolateral corner (PLC) reconstructions are particularly vulnerable to convergence. This is secondary to the limited amount of bony real estate available on the lateral distal femur. Previous studies have attempted to define a specific angle to direct the LCL tunnel away from the ACL tunnel. However, inconsistency with ACL femoral socket creation and variability in bony architecture can make this strategy unreliable. This surgical technique describes how to minimize the risk of ACL and LCL tunnel convergence during ACL and PLC reconstructions.

Hip arthroscopy is an increasingly common procedure to treat intra‐articular conditions such as labral tears and femoroacetabular impingement. With the increase in frequency of such procedures, so too are revision arthroscopic hip procedures. Capsular repair in the setting of revision hip arthroscopy can be challenging due to the presence of adhesions and scar tissue formation that obscure tissue planes, suboptimal quality of residual capsular tissue, and the presence of capsular tissue defects. This technical note aims to describe the key surgical principles and considerations of revision hip capsular closure.

Abstract Purpose The aim of this systematic review and meta‐analysis was to quantify and compare the evidence on the results obtained with the surgical treatments for meniscal lesions in athletes. Methods A literature search was conducted on PubMed, Cochrane and Web of Science in August 2025 according to the PRISMA guidelines. Inclusion criteria were clinical studies (randomised controlled trials [RCTs], non‐randomised comparative studies and case series), ≥6 patients, in the English language, on the surgical treatment of meniscal lesions in athletes. A meta‐analysis was conducted on the rate of patients returning to sport, the time to return to sport, and the rate of patients returning to the pre‐injury level of sport. Patient‐reported outcome measures, adverse events, failures and reoperation rates, as well as risk of bias and quality of evidence, were also documented. The risk of bias was assessed using the Cochrane RoB 2.0 tool, the Cochrane ROBINS‐I tool, and the JBI Critical appraisal checklist. The quality of evidence was assessed using a modified Coleman score and the GRADE tool. Result The mean time to return to sport was 2.1 months for meniscectomy, 5.8 months for meniscal repair, and 8.9 months for meniscal allograft transplantation (MAT). Statistically significant differences were observed between meniscectomy and repair and between meniscectomy and MAT (both p < 0.001). Meniscectomy showed a return to sport rate of 98.2%, meniscal repair of 96.9%, and MAT of 94.2%, while return to the same pre‐injury level of sport was reported as 84.4% for meniscectomy, 81.3% for meniscal repair, and 77.4% for MAT, with no statistically significant differences between groups. The mean modified Coleman Methodology Score for the included studies was 66.6 ± 7.0. Conclusion Meniscectomy, meniscal repair, and MAT are all able to provide high rates of return to sport in athletes. In the investigated treatment cohorts, meniscectomy presented the shortest pooled time to return to sport, followed by meniscal repair and MAT. Importantly, all treatments offered good rates of return to the same level of athletic performance. The treatment choice should be guided by an individualised, multidisciplinary approach aimed at providing a patient‐tailored treatment strategy to optimise both athletic recovery and joint preservation. Level of Evidence Level I.

Background: Stable osteochondritis dissecans (OCD) lesions are primarily treated nonoperatively. Nonoperative treatment includes several recommendations, including the use of an unloader brace. However, little is known about the clinical effectiveness of unloader bracing and its influence on OCD healing, return to sports, and patient-reported outcomes (PROs). The purpose of this investigation was to evaluate the impact of unloader bracing on patients with stable medial femoral condyle (MFC) OCD lesions treated nonoperatively. Purpose: To investigate the influence of valgus unloader bracing on the success of treating stable MFC OCD with nonoperative treatment strategies. Study Design: Cohort study; Level of evidence, 2. Methods: The authors used a prospective cohort of patients receiving nonoperative care for stable MFC knee OCD lesions. The primary variable of interest was the efficacy of bracing. The primary outcomes were transition from nonoperative care to surgical intervention, return-to-play (RTP) clearance, and PROs. Bivariate testing was used to determine if there were differences between groups. Chi-square testing was used to determine if there were differences in rates of transition to surgery by group. The timing of the transition by each group was assessed using a Wilcoxon rank-sum test, given the nonparametric nature of the data. Kaplan-Meier survival analysis was used to calculate time at risk, incidence rate, and survival times for each group. Results: A total of 185 knees (bracing group: 123 [66.5%] knees; no-bracing group: 62 [33.5%] knees) were analyzed. Overall, 142 (76.8%) knees were successfully treated nonoperatively. Transition to surgery occurred in 43 (23.2%) knees. There were no differences in transition to surgery by groups, with no differences seen by group. Of the knees that did not transition to surgical care, 65 (71.4%) in the bracing group and 38 (74.5%) in the no-bracing group received RTP clearance ( P = .693). PRO scores were similar between the 2 groups at the time of RTP clearance. Conclusion: The inclusion of an unloader brace in the nonoperative treatment for stable MFC OCD lesions did not decrease the likelihood of patients undergoing surgical intervention or improve their PRO scores at the time of RTP clearance. Registration: NCT02771496 (ClinicalTrials.gov identifier).

Background: Distal femoral osteotomy (DFO) may be performed via either a lateral opening-wedge (LOW) or medial closing-wedge (MCW) osteotomy with meaningful clinical improvements; however, the effects of each DFO technique on leg length have not been well characterized. Purpose: To (1) validate a radiographic measurement technique to predict leg length changes after DFO and (2) compare the change in leg length after DFO for the LOW and MCW techniques. Study Design: Cohort study; Level of evidence, 3. Methods: Preoperative and postoperative full-length standing radiographs obtained from patients who underwent DFO at 1 of 2 academic medical centers were evaluated. The region on the medial (for LOW) or lateral (for MCW) distal femur cortex that would be the “hinge point” during DFO was identified on the radiographs. The distance from the center of the femoral head to the hinge point ( A ), the distance from the hinge point to the center of the talus ( B ), and the resultant angle (α) were measured. The equation presented within the text was used to plot the predicted leg length changes corresponding to the change in alpha angle produced by DFO. Comparisons were made between (1) the predicted and measured leg length changes after DFO and (2) the measured leg length change after LOW versus MCW osteotomies. Results: For both LOW (n = 10) and MCW (n = 10) osteotomies, the predicted leg length change was equivalent to the true change measured on postoperative radiographs (LOW: P = .16; MCW: P = .85). There was a mean lengthening of 0.85 mm (range, 0.5-1.3 mm) for every 1° of mechanical axis correction with LOW DFO, compared to a mean shortening of 0.45 mm (range, 0.1-1.4 mm) per 1° of MCW correction. Conclusion: Preoperative radiographic imaging can be used to predict leg length change after DFO with high reliability. Surgeons can expect approximately 0.85 mm of lengthening per 1° of DFO correction when performing LOW osteotomies, compared to 0.45 mm of shortening per 1° of correction for MCW osteotomies. However, the most accurate prediction results from patient-specific calculations.