Medial meniscus posterior root tears (MMRTs) disrupt hoop stress transmission and biomechanically resemble total meniscectomy, accelerating medial compartm

Purpose: To evaluate clinical and fracture-related factors associated with failed closed reduction in high-risk pediatric supracondylar humerus fractures (SCHF), with emphasis on fracture morphology and intraoperative multidirectional instability. Methods: This retrospective cohort study included 318 consecutive children aged 2–12 years who underwent surgery for Gartland type III SCHF or intraoperatively confirmed Gartland type IV instability between 2015 and 2025. Fractures were classified as typical extension-type, medial oblique, lateral oblique, or flexion-type. Univariable and multivariable logistic regression analyses were performed. Results: Closed reduction was successful in 192 patients, whereas 126 required conversion to open reduction. Flexion-type fractures had the highest open reduction rate (80.0%; p < 0.001). In the full multivariable model, Gartland type IV instability was strongly associated with open reduction (odds ratio 5.21, 95% confidence interval 2.69 to 10.53; p < 0.001). Compared with flexion-type fractures, typical, medial oblique, and lateral oblique patterns had significantly lower adjusted odds. Older age and longer time from injury to surgery were also associated with open reduction. Conclusions: Flexion-type morphology and intraoperatively confirmed Gartland type IV instability were strongly associated with failed closed reduction. These findings may help surgeons anticipate reduction difficulty and plan operative resources in high-risk pediatric SCHF. Significance of Study: Recognizing fracture morphology and intraoperative multidirectional instability may help surgeons anticipate failed closed reduction in high-risk pediatric SCHF. Level of evidence: III

Introduction: Neurovascular compromise following primary or revision total knee arthroplasty is a rare but severe complication. To the best of our knowledge, there have been reports of pseudoaneurysm of the popliteal artery following primary and revision; however, an anterior tibial artery pseudoaneurysm with articulating spacer has not been described yet. Case presentation: We introduce a rare case of anterior tibial artery pseudoaneurysm and concomitant foot drop caused by an articulating spacer in a two-stage revision for infected knee replacement. Displacement of the articular spacer was observed on knee x-rays. Hematoma and pseudoaneurysm were detected. The patient was operated on urgently, and a pseudoaneurysm originating from the anterior tibial artery was intraoperatively observed. Discussion: Vascular complications following TKA are rare but could be limb-threatening and even life-threatening. If postoperative displacement of the articulating spacer is observed with neurovascular symptoms, orthopedic surgeons should be alerted to the possibility of a pseudoaneurysm. Conclusion: Although rare, anterior tibial artery pseudoaneurysm should be considered among vascular injuries in revision knee arthroplasty cases. Highlights:

Purpose: Posterior medial meniscus root tears often cause persistent extrusion and altered joint mechanics despite repair. This study compared standard transtibial pull-out repair with repair plus a second-tunnel centralization, hypothesizing better patient-reported outcomes without major MRI extrusion changes. Methods: This retrospective two-center cohort (2019–2024) included adults with MRI-confirmed root tears treated with anatomic repair alone or with an additional centralization tunnel. Propensity matching yielded 96 patients (54 vs 42). The primary endpoint was 24-months change in IKDC score. Secondary outcomes included KOOS subscales, Lysholm, visual analogue scale pain, and Tegner activity. Structural outcomes—medial meniscus extrusion and Meniscal Extrusion Index—were assessed on coronal MRI at 12 ± 4 months. Analyses used ANCOVA adjusted for baseline values, supported by inverse-probability weighting and mixed-effects checks. Results: Baseline characteristics were balanced. Extrusion changes were small and similar; residual pathologic extrusion rates were comparable (65% vs 62%). Centralization showed greater IKDC improvement (+5.7 points; p = 0.008) and higher KOOS-Quality of Life. Knees with ≥3 varus demonstrated additional benefit (interaction p = 0.048). Complications were infrequent. Conclusions: Second-tunnel centralization significantly increased the probability of achieving clinically meaningful functional improvement , despite unchanged static MRI extrusion . This suggests dynamic load-sharing benefits not captured by static imaging. Therefore, centralization is recommended as a selective adjunct, particularly in varus alignment , rather than a routine necessity.