This study shows that distal clavicle resection combined with rotator cuff repair for asymptomatic ACJ arthritis with inferiorly directed osteophytes lower functional scores due to temporary pain in early postoperative periods, but better functional outcomes with satisfactory pain relief and no reoperation rate were observed after 2 years.

PurposeTo compare clinical outcomes between the conventional round and rectangular tunnel techniques in single‐bundle posterior cruciate ligament (PCL) reconstruction. MethodsTwenty‐seven and 108 patients who underwent PCL reconstructions using a rectangular dilator (Group 1) and rounded tunnel reamer (Group 2), respectively, were included. The exclusion criteria were having a concomitant fracture, osteotomy, subtotal or total meniscectomy, and no remnant PCL tissue. A 4:1 propensity score matching was performed. The knee laxity on stress radiography, International Knee Documentation Committee Subjective Knee Evaluation score, Tegner activity score and Orthopädische Arbeitsgruppe Knie score were evaluated. ResultsNo significant differences were found between the groups in terms of clinical scores. (n.s.) The mean posterior translations were also not significantly different between the Group 1 and 2 (3.6 ± 2.8 and 3.8. ± 3.1 mm, respectively; n.s.). However, 3 patients (11.1%) in Group 1 and 15 patients (13.8%) in Group 2 showed posterior translation of > 5 mm. The combined posterolateral corner sling technique was performed for 27 patients (100%) in Group 1 and for 96 patients (88.9%) in Group 2. We found no significant difference in rotational stability at the final follow‐up. One patient was found to have a femoral condyle fracture during rectangular femoral tunnel establishment, which was healed after screw fixation, without laxity, during follow‐up. The intra‐ and inter‐observer reliabilities of the radiological measurements ranged from 0.81 to 0.89. ConclusionArthroscopic anatomical remnant‐preserving PCL reconstruction using a rectangular dilator showed satisfactory clinical results and stability as compared with PCL reconstruction using a conventional rounded reamer. Rectangular tunnel technique in PCL reconstruction could be a good treatment option with theoretical advantage to be anatomic. Level of evidenceLevel IV.

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First RCT meniscal allograft transplantation v Physiotherapy, a clinically meaningful and statistically significant improvement in the KOOS4 score favouring surgery was seen. Other patient reported outcomes were not statistically significant in this pilot investigation. These results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation. ABSTRACT DATAPurpose: Meniscal allograft transplantation has been performed for over 30 years but has never been rigorously evaluated for efficacy. The aim of this study was to perform the first randomised controlled trial (RCT) comparing meniscal allograft transplantation to physiotherapy. Materials and Methods: A single centre pilot RCT with parallel preference groups was performed on participants with a symptomatic knee compartment that had previously had a (sub)total meniscectomy. Participants were randomised to either meniscal allograft transplantation or a personalised physiotherapy programme, and stratified for limb malalignment. Participants not willing to be randomised entered the preference groups. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Lysholm score and complications were collected at baseline and four, eight and twelve months following the interventions. Results: Thirty-six participants entered the study; 21 were randomised (mean age 27.5 years, 81% lateral meniscectomies) and 15 chose their treatments (mean age 28.7, 74% lateral meniscectomies). Baseline demographics and treatment outcomes were similar between the randomised and preference groups, allowing pooling of data. The mean improvement in patient reported outcomes at one year in the meniscal allograft transplantation and physiotherapy groups respectively were: 24.3 and 12.5 in the KOOS4 composite score (p¼0.03), 18.8 and 10.4 (p¼0.16) in the IKDC score and 20.4 and 13.1 (p¼0.22) in the Lysholm score. There were five complications in the meniscal allograft transplantation and one in the physiotherapy groups. Conclusions: In this first RCT assessing efficacy of meniscal allograft transplantation, a clinically meaningful and statistically significant improvement in the KOOS4 score favouring surgery was seen. Other patient reported outcomes were not statistically significant in this pilot investigation. These results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation. However, a multi-centre RCT is required to further investigate this question.