Anterolateral augmentation during primary anterior cruciate ligament (ACL) reconstruction (ACLR) may lower rates of ACL graft failure. However, differences in costs between two techniques, lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), are unclear. To perform a systematic review and subsequent cost-effectiveness analysis comparing LET versus ALLR in the setting of primary ACLR. The hypothesis was that LET is more cost-effective than ALLR. A systematic review was conducted on studies in which patients underwent primary ACLR with a concomitant LET or ALLR with minimum 24 months follow-up published between January 2013 and July 2023. Primary outcomes included ACL graft failure rates and Knee Injury and Osteoarthritis Outcome Survey-Quality of Life (KOOS-QoL) subscale scores, which were used to determine health utilities measured by quality adjusted life years (QALYs) gained. A decision tree model with one-way and two-way sensitivity analyses compared the cost of primary ACLR with a concomitant LET, independent autograft ALLR, or independent allograft ALLR. Costs were estimated using a combination of QALYs, institution prices, literature references, and a survey sent to 49 internationally-recognized high-volume knee surgeons. A total of 2,505 knees undergoing primary ACLR with concomitant LET (n = 1,162) or ALLR (n = 1,343) were identified from 22 studies. There were 77 total ACL graft failures with comparable failure rates between patients receiving LET versus ALLR (2.9% vs. 3.2%, P = .690). The average QALYs gained was slightly higher for those who received LET (0.77) compared to ALLR (0.75). Survey results revealed a 5-minute longer median self-reported operative time for ALLR (20 minutes) than LET (15 minutes). The estimated costs for LET, autograft ALLR, and allograft ALLR were $1,015, $1,295, and $3,068, respectively. Anterolateral augmentation during primary ACLR with LET is more cost-effective than independent autograft and allograft ALLR given the lower costs and comparable clinical outcomes. Surgeons may utilize this information when determining the optimal approach to anterolateral augmentation during primary ACLR, although differences in preferred technique and health care systems may influence operative efficiency and material costs. Systematic review; Level of evidence, IV.

Meniscus tears are prevalent in isolation and in combination with anterior cruciate ligament (ACL) injury. Meniscus lesions can be difficult to access and often display complex tear patterns, which result in technical challenges for the operating surgeon during surgical treatment. The aim of this video article is to demonstrate technical tips and tricks for performing all-inside repair of challenging meniscus tears. The presented techniques are indicated in young, physically active patients with symptomatic tears of the lateral and medial menisci, with or without concomitant ACL injury. The procedure is performed using standard anterolateral and anteromedial arthroscopic portals for direct visualization of complex meniscus tear patterns and all-inside instrument access. A suture passing device is used for the placement of suture loops for meniscus root repair. All-inside repair devices are used to repair the radial meniscal tears along the native circumferential fibers using a horizontal mattress suture configuration, with curved devices to achieve optimal access to challenging tears affecting the anterior and posterior aspects at the mid-body of the meniscus. Repair of radial tears at the avascular zone of the meniscus may be augmented with an autologous fibrin clot delivered using an arthroscopic cannula.

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.

Background: Peroneal tendon subluxation is a rare pathology, generally associated with sport-induced trauma, that occurs due to the rupture of the superior peroneal retinaculum. The diagnosis is mainly clinical, but the use of imaging techniques, such as dynamic ultrasound and magnetic resonance imaging, may contribute to its clarification. Treatment may be conservative or surgical, although there is no consensus on the most appropriate technique to be employed. We report a case of subluxation of the peroneus brevis tendon, with no apparent traumatic cause, in which there was a need for a surgical approach after the failure of conservative treatment. Case presentation: A 25-year-old White woman presented pain and locking of the lateral side of the left foot 2 years earlier, with no history of trauma. The patient felt pain upon palpation and presented snapping during flexion–extension of the left ankle. On dynamic ultrasonography, an anterior subluxation of the peroneus brevis tendon occurred when the ankle was in dorsiflexion, suggesting superior peroneal retinaculum injury. Surgical correction was recommended after 2 months of conservative treatment with no improvement. The chosen surgical technique was isolated reattachment of the superior peroneal retinaculum, which proved successful. Conclusions: Peroneal tendon subluxation has no established preferred surgical technique. This case demonstrates superior peroneal retinaculum repair as an efficient surgical approach for this condition. Furthermore, the atraumatic mechanism of injury in this case, along with the unknown true incidence of peroneal tendon subluxation, highlights the need to consider this pathology in cases of ankle injuries.

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.