Background: Residual rotational instability after isolated anterior cruciate ligament reconstruction (ACLR) has been a challenge for many years. Anterolateral extra-articular procedures (AEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET), are performed as a surgical option for additional rotational stability, but clear evidence for their usefulness is lacking. Purpose: To conduct a systematic review and meta-analysis of the literature regarding the efficacy of AEAP in primary ACLR. Study Design: Systematic review; Level of evidence, 3. Methods: A literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. MEDLINE, EMBASE, and the Cochrane Library were searched in April 2020, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 3444 studies were screened, and 20 studies (11 randomized controlled trials and 9 nonrandomized studies) were evaluated. Functional outcomes, stability, and complications were compared between patients who underwent primary ACLR with AEAP and those who underwent isolated primary ACLR. For subgroup analysis, outcomes were compared according to AEAP technique (ALLR vs LET) and time from injury to surgery (≤12 vs >12 months). The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool, Jadad scale, and Newcastle-Ottawa Scale. Results: Compared with isolated ACLR, combined ACLR with AEAP led to improved pivot-shift grades and graft failure rates, regardless of the AEAP technique or of time from injury to surgery. A limited, marginal improvement in subjective function score was observed in patients who underwent AEAP combined with ACLR. In contrast to ALLR, patients who underwent LET combined with ACLR had an increased risk of knee stiffness and adverse events. Conclusion: Our review suggests that when there is a need to improve rotational stability and subjective function, AEAP combined with primary ACLR can be considered regardless of time from injury. ALLR appeared to be a better option for improving rotational stability compared with LET.

Beom JY, et al. Clin Orthop Surg. 2018 Jun;10(2):191-196. https://doi.org/10.4055/cios.2018.10.2.191

Transpedicular screw instrumentation systems have been increasingly utilized during the fusion of lumbar spine procedures. The superior segment facet joint violation of the pedicle screw is thought to have potential for accelerating symptomatic adjacent-segment pathology (ASP). The purpose of this study was to investigate the relationship between the superior segment facet joint violation by transpedicular screws and the development of ASP. Among all patients who underwent operations involving one- or two-level posterior lumbar arthrodesis at the Chonnam National University Hospital from 1992 to 2012, 87 patients were selected for this study. Fifty-six patients were included in the ASP group, and 31 were included in the non-ASP group. We used lumbar three-dimensional computed tomography (CT) to assess the violation of the superior facet joint by a transpedicular screw. The assessment is presented in scores ranging from zero to two, with zero indicating no violation (type I); one point indicating suspected violation (type II); and two points indicating definitely facet joint violation (type III). Facet violation was reported in 31 patients in the ASP group (n = 56), and in 13 patients in the non-ASP group (n = 31). The types of facet joint violation according to our scoring system were as follows: type I, 59 screws (52.7%); type II, 26 screws (23.2%); and type III, 27 screws (24.1%) in the ASP group; and type I, 43 screws (69.4%), type II, 14 screws (22.6 %); and type III, 5 screws (8.0%) in the non-ASP group. The score of facet joint violation in each patient according to our scoring system were as follows: 0 points, 25 patients (44.6%); 1 point, 8 patients (14.3%); 2 points, 4 patients (7.1%); 3 points, 11 patients (19.7%); 4 points, 8 patients (14.3%) in the ASP group; and 0 points, 18 patients (58.1%); 1 point, 4 patients (12.9%); 2 points, 7 patients (22.6%); 3 points, 2 patients (6.4%); 4 points, 0 patients (0%) in the non-ASP group. The mean scores were 1.4 points in the ASP group and 0.8 points in the non-ASP group (p < 0.05). We conclude that the position of the pedicle screw farther away from the facet joint surface can reduce the degeneration of the superior adjacent segment. Therefore, close attention to the screw position during surgery may reduce the rate of superior adjacent-segment pathologies.

Background: The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT. Methods: From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis (OA) according to the Kellgren-Lawrence (K-L) classification. We compared the hip-knee-ankle angle (HKAA), medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method. Results: All clinical outcomes were significantly improved in both groups after treatment, with no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p = 0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87 and 88%, respectively. Conclusions: This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression in middle-aged patients with MMPRT. Level of evidence: Level III; retrospective comparative study.

Background: Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are well-established treatments for medial knee osteoarthritis (OA). However, over the past 20 years, results of comparisons of long-term survival rates and outcomes have remained controversial. Furthermore, in patients at the boundary age, from 50 to 70 years, considering age as a treatment indication, selecting a surgical method is difficult. Therefore, we aimed to investigate conversion rates to total knee arthroplasty (TKA) and perioperative adverse outcomes between the two surgical methods in mid-age patients. Methods: We extracted data from the Korean National Health Insurance claims database. A total of 70,464 patients aged between 50 and 70 years, considered as mid-age patients were included in the final study population. We used a multivariable Cox proportional hazard regression model, adjusting for potential confounders such as age, sex, insurance type, region of residence, hospital type, comorbidities, and the Charlson comorbidity Index (CCI). Results: Of the 70,464 patients, 21,194 were treated with UKA and 49,270 were treated with HTO. HTO showed a higher risk of revision than UKA at five, and 10 years and during the whole observation period. The incidence of deep vein thromboembolism, and surgical site infection was significantly higher in UKA than in HTO. Conclusions: It is important to choose an appropriate surgical method considering that UKA has better results in terms of long-term survival rates but may have a higher incidence of various complications.