Page 10 - ISAKOS 2020 Newsletter Volume 2
P. 10

Meniscal Repair Failure Risk Does Not Differ by Sex
Christopher Hamilton, David C. Flanigan, Kishan H. Patel, Nathaniel Lundy, Ryan Blackwell, Robert A. Magnussen
Systematic Review
Meniscal can be carried out with a variety of techniques. Regardless of technique and implant choice, it is critical to understand and consider patient-related factors, which can influence outcome. The purpose of this systematic review and meta-analysis was to determine if the sex of the patient has an effect on the risk of failure following meniscal repair. The authors identified 11 identified studies with a total of 886 patients (556 males and 330 females). Meniscal repair failure was reported in 192 patients (21.7%). The risk of failure was 21.1% for males and 21.5% for females. Meta-analyses demonstrated no significant difference in the risk of failure on the basis of sex in either the three studies in which repair success arthroscopically (p = 0.66) or the eight studies in which failure was defined on the basis of clinical assessment or the need for repeat surgery (p = 0.92). The authors noted that more data are needed to evaluate patient-reported outcomes of meniscal repair on the basis of sex.
ACL Reconstruction with Remnant Preservation
Benjamin B. Rothrauff, Eiji Kondo, Rainer Siebold, Joon Ho Wang, Kyoung Ho Yoon, Freddie H. Fu
Current Concepts Review
The authors noted (1) that future studies should better describe the ACL tear pattern, remnant volume, remnant quality, and surgical technique, (2) that progress in understanding and applying remnant preservation may inform, and be reciprocally guided by, ongoing research on ACL repair, and (3) that the goal of research on ACLR with remnant preservation is not only to achieve anatomic structural restoration of the ACL but also to facilitate biological healing and regeneration to ensure a more robust and functional graft.
Medial-Side Knee Injuries: Simplifying the Controversies
David Figueroa, Rodrigo Guiloff, Alex Vaisman, Francisco Figueroa, Robert C. Schenck, Jr.
Current Concepts Review
Injuries to the medial side of the knee (MSK) are the most common knee ligament lesions. Historically, these injuries have been treated conservatively; however, a better understanding of the anatomy and biomechanics of the different structures of the MSK have resulted in diverse and controversial opinions about the ideal treatment of these lesions and variations in the literature with regard to the nomenclature used to describe the same surgical techniques. The diagnosis of MSK injuries must involve a critical thinking process to precisely identify which lesions imply an imminent risk of healing failure. This review article provides an evidence and clinical-based clarification of the controversies regarding injuries to the MSK and proposes an evidence-based algorithm for their treatment.
Endoscopic Release of Posterior Capsuloligamentous Structures for Painful Ankle Dorsiflexion
Benjamin Hickey, Miquel Dalmau-Pastor, Jón Karlsson, James Calder
Prospective Case Series
The purpose of this study was to evaluate the effect of arthroscopic release of the posterior capsuloligamentous structures on ankle dorsiflexion and function in patients with painful limitation of ankle dorsiflexion. Thirteen adult patients with a median age of 26 years (range, 19 to 44 years) were included. None of the patients had clinically relevant gastrocnemius, soleus, or Achilles contracture, and patients with anterior osseous impingement or ankle degeneration on CT scans were excluded. All patients underwent combined anterior and posterior ankle arthroscopies with resection of posterior capsuloligamentous structures and the posterior fibulotalocalcaneal ligament. At 2 years postoperatively, the ankle dorsiflexion range had increased by 15° (range, 0° to 25°) (p < 0.0001).
ACL tears are a common knee injury, and anatomic ACL reconstruction (ACLR) is now the standard of care to restore knee stability. Nevertheless, re-tear rates exceeding 5% are commonly reported, with an even higher percentage of patients being unable to achieve preinjury knee function. As the torn ACL remnant contains elements essential to ACL function (e.g., cells, blood vessels, and mechanoreceptors), it has been hypothesized that ACLR with remnant preservation may improve graft remodeling, in turn more quickly and completely restoring ACL structure and function. In this Current Concepts review, the summarized the present understanding of ACLR with remnant preservation, which includes selective bundle reconstruction of partial (one- bundle) ACL tears and single-bundle and double-bundle ACLR with minimal to partial debridement of the torn ACL stump. Reported benefits of remnant preservation included accelerated graft revascularization and remodeling, improved proprioception, decreased bone tunnel enlargement, individualized anatomical bone tunnel placement, improved objective knee stability, and early mechanical support (with selective bundle reconstruction) to healing tissues. However, clinical studies of ACLR with remnant preservation are heterogeneous in terms of the description of remnant characteristics and surgical technique. Currently, there is insufficient evidence to support the superiority of ACLR with remnant preservation over the standard technique.

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