Background: Tibial tubercle transfer (TTT) and medial patellofemoral ligament (MPFL) reconstruction have both shown, either in isolation or in combination, to provide improved patellofemoral joint (PFJ) stability. There are few studies that provide evidence that this remains true in the long term. Purpose: To compare the long-term results of patellar instability after TTT with and without MPFL reconstruction in 2 randomized groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 34 patients (36 knees) were randomized to 2 groups. The first group underwent lateral release (LR) and TTT for confirmed maltracking of the patella (control group). The second group underwent MPFL reconstruction in addition to TTT and LR (reconstruction group). Patients were followed up with validated questionnaires (Kujala score, Tegner activity score), a visual analog scale (VAS) assessing their insecurity, and a clinical assessment at a minimum of 5 years postoperatively. Participants also underwent quantitative computed tomography (CT) at 1 year for comparison. Two patients in the control group and 1 patient in the reconstruction group were lost to follow-up at 5 years. Results: There were no significant differences in the Kujala ( P = .75), Tegner ( P = .36), or VAS ( P = .75) scores at any time period. One patient in the control group sustained a patellar redislocation at 3 years. Five patients in the control group and 2 in the reconstruction group had functional failures and required reoperations; however, this was not statistically significant ( P = .30). There were no significant differences between groups in the time to return to school or work ( P = .65) or sports ( P = .38) after surgery. Overall patient satisfaction was higher in the reconstruction group compared with the control group ( P = .04), and quantitative CT scans showed that the reconstruction group had a statistically significant improvement in the mean patellar tilt (6° vs −8°, respectively; P = .03) and mean congruence angle (13° vs −11°, respectively; P = .03) in the quadriceps-contracted state compared with the control group. Conclusion: Reconstruction of the MPFL in addition to TTT and LR resulted in improved alignment parameters (congruence angle, patellar tilt angle) as well as patient satisfaction. The Kujala and Tegner scores were no different between the 2 groups at any time period. There was insufficient evidence to conclude that the addition of MPFL reconstruction to TTT results in fewer redislocations or reoperations. This study concludes that MPFL reconstruction improves PFJ alignment and patient satisfaction; however, further studies with larger patient numbers are required to satisfy its significance with respect to redislocation rates and functional scores in the long term.

Background: Lateral extra-articular tenodesis (LEAT) aims to improve anterolateral stability of the injured knee during anterior cruciate ligament reconstruction (ACLR) surgery. Inconclusive evidence surrounding the efficacy and safety of LEAT has propelled clinical interest and ongoing discussions. Purpose: To establish level 1 evidence by assessing randomized controlled trials (RCTs) with minimum 2-year follow-up that directly compared ACLR with LEAT (LEAT group) and ACLR alone (non-LEAT group) in terms of clinical outcomes and complications. Study Design: Meta-analysis and systematic review; Level of evidence, 1. Methods: Meta-analysis was performed with a multidatabase search (Cochrane, EMBASE, OVID Medline, PubMed, and Web of Science) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on September 9, 2020. Data from published RCTs meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. Results: A total of 7 RCTs were included, consisting of 517 LEAT and 589 non-LEAT patients. Only autografts were used for ACLR and LEAT. A variety of LEAT techniques and autograft fixation methods were used. We found improved stability (residual positive pivot shift: risk ratio [RR], 0.59; 95% CI, 0.39-0.88; P = .01) and better clinical outcomes (International Knee Documentation Committee [IKDC] score: mean difference [MD], 2.31; 95% CI, 0.54-4.09; P = .01; and Lysholm score: MD, 2.71; 95% CI, 0.68-4.75; P = .009) in the LEAT than non-LEAT group. Graft rerupture rate was 3 times less likely (RR, 0.31; 95% CI, 0.17-0.58; P < .001) in the LEAT group than the non-LEAT group. Conclusion: Good-quality evidence is available to support the efficacy of LEAT in improving anterolateral knee stability and reducing graft reruptures in primary ACLR. LEAT should be considered in patients with high risk factors. Although Lysholm and IKDC scores were statistically better in the LEAT group, these are unlikely to be clinically significant. Future studies should aim to identify patient populations that would best benefit from LEAT with ACLR.

Background: Deficits in neuromuscular control are common after anterior cruciate ligament (ACL) reconstruction and may be associated with further knee injury. The knee valgus angle during a single-leg squat (SLS) is one measure of neuromuscular performance. Purpose: To determine whether the knee valgus angle during SLS changes between 6 and 12 months after ACL reconstruction and to assess how the operative knee valgus angle compares with that of the contralateral side. Study Design: Case series; Level of evidence, 4. Methods: A cohort of 100 patients with uninjured contralateral knees were assessed at 6 and 12 months after primary hamstring autograft ACL reconstruction. Participants performed the SLS on each leg, and the knee valgus angle was measured via frame-by-frame video analysis at 30° of flexion and at each patient’s maximum knee flexion angle. Results: For the operative limb at 30° of flexion, a small but statistically significant reduction was noted in the valgus angle between 6 and 12 months (5.46° vs 4.44°; P = .002; effect size = 0.24). At 6 months, a slightly higher valgus angle was seen in the operative limb compared with the nonoperative limb (5.46° vs 4.29°; P = .008; effect size = 0.27). At maximum flexion, no difference was seen between limbs in the valgus angle at either 6 or 12 months, and no change was seen in the operative limb between 6 and 12 months. At 6 months and 30° of knee flexion, 13 patients had a valgus angle greater than 10°. This group also had a higher mean valgus angle in the contralateral limb compared with the contralateral limb in the other 87 patients (8.5° vs 3.65°; P < .001). Conclusion: During a controlled SLS, the knee valgus angle remained essentially constant, and minimal limb asymmetries were present over the 6- to 12-month postoperative period, a time when athletes typically increase their activity levels. Whether changes or asymmetries will be seen with more dynamically challenging tasks remains to be determined. When present, high valgus angles were commonly bilateral.

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Intra-articular disorders of the hip in the elite athlete are common and potentially career threatening. Hip arthroscopy has been shown to be a safe and successful method of treating these conditions. This study examines the effectiveness of hip arthroscopy in facilitating an early return to professional level sport. We prospectively followed 65 professional athletes (mostly Australian Rules Football players) before and after hip arthroscopy using the Modified Harris Hip Score (MHS) and the Non-Arthritic Hip (NAH) Score. We followed them to the 1 year mark and recorded the time required for them to return to sport. Follow-up was achieved in 100% of patients. Intraoperative findings included femoroacetabular impingement, labral pathology and ligamentum teres injuries. Both MHS and NAH Scores showed highly statistically significant improvements up to the 1 year mark. All but 3 athletes returned to professional level sport. The mean return to sport time was 11.9 weeks. The use of arthroscopy to manage common intra-articular hip disorders in elite athletes is safe, effective and facilitates an early return to sport.

The ligamentum teres has traditionally been described as a vestigial remnant or redundant structure with little contribution to hip biomechanics or function. However, interest in the ligamentum teres has been renewed as evidence has emerged that it not only plays a role as a pain generator in the hip but also acts as a secondary stabilizer to supplement the work of the capsular ligaments. Furthermore, an association has been proposed between tearing of the ligamentum teres and the development of degenerative hip disease. However, the question remains, is it a cause-and-effect relationship?

Collision tumors within the retroperitoneum are rare. We present the case of a 54-year-old man with an incidental finding of a well-defined iliopsoas mass. He underwent marginal resection via an anterior superior ilio-inguinal approach. Histological examination revealed typical features of a schwannoma surrounded by a notable plasma cell infiltrate. On immunohistochemistry stains, the spindled cells displayed diffuse, strong nuclear and cytoplasmic positivity for S100, whereas epithelial membrane antigen, glial fibrillary acidic protein, and neurofilament stains were uniformly negative. The plasma cell infiltrate was diffusely positive for CD 138, with a majority of them demonstrating positive staining for lambda light chain and negative for kappa light chain. Hematological review found no evidence of marrow plasmacytosis and multiple myeloma was ruled out. At 12 month follow-up, the patient remains free of any recurrence. To our knowledge this is the second case of a schwannoma coexisting with a monoclonal plasma cell infiltrate and the first in the retroperitoneum.

Purpose:Reconstruction of the medial patellofemoral ligament (MPFL) is increasingly used to restore the primary ligamentous restraint to patella dislocation. The purpose of this randomised controlled trial is to compare the 5 year results of the addition of autograft MPFL reconstruction to tibial tubercle transfer (TTT) and lateral release (LR) (reconstruction group) to TTT and LR alone (control group) for recurrent patella dislocation.Methods:Thirty-four patients (36 knees) were randomised to two groups. Two patients in the control group (TTT + LR) and three patients in the reconstruction group (MPFL + TTT + LR) group were lost to follow up at 5 years.Results:There were no significant differences in Kujala and Tegner scores or “insecurity” Visual Analogue Scale (VAS) at any time period. There was a trend to a lower average VAS in the reconstruction group at six weeks but also poorer average flexion. There were no significant differences in time to return to school, work or sports. Quantitative CT scans showed the reconstruction group had a significant improvement in average patella tilt (6 degrees vs -8 degrees, p = 0.03) and average congruence angle (13 degrees vs -11 degrees, p = 0.03) in the quadriceps contracted state. At 5 years the MPFL/TTT reconstruction group had a lower revision rate (2/17) compared to the control group of TTT alone (5/16).Conclusion:Patients who underwent an MPFL reconstruction in addition to a TTT had a comparatively significant improved patella congruence on quantitative CT Scan. At 5 years the MPFL/TTT reconstruction group had a lower but non significant revision rate compared to the control group of TTT alone.