[Refixation of a posterior medial root lesion in combination with centralization by a meniscotibial suture]. / Refixation einer posterioren medialen Wurzelläsion in Kombination mit Zentralisation durch meniskotibiale Naht.

OBJECTIVE: Refixation of a posterior root lesion of the medial meniscus via a tibial drill tunnel and prevention of extrusion using a meniscotibial suture (centralization). INDICATIONS: Posterior root lesion of the medial meniscus. CONTRAINDICATIONS: Grade 4 cartilage damage in the corresponding compartment, uncorrected varus or valgus deformities, symptomatic instabilities, extensive degenerative tears apart from the root region. SURGICAL TECHNIQUE: Knee arthroscopy via the high anterolateral standard portal. Diagnostic arthroscopy to check indication. Locate the insertion zone on the tibial plateau and local debridement until the bone of the tibial plateau is visible. Insertion of a targeting device and drilling of a targeting wire into the center of the insertion zone in the area of the intercondylar eminence. Overdrill the target wire with a 4.5 mm drill. Reinforcement of the medial meniscus posterior horn with braided suture material. The reinforcing thread is inserted into the bone tunnel via an eyelet wire with a thread loop. Optional additional centralization with incision in the middle part of the meniscus. Reinforcement of the meniscus base with braided suture material using the "outside in" technique and fixation of the inner meniscus base at the edge of the tibial plateau using a transosseous extraction suture or a suture anchor. POSTOPERATIVE MANAGEMENT: Six weeks nonweight-bearing (0 kg), then gradually increased load. Range of motion: 4 weeks E/F 0-0-60°, 2 weeks 0-0-90°, optionally use of a valgus brace (varus of < 5°). RESULTS: In root lesions of the medial meniscus, transosseous refixation significantly improves knee function (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee Injury and Osteoarthritis Outcome scores) and reduces osteoarthritis progression. However, a transosseous suture alone could not significantly reduce postoperative extrusion. However, previous studies have shown that additional centralization can significantly reduce extrusion.

[Reconstruction of the medial collateral ligament complex with a flat semitendinosus auto- or allograft]. / Rekonstruktion des medialen Kollateralbandkomplexes mit einem flachen autologen oder allogenen Semitendinosussehnentransplantat.

OBJECTIVE: Replacement of superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) with an allograft. INDICATIONS: Chronic 3° isolated medial instability and combined anteromedial or posteromedial instability. CONTRAINDICATIONS: Infection, open growth plates, restricted range of motion (less than E/F 0-0-90°). SURGICAL TECHNIQUE: Longitudinal incision from medial epicondyle to superficial pes anserinus and exposure of the medial collateral ligament complex. Thawing of the allogeneic semitendinosus tendon graft at room temperature, reinforcement of the tendon ends with sutures and preparation of a two-stranded graft. Placement of guidewires in the sMCL and POL insertions and control with image intensifier. Tunnel drilling. Pulling the graft loop into the femoral bone tunnel and fixation with a flip button. Pulling the two graft ends into the tibial tunnels. Tibial fixation by knotting the suture ends in a 20° flexion on the lateral cortex. Suture the tendon bundles to the remaining remnants of the medial collateral ligament complex to adopt the flat structure of the natural medial collateral ligament complex. POSTOPERATIVE MANAGEMENT: Six weeks partial weight-bearing, immediately postoperatively splint in the extended position, after 2 weeks movable knee brace for another 4-6 weeks. Mobility: 4 weeks 0-0-60, 5th and 6th weeks 0-0-90. RESULTS: From 2015-2021, this surgical procedure was performed in 19 patients (5 women, 14 men, age 34 years). Mean Lysholm score at follow-up after at least 2 years was 89 (76-99) points. In 6 patients, there was restricted range of motion 3 months postoperatively, which resulted in further therapy (3 נsystemic cortisone therapy, 3 נarthroscopically supported manipulations under anesthesia).

[Reconstruction of the patellar tendon with autologous or allogeneic semitendinosus tendon transplant for chronic rupture]. / Rekonstruktion der Patellarsehne mit autologem oder allogenem Semitendinosussehnentransplantat bei chronischer Ruptur.

OBJECTIVE: Reconstruction of a patellar tendon defect in the event of a chronic rupture. INDICATIONS: Chronic rupture of the patellar tendon due to delayed diagnosis or failure of primary refixation with a dehiscence that does not allow for anatomical refixation without patellar tendon shortening. CONTRAINDICATIONS: Infection. SURGICAL TECHNIQUE: Approximately 15 cm long incision from the tibial tuberosity to the patella. Depicting the rupture. Debridement of the tendon and insertion. Suture in the quadriceps tendon and distalization of the patella. If sufficient distalization of the patella is not possible, optionally perform a VY-plasty of the quadriceps tendon. Measuring the dehiscence. Securing the height of the patella by applying a patellotibial cerclage (strong suture cord). Extension of an existing tendon stump using a Z-plasty. Creation of 2 bone tunnels (diameter approx. 5 mm) in the patella and the tibial tuberosity. Insertion of an autologous or allogeneic semitendinosus tendon transplant and securing it by knotting the retaining threads in front of the tibial tuberosity. POSTOPERATIVE MANAGEMENT: Six weeks of partial weight-bearing with 10 kg of body weight in a straight, removable splint. Range of movement: weeks 1-4 E/F 0-0-60°, weeks 5-6 E/F 0-0-90°. RESULTS: Seven patients who underwent this surgery as described above had a minimum follow-up of 2 years. Secondary lengthening of the quadriceps tendon had to be performed twice due to excessive retraction. All patients were able to perform active extension postoperatively. The Lysholm score rose from 49.3 to 83.2 points. No further rupture was detectable in the final ultrasound examination.

[Modified pendulum osteotomy to correct severe tibial varus deformity]. / Modifizierte Pendelosteotomie zur Korrektur einer hochgradigen tibialen Varusdeformität.

OBJECTIVE: Correction of a severe tibial varus deformity near the knee joint with only a slight influence on leg length and patella height. INDICATIONS: Medial osteoarthritis and/or cartilage damage with a severe varus deformity > 10° with a medial proximal tibial angle (MPTA) < 80°. CONTRAINDICATIONS: Femoral varus deformity with lateral distal femoral angle > 91°, severe lateral cartilage damage, lateral osteoarthritis, lateral meniscus loss. SURGICAL TECHNIQUE: Skin incision of approx. 8-10 cm between the tibial tuberosity and the head of the fibula. Exploration of the peroneal nerve. Detachment of the extensors. Insertion of an obliquely ascending guidewire ending approximately 10 mm below the medial articular surface. Insertion of a second guidewire. This aims at the middle of the first wire (hemi wedge). Check the wire position under fluoroscopy. Osteotomy with an oscillating saw under cooling. Removal of the wedge and closure of the osteotomy. Percutaneous needling of the medial collateral ligament with a cannula to carefully lengthen the ligament. Check the correction result with a metal rod. Osteosynthesis with lateral angle-stable plate. POSTOPERATIVE MANAGEMENT: Partial weight-bearing with 10 kg for 6 weeks postoperatively, free range of motion. RESULTS: Reports from the literature show that good clinical results can be achieved with this procedure for severe tibial varus deformities. Postoperative leg length discrepancies are less common with this procedure than with laterally closing osteotomy.

[VY-plasty for chronic quadriceps tendon rupture]. / VY-Plastik bei chronischer Ruptur der Quadrizepssehne.

OBJECTIVE: Lengthening of the quadriceps tendon for dehiscence in chronic rupture. INDICATIONS: Chronic rupture of the quadriceps tendon with delayed diagnosis or failure of primary refixation with a dehiscence between 1 and 5 cm. CONTRAINDICATIONS: Dehiscence of more than 5 cm. SURGICAL TECHNIQUE: Reopen the old incision and lengthen it to about 20-25 cm if necessary. Visualize the rupture. Debridement of the tendon and the insertion. Measurement of the dehiscence. Creation of a V-flap and reinforcement with a holding seam. Gradual mobilization of the V­flap distally and reinforcement with two strong suture cords (braided suture size 5). Drilling of three obliquely ascending drill holes through the patella. Transosseous threading of the two reinforcement cords through the three drill holes. Knotting the reinforcement cords on the patella. Closure of the gap between the patella and the superficial tendon leaflet with a #2 braided suture. Closure of the gap between the V­flap and the quadriceps tendon. POSTOPERATIVE MANAGEMENT: Six weeks of partial weight-bearing with 20 kg in a straight orthosis. Mobility: weeks 1-4 E/F 0-0-60, weeks 5 and 6 E/F 0-0-90. RESULTS: We were able to follow-up 8 patients (mean age: 63.1 ± 4.5 years), who underwent this surgery in the manner described. All patients were able to perform an active extension postoperatively. The Lysholm score increased from 46.4 (±â€¯5.4) points preoperatively to 81.6 (±â€¯6.5) points postoperatively. No further rupture was detectable in the ultrasound examination at latest follow-up after an average of 27 (18-36) months.

[Subtuberosity anterior closing wedge osteotomy to correct the increased posterior slope of the tibial plateau]. / Subtuberositäre anterior schließende Osteotomie zur Korrektur der erhöhten posterioren Reklination des Tibiaplateaus.

OBJECTIVE: Reduction of increased reclination of the tibial plateau (posterior slope) to improve the anterior stability of the knee joint. INDICATIONS: Increased posterior reclination of the tibial plateau greater than 12° in combination with recurrent instability after anterior cruciate ligament (ACL) reconstruction. CONTRAINDICATIONS: Hyperextension of more than 15° (relative). SURGICAL TECHNIQUE: Anterior skin incision approximately 8-10 cm above the tibial tuberosity. Insertion of two converging guidewires directly below the patellar tendon ending obliquely in the area of the posterior cruciate ligament (PCL) insertion. Control of the wire position with the image intensifier core. Oscillating saw osteotomy. Removal of the wedge and closure of the osteotomy. Osteosynthesis with interfragmentary screw and medial angle-stable plate. POSTOPERATIVE MANAGEMENT: Partial load with 10-20 kg for 2 weeks, then step by step increase in load. Mobility: free. RESULTS: To date we have operated on 36 patients with recurrent instability after ACL reconstruction (20 men, 16 women, average age 34.4 years) in the manner described in this article. In 25 cases, enlarged bone tunnels were filled with allogeneic bone at the same time. The posterior slope of the tibial plateau could be reduced from an average of 14.5° to 8.8°. In 28 cases another ACL reconstruction was performed after an interval of 4-12 months. The Lysholm score significantly increased from 76.3 points to 89.2 points.

Reconstruction of the Medial Collateral Ligament Complex With a Flat Allograft Semitendinosus Tendon.

The aim of this Technical Note is to reconstruct the medial collateral ligament complex with the superior medial collateral ligament and posterior oblique ligament as anatomically as possible. An allograft or contralateral semitendinosus autograft is used for anatomic reconstruction of the superior medial collateral ligament and posterior oblique ligament. After bony fixation, the tendon bundles are sutured to the remnants of the medial collateral ligament complex. Thus, the tubular grafts are pulled apart to form a flat shape that resembles that of the normal medial ligaments.

Management after acute injury of the anterior cruciate ligament (ACL). Part 3: Recommendation on surgical treatment.

PURPOSE: The aim of this consensus project was to give recommendations regarding surgical treatment of the anterior cruciate ligament (ACL) injured patient. METHODS: For this consensus process, an expert, steering and rating group was formed. In an initial online meeting, the steering group, together with the expert group, formed various key topic complexes for which multiple questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS: During this consensus process, 30 topics regarding the surgical management and technique of ACL reconstruction were identified. The literature search for each key question resulted in 30 final statements. Of these 30 final statements, all achieved consensus. CONCLUSIONS: This consensus process has shown that surgical treatment of ACL injury is a complex process. Various surgical factors influence patient outcomes. The proposed treatment algorithm can be used as a decision aid for the surgeon. LEVEL OF EVIDENCE: Level V.

[Treatment of acute injury of the anterior cruciate ligament : Always only reconstruction?] / Behandlung der akuten Verletzung des vorderen Kreuzbands : Immer nur Rekonstruktion?

The aim of treatment of a ruptured anterior cruciate ligament (ACL) is the return of the patient to an acceptable level of activity without giving way phenomena as well as adequate treatment of prognostically relevant concomitant lesions. The treatment of acute ACL ruptures can be either early reconstruction or a primary physiotherapy with optional later reconstruction. Which path is taken depends on possible concomitant injuries that require early surgical intervention (e.g., repairable meniscal injury or distal rupture of the medial collateral ligament) and on patient-specific factors (age, level of activity). Isolated ruptures of the ACL can also be primarily treated without surgery. Then the injured knee joint should first be so far conditioned by rehabilitative measures that pain, swelling and posttraumatic restriction of movement are improved and neuromuscular training can be started. A screening test consisting of jumping tests, patient-reported outcome measures and the testing for giving way phenomena can be suitable to differentiate compensators (copers) from noncompensators (non-copers). Surgical reconstruction of the ACL should be recommended to non-compensators in the sense of participatory decision-making. Activity modification (adapter) can also be considered as a treatment strategy. If instability events (giving way) or secondary meniscal lesions occur during nonsurgical therapy, cruciate ligament reconstruction should be considered.

Clinical Outcome after Medial Open-Wedge High Tibial Osteotomy: Comparison of Two Angular Stable Locking Plates-TomoFix™ versus LOQTEQ® HTO Plate.

This study evaluated bony healing and clinical results after medial open-wedge HTO to compare the outcome of the LOQTEQ® HTO plate and the TomoFix™ internal plate fixator. A prospective, non-randomised, comparative study was undertaken. The same surgical technique for the medial open-wedge HTO was used in two treatment groups. In Group 1, the TomoFix™ implant was used for osteosynthesis, and, in Group 2, the LOQTEQ® HTO plate was used. All patients were examined before surgery (T0) and then at 12 months (T1) and at 24 months (T2) postoperatively. The primary outcome measure was the KOOS pain subscore. The secondary outcome criteria were other KOOS subscales, the Tegner score, radiological healing (RUST), and incision length. The KOOS pain subscale and the other KOOS subscores increased significantly in both groups from T0 to T1 and T2 without a significant group difference at each timepoint. The activity measured with the Tegner scale increased significantly from T0 to T2 without a significant group difference. No radiological signs of implant failure were observed in any case at the one-year X-ray, and no patient fulfilled the criteria for non-union. There was no significant difference in the frequency of adverse effects between the two treatment groups. The length of the incision was significantly shorter in the LOQTEQ® HTO group than in the TomoFix™ group. The results of this study show that patient-related outcome scores (KOOS, Tegner) increased after medial open-wedge HTO. There was no difference in clinical outcome or radiological healing between the treatment groups. Both plates are suitable for the osteosynthesis of open-wedge HTO.

A systematic review of transphyseal ACL reconstruction in children and adolescents: comparing the transtibial and independent femoral tunnel drilling techniques.

PURPOSE: Aim of this systematic review was to analyze the outcome after transphyseal ACL reconstruction in children and adolescents regarding the femoral drilling technique. METHODS: A systematic literature search was carried out in various databases on studies on transphyseal ACL reconstruction in children and adolescents. The literature search was limited to the last 20 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were growth disturbances such as leg length discrepancies or deformities and clinical scores. The present study was registered prospectively ( www.crd.york.ac.uk/PROSPERO ; CRD42022345964). RESULTS: A total of 22 retrospective or prospective case series (level 4 evidence) were identified that reported on transphyseal ACL reconstruction in children and adolescents. The overall failure/rupture rate after transphyseal ACL reconstruction was 11.0%. The overall ACL rupture rate of the contralateral side was 9.7%. No statistical significant difference in the failure rates between independent and transtibial drilling techniques could be detected ((p = 0.76/p = 0.28)). Furthermore no statistical significant differences in the rate of reported growth disturbances between independent and transtibial drilling techniques were shown (p = 0.15). The reported clinical scores at follow-up (mean follow-up 5.05 years) revealed good to very good results. CONCLUSION: This systematic review demonstrates that children and adolescents have a relatively high failure rate after transpyseal ACL reconstruction without any statistically significant differences between independent or transtibial drilling techniques regarding reruptur rates or the rate of growth disturbances. The results of this systematic review warrant a comparison of both techniques for femoral tunnel drilling in a controlled randomized trial.

Etiology of posterior meniscus root tears: medial vs. lateral.

PURPOSE: The aim of this study was to generate more information on the etiology and pathogenesis of medial (MM) and lateral (LM) meniscus root tears. Our hypothesis was that root tears of the MM predominantly result from degenerative damage, whereas root injuries of the LM are mainly of traumatic origin. METHODS: Consecutively, 53 patients with a root tear of the medial meniscus (MMRT) and 51 patients with a root tear of the lateral meniscus (LMRT) were included in this study. The diagnosis was confirmed radiologically by MRI as well as arthroscopically. In addition to patient-specific data such as age, BMI and trauma history, the leg axis was determined and accompanying injuries (ligamentous and chondrogenic) were documented. RESULTS: The mean age of the MMRT group was 57.2 (± 11.2) years, and that of the LMRT group 33.9 (± 11.4) years. The BMI was significantly higher in the MMRT group compared to the LMRT (30.5 vs. 25.1). 82.4% of patients in the LMRT group demonstrated an accompanying anterior cruciate ligament (ACL) rupture, whereas only 5.7% of the MMRT were associated with an ACL injury. A trauma was described in only 13.2% of patients of the MMRT group in contrast to 88.2% of the LMRT group. An extrusion > 3 mm of the MM in the coronal plane of MRI images could be detected in 86.8% of patients, whereas in the LMRT group, it was 15.7%. The mechanical varus angle was 5.6° in the MMRT group and 2.4° in the LMRT group. The rate and degree of concomitant cartilage damage in the affected compartment was significantly higher in the group with medial root injuries than in the group with lateral root tears. CONCLUSIONS: The root injuries of the MM and LM show significant differences in terms of patient age, etiology and accompanying injuries. Root injuries to the medial meniscus are mostly of non-traumatic origin and more likely to occur in the context of medial osteoarthritis and varus deformity of the knee. Lateral root tears tend to be predominantly traumatic and are frequently associated with ACL ruptures. However, in the MMRT group, a small subgroup with a traumatic etiology and in the LMRT group a small subgroup of patients with non-traumatic etiology could be identified. LEVEL OF EVIDENCE: III.

Management after acute rupture of the anterior cruciate ligament (ACL). Part 1: ACL reconstruction has a protective effect on secondary meniscus and cartilage lesions.

PURPOSE: The aim of this consensus project was to validate which endogenous and exogenous factors contribute to the development of post-traumatic osteoarthritis and to what extent ACL (anterior cruciate ligament) reconstruction can prevent secondary damage to the knee joint. Based on these findings, an algorithm for the management after ACL rupture should be established. METHODS: The consensus project was initiated by the Ligament Injuries Committee of the German Knee Society (Deutsche Kniegesellschaft, DKG). A modified Delphi process was used to answer scientific questions. This process was based on key topic complexes previously formed during an initial face-to-face meeting of the steering group with the expert group. For each key topic, a comprehensive review of available literature was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Consensus was defined a-priori as eighty percent agreement. RESULTS: Of the 17 final statements, 15 achieved consensus, and 2 have not reached consensus. Results of the consensus were summarized in an algorithm for the management after ACL rupture (infographic/Fig. 2). CONCLUSION: This consensus process has shown that the development of post-traumatic osteoarthritis is a complex multifactorial process. Exogenous (primary and secondary meniscus lesions) and endogenous factors (varus deformity) play a decisive role. Due to the complex interplay of these factors, an ACL reconstruction cannot always halt post-traumatic osteoarthritis of the knee. However, there is evidence that ACL reconstruction can prevent secondary joint damage such as meniscus lesions and that the success of meniscus repair is higher with simultaneous ACL reconstruction. Therefore, we recommend ACL reconstruction in case of a combined injury of the ACL and a meniscus lesion which is suitable for repair. LEVEL OF EVIDENCE: Level V.

Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL-injured patient.

PURPOSE: The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS: For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS: During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS: This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE: Level V.

No increased rate of cyclops lesions and extension deficits after remnant-preserving ACL reconstruction using the sparing technique.

BACKGROUND: Remnant-preserving anterior cruciate ligament reconstruction (ACLR) should have advantages for postoperative remodeling and proprioception. However, it has been suggested that the larger diameter of the graft tends to lead to impingement phenomena with a higher rate of cyclops lesions. The aim of this work was to find out whether the remnant-preserving ACLR actually leads to an increased rate of range of motion restraints compared to the remnant-sacrificing technique. METHODS: Patients, who fulfilled the inclusion criteria, were followed up for one year after surgery. The primary endpoint was arthrolysis due to extension deficit or cyclops syndrome. Secondary outcome measures were pain (NRS), knee function (KOOS), patient satisfaction and return to sports rate. RESULTS: One hundred and sixty-four patients were included in the study, 60 of whom received the "remnant augmentation" procedure (group 1). In the remnant augmentation group, one cyclops resection was performed, whereas in the non-remnant augmentation group three cyclops lesion resections had to be performed (odds ratio 0.6). There was no difference between the groups in pain (NRS) and knee function (KOOS) and patient satisfaction. The return to sports rate after one year was higher in the remnant augmentation group. CONCLUSIONS: Patients who have undergone the sparing "remnant augmentation" ACLR have no increased risk of cyclops lesion formation or extension deficit in the first year after surgery. An improvement of the proprioceptive abilities by remnant augmentation ACLR should be investigated in further studies. LEVEL OF EVIDENCE: III (prospective cohort study).

The use of tranexamic acid reduces blood loss in osteotomy at knee level: a systematic review.

PURPOSE: Aim of this systematic review was to evaluate the literature regarding the effect of tranexamic acid (TXA) on the outcome after knee osteotomy. METHODS: A systematic literature search was carried out in various databases on studies on the use of tranexamic acid in osteotomies around the knee. Primary outcome criterion was the hemoglobin (drop). Secondary outcome criteria were total blood loss, drainage volume, adverse effects such as thromboembolic events, blood transfusions, wound complications and clinical scores. A meta-analysis was performed for quantitative measures. The present study was registered prospectively ( www.crd.york.ac.uk/PROSPERO ; no.: CRD42021229624). RESULTS: Seven studies with 584 patients (TXA group: 282 patients, non TXA group: 302 patients) Hemoglobin decrease (1.54 g/dl vs. 2.28 g/dl), blood loss (394.49 ml vs. 595.54 ml) and drainage volume (266.5 ml vs. 359.05 ml) were significantly less in the TXA group compared to the non TXA group. No thromboembolic event was noted in any study. In the non TXA group four blood transfusions were given. Eleven wound complications occurred in the non TXA group in comparison to two wound complications in the TXA group. CONCLUSIONS: The results of the present study show that the application of TXA reduces hemoglobin drop, blood loss and drainage volume. These effects could be responsible for the lesser rate of side effects after administration of TXA during knee osteotomy.

A systematic review about long-term results after meniscus repair.

PURPOSE: Aim of this systematic review was to analyze long-term results after meniscus refixation. METHODS: A systematic literature search was carried out in various databases on studies on long-term results after meniscus refixation with a minimum follow-up of 7 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were radiological signs of osteoarthritis (OA) and clinical scores. RESULTS: A total of 12 retrospective case series (level 4 evidence) were identified that reported about failure rates of more than 7 years follow-up. There was no statistical difference in the failure rates between open repair, arthroscopic inside-out with posterior incisions and arthroscopic all-inside repair with flexible non-resorbable implants. In long-term studies that examined meniscal repair in children and adolescents, failure rates were significantly higher than in studies that examined adults. Six studies have shown minor radiological degenerative changes that differ little from the opposite side. The reported clinical scores at follow-up were good to very good. CONCLUSION: This systematic review demonstrates that good long-term outcomes can be obtained in patients after isolated meniscal repair and in combination with ACL reconstruction. With regard to the chondroprotective effect of meniscus repair, the long-term failure rate is acceptable. LEVEL OF EVIDENCE: IV.

Soaking ACL grafts in vancomycin solution (1 mg/ml) reduces the infection rate without increasing the risk for re-rupture and arthrofibrosis.

PURPOSE: The aim of the present study was to evaluate if the vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. The hypothesis was that local antibiotic prophylaxis by soaking ACL grafts in vancomycin results in significantly less infections than ACL reconstruction without local antibiosis. METHODS: In group 1, 636 patients who were operated between 1.9.2014 and 31.8.2016 received no local antibiotic treatment with vancomycin. In group 2, 536 patients who were operated between 1.9.2016 and 31.8.2018 received local antibiotic treatment with vancomycin (1 mg/ml). In this group the graft was soaked in the vancomycin solution for 10 min prior to graft passage and fixation. RESULTS: In group 1 (ACL reconstruction without vancomycin application), a postoperative infection was detected in ten patients (infection rate: 1.6%). In group 2 (ACL reconstruction with 1 mg/ml vancomycin), no postoperative infection was detected (infection rate: 0%). The statistical analysis showed a clear significant difference between the two groups (p = 0.002). The re-rupture rate and the rate of arthrofibrosis differed not significantly between the two treatment groups (p = 0.526). CONCLUSION: The results of the present study show that graft soaking in vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. LEVEL OF EVIDENCE: III.

Use of tranexamic acid in medial open wedge high tibial osteotomy.

PURPOSE: Aim of this study was to evaluate the effect of tranexamic acid (TXA) on the outcome after medial open wedge osteotomy. MATERIAL AND METHODS: A prospective non-randomized comparative study with 52 patients has been performed. In both treatment groups, the same surgical technique for the medial open wedge HTO was used. In group 1 (N: 26) the patients received 1 g TXA i.v. preoperatively, in group 2 (N: 26) no TXA was given. Primary outcome measure was the decrease in hemoglobin concentration. Secondary outcome criteria were postoperative pain, intraarticular effusion (measured by ultrasound), range of motion (ROM) at discharge, peri- and postoperative complications and the KOOS PS (pre- and postoperatively at 1 year follow up). RESULTS: Hemoglobin decrease was significantly less in the TXA group compared to the non TXA group. Postoperative pain and intraarticular effusion was also significantly lower and ROM at discharge was higher in the TXA group. There was no group difference in peri- and postoperative complications and the pre- and postoperatively KOOS PS. CONCLUSIONS: The results of the present study show the systemic application of 1 g TXA reduces hemoglobin drop and postoperative morbidity (pain, intraarticular effusion, and ROM) after tibial open wedge HTO.