Objective: To determine the correlation between the anterior knee pain and the morphological characteristics of lateral femoral trochlea; to explore the potential pathogenesis of the patellar -lateral femoral condyle friction syndrome. Methods: A total of 80 knees of patients with anterior knee pain were retrospectively analyzed using magnetic resonance imaging (MRI) and CT-Scan data for a 5-year period from our database. We measured: the lateral femoral trochlea angle and lateral trochlear height. A group of patients without anterior knee pain (n=80) was enrolled as a control. All the parameters were compared between the two groups. Results: The lateral trochlear height was significantly higher (p < 0.001) in the anterior knee pain group than in the control group. However, the lateral femoral trochlea angle showed no significant difference. Conclusions: The morphological characteristics of lateral femoral condyle are correlated with anterior knee pain syndrome. The height of the lateral trochlea may be an important causal cofactor in the pathogenesis of anterior knee pain and an important element to consider in the etiopathogenetic analysis of the patellar -lateral femoral condyle friction syndrome.

Aim: Classifying trochlear dysplasia (TD) is useful to determine treatment options for patients suffering from patellofemoral instability (PFI). There is no consensus on which classification system is more reliable and reproducible for this purpose, to guide clinicians in treating PFI. There are also concerns about validity of Dejour classification (DJC), which is the most widely used classification for TD, having only a fair reliability score.
The Oswestry-Bristol classification (OBC) is a recently proposed system of classification of TD and the authors report a fair-to-good interobserver agreement and good-to-excellent intra-observer agreement.This study aimed to compare the reliability and reproducibility of these two classifications. Methods: 6 assessors (4 consultants and 2 registrars) independently evaluated 100 magnetic resonance (MR) axial images of the patella-femoral joint (PFJ) for TD and classified them according to OBC and DJC. These assessments were again repeated after 4 weeks. The inter and intra-observer reliability scores were calculated using Cohen’s kappa and Cronbach’s alpha. Results: Both classifications showed good to excellent reliability with high alpha scores. The OBC classification showed a substantial intra-observer agreement (mean kappa 0.628) [p<0.005] whereas the DJC showed a moderate agreement (mean kappa 0.572) [p<0.005]. There was no significant difference in kappa values when comparing the assessments by consultants to those by registrars, in either classification systems. Conclusion: This large study shows both classification systems to be reliable for classifying TD based on MR axial images of the PFJ, with the simple to use OBC having a higher intra-observer reliability score compared to the DJC.

A series of 11 patients who suffered from acute patellar dislocation with associated osteochondral fractures of patella were included in the series. All patients underwent fixation of the osteochondral fracture using Herbert Screw system, after a diagnostic arthroscopy and using a medial parapatellar approach. The mean minimum follow up was 18 months, and MRI, Lysholm Knee scoring system and X Rays (AP, Lateral and Skyline) views were used to assess outcomes. 8 patients reported excellent outcomes, 2 reported good outcomes and 1 patient developed a poor outcome due to implant failure. This study addresses not only the timely diagnostic approach and early treatment for a good clinical result but also surgical pearls and pitfalls to address such major debilitating injury in the young athlete.

Introduction: Meniscal ramp lesions (MRL), once considered rare, are associated with anterior cruciate ligament rupture (ACL). Arthroscopic surgery has led to the discovery of an increasing number of MRL that are not diagnosed preoperatively. The objective of our work was to study the frequency and risk factors of these lesions. Methods: We studied retrospectively the last 100 patients operated for ACL rupture between 2019 and 2020. We looked for factors involved in the genesis of these lesions. MRI sensitivity, specificity, reliability and predictive values were calculated. Lesional associations were sought. Results: The frequency of MRL was 25%. This injury was more frequent in male (85%) sportsmen (69%) under 30 years old (61%) and the trauma causing this type of injury was a sports accident (76%), of the leaning type (84%) affecting the dominant side (88%). The only parameter with a statistically significant result was the duration of the trauma. In our work MRI had a sensitivity of 72%, specificity of 75%, negative predictive value of 89% and positive predictive value of 49%. Based on these results, the reliability of MRI was 74%. Arthroscopic surgery is considered as the "gold standard" in the diagnosis of these lesions but the classical approaches remain insufficient to fully explore and repair MRL. Conclusion: Meniscal ramp lesion has diagnostic particularities: MRI imaging has insufficient detection and with arthroscopic surgery lesions may go unnoticed. Faced with the risk of ACL ligamentoplasty failure if the ramp is not repaired, a codified protocol and recommendations are necessary.

Meniscal root tears are increasingly recognized as an important pathologic condition that results in a nonfunctional meniscus and if not properly repaired or undiagnosed, biomechanical and degenerative changes may occur. Although the posterior meniscal root has recently gained significant attention, a paucity of literature exists surrounding pathology of the anterior meniscal root attachment and its surgical management is still controversial. We wish to propose a successful technique of suture anchor to repair tears of the anterior horn of the medial meniscus (AHMM). Case report radiological exams showed an extruded medial meniscus with truncation due to anterior root lesion (LaPrade type II). Arthroscopic repair was performed - AHMM was sutured with a double looped nonabsorbable suture and reattached to the tibial plateau using a knotless suture anchor. After proper rehabilitation an excellent functional outcome was reached, and control MRI verified anatomical meniscal integrity. Transtibial pull-out suture represents an alternative refixation method of the AHMM but it has several disadvantages - creates a relatively long construct that might result in micromotion with compromising healing and abrasion of the material. Furthermore, tunnel drilling might be challenging with the risk of anterior cortical breach. Arthroscopic repair of the anterior medial meniscus root with a knotless suture anchor is a feasible technique - it represents a demanding procedure that aims to restore the normal architecture and function of menisci and which does not interfere with concomitant procedures to the knee, being minimally invasive and bone-sparing.

Tibial eminence fracture is an intra-articular avulsion of the bony attachment of the ACL that is habitually seen in skeletally immature children and have been historically treated as an isolated injury. Although far less common, it can occur in adults and frequently involve other lesions that are often underestimated. Case report radiological exams showed a large tibial eminence avulsion fracture, displaced and comminuted (Meyers and Mckeever type IV), lateral meniscus anterior root fracture-avulsion with gross subluxation (LaPrade type V) and anterior intermeniscal ligament entrapment. Arthroscopic repair was performed - two suture were passed at the base of ACL and two tibial tunnels were created, one medial to ACL insertion and another adjacent to the lateral meniscus anterior root of - sutures were collected to the tibial tunnels, tensioned and tied above a cortical button. Then a simultaneous anatomic repair of ACL and anterior root of lateral meniscus was achieved. After proper rehabilitation an excellent functional and radiological outcome was reached. A high level of suspicion is necessary once an entrapped meniscal horn or intermeniscal ligament represent significant blocks to anatomic reduction with either nonoperative or operative treatment. The most common methods of fixation reported are screw or suture-button system but, in cases like this, the presence of comminution contraindicates the use of screw and demanding alternative techniques should be found. Adequate preoperative planning and a thorough knowledge of the anatomy of the knee are essential, allowing better perception of the injury and consequently simultaneous and profitable surgeries.

Introduction: Obesity, smoking, and older age have been shown to be predictive of poor postoperative outcomes in prior literature assessing knee procedures. The purpose of this study is to evaluate the risk that obesity, smoking, and older age have on 30-day postoperative outcomes of patients undergoing arthroscopic meniscus repair. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively analyzed between 2008 and 2016. Patients undergoing arthroscopic meniscus repair were stratified by age, body mass index (BMI), and smoking status. Patient demographics, operative details, and postoperative outcomes were assessed. Multiple binary logistic regression analysis was used. Results: 76,295 patients were identified. 12% were normal weight, 31.9% overweight, 27.7% obese, 14.8% obese class II, and 12.4% obese class III. Mean mCCI comorbidity index was 0.44, 16.1% were smokers. Rates of complications, reoperations, and readmissions were 1.1%, 0.3%, and 0.7%, respectively. Controlled regression analysis determined mCCI (OR: 1.5 [1.3-1.7]), smoking (OR: 1.2 [1.0-1.4]), and ages 30-39 (OR 1.4 [1.1-1.9]), 70-79 (OR: 1.5 [1.1-2.1]), and 80+ (OR: 3.5 [2.3-5.4]) (all, p≤0.05) to be significantly predictive for postoperative complications. mCCI (OR: 1.6 [ 1.5-1.8]), smoking (OR: 1.6 [1.3-2.0]), ages 70-79 (OR 1.8 [1.2-2.8]) and 80+ (OR: 2.5 [1.3-2.0]) (all, p<0.005) were predictive of readmission. Only mCCI (OR: 1.5 [1.3-1.7], p<0.001) and smoking (OR: 1.4 [1.1-1.9], p=0.020) were predictive of reoperation. Conclusion: Older age, smoking, and comorbidity burden were significant predictors of postoperative complications, reoperations, and/or readmissions.

Aim: To compare clinical and radiological treatment outcomes of patients with an isolated longitudinal medial meniscal tear in red-red and red-white zones with inside-out and all-inside technique repair. Methods: Retrospective analysis of 60 patients with isolated longitudinal medial meniscal tear who were treated in SI “The Institute of Traumatology and Orthopedics by NAMS of Ukraine" since 2017 till 2020. Excluded criteria were patients with III-IV knee osteoarthritis by Kellgren-Lawrence, chondral lesions III-IV grade by Outerbridge. All patients were divided into 2 groups. 37 (67,7%) patients were treated with inside-out technique, 23 (38,3%) patients – all-inside technique. The mean age was 33,8±10,4 years (range, 13-58 years). Final clinical assessments were performed at a mean of 12.4 ± 3.9 months after surgery. Results: the mean IKDC Score was 83,6±7.8 points in all-inside group and 81,8±12.6 points in inside-out group (p=0.518). Best results were received by patients, who had meniscal repair done in range of 20,4±5 days after injury. Conclusion: Results did not show a considerable difference between short-term results in both groups. It shows that both meniscal repair technique demonstrates good treatment results in patients with an isolated longitudinal meniscal tear in red-red and red-white zones.

Background: Chondral lesions are found frequently with ACL injuries, However, questions regarding the grade and location of chondral lesions and their association with below mentioned factors are still incompletely answered in the literature. This study aimed to find out association of chondral lesions, their location and grade with anterior cruciate ligament tears with age, gender, time since injury, mode of injury, mechanism of injury and pre-injury knee activity. Methods: In this prospective study on 200 patients who underwent arthroscopic ACL reconstruction from March 2014 to March 2018 in Manipal hospital, India. To find out grade, location of chondral lesions and their association with age, gender, time since injury, made of injury, mechanism of injury and Tegner pre-injury knee activity score, statistical analysis was done. Results: Increased proportion of chondral lesions in the age group of 41-55 years is about 50.0%, overall, 35.0% of the patients had chondral lesions. Medial femoral condyle was most common location involved in all age group and males. As age increases grade of chondral lesion increase. Involvement of medial femoral condyle in 52.2% male and lateral femoral condyle in 33.3% female. increased proportion Of Chondral Lesions >6 months from injury. Conclusions: We conclude that age more than 40 years and time since injury >6 months are risk factors for chondral lesions. Similarly, grade of chondral lesion increases with increase in time since injury. Medial femoral condyle is the commonest location of the chondral lesions in all age groups and males, whereas lateral femoral condyle in females.

Focal chondral injuries in the adolescent population are a challenge for orthopedists due to their limited healing potential. Cartilage regeneration techniques have made significant advances in the past decade, however, their role in the pediatric population is still not well defined due to the lack of long-term quality studies.
Classically, fixation has been described as the treatment of choice for osteochondral defects with a true bone component, while excision has been reserved for purely cartilaginous fragments. Recent reports, however, have shown successful fixation of purely cartilaginous lesions. The literature regarding the reduction and fixation of large cartilage fragments is limited to clinical cases, and the objective of this work is to contribute one more case to the literature regarding the successful fixation of a large cartilage fragment.
The vast majority of the cases described were performed with open arthrotomy, with rare exceptions from published cases in which arthroscopic fixation was performed.
We have now 1 year of follow-up and there has been a regression of complaints of gonalgia and integration of the chondral fragment.
We present the clinical case of a 16-year-old adolescent with complaints of mechanical pain with 1 year of evolution. She performed an MRI that showed a delamination of a purely chondral fragment, of large dimensions, at the level of the external femoral condyle. It has been successfully treated with the chondral dart system. Chondral darts worked well, allowing a large fragment of cartilage without subchondral bone to be repaired and fixed back to its native location.

Introduction: Osteotomy and cartilage replacement-based procedures (OCRBPs) have not been studied in depth to determine general trends in procedures performed. Likewise, general demographics have not been established. Methods: The (NSQIP) database was queried for QCRBP patients in 2008-2016. Descriptive analysis assessed patient demographics, complications, and yearly procedural trends. Statistical significance in yearly trends was assessed using Pearson correlation. Results: 6,955 patients were identified. Patients who have undergone OCRBP increased by an annual average of 43.5% (r=0.99, p<0.01). The total number of FSSOs rose from 10 in 2008 to 74 in 2016 with a yearly increase of 30.2% (r=0.93, p<0.01). Mean patient age was 48.0 years, 60.1% were female, average BMI was 29.3 kg/m2, and average rates for surgical and medical complications were 2.3% and 20.1%, respectively. The most common diagnosis was unspecified osteoarthritis of the knee, accounting for 14.9% of diagnoses. The total amount of HTOs from 3 in 2008 to 79 in 2016 with an average yearly increase of 58.8% (r=0.96, p<0.01). Mean patient age was 39.6 years, 62.7% were male, average BMI was 30.7 kg/m2, and average rates for surgical and medical complications were 4.9% and 4.5%, respectively. The most common diagnosis was osteoarthrosis of lower leg accounting for 24.3% of cases. Conclusion: The number of patients who have undergone OCRBP increased. Despite the increment in the yearly total number of patients reported in the NSQIP, OCRBPs increased at a higher rate. HTO had the greatest rate of surgical complications. FSSO had the greatest rate of medical complications.