This study demonstrates that a combined reconstruction can be an effective procedure without specific complications at a minimum follow-up of 2 years. Longer term and comparative follow-up studies are necessary to determine whether these combined reconstructions improve the results of ACL treatment.

Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partialthickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial-or full-thickness tear) and associated meniscotibial ligament disruption. An original technique of arthroscopic suture placement through a single posteromedial portal with a 25 curved suture hook device is described.D ata from anterior cruciate ligament (ACL) registries show that 47% to 61% of ACL tears are associated with meniscal lesions.

Level IV, therapeutic study, case series (no control group).

Preservation of the anterior cruciate ligament (ACL) remnant during ACL reconstruction has the advantages of improved vascularity and synovial encircling of the graft tendon. We describe a technique called singleeanteromedial bundle biological augmentation (SAMBBA) using complete preservation of the ACL remnant, as well as preservation of the semitendinosus tibial insertion, that uses standard portals and equipment.

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AimSocial media (SoMe) platforms have become leading methods of communication and dissemination of scientific information in the medical community. They allow for immediate discussion and widespread engagement around important topics. It has been hypothesized that the activity on Twitter positively correlates with highly cited articles. The purpose of this study was to analyze the prevalence and activity of Trauma and Orthopaedic Surgery journals on Twitter, with the hypothesis that impact factor is positively associated with Twitter usage.MethodsThe top 50 Trauma and Orthopaedic Surgery journals, ranked by 2016 Impact Factor were analyzed. The Twitter profiles of each journal or affiliated society were identified. Other SoMe platforms used were also recorded. Twitonomy software (Digonomy Pty Ltd, New South Wales, Australia) was used to analyze the Twitter profiles over a one-year period. Twitter Klout Scores were recorded for each journal to approximate the SoMe influence. Altmetric Scores (the total number of mentions via alternative metrics) were also recorded. Statistical analysis was carried out to identify correlations between journal Impact Factors, SoMe activity, Twitter Klout Scores and Altmetric Scores. ResultsTwenty-two journals (44%) had dedicated Twitter profiles. Fourteen journals (28%) were associated with societies that had profiles and 14 journals (28%) had no Twitter presence. The mean Impact Factor overall was 2.16 +/- 0.14 (range, 1.07-5.16). The journals with dedicated Twitter profiles had higher Impact Factors than those without (mean 2.41 vs. 1.61; P=0.005). A greater number of Twitter followers were associated with higher Impact Factors (R2 0.317, P=0.03). Journals with higher Twitter Klout Scores had higher Impact Factors (R2 0.357, P=0.016). Altmetric Score was positively associated with Impact Factor (R2 0.310, P=0.015). Journals with higher numbers of retweets (virtual citations in the Twittersphere) had higher Altmetric Scores (R2 0.463, P=0.015).ConclusionTrauma and Orthopaedic Surgery journals with dedicated Twitter profiles have higher Impact Factors than those without. Altmetrics is likely to play a significant role in the literature evaluation going forward along with the traditional metrics. The engagement with Twitter by Trauma and Orthopaedic surgeons should be encouraged.

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