The aim of this review is to evaluate long-term follow-up and survival analysis studies regarding high tibial osteotomies (HTO) for the treatment of medial knee arthritis. Despite the good number of studies available, comparison and pooling of the results are challenging because of the different evaluation systems and techniques used. However, in general, published studies on HTO report good long-term results with a correct patient selection and a precise surgical technique. Based on our findings, the ideal candidate for an HTO is a young patient (<60 years of age), with isolated medial osteoarthritis, with good range of motion and without ligamentous instability. Furthermore, the literature review shows that the outcomes gradually deteriorate with time.

The contralateral normal knee anterior cruciate ligament is at a similar risk of anterior cruciate ligament tear (3.0%) as the anterior cruciate ligament graft after primary anterior cruciate ligament reconstruction (3.0%).

Background The predictors of ACL reconstruction outcome at six years as measured by validated patient based outcomes instruments are unknown. Hypothesis We hypothesize that certain variables evaluated at the time of ACL reconstruction will predict return to sports function (as measured by the IKDC and KOOS Sports and Recreation subscale), knee-related quality of life (as measured by the KOOS Knee Related Quality of Life subscale), and activity level (as measured by the Marx scale). Potential predictor variables include demographics, surgical technique and graft choice for ACL reconstruction, and intra-articular injuries and treatment. Study Design Prospective cohort, Level 1 Methods All unilateral ACL reconstructions from 2002 currently enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) cohort were evaluated. Patients preoperatively completed a series of validated outcome instruments, including the IKDC, KOOS, and Marx activity level. Physicians documented intra-articular pathology, treatment, and surgical techniques utilized at the time of surgery. At 2 and 6 years postoperatively, patients completed the same validated outcome instruments. Results Follow-up was obtained on 395/448 (88%) at 2 years and 378/448 (84%) at 6 years. The cohort was 57% male with median age of 23 at the time of enrollment. The ability to perform sports function was maintained at six years (IKDC T2 = 75, T6 = 77; KOOSsports/rec T2 = 85, T6 = 90). The Marx activity level continued to decline from baseline (T0 = 12, T2 = 9, T6 = 7). Revision ACL reconstruction and use of allograft predicted worse outcomes on the IKDC and both KOOS subscales. Lateral meniscus treatment, smoking status, and BMI at T0 were each predictors on two of three scales. The predictors of lower activity level were revision ACL reconstruction and female sex. Conclusions Six years after ACL reconstruction, patients are able to perform sports-related functions and maintain a high knee-related quality of life similar to their two year level, although their physical activity level (Marx) drops over time. Choosing autograft rather than allograft, not smoking, and having normal BMI are advised to improve long-term outcomes.

Background:Tearing an anterior cruciate ligament (ACL) graft is a devastating occurrence after ACL reconstruction (ACLR). Identifying and understanding the independent predictors of ACLR graft failure is important for surgical planning, patient counseling, and efforts to decrease the risk of graft failure.Hypothesis:Patient and surgical variables will predict graft failure after ACLR.Study Design:Prospective cohort study.Methods:A multicenter group initiated a cohort study in 2002 to identify predictors of ACLR outcomes, including graft failure. First, to control for confounders, a single surgeon’s data (n = 281 ACLRs) were used to develop a multivariable regression model for ACLR graft failure. Evaluated variables were graft type (autograft vs allograft), sex, age, body mass index, activity at index injury, presence of a meniscus tear, and primary versus revision reconstruction. Second, the model was validated with the rest of the multicenter study’s data (n = 645 ACLRs) to evaluate the generalizability of the model.Results:Patient age and ACL graft type were significant predictors of graft failure for all study surgeons. Patients in the age group of 10 to 19 years had the highest percentage of graft failures. The odds of graft rupture with an allograft reconstruction are 4 times higher than those of autograft reconstructions. For each 10-year decrease in age, the odds of graft rupture increase 2.3 times.Conclusion:There is an increased risk of ACL graft rupture in patients who have undergone allograft reconstruction. Younger patients also have an increased risk of ACL graft failure.Clinical Relevance:Given these risks for ACL graft rupture, allograft ACLRs should be performed with caution in the younger patient population.

Ankle sprains are among the most common athletic injuries and represent a significant source of persistent pain and disability. Despite the high incidence of ankle sprains in athletes, syndesmosis injuries have historically been underdiagnosed, and assessment in terms of severity and optimal treatment has not been determined. More recently, a heightened awareness in sports medicine has resulted in more frequent diagnoses of syndesmosis injuries. However, there is a low level of evidence and a paucity of literature on this topic compared with lateral ankle sprains. As a result, no clear guidelines are available to help the clinician assess the severity of injury, choose an imaging modality to visualize the injury, make a decision in terms of operative versus nonoperative treatment, or decide when the athlete may return to play. Increased knowledge and understanding of these injuries by clinicians and researchers are essential to improve the prevention, diagnosis, and treatment of this significant condition. This review will discuss the anatomy, mechanism of injury, diagnosis, and treatment of syndesmosis sprains of the ankle while identifying controversies in management and topics for future research.