Mostowy M, et al. Clin Orthop Surg. 2023 Feb;15:e12. https://doi.org/10.4055/cios22278

Purpose: Arthroscopy in popliteal cyst surgery enables addressing all components of its pathomechanism: the cyst wall, valvular mechanism, and concomitant intra-articular pathologies. Techniques differ as to the management of the cyst wall and the valvular mechanism. This study aimed to assess the recurrence rate and functional outcomes of a cyst wall and valve excising arthroscopic technique with concurrent intra-articular pathology management. The secondary purpose was to assess cyst and valve morphology and concomitant intra-articular findings. Methods: Between 2006 and 2012, 118 patients with symptomatic popliteal cysts refractory to at least three months of guided physiotherapy were operated on by a single surgeon using a cyst wall and valve excising arthroscopic technique with intra-articular pathology management. Patients were evaluated preoperatively and at a mean follow-up of 39 months (range 12–71) by ultrasound, Rauschning and Lindgren, Lysholm, and VAS of perceived satisfaction scales. Results: Ninety-seven out of 118 cases were available for follow-up. Recurrence was observed on ultrasound in 12/97 cases (12.4%); however, it was symptomatic only in 2/97 cases (2.1%). Mean scores improved: Rauschning and Lindgren from 2.2 to 0.4, Lysholm from 54 to 86, and VAS of perceived satisfaction from 5.0 to 9.0. No persistent complications occurred. Arthroscopy revealed simple cyst morphology in 72/97 (74.2%) and presence of a valvular mechanism in all cases. The most prevalent intra-articular pathologies were medial meniscus (48.5%) and chondral lesions (33.0%). There were significantly more recurrences in grade III–IV chondral lesions (p = 0.03). Conclusions: Arthroscopic popliteal cyst treatment had a low recurrence rate and good functional outcomes. Severe chondral lesions increase the risk of cyst recurrence.

Background: Using Platetet-Rich Plasma (PRP) in anterior cruciate ligament reconstruction (ACLR) has been suggested to improve patient outcomes. The aim of this study was to assess the impact of PRP administration on pain, range of motion (ROM) restoration and the functional results of ACLR performed with quadriceps tendon bone (QTB) autografts. Methods: A total of 106 patients were included in this multicenter study. Fifty-two patients underwent single-bundle QTB ACLR and 54 patients underwent the same procedure with additional PRP administration. Results: Mean time of need for on-demand analgesia was 8 days in the PRP group and 11 days in no-PRP group. Symmetric full extension was restored in a mean of 40 days in the PRP group and 53 days in the no-PRP group. Ninety degrees of flexion was restored at a mean of 21 days in the PRP group and 25 days in the no-PRP group. At 18 months postoperatively, the mean side-to-side difference in anterior tibial translation with the use of an arthrometer (Rolimeter, Aircast Europa) was 1.3 mm in the PRP group vs. 2.7 mm in the no-PRP group. Mean tibial tunnel widening was 1.4 mm in the PRP group vs. 2.1 mm in the no-PRP group. The mean score in the pain section of the KOOS scale was 93 in the PRP group vs. 89 in the no-PRP group. For the IKDC scale, 53 patients in the PRP group graded A or B and 1 patient graded C. In the no-PRP group, 48 patients graded A or B and 4 patients graded C or D. Conclusions: The use of PRP in QTB ACLR may decrease the need for on-demand analgesia and accelerate ROM restoration as well as improve knee stability, lessen the extent of tibial tunnel widening and potentially diminish pain at 18 months postoperatively. Further studies will be needed to confirm all authors’ conclusions.

The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most extensively investigated technique. ACL reconstruction with a pedunculated hamstring graft provides superior revascularization of the graft along with higher mechanical strength. The usage of a graft enveloped with a periosteum was proposed to enhance the tendon-bone unit formation, and consequently, to prevent the bone tunnel widening. The muscle tissue on the graft is a potential source of stem cells. However, an excessive amount may weaken whole graft strength despite its enhanced remodeling. Similarly, amniotic tissue may augment the ACL reconstruction with stem cells and growth factors. Despite the existence of several surgical techniques that utilize amnion, the outcomes of these augmentation methods are lacking. Lastly, the intra-articular transplantation of the synovium on the surface of an ACL was proposed to augment the graft with synovial tissue and blood vessels. In conclusion, diverse approaches are being developed in order to enhance the maturation of an ACL reconstruction graft. Although these approaches have their foundation in on well-established scientific research, their outcomes are still equivocal. Clinical trials of high quality are needed to evaluate their utility in clinical practice.