Background: A large number of systematic reviews and meta-analyses regarding the meniscus have been published. Purpose: To provide a qualitative summary of the published systematic reviews and meta-analyses regarding the meniscus. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of all meta-analyses and systematic reviews regarding the meniscus and published between July 2009 and July 2019 was performed with PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts, narrative reviews, articles not written in English, commentaries, study protocols, and topics that were not focused on the meniscus were excluded. The most pertinent results were extracted and summarized from each study. Results: A total of 332 articles were found, of which 142 were included. Included articles were summarized and divided into 16 topics: epidemiology, diagnosis, histology, biomechanics, comorbid pathology, animal models, arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root repairs, meniscal allograft transplantation (MAT), meniscal implants and scaffolds, mesenchymal stem cells and growth factors, postoperative rehabilitation, postoperative imaging assessment, patient-reported outcome measures, and cost-effectiveness. The majority of articles focused on APM (20%), MAT (18%), and meniscal repair (17%). Conclusion: This summary of systematic reviews and meta-analyses delivers surgeons a single source of the current evidence regarding the meniscus.

Objectives: To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures.Design: Retrospective cohort.Setting: Level I trauma center.Patients: Elderly trauma patients admitted from 2007 to 2014. Methods:We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex.Main Outcome Measurement: One-year all-cause mortality defined as death within 12 months from date of hospitalization.Results: Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90-0.96], P , 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84-0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89-1.01), P = 0.103]. Conclusions:In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year allcause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted.

Background:We summarized the clinical outcomes and predictors of clinical outcomes after microfracture for chondral lesions in the patellofemoral joint (PFJ).Methods:Embase, PubMed, CENTRAL, BIOSIS, and CINAHL databases were searched between January 1, 1980, and January 1, 2019, to identify all articles that examined outcomes or predictors of outcomes of microfracture in patients with patellofemoral chondral lesions. Studies of full-thickness chondral lesions in the PFJ were included, whereas those involving adolescents, partial-thickness chondral lesions, and underlying patellar instability were excluded.Results:We found a total of 257 articles, of which 8 articles (174 patients) met our inclusion criteria. All studies found improvement in clinical outcomes after microfracture in the PFJ. Younger patients showed greater improvement in clinical outcomes than older patients. However, the effect of size, severity (grade), or location of chondral lesions on clinical outcomes after microfracture is unclear.Conclusion:We found improvement in clinical outcomes after microfracture in the PFJ at midterm follow-up. Age may be a predictor of successful outcomes and longevity of the repair; however, there is insufficient evidence regarding the influence of defect size, severity, and location on clinical outcomes.

Objective To characterize the changes to bone tunnels, graft fixation devices, and physes that occur on radiographs of skeletally immature individuals at least 2 years after transphyseal anterior cruciate ligament reconstruction (ACLR). Materials and methods Skeletally immature patients who underwent transphyseal ACLR were recruited to complete postoperative assessment at ≥ 2 years. The dimensions of tibial and femoral bone tunnels, position of graft fixation devices, and presence of growth arrest were assessed on radiographs, and pain visual analog and International Knee Documentation Committee scores were obtained. Paired t tests were used for comparisons. Results Nine patients were included with an average follow-up of 4.6 years postoperatively. There were no cases of premature physeal closure postoperatively and clinical outcome measures were excellent in all patients. The length of the intra-articular portion of anterior cruciate ligament graft increased postoperatively (P = 0.01). Distance between the tibial hardware and proximal tibial physis also increased over time on anteroposterior (P = 0.001) and lateral (P = 0.003) radiographs. However, the distance between the femoral hardware and distal femoral physis was unchanged and in five patients was associated with proximal femoral tunnel enlargement. Conclusion Proximal femoral tunnel expansion and lack of proximal migration of the femoral button were seen in more than half of our patients. However, these findings had no detrimental effects on clinical outcome measures or remaining skeletal growth.

Background: Open and fluoroscopic techniques have been described for localization of the femoral attachment site in medial patellofemoral ligament (MPFL) reconstruction. No study to date has evaluated if one technique is superior to another in terms of complications. Purpose: To review the literature comparing clinical outcomes of MPFL reconstruction using the fluoroscopic versus open technique to localize the site of femoral graft placement. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed via PubMed, Embase, and CINAHL to identify articles published between the inception of these databases and March 1, 2022, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This search yielded 4183 publications for initial review. Studies with at least a 2-year follow-up and complete reporting of patient-reported outcomes, range of motion, recurrent instability, and/or complications (ie, stiffness, infection, persistent pain) were included. We excluded studies of patients with collagen disorders; revision surgeries; surgeries with concomitant procedures; synthetic MPFL reconstruction; MPFL repairs; combined open and radiographic technique; and case series that included <10 patients. A proportional meta-analysis was performed by calculating the pooled estimate of incidence with 95% CIs using a fixed-effects model with double arcsine transformation (Freeman-Tukey) for each type of surgical technique (fluoroscopic or open). Results: A total of 29 studies met our inclusion criteria, of which 15 studies (566 patients) used the open technique and 14 studies (620 patients) used fluoroscopy. There were no significant differences between the open and fluoroscopic techniques in the incidence of postoperative apprehension ( P = .4826), postoperative subjective instability ( P = .1095), postoperative objective instability ( P = .5583), reoperations ( P = .7981), recurrent dislocation ( P = .6690), or arthrofibrosis ( P = .8118). Conclusion: Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications.