The American journal of sports medicine
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The femoral tunnel in anterior cruciate ligament reconstruction (ACLR) can be created by the transtibial (TT) or tibial-independent (TI) methods. An anatomically located femoral tunnel can be more consistently achieved by TI methods, which include the anteromedial portal and lateral (outside-in, retrodrill) techniques. Nonanatomic graft placement in ACLR can result in postoperative instability and meniscal or chondral injury. An anatomically located graft is subjected to higher postoperative physiologic forces than one placed nonanatomically. ⋯ In the largest known study of its type examining femoral tunnel drilling method for primary ACLR, after adjustment for age, sex, BMI, race, graft type, and femoral fixation, TI techniques were found to carry higher risk of aseptic revision compared with the TT method, while no difference was observed in risk for aseptic reoperation.
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Hip arthroscopy for the treatment of instability in the setting of borderline dysplasia is controversial. Capsular management in such cases is an important consideration, and plication has been described as a reliable technique, with good midterm outcomes reported when indications are appropriate. ⋯ Stringent criteria for patient selection and meticulous repair or augmentation of the static stabilizers of the hip yielded favorable clinical outcomes in this study cohort with borderline dysplasia. Within this carefully selected group, the analysis revealed that increased age was the main risk factor for failure in the management of borderline hip dysplasia via isolated primary arthroscopic hip surgery with capsular plication.
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Previous research demonstrated that the attachment of the anterolateral ligament (ALL) to the lateral meniscus is stiffer and stronger in its tibial attachment than its femoral attachment. How this relates to anterolateral knee stability and lateral meniscal function is unknown. ⋯ Tears of the midbody and/or posterior root attachment of the lateral meniscus are often observed at the time of ACL reconstruction. Increased anterolateral rotatory laxity has been observed in both lateral meniscus- and ALL-deficient states in combination with an ACL injury. While no significant functional relationship was found between the ALL and lateral meniscus, ALL sectioning did result in increased knee joint patholaxity, as demonstrated by composite tibiofemoral rotations.
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Patellar Tendon-Lateral Trochlear Ridge Distance: A Novel Measurement of Patellofemoral Instability.
Abnormalities in the trochlea-patella-tibia relationship have been shown to be risk factors for recurrent patellofemoral instability, although no current measurements quantify patellar containment in the trochlea. Standard measurements, such as tibial tubercle-trochlear groove (TT-TG) distance, do not account for the containment of the patella by the trochlea. Our goal was to develop a measurement to assess how well the trochlea contained the extensor mechanism. ⋯ PT-LTR is reliable, predictable, and discriminative for patellofemoral dislocations. This measurement had sensitivity similar to that of TT-TG but with higher specificity.
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Cartilage lesions are a significant cause of morbidity and impaired knee function; however, cartilage repair procedures have failed to reproduce native cartilage to date. Thus, osteochondral allograft (OCA) transplantation represents a 1-step procedure to repair large chondral defects without the donor site morbidity of osteochondral autograft transplantation. ⋯ Improved patient-reported outcomes can be expected after OCA transplantation, with a survival rate of 78.7% at 10 years. Revision cases, patellar lesions, and bipolar lesions were associated with worse survival rates; therefore, utilization of the most appropriate index cartilage restoration procedure and proper patient selection are key to improving results.