Although the repair of the medial meniscus posterior root tears is frequently successful, clinical outcomes are not always favorable due to postoperative meniscal extrusion which recognized as a potential clinical problem.
Anatomic meniscus root repairs with a transtibial pullout technique have been shown biomechanically to restore mean and peak contact pressures in the medial compartment. However, nonanatomic root repair has been reported to be ineffective at restoring joint pressures back to normal. Meniscal extrusion is often a consequence of nonanatomic repair and is correlated with progression of OA.
New arthroscopic techniques have been developed to address this problem by centralizing the body of the meniscus to the tibial plateau.
It was predicted that adding a centralization suture would assist restore normal joint load-bearing qualities and the native quantity of meniscal extrusion after a root tear.
Biomechanical studies have demonstrated that centralization can improve meniscus mechanics and potentially reduce the risk of osteoarthritis.

The purpose of this retrospective study was to examine the clinical outcomes of anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using a free quadriceps (QUADRI) tendon or a quadrupled hamstring (HAM) autograft.Material and method: The retrospective analysis (Level III, Therapeutic Study) included consecutive patients who underwent ACL reconstruction between April 2017 and April 2020 using either a free quadriceps tendon autograft or a hamstring tendon autograft. All patients underwent ACL reconstruction to treat isolated ACL injuries. The Tegner-Lysholm knee scoring system and the modified Cincinnati knee score were used for evaluation before surgery, and at six weeks, six months, and one-year follow-up time.Results: In the present study, 35 people underwent quadriceps (QUADRI) grafts and 35 underwent hamstring (HAM) grafts. The demographic data for the groups were extremely comparable. The mean follow-up length for the HAM group was 11.96±0.28 months, while the QUADRI group had a mean follow-up period of 11.25±0.43 months. No significant variations in the Cincinnati score were observed between the two groups during any of the treatment's follow-up periods. Similarly, the Tegner Lysholm Score revealed no statistically significant differences between clinical outcomes in the HAM and QUADRI groups at all follow-up visits, except for the sixth week.Conclusion: Clinical outcomes are comparable in terms of stability and subjective assessments following ACL reconstruction using a free quadriceps or hamstring tendon autograft.

Background: RAMP lesions occur in the RAMP area; the menisco-tibial attachment of the posterior horn of the medial meniscus. The incidence of meniscal injuries including RAMP lesions differ with many co-variables. Aim of this work: to identify incidence and define the correlation of RAMP lesions with ACL injuries, age, gender, mode of injury, duration and MRI findings. Patients and methods: Between September 2016 and September 2017, 100 patients with ACL deficient knees undergoing arthroscopic ACL reconstruction were examined using standard anterior portals during routine DKA for presence of RAMP lesions prior to ACL reconstruction. Anatomic single bundle (ASB) ACL reconstruction was performed for all patients. Whenever a RAMP lesion was found, it was repaired using all-inside suture technique . Results: Out of 100 patients, 26 had a RAMP lesion. It had a higher incidence amongst males, however there was no correlation with age. It is more common with indirect non-contact mechanism of trauma. Twenty (76.9%) out of 26 patients who underwent meniscal repair never complained of mechanical symptoms or pain. Four (15.4%) patients continued to complain of posteromedial knee pain but no symptoms of locking. Only two (7.69%) patients had mechanical symptoms one after 6 and the other after 9 months which warranted a second look arthroscopy. Conclusions: The incidence of RAMP lesions in this study is the highest reported in the literature. It is not an uncommon association with ACL injury. Standard anterior portals are reliable for diagnosis and management of RAMP lesions

Background: ACL reconstruction (ACLR) has evolved for the last many decades in terms of graft choice. Bone-patellar-tendon-bone, hamstrings, Achilles, and peroneus longus are all suitable choices. Quadriceps tendon autograft is another suitable option. Method: We analyzed 113 patients from December 2017 to January 2021, with a mean age of 26.4 (18-47), and a mean follow up of 27.3 months. Group A (Hamstring) had 58 patients and group B (Quadriceps) had 55 patients. Mean IKDC and Lysholm score and Tegner activity were similar in both groups preoperatively. Patients were followed up 2nd week, 4th week, and 3, 6, 12, and 24 months postoperatively and their IKDC, Lysholm score along with return to sports and return to pre-injury level were noted. Results: At final follow up, both groups performed similarly in terms of IKDC and Lysholm scores. 87% patients from group B returned to sports while 81% from Group A returned to sports (p >0.05). 69% patients from group B returned to PIL while 55% from group A returned to PIL (p <0.05). Hamstring autograft was significantly associated with higher donor site morbidity (DSM) as compared to quadriceps tendon (p <0.05). Conclusion: QT provides comparable functional outcomes to HT but gives a better chance to athletes to return to preinjury athletic level. Moreover, it provides superior outcomes that HT due to reduce DSM at 24 months. Further studies are needed to confirm the results.

The anteromedial portal technique of the femoral tunnel preparation during the anterior cruciate ligament reconstruction requires hyperflexion of the knee. In a hyperflexed knee the arthroscopic visualisation of the laser markings while reaming is obscured. Our technique helps in preparation of the femoral tunnel reliably without the need for arthroscopic visualisation using the anteromedial portal as a reference point to calculate the depth while drilling. In this technique, there is no obligation of either any additional incision or use any other special instruments

INTRODUCTION: The technique of arthroscopic anterior cruciate ligament reconstruction (ACLR) has undergone many modifications in the recent times with improved understanding of anatomy, kinematics, and biology of the graft. Our case series describe the technique with preserving semi-T tibial insertion, eliminating the need for a tibial side fixation implant. METHODOLOGY: 700 patients with complete ACL tear were operated by same surgeon in two different hospitals in last 8 years. The semi-T graft was harvested with an open stripper and augmented with fiber wire stiches and tunneling was done and femoral side button was used same as conventional technique. The free end is now sutured to the periosteum and secured. The mean age was 33 years and 1 year follow up was completed in 654 patients. The functional outcome was assessed at regular follow ups using IKDC score. RESULTS : Functional outcome was good to excellent in our study group IN 93% of patients. Post operative IKDC score is 81.6 compared to pre operative IKDC score 35.8. No graft failure was noted, and 9 cases came up after re-tear due to injury. One infection was noted. CONCLUSION: The main finding of this study is that tibial attachment preserving semi-T graft without a tibial implant is a simple, time saving, cost effective technique that provides a consistently satisfactory outcome with no complications like bio-screw reaction, graft loosening and laxity. All the patients returned to their pre-injury level of activity and no graft related complications.

Background: ACL Reconstruction with stump sparing is a new technique aiming to reduce the loss of mechanoreceptors in the native ACL. This prospective study aimed to evaluate the functional and proprioceptive outcomes of ACL reconstruction with remnant sparing. Methods: 58 patients with ACL injuries were included in this study. 26 patients underwent ACL reconstruction using a hamstring autograft with remnant tissue preservation (group A) and 32 patients underwent standard ACL reconstruction. Patients were followed up at 3, 6 months, and 12 months post-operatively. The primary outcomes measured were joint position sense, range of motion, and subjective knee function, and return to sports. Results: At the 2-year follow-up, all patients demonstrated good knee stability, and range of motion, and functional knee scores. Patient with remnant sparing had better proprioception than the other group (p <0.05). At the last follow-up, group A had 0.7o difference in JPS test and group B had 1.1o difference. Both groups had similar IKDC scores, Lysholm scores, and mean return to sports. Conclusion: Our study suggests that ACL reconstruction with remnant sparing is a safe and effective treatment option for ACL injuries. The preservation of remnant tissue provides better knee proprioception likely due to the preservation of mechanoreceptors of native ACL. Further studies with larger sample sizes and longer follow-up periods are warranted to confirm these findings.

Anterior cruciate ligament (ACL) reconstruction is a commonly performed surgical procedure for individuals who suffer from ACL injuries. However, traditional ACL reconstruction techniques involve complete removal of the torn ligament, which can lead to loss of proprioception, altered knee kinematics, and the risk of subsequent osteoarthritis.
Remnant-sparing ACL reconstruction is a relatively new surgical technique that aims to preserve the native ACL remnants during reconstruction. The goal of this technique is to achieve better postoperative proprioception, improved biomechanical stability, and reduce the risk of subsequent osteoarthritis.
The surgical technique involves careful preservation of the remnants of the torn ACL. The surgeon will perform a diagnostic arthroscopy to evaluate the extent of the injury and to identify the remnant fibers that can be preserved. The remnant fibers are then carefully dissected, and the torn ACL is removed, leaving the remnant fibers intact. The graft is then prepared, and the remnant fibers are used as a guide to ensure that the graft is placed in the same anatomical position as the original ACL.
Several studies have demonstrated the clinical benefits of remnant-sparing ACL reconstruction such as better proprioception, less postoperative pain, and better knee function compared to those who undergo traditional ACL reconstruction. Additionally, long-term outcomes studies have shown that this technique reduces the risk of osteoarthritis and leads to better joint stability compared to traditional ACL reconstruction techniques.
In conclusion, remnant-sparing ACL reconstruction is a promising surgical technique that may provide improved outcomes for patients undergoing ACL reconstruction surgery.

Purpose: To compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction.
Methods: A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability and subjective pain on activity. Results: A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. There was no association between subjective stability, sIKDC, ACL-RSI and pivot shift grade, and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at 6 weeks, 12 weeks, 6 months, and 9 months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22 degrees (95%CI -40.7 -3.4; P=0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups. Conclusion: ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot-shift grade and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.

Purpose:
This study aimed to evaluate all RCTs available in the literature investigating the efficacy of TXA use in arthroscopic rotator cuff repairs.
Methods:
Seven databases were systematically searched until November 1, 2022. RCTs investigating the use of tranexamic acid in arthroscopic rotator cuff repair and reporting at least one of the outcomes of interest were included. Quality was evaluated using RoB (Risk of Bias)2 tool.
Results:
A total of 510 randomized patients (253 females, 257 males) were included with a mean age of 58.08 and 58.88 for tranexamic acid and the control groups, respectively. Bias was graded “Low” in two RCTs and “Some concerns” in five RCTs. Visual analog scale (VAS) for pain was significantly different with TXA use at postoperative day one (WMD= -0.55; 95%CI: -1.07- -0.04, P-value=0.04). Operative time was significantly higher for the control group (WMD= -7.97; 95%CI: -15.19- -0.74, P-value=0.04). The impact of TXA on visual clarity during shoulder arthroscopy remains uncertain. However, postoperative shoulder swelling results were comparable in both groups (WMD= -1.71; 95%CI: -3.72-0.29, I2=99%, P-value=0.69).
Conclusions:
Pooled data suggest that the use of TXA in shoulder arthroscopy does reduce postoperative shoulder pain and has a positive effect on decreasing operative time compared to placebo. However, the reduction in pain may not be clinically significant, and there is no effect on reducing shoulder swelling. The impact of TXA on visual clarity remains inconclusive, and further research is needed using methodologically rigorous articles that incorporate objective measures and controlled factors to eliminate subjective bias.

ABSTRACT

Objective: To investigate the efficacy of tranexamic acid (TXA) administration on visual clarity in
patients undergoing shoulder arthroscopy

Methods: We searched MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science for relevant
clinical trials. We conducted the analysis of continuous data using mean difference (MD) or
standardized mean difference (SMD) with a relative 95% confidence interval [CI]. Dichotomous
outcomes were analyzed using the risk ratio (RR). We analyzed heterogeneous outcomes under
the random-effects model.
The main outcomes of interest were: Visual clarity rating grade score,
visual clarity rating grades 1, 2, and 3 percentage, Operative time, number of times of hydro-
pressure adjustment, estimated blood loss, change in shoulder size (deltoid and axillary),
Postoperative day 1 pain VAS score, and amount of irrigation solution.

Results: A total of five randomized clinical trials (RCTs) were included in this meta-analysis. The
overall risk of bias was low. Regarding the visual clarity rating grade score, the analysis favored
the TXA group significantly (SMD = 1.00 [0.53, 1.47], p<0.001). As for the percentage of patients
with visual clarity rating grade 3, the combined MD was statistically in favor of the TXA group
(9.10 [4.05, 14.15], p<0.001). We found no statistically significant difference among other
outcomes (P>0.05). We conducted a meta-regression analysis and found that increasing TXA dose
is not significantly associated with better visual clarity scores (p=0.16).

Conclusion: Tranexamic acid is a reliable drug in increasing visual clarity in patients undergoing
shoulder arthroscopy.

OBJECTIVES: Study the correlation between Anterior Cruciate Ligament footprint and graft size , and the effect on overall stability. The efficacy of the method in reconstructing the ACL footprint as close as possible to the native ACL and reconstructing a maximum ACL insertion site area to regain a maximum of ACL function. MATERIALS AND METHODS: About 60 adult patients were taken up for elective procedures, evaluated pre-operatively, intra-operatively and post-operatively.Intra-operatively the footprint was measured using the Arthroscopic ruler and the graft harvested, accurately measured to restore the footprint.All patients who showed signs of instability, pre-operatively and post-operatively , both clinically and using the KT-1000 Arthrometer were analyzed using the IKDC scores at the end of one month , three months and six months. RESULT : Correlation between tibial diameter and graft size was found to be statistically significant .Results are similar to a study by Rainer Siebold in 2011 on the concept of complete footprint restoration . Despite the large number of KT-1000 studies in the literature, there is no consensus on its sensitivity and specificity. Its sensitivity ranged from 0.50 to 0.97, and its specificity ranged from 0.70 to 0.93.
REFERENCES :Chhabra A, Starman JS, Ferretti M, Vidal AF, et al. Anatomic, radiographic, biomechanical, and kinematic evaluation of the anterior cruciate ligament and its two functional bundles. J Bone Joint Surg AM. 2006;Suppl.4:2-10
Rainer Siebold (2011) The concept of complete footprint restoration with guidelines for single and double-bundle ACL reconstruction . Knee Surg Sports Traumatology Arthroscopy ( 2011 )19:699-706

Introduction: Superior clinical outcomes when graft placement is aligned with the native ACL, and accuracy of femoral tunnel placement depend on proper footprint viewing and proper drilling technique.
Femoral tunnel placement techniques could be done using different viewing portals, however,
controversy exists between anterior arthroscopy and posterior arthroscopy methods.
Purpose: The purpose of this study was to systematically review risks, benefits, advantages, and disadvantages of the different viewing portals for creating the ACL femoral tunnel
methods:
Databases: PubMed search of English-language studies January 1, 2000 – November 1, 2021
Terms: anterior cruciate ligament” “femoral footprint” "portals"

Any ACL femoral tunnel drilling method using anterior or posterior portals for femoral footprint localization were reviewed

Studies reporting risks, benefits, advantages, and/or disadvantages of any ACL femoral tunnel drilling method using anterior or posterior portals for femoral footprint localization
References of included articles were reviewed
Outcomes
Anterior viewing methods advantages and disadvantages
Posterior viewing methods advantages and disadvantages
Result:
289 articles searched in the databases
Published between 2000 to 2021
105 citations excluded after screening the titles and abstracts.
184 studies were included in the analysis
119 studies showed the advantages of AM portal, 45 study compared AM or AAM, and transtibial drilling method viewing from AL or AM portal, 20 studies discussed posterior viewing portals, 6 studies compared between anterior arthroscopy and posterior arthroscopy
conclusion: There is no one, single viewing method, established for femoral tunnel footprint in ACL reconstruction

anterior and posterior viewing methods show subjective advantages, disadvantages, risks, and benefits

Osteoarthritis of the shoulder can lead to severe pain and dysfunction. Conservative management is the initial treatment. Operative treatment for non-responding patient has majorly been reliant on shoulder arthroplasty and glenohumeral resurfacing. Joint preserving treatment options have been sparingly used for osteoarthritis of the shoulder. We discuss the load of this problem in healthcare and share our experience on arthroscopic reconstruction of the articular cartilage of the shoulder. After diagnostic arthroscopy, biceps tendon pathology is addressed; capsular release is performed if the shoulder is stiff; inferior, anterior, and posterior osteophytes are removed; micro-drilling is performed as appropriate in the glenoid and humerus articular surfaces and is followed by injection of autologous bone marrow concentrate harvested from the iliac crest. Postoperatively the patient is rehabilitated initially on an abduction brace, followed by range of motion and strengthening exercises. Arthroscopic joint preservation surgery can be a good treatment option for carefully selected patients with shoulder arthritis.

Introduction: Autologous chondrocyte implantation (ACI) is a cell therapy to treat focal cartilage lesions. From 1996 until 2023, in our center, 723 patients have been treated with ACI: 152 with ACI under periosteal flap, 174 with Matrix-induced ACI (MACI) and 397 with High-Density ACI (HD-ACI). We describe the results of 155 patients with knee/ankle defects treated with HD-ACI with 8 years of follow-up. Methods and Materials: Patients (124 with knee injury and 32 in the ankle) were evaluated 6 months, 1 year, 4 and 8 years after surgery for pain, by the Visual Analogic Scale (VAS), joint functionality with the International Knee Documentation Committee Subjective Knee (IKDC) or the American Orthopedic Foot and Ankle Score (AOFAS). MOCART (Magnetic Resonance Observation Cartilage Repair Tissue) was determined at 1, 4 and 8 years. Results: Swelling, bone edema and VAS significantly decreased from basal until 8-year follow-up. IKDC significantly increased from 40.1 (9.2 – 74.6) in the basal visit to a median of 85.5 (26 – 100) in the 8-year follow-up visit (p<0.001). AOFAS score also significantly increased from a median basal value of 39.6 (21 – 48) to a median of 90 (40 – 100) 8 years after surgery (p<0.001). Median MOCART score ranged from73 to 76 in the knee and from 73 to 75 in the ankle. Conclusion: Our results demonstrate that HD-ACI is a safe and effective technique for the treatment of cartilage defects in the knee and ankle, improving long-term clinical and subjective perception of the joint functionality.

BACKGROUND: Revision of a failed anterior cruciate ligament reconstruction is a complex procedure and needs assessment of cause of failure, to recognize the associated pathologies and to have a well-structured operative plan. We report our experience in the management of two patients, who underwent re-revision ACL reconstruction. Patient 1:
42-year male patient, a recreational football player, who had previously undergone a hamstring ACL reconstruction presented with pain and instability and varus deformity. Scannogram revealed 15 deg varus deformity. MRI revealed a complete tear of reconstructed ACL. He underwent single stage high tibial osteotomy and re -revision ACL reconstruction with quadriceps tendon graft with suture tape augmentation. Patient recovered well and achieved full knee range of motion and at 12 months had returned to football. Patient 2: 37-year recreational football player had undergone ACL reconstruction twice with ipsilateral and contralateral hamstring tendon grafts. Limb alignment assessment revealed no significant deformity. MRI revealed bucket handle tear of medial meniscus with partial tear of reconstructed ACL. Arthroscopic medial meniscus repair and bundle preserving bone-patella tendon-bone ACL reconstruction were performed. Postoperatively patient recovered well and went on to achieve full knee motion at 2 months postoperatively. At last, follow up at 6 months, he had returned to light sports without any instability. CONCLUSION: We review key points in evaluating and managing patients who present with a failure, including identifying the etiology of failure, recognizing concomitant pathology, and understanding operative considerations for the revision procedure.