Medial Collateral Ligament Reconstruction and Repair Show Similar Improvement in Outcome Scores, But Repair Shows Higher Rates of Knee Stiffness and Failure: A Systematic Review.

PURPOSE: To compare patient-reported outcomes and complications in patients with medial collateral ligament (MCL) injuries undergoing repair versus reconstruction with a minimum 2-year follow-up. METHODS: A literature search was conducted using the PubMed, Scopus, and Embase-computerized databases from database inception to November 2022, according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies evaluating clinical outcomes and complications at a minimum of 2 years following MCL repair versus reconstruction were included. Study quality was assessed using the MINORS criteria. RESULTS: A total of 18 studies published from 1997 to 2022, consisting of 503 patients were identified. Twelve studies (n = 308 patients; mean age: 32.6 years) reported outcomes following MCL reconstruction, and 8 studies (n = 195 patients; mean age: 28.5 years) reported results following MCL repair. Postoperative International Knee Documentation Committee, Lysholm, and Tegner scores ranged from 67.6 to 91, 75.8 to 94.8, and 4.4 to 8, respectively, in the MCL reconstruction group, compared to 73 to 91, 75.1 to 98.5, and 5.2 to 10, respectively, in the MCL repair group. Knee stiffness was the most commonly reported complication following MCL repair (range: 0% - 50%) and reconstruction (range: 0% - 26.7%). Failures occurred in 0% to 14.6% of patients following reconstruction versus 0% to 35.1% of patients undergoing MCL repair. Manipulation under anesthesia (MUA) for postoperative arthrofibrosis (range: 0% - 12.2%) and surgical debridement for arthrofibrosis (range: 0% - 20%) were the most commonly reported reoperations in the MCL reconstruction and repair groups, respectively. CONCLUSIONS: MCL reconstruction versus repair both demonstrate improved International Knee Documentation Committee, Lysholm, and Tegner scores. MCL repair demonstrates higher rates of postoperative knee stiffness and failure at a minimum 2-year follow-up. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

A Rare Location of Osteosarcoma in the Cuboid Bone: A Case Report.

CASE: In this case report, we describe a patient with left foot pain whose magnetic resonance imaging revealed a destructive tumor of the left cuboid bone. A biopsy of the tumor confirmed an osteoblastic osteosarcoma of the cuboid, and the patient was treated with chemotherapy followed by a below-the-knee amputation. CONCLUSION: There are only a handful of cases reporting osteosarcoma of the cuboid bone, and challenges remain in properly diagnosing the lesion to recommend the best course of treatment.

An 18-Year-Old Female Athlete Presenting with Knee Pain Following a Basketball Game and Diagnosed with Bilateral Patellar Stress Fractures.

BACKGROUND Stress fractures of the patella are rare, may result from overuse, and can be difficult to detect on imaging. Furthermore, the differential diagnosis of the anterior knee pain associated with most patellar stress fractures is broad, making it difficult to quickly reach the diagnosis. This report is of an 18-year-old female athlete presenting with knee pain after playing basketball and diagnosed with bilateral patellar stress fractures. CASE REPORT An 18-year-old female athlete with a history of bilateral anterior knee pain presented with left knee pain and swelling following a basketball game. X-ray images and magnetic resonance imaging (MRI) revealed a displaced inferior pole fracture of the left patella. The patient underwent surgical fixation of the patella. Approximately 4 months following surgical fixation of the left patella, right anterior knee pain persisted, and imaging demonstrated a stress reaction in the inferior pole of the right patella. The patient was ultimately treated with surgical fixation of the right patella as well. CONCLUSIONS This report demonstrates that, although stress fractures of the patella are rare, and bilateral stress fractures of the patella are even more rare, this condition may present with pain and usually with a history of high-impact exercise. Challenges remain in identifying patellar stress fractures early in their progression and determining the best course of treatment.