Background: Postoperative infection following anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication that can compromise patient outcomes, leading to prolonged recovery, graft failure, and knee dysfunction. Although infection rates are reported to be less than 2%, it remains essential to implement strategies to reduce infection risk and improve surgical outcomes. Methods: This review explores current evidence on the prevention of infections in ACLR, emphasizing the importance of timely antibiotic prophylaxis and vancomycin presoaking of grafts, which has been associated with a substantial reduction in infection rates. Results: Empirical antibiotic therapy should be started immediately after joint aspiration when infection is suspected. Treatment must prioritize culture-specific antibiotic regimens to optimize patient outcomes. Surgical intervention with arthroscopic debridement and irrigation needs to occur as soon as the diagnosis of infection is made. Often, this is performed with a focus on retaining the graft in order to preserve knee stability, if possible. Careful intraoperative management, along with the aid of infectious disease specialists, is paramount to help optimize outcomes following infection after ACLR. Conclusions: This review emphasizes the need for treatment protocols and highlights areas for future research to establish clear guidelines on infection after ACLR, especially with decisions of graft retention versus removal.

Purpose: This study introduces the posterior tibial plateau offset (PTO). It was hypothesised that (1) the PTO is reliably quantifiable and (2) correlates with the posterior tibial slope (PTS). Methods: The study involved lateral radiographs of patients who sustained an anterior cruciate ligament (ACL) graft failure and a control group. Exclusion criteria were skeletal immaturity, osteoarthritis (Kellgren and Lawrence grade > I), lateral radiographs with <15 cm of tibial shaft, or malrotated radiographs. The PTS was measured in both groups. The PTO was defined as the relative distance from the posterior tibial plateau to the tibial shaft axis in relation to the sagittal diameter of the tibial plateau (in%). Linear correlation assessed the PTS to PTO association. Results: A total of 146 patients (ACL graft failure, n = 103; control group, n = 43; 45% female, 60% left knees) were included. Mean overall PTO was 82% ± 7% (1%–35%), and mean PTS was 12° ± 3 (7–20). The PTS and PTO showed a moderate positive correlation in the overall collective ( r = 0.5; p < 0.001), ACL graft failure group ( r = 0.49; p < 0.001), and control group ( r = 0.69; p < 0.001), indicating a higher slope corresponded to a greater PTO. There was no statistical difference in PTO between the ACL failure and the control group (82% vs. 83%, p < 0.05). ICC between three raters was (0.8–0.9; p < 0.05). Conclusion: The PTO is a simple and repeatable measurement. A higher PTS is associated with a greater PTO, and the variability of the PTO across the patients with ACL graft failure and the control group was high. When planning osteotomy levels in the highly sloped proximal tibia, the PTO may be considered to optimise individualised planning for patients with failed ACL reconstruction. Level of Evidence: Level V.

Purpose: The aim of this study was to analyze the 50 most cited studies on meniscus root tears, analyzing their bibliographic parameters and methodological quality. The hypothesis of this study was that citations would not correlate with study quality. Methods: A literature search on Web of Science was performed to determine the 50 most cited studies on the topic of 'meniscus root' in human orthopaedics between 1 January 1990 and 9 December 2024. Bibliographic parameters and Modified Coleman Methodological Score (MCMS; 0–100 points), Methodological Index for Non‐Randomised Studies (MINORS 0–24 points), Biomechanics Objective Basic Science Quality Assessment Tool (BOBQAT; 0–100 points) and Radiologic Methodology and Quality Scale (MQCSRE; 0–30 points) were evaluated. The Mann–Whitney U test and Kruskal–Wallis test were used to compare groups. Linear regression analysis evaluated whether total citations correlate with study quality scores. Results: The 50 most cited studies on meniscus root tears averaged 165 ± 100 (range 92–721) citations per article, with a mean citation density of 15.3 ± 8.1 per year (range 6.4–45.1). The American Journal of Sports Medicine published 18 studies (36%), and 25 studies (50%) originated from institutions in the United States. Clinical ( n = 17, 34%) and biomechanical ( n = 13, 26%) studies were most common. Mean quality scores were: MCMS 64.9 ± 7.0, MINORS 14.9 ± 4.7, BOBQAT 80.6 ± 6.9, and RQMS 20.2 ± 1.5. Mean citation densities were higher in biomechanical studies (17.0 ± 10.1) and clinical studies (15.0 ± 5.8) than in radiological studies (9.6 ± 2.5; p = 0.022). Studies published in the United States had higher mean citation densities (18.7 ± 9.6) than those from Korea (12.1 ± 3.6; p < .001) or Germany (10.9 ± 3.9; p < 0.026). Citations or citation densities were not correlated with study quality ( p = 0.282). Conclusion: The methodological quality of the 50 most cited studies on meniscus root tears was moderate, and the number of citations did not correlate with their quality scores. This list can serve as a valuable reference for orthopaedic surgeons seeking to explore the literature on meniscus root tears. Level of Evidence: Level V, cross‐sectional study.

Background: Osteotomies to correct knee alignment are powerful tools to unload the joint in unilateral osteoarthritis (OA) or to augment meniscal and ligamentous procedures. Patient-specific implants (PSI) are accurate tools that enable greater precision in preoperative planning and technical ease of use. Indications: One indication for medial opening wedge high tibial osteotomy (HTO) is isolated, symptomatic medial compartment OA in a relatively young patient with varus malalignment. In this joint preservation procedure, addressing concomitant pathology—including meniscus root tears—optimizes compartment biomechanics and may lead to improved outcomes. PSI simplifies this technique by avoiding tunnel compromise and enabling greater intraoperative precision than manual techniques. Technique Description: PSI is preoperatively planned and manufactured via computed tomography imaging. After dissection, the PSI guide is then placed on the tibia and pinned into place. Once positioned appropriately, guide holes are drilled, and pegs are placed. A saw is then placed through the cut guide, and biplanar cuts are made in the anterior third of the tibia just behind the tubercle. Using anteromedial and anterolateral portals, diagnostic arthroscopy is performed, and the tear is lightly debrided. Meniscal quality was deemed suitable for repair. A luggage tag construct is used for adequate meniscal fixation, and the PSI guide is drilled for meniscal root fixation. A plate is provisionally held proximally with pegs, and a spreader is introduced to open the osteotomy to planned correction. Precontoured allograft bone graft is then placed into the osteotomy site, and an anchor is placed just medial to the plate and is used to fix the root repair. Results: PSI has been frequently reported to be more precise than manual techniques, with complication profiles similar to those of manual HTOs. While the PSI has built-in safeguards that protect against hinge fractures, these can still occur, and caution must be exercised to avoid this complication. Discussion/Conclusion: PSIs enhance HTO accuracy and allow for optimization of concomitant procedures, such as meniscal root repair, to avoid tunnel compromise from osteotomy fixation. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Meniscus and ligament injuries of the knee can have significant implications on both short-term activity level as well as long-term knee health. While great advancements in technique and treatment strategy for these injuries have been made in recent years, clinical failure and progressive joint deterioration remain significant concerns. At the same time, technical advancements are being made throughout orthopedics, especially in the field of sports medicine. Many of these developing technologies focus on augmenting stability in the early postoperative period while optimizing biology, with the end goal of a well-integrated repair or reconstruction of the injured structure. Although these technologies are rapidly expanding, with many similar ideas developing in parallel, a basic understanding of the current landscape will be necessary to incorporate them into practice moving forward. Four main augmentation strategies pertaining to meniscoligamentous injuries involve suture, scaffolds, allograft, and biologics. Although the literature is in its infancy for some of these techniques, short- and mid-term outcomes have been promising for many of them. Direct comparison between techniques is often limited by heterogeneity in their application and study design. Ultimately, further study and appropriate incorporation of these augmentation strategies will help to improve current surgical technique with the goal of improving short-term recovery and long-term joint health for patients with meniscoligamentous injuries. This article provides an overview of the current landscape of strategies and technologies in augmentation of meniscus and ligament surgery.

Background: Traumatic rotator cuff injuries are infrequently encountered among pediatric patients. Literature describing isolated subscapularis injuries, specifically with an associated avulsion fracture of the lesser tuberosity, is limited to case reports, with most patients undergoing operative management. Indications: In this video submission, we present the case of a 12-year-old male patient who presented to the clinic with right shoulder pain following a traumatic injury during competitive wrestling. The patient's examination was notable for pain and weakness with testing of subscapularis function. Magnetic resonance imaging revealed an isolated right subscapularis injury with avulsion of the lesser tuberosity. There was maintained attachment of the superior aspect of the subscapularis insertion and integrity of the biceps sling, but the remainder of the lesser tuberosity apophysis was displaced. For these reasons, shoulder diagnostic arthroscopy and arthroscopic versus open subscapularis repair were pursued. Technique Description: The patient was placed in the standard beach-chair position. Diagnostic arthroscopy was performed, but there was limited visualization of the apophyseal avulsion, given that the superior border of the subscapularis tendon remained attached. Conversion to open repair via a standard deltopectoral approach was performed. A complete avulsion of the subscapularis tendon apophyseal complex distal to the biceps tendon was discovered. Two all-suture-based anchors were used to fixate the subscapularis avulsion to its native footprint. Postoperatively, the patient was made nonweightbearing in a sling and followed a standard rotator cuff repair protocol with gradual reestablishment of shoulder motion beginning at 6 weeks and initiation of rotator cuff strengthening at 3 months postoperatively. Results: There were no complications encountered throughout the procedure. The patient progressed with physical therapy, achieving full shoulder range of motion by 12 weeks. Strengthening was initiated at 3 months, and by the 6-month follow-up, the patient had returned to all sports, experiencing no pain or deficits in shoulder range of motion and strength. Discussion/Conclusion: This pediatric patient's subscapularis tear and lesser tuberosity avulsion fracture were successfully repaired via an open approach, resulting in an excellent outcome and a return to the previous level of sports activity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.