Purpose With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. UK) for consideration in the presented practice recommendations. Results World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. Conclusion Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosolgenerating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. Level of evidence IV.

The roadmap to elective surgery resumption after this COVID-19 pandemic should be progressive and cautious. The aim of this paper was to give recommendations and guidelines for resuming elective orthopedic surgery in the safest environment possible. Elective surgery should be performed in COVID-free facilities and hospital stay should be as short as possible. For matters of safety, patients considered first for surgery should be carefully selected according to COVID infection status/exposure, age, ASA physical status classification system / risk factors, socioprofessional situation and surgical indication. A strategy for resuming elective surgery in four phases is proposed. Preoperative testing for COVID-19 infection is highly recommended. In any cases, COVID symptoms including fever and increased temperature should be constantly monitored until the day of surgery. Elective surgery should be postponed at the slightest suspicion of a COVID-19 infection. In case of surgery, adapted personal protective equipment in terms of gowns, gloves, masks and eye protection is highly recommended and described.

Similarities in patient demographics and injury activity were observed between all cohorts of ACLR. However, graft and fixation choices differed. Revision rates were low. This work, including >100 000 ACLR, is the most comprehensive international description of contemporary practice to date.

Purpose The purpose of this study was to analyse patient and injury characteristics as well as arthroscopic findings in a prospective cohort of ACL‐injured patients with or without an associated ramp lesion. Methods Two hundred and twenty‐four patients undergoing a primary (n = 196) or revision (n = 28) ACL reconstruction were included. The presence of a ramp lesion was determined by a systematic arthroscopic inspection of the posteromedial compartment. Chi‐square tests were used to compare the population of ACL‐injured patients with and without a ramp lesion regarding sex, age, body mass index, previous ACL injuries, sport before injury, and injury characteristics. Significance was set at p < 0.05. Results Fifty‐three out of 224 patients had a ramp lesion (24%). The presence of the latter was not related to any of the analysed patient characteristics. The prevalence of the lesion was higher in contact injuries (n = 19; 41%) compared with non‐contact injures (n = 34; 19%; p < 0.001). It was higher in patients with complete ACL ruptures (n = 49; 27%) as opposed to partial ruptures (n = 1; 4%; p = 0.01). A patient was 2.98 [95% CI 1.49–5.98] times more likely to have a ramp lesion if the ACL injury was declared to have been caused by direct contact and 8.71 [95% CI 1.15–66.12] times more likely if the ACL tear was complete. Conclusion Ramp lesions may be anticipated in almost one out of four patients undergoing ACL reconstruction, especially if a patient sustained a contact injury and in the presence of a complete ACL tear. Level of evidence III.

Purpose The purpose of this study was to compare preoperative knee laxity between two groups of patients with primary or revision ACL reconstruction with or without an associated ramp lesion of the medial meniscus. Methods Two‐hundred and seventy‐five patients with an ACL reconstruction (243 primaries; 32 revisions) were prospectively screened using direct arthroscopic visualisation and divided into a ramp lesion group (RLG) and a control group (CG) regardless of the presence of other associated meniscal tears. All patients were clinically examined under anaesthesia before surgery by grading the Lachman and pivot shift tests. Results Fifty‐eight patients were included in the RLG. The CG included 217 patients. With all meniscus lesions included, there were no significant differences between the two groups. After excluding all other meniscus lesions in both groups except for ramp lesions in the RLG, the prevalence of a grade III pivot shift was higher in the RLG (32 remaining patients; 47% grade III) compared to the CG (91 remaining patients; 24% grade III, p = 0.02). The difference of patients with a grade III pivot shift between the CG and RLG remained significant after removal of revision ACL reconstructions (CG, 85 remaining patients; 25% grade III—RLG, 27 remaining patients; 44% grade III, p = 0.05). Conclusion Patients with an isolated ramp lesion of the medial meniscus in association with an ACL injury displayed a higher amount of dynamic rotational laxity as expressed by the pivot shift test in comparison to patients with isolated ACL injury and no ramp lesion. The association between ramp lesions of the medial meniscus and increased pivot shift grading suggests that it is important to diagnose and repair them during ACL reconstruction surgery. Level of evidence III.

Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.

PurposeThe purpose of this study was (1) to describe the meniscus tear pattern in anterior cruciate ligament (ACL)‐injured patients, with a special focus on medial meniscus (MM) ramp lesions and lateral meniscus (LM) root tears and (2) to determine whether patient and injury characteristics were associated with meniscus tear patterns. MethodsData from 358 cases of ACL primary and revision reconstruction surgeries were extracted from a center‐based registry. During arthroscopy, the presence of associated meniscus lesions was documented by systematically inspecting the anterior and posterior tibiofemoral compartments. With a special focus on MM ramp lesions and LM root tears, groups of different injury tear patterns were formed. Chi‐square tests were used to determine whether these groups differed with respect to various patient and injury characteristics, including gender, previous ipsilateral ACL injuries, the injury’s relation to sport, person contact during injury and the type of ACL tear. Median age at surgery and body mass index were compared between groups using the Kruskal–Wallis test. Significance was set at p < 0.05. ResultsTwo hundred and thirty‐nine ACL injuries (67%) showed additional meniscal injuries, of which 125 (52%) involved the MM ramp and/or the LM root. Ramp lesions were more frequent in males (23% vs 12% in females, p < 0.01), in contact injuries (28% vs 16% in non‐contact, p < 0.05) and in complete ACL tears (21% vs 5% in partial, p < 0.05). Combined injuries of the MM ramp and the LM root showed a higher percentage of contact injuries compared to non‐contact injuries (10% vs 4%, p < 0.05). ConclusionTwo‐thirds of all ACL injuries showed a concomitant meniscus injury, of which half involved the biomechanically relevant, but previously often undiagnosed RLMM or the PRLM. These findings provide evidence that until recently about half of ACL‐associated meniscus injuries were not properly identified. Ramp lesions were more frequent in males, contact injuries and in complete ACL tears. These findings stress the need for a systematic assessment and a better understanding of the pathomechanism of these specific injuries which may have an important impact on knee biomechanics and the outcome of ACL reconstruction. Level of evidenceIII.

Hamstring injuries are very common in sports medicine. Knowing their anatomy, morphology, innervation, and function is important to provide a proper diagnosis, treatment as well as appropriate prevention strategies. In this pictorial essay, based on anatomical dissection, the detailed anatomy of muscle–tendon complex is reviewed, including their proximal attachment, muscle course, and innervation. To illustrate hamstrings’ role in the rotational control of the tibia, the essay also includes the analysis of their biomechanical function. Level of evidence V (expert opinion based on laboratory study).