Background: Technical innovation has led to the renaissance of anterior cruciate ligament (ACL) repair in the past decade. Purpose/Hypothesis: The present study aimed to compare instrumented knee joint laxity and patient-reported outcomes (PROs) after ACL repair with those after primary ACL reconstruction for acute isolated ACL tears. It was hypothesized that ACL repair would lead to comparable knee joint stability and PROs at 5 years postoperatively in comparison with ACL reconstruction. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 85 patients with acute ACL tears were randomized to undergo either ACL repair using dynamic intraligamentary stabilization (DIS) or primary ACL reconstruction with a semitendinosus tendon autograft. The primary outcome was the side-to-side difference in anterior tibial translation (ΔATT) assessed by Rolimeter testing at 5 years postoperatively. Follow-up examinations were performed at 1, 2, and 5 years. PROs were assessed using the Tegner activity scale, the International Knee Documentation Committee (IKDC) subjective score, and the Lysholm score. Furthermore, the rates of recurrent instability, other complications, and revision surgery were recorded. A power analysis was performed a priori, and the Friedman test, Mann-Whitney U test, and Bonferroni correction were applied for statistical comparisons with significance set at P < .05. Results: The mean age at inclusion was 28.3 ± 11.5 years in the ACL repair group and 27.1 ± 11.5 years in the ACL reconstruction group. At 5 years postoperatively, a total of 64 patients (ACL repair: n = 34 of 43 [79%]; ACL reconstruction: n = 30 of 42 [71%]) were available for follow-up. At 5 years, ΔATT was 1.7 ± 1.6 mm in the ACL repair group and 1.4 ± 1.3 mm in the ACL reconstruction group ( P = .334). Preinjury PROs were restored as soon as 1 year after surgery and plateaued until 2 and 5 years postoperatively in both groups. At the 5-year follow-up, the mean Lysholm score was 97.0 ± 5.4 versus 94.5 ± 5.5 ( P = .322), respectively, and the mean IKDC subjective score was 94.1 ± 9.9 versus 89.9 ± 7.8 ( P = .047), respectively, in the ACL repair group versus ACL reconstruction group. At 5 years postoperatively, 12 patients in the ACL repair group (35%; age <25 years: n = 10/12; Tegner score ≥7: n = 10/12) had recurrent instability, of whom 10 underwent single-stage revision ACL reconstruction. In the ACL reconstruction group, there were 6 patients with recurrent instability (20%; age <25 years: n = 6/6; Tegner score ≥7: n = 5/6); however, in 5 patients, staged revision was required. Differences between both groups regarding recurrent instability ( P = .09) or ACL revision surgery ( P = .118) were not statistically significant. Recurrent instability was associated with age <25 years and Tegner score >7 in both groups. Conclusion: At 5 years after ACL repair with DIS, instrumented knee joint laxity and PROs were comparable with those after ACL reconstruction. Although no significant difference was found between repair and reconstruction, a critical appraisal of the rates of recurrent instability (35% vs 20%, respectively) and revision surgery (38% vs 27%, respectively) is needed. Young age and a high preinjury activity level were the main risk factors for recurrent instability in both groups. However, single-stage revision ACL reconstruction was possible in each case in the ACL repair group. Although ACL reconstruction remains the gold standard in the treatment of ACL tears, the present study supports the use of ACL repair with DIS as a feasible option to treat acute ACL tears in patients aged ≥25 years with low to moderate activity levels (Tegner score <7). Registration: DRKS00015466 (German Clinical Trials Register).

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Background: In the current literature, studies on the anatomy of the anteromedial region of the knee are scarce. However, the anteromedial structures, especially the longitudinal medial patellar retinaculum (MPR), may play an important role in restraining external tibial rotation. Purpose: To conduct a layer-by-layer dissection of the anteromedial side of the knee and describe qualitatively and quantitatively the MPR anatomy pertaining to surgically relevant landmarks. Study Design: Descriptive laboratory study. Methods: A total of 10 fresh-frozen human cadaveric knees (mean age 81 ± 16.3 years) without history of previous ligament injury were used in this study. A layer-by-layer dissection was performed, and measurements were obtained using a tactile 3-dimensional (3-D) measuring arm to define the anatomy of the MPR in relation to surgically relevant landmarks, such as the superficial medial collateral ligament (sMCL) and medial patellofemoral ligament (MPFL). The 3-D datasets were used for multiplanar reconstruction. Results: The tibial and femoral attachment of the MPR were identified in 100% of cases. Layer-by-layer dissection confirmed its close topography to the sMCL. The mean length of the MPR was 84.9 ± 9.1 mm. The average width of the tibial and femoral attachment was 23.8 ± 3.1 mm and 69.2 ± 8.2 mm, respectively. The distance from the midpoint of the MPR tibial attachment to the midpoint of the distal tibial attachment of the sMCL was 27.2 ± 5.8 mm. Femorally, the MPR attached at the anterior border of the MPFL over a mean distance of 52.3 ± 9.4 mm. Conclusion: The MPR is a distinct tibiofemoral structure with well-defined tibial and femoral attachments, which could be consistently identified. Layer-by-layer dissection confirmed its close topography to the sMCL and MPFL. Clinical Relevance: As injuries to the anteromedial side of the knee may contribute to anteromedial rotational rotatory instability (AMRI), precise knowledge of the underlying anatomy of the MPR may be necessary to perform an anatomic reconstruction of the anteromedial side of the knee.

Background Olecranon fractures are common injuries that can occur in patients of any age. To assess the postoperative outcome, multiple scoring systems like the DASH, MEPS und Morrey Score have been described. The goal of this paper is to compare the subjective elbow value (SEV) to these commonly used scoring systems. We hypothesized that the SEV would have a high correlation and practicability for the evaluation of elbow function after isolated olecranon injury. Patients and Methods Clinical data of 40 patients were collected and retrospectively analysed. All patients suffered an isolated olecranon fracture and were surgically treated by tension band wiring or plate fixation. In the follow-up examinations the Mayo Score, DASH Score, Morrey Score and SEV were measured for correlation purposes. Results The mean follow-up time was 70.5 ± 45.6 months. The median DASH Score was 9.9 (4.1 – 20.4) and 100 (85 – 100) for the MEPS. The median Morrey Score was 98 (92 – 100). The median SEV was 90% (80 – 95%). The Pearson correlation between the DASH and SEV was −0.85 and 0.80 between the MEPS and the SEV. Conclusions The SEV shows a high correlation to the most commonly used scoring systems for outcome evaluation after elbow injury. It is easy to use and can be seen as a valuable tool to assess patients after olecranon fractures.

Background: The promising biomechanical stability of bone staples (BSs) in cortical fixation of tendon grafts for medial collateral ligament (MCL) reconstruction has been revealed by a previous investigation. However, it is currently unknown if the biomechanical stability of cortical fixation of tendon grafts depends on the BS design. Purpose: To assess the biomechanical stability of cortical fixation of tendon grafts in knee surgery using 4 different BS designs. Study Design: Controlled laboratory study. Methods: Cortical fixation of tendon grafts was performed in a porcine knee model at the tibial insertion area of the MCL using 4 different BS designs (n = 40): 8-mm width without spikes (n = 10), 8-mm width with spikes (n = 10), 14-mm width with spikes (n = 10), and 13 mm–wide 4-prong staples with spikes (n = 10). Specimens were mounted in a materials testing machine, and cyclic loading was applied to the tendon graft (500 cycles at 50 and 100 N, respectively), followed by load-to-failure testing. The Kruskal-Wallis test was performed for statistical analysis ( P < .05), and the post hoc Dunn test was performed for multiple comparisons. Results: In 4 of 10 specimens with graft fixation using BSs without spikes, slippage of the tendon underneath the BS led to failure of the construct during cyclic loading to 100 N. In the other groups, no fixation failure was observed during cyclic loading. Furthermore, graft fixation using BSs without spikes was found to have significantly more elongation during cyclic loading (8.2 ± 1.9 mm) and a lower ultimate failure load (170 ± 120 N) compared with graft fixation using narrow BSs with spikes (3.4 ± 1.2 mm [ P < .0001] and 364 ± 85 N [ P < .05], respectively) and graft fixation using broad BSs with spikes (4.5 ± 1.4 mm [ P < .05] and 429 ± 67 N [ P < .001], respectively). No statistical differences in elongation during cyclic loading or ultimate failure load were found between 4-prong staples with spikes (5.0 ± 1.3 mm and 304 ± 85 N) and narrow or broad staples with spikes. Conclusion: The biomechanical stability of cortical fixation of an MCL graft was comparable between each BS design with spikes (narrow, broad, and 4-prong) in a porcine knee model, whereas BSs without spikes led to failure of the fixation construct during cyclic loading in 4 of 10 specimens and increased elongation and lower ultimate failure loads in the remainder of the group. BSs without spikes may therefore not be recommended for graft fixation. Clinical Relevance: The use of BSs can help to avoid the conflict of converging tunnels in multiligament reconstruction surgery. An implant design with spikes yields significantly higher biomechanical stability than BSs without spikes.