Use of tourniquet in anterior cruciate ligament reconstruction: Is it truly necessary? A prospective randomized clinical trial.

PURPOSE: To examine the effects of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of (1) intraoperative visualization, (2) surgical time, (3) consumption of sterile saline, and (4) postoperative pain. METHODS: In this prospective randomized clinical trial, patients were assigned to Tourniquet Group or No Tourniquet treatment groups. The primary outcomes were intraoperative visualization, with scores ranging from 0 to 10 (0 = no visibility; 10 = clear and perfect display), surgical time, and the consumption of sterile saline. The secondary aim was to measure postoperative pain (24 h after surgery) with the visual analog scale (VAS) for pain. RESULTS: A total of 71 patients were included in the No Tourniquet group, and 75 were included in the Tourniquet group, with mean ages of 26.73 ± 8.05 years and 26.95 ± 10.11 years, respectively (p = .88). In the No Tourniquet group, 37 concomitant meniscal lesions were treated, whereas in the Tourniquet group, 38 (p = .99) were treated. The mean surgical times were 51.07 ± 6.90 and 50.03 ± 7.62 (p = .325), respectively, while the mean amount of saline consumed was 6.17 ± 1.18 L versus 5.89 ± 1.23 L (p = .217). Both groups achieved optimal visualization, with a sum of all surgical steps of 65.49 ± 1.86 for the no tourniquet group and 65.39 ± 1.88 for the Tourniquet group (p = .732). Postoperative pain was significantly lower in the No Tourniquet group (VAS score: 2.82 ± 1.33 vs 5.80 ± 1.22). CONCLUSIONS: Tourniquet use during ACL reconstruction does not improve intraoperative visualization and does not reduce surgical time but leads to greater postoperative pain with a risk of well-known tourniquet-related complications. LEVEL OF EVIDENCE: Level I - Randomized clinical trial.

Quantitative and Compositional MRI of the Articular Cartilage: A Narrative Review.

This review examines the latest advancements in compositional and quantitative cartilage MRI techniques, addressing both their potential and challenges. The integration of these advancements promises to improve disease detection, treatment monitoring, and overall patient care. We want to highlight the pivotal task of translating these techniques into widespread clinical use, the transition of cartilage MRI from technical validation to clinical application, emphasizing its critical role in identifying early signs of degenerative and inflammatory joint diseases. Recognizing these changes early may enable informed treatment decisions, thereby facilitating personalized medicine approaches. The evolving landscape of cartilage MRI underscores its increasing importance in clinical practice, offering valuable insights for patient management and therapeutic interventions. This review aims to discuss the old evidence and new insights about the evaluation of articular cartilage through MRI, with an update on the most recent literature published on novel quantitative sequences.

Meniscus-Related Videos on TikTok Are Widely Viewed and Shared but the Educational Quality for Patients Is Poor.

Purpose: To evaluate the quality of meniscus-related TikTok videos to better understand their value for patient education. Methods: The term "meniscus" was used as the key word for an extensive online search of video content on the TikTok on November 14, 2023. The first 100 videos were used for analysis. The duration of the videos and the number of likes, shares, and views were recorded for each video. Furthermore, videos were categorized based on the source (health workers, private user), the type of subject (patient experience, physical therapy, anatomy, clinical examination, surgical technique and injury mechanism), type of content (patient experience/testimony, education, rehabilitation), and the presence of music or voice. The quality and reliability assessments of video contents were conducted using the DISCERN instrument, the Journal of the American Medical Association benchmark criteria, and Global Quality Score. Results: Of the 100 videos included in this study, 62 (62%) videos were published by health workers and 38 by private users (38%). Most of the information regarded patient experience (36, 36%), followed by physical therapy (32, 32%), anatomy (14, 14%), clinical examination (8, 8%), surgical technique (6, 6%), and injury mechanism (4, 4%). Video content reported patient experience in 39 (39%) videos, rehabilitation in 31 (31%) videos, and education in the remaining 30 (30%). The mean length of the videos was 39.12 ± 49.56 seconds. The mean number of views was 1,383,001.65 ± 5,291,822.28, whereas the mean numbers of comments, likes and shares were 408.53 ± 1976.90, 54,763.43 ± 211,823.44 and 873.70 ± 2,802.01, respectively. The mean DISCERN score, Journal of the American Medical Association benchmark criteria score, and Global Quality Score were 17.93 ± 5.07, 0.24 ± 0.47, and 1.15 ± 0.41, respectively. Conclusions: Meniscus-related videos on TikTok are widely viewed and shared but the overall educational value to patients is poor. Clinical Relevance: As patients increasingly use social media to learn about their conditions, it is important for orthopaedic health care professionals to understand the limitations of TikTok videos addressing the meniscus as potential sources of information for their patients.

Endoscopic-Assisted Evacuation: A Useful Adjunct for the Management of Prepatellar Hematomas.

Management of prepatellar hematomas can be difficult, and recurrences or persistent oozing are common. Endoscopic-assisted management of these hematomas has not been reported. We present the case of a 44-year-old lady with traumatic prepatellar hematoma who was managed with the evacuation of the hematoma assisted by endoscopic visualization and debridement. She recovered completely within three weeks and remained asymptomatic on the last follow-up at six months. Endoscopic visualization of the hematoma cavity is a useful adjunct to managing prepatellar hematomas, with the potential to identify and control sources of future concerns in wound healing.

Both Hamstring and Quadriceps Tendon Autografts Offer Similar Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction in Patients Aged 50 Years or Older.

PURPOSE: To compare the outcomes of hamstring tendon (HT) and quadriceps tendon (QT) autografts for anterior cruciate ligament (ACL) reconstruction in patients aged 50 years or older in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity, and sports preference. METHODS: Between 2010 and 2022, prospectively collected data were obtained from an institutional database. Patients aged 50 years or older who underwent primary arthroscopic ACL reconstruction with either HT or QT autograft and had a minimum 2-year follow-up were included. Patients with concomitant meniscal, cartilage, and medial collateral ligament injuries were also included. Patients undergoing revision ACL reconstruction, those undergoing primary ACL reconstruction with a graft other than HT or QT autograft, and those with contralateral knee injuries or ipsilateral osteoarthritis (Ahlbäck stage ≥2) were excluded. Patients were evaluated in terms of the Lysholm knee score, Tegner activity level, and visual analog scale (VAS) score for pain before injury and at 2-year follow-up, as well as graft failure, QT rupture, and return to sport. The Mann-Whitney test was used to analyze unpaired samples, whereas the Friedman test was used to analyze variables over time. The χ2 statistic test was used to determine differences in categorical data between groups. RESULTS: The number of patients in the QT and HT groups was 85 and 143, respectively. In the QT and HT groups, the mean age was 54.4 years (range, 50-65 years) and 56.4 years (range, 50-65 years), respectively, and 49% and 51% of patients were men, respectively. The 2 groups did not differ significantly in terms of age, sex, time from injury to surgery, and concomitant injuries. No significant differences in preinjury patient-reported outcome measures, consisting of the Lysholm score, Tegner activity level, and VAS pain score, were found between the 2 groups (P > .05). At the 2-year follow-up, the Lysholm knee score, Tegner activity level, and VAS pain score improved to preinjury levels and no significant differences in preinjury and 2-year follow-up functional scores were noted between the 2 groups (P > .05). Furthermore, at the 2-year follow-up, the Lysholm score and VAS pain score did not show significant differences (P = .390 and P = .131, respectively) between the QT and HT groups. Similarly, no differences in Tegner activity level were observed between the HT and QT groups at the 2-year follow-up. No significant differences in terms of the minimal clinically important difference were detected between the 2 groups for the Lysholm knee score (P = .410) and Tegner activity level (P = .420). The 2 groups did not differ in terms of patients' percentage of sports participation at baseline and at the 2-year follow-up (P > .05). A significant decrease (P = .01) in participation in skiing/snowboarding was reported in the HT group at the 2-year follow-up compared with baseline (116 patients [81%] vs 98 patients [69%]). No case of graft failure or QT rupture was reported in either group. CONCLUSIONS: Arthroscopic ACL reconstruction using HT or QT autografts in athletically active patients aged 50 years or older provides satisfactory patient-reported functional outcomes and allows recovery of the preinjury level of activity. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Should I add orthobiologics to my knee osteotomy practice? A systematic review.

IMPORTANCE: Orthobiologics has seen a renaissance over the last decade as an adjunct therapy during osteotomy due to the limited inherent regenerative potential of damaged intraarticular tissues. AIM OR OBJECTIVE: This systematic review aims to present the latest evidence regarding using orthobiologics with simultaneous high tibial osteotomy (HTO) for knee osteoarthritis. The results of this study may guide surgeons to improve their clinical results and clear the air regarding confusion over whether or not to add orthobiologics to HTO in clinical practice backed by scientific evidence. EVIDENCE REVIEW: According to PRISMA guidelines a systematic search for relevant literature was performed in the PubMed (MEDLINE), Scopus, EMBASE, and Cochrane Library databases of all studies published in English from January 1990 to May 2023. The following search terms were entered into the title, abstract, and keyword fields: "knee" or "osteotomy" AND "valgus" or "varus" AND "regenerative medicine" or "PRP" or "mesenchymal stem cells" or "stem cells" or "BMAC" or "bone marrow" or "growth factors" or "umbilical cord blood-derived mesenchymal stem cell" or "stromal vascular fraction". The AMSTAR-2 checklist was used to confirm the quality of the systematic review. Randomised controlled trials (RCTs), prospective and retrospective comparative cohort studies, case-control studies, and case series were included. Studies that reported clinical outcomes in patients treated with knee osteotomy for varus/valgus knee with concomitant adjunction of regenerative treatment [Platelet-rich plasma (PRP), Adipose-derived stem cells (ADSC), Human Umbilical Cord Blood-Derived (HUCBD), Mesenchymal Stem Cells (MSC), bone marrow aspirate concentrate (BMAC), stromal vascular fraction (SVF)] were included. The outcome measures extracted from the studies were the KOOS score, Lysholm score, Subjective IKDC, WOMAC Score, KSS, Tegner, HSS, radiographic tibiofemoral angle, posterior tibial slope and complications. The current systematic review is registered in the PROSPERO Registry (CRD42023439379). FINDINGS: Osteotomy for unicompartmental arthritis with adjunction of orthobiologics such as PRP, ADSC, HVCBD, MSC, BMAC, and SVF presents a consistent statistically significant clinical improvement compared to preoperative scores regardless of the treatment modality used and there were no notable complications associated with the use of these novel agents. CONCLUSIONS AND RELEVANCE: Orthobiologics and knee osteotomies could improve outcomes in patients with knee osteoarthritis desiring Knee preservation surgeries. However, only a few studies are available on the topic to conclude anything with certainty, the patients included in the studies could not be disintegrated based on the grade of osteoarthritis (OA), type, dosage and frequency of administration of orthobiologic and type of additional surgical procedures used. Therefore, better-structured RCTs are required to implement this finding into routine Orthopaedic practice. LEVEL OF EVIDENCE: Level 4.

Partial subscapularis tear: State-of-the-art.

The subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from traumatic injury or intrinsic degeneration. Partial SSC tears can range in severity and be classified into different categories based on the location of the tear, size of the lesion, and associated pathology. The tear usually begins from the superolateral margin in the first facet and propagates downwards. It is frequently associated with biceps pathology or anterosuperior lesions. These tears are now increasingly recognized as distinct pathology that requires specific diagnostic and management approaches. The current management approaches are shifting towards operative, as partial SSC tears are increasingly recognized as a distinct pathology. At present, there is no consensus regarding the timing of repair, but the relative tendency of the SSC to retract much faster than other rotator cuff muscles, and difficulty in mobilization, advocates an early repair for SSC irrespective of the lesion size. An associated biceps pathology can be treated with either tenotomy (biceps delamination/erosion) or tenodesis. The techniques of partial SSC repair are constantly improving. There is no reported difference in use of 2-anchor-based conventional single-row (SR), a 3-anchor-based interconnected double-row technique, or a 2-anchor-based interconnected hybrid double-row construct in the repair construct. However, the 2-anchor-based interconnected double-row provides an advantage of better superolateral coverage with leading-edge protection, as it helps in placing the superolateral anchor superior and lateral to the original footprint. A timely intervention and restoration of the footprint will help restore and rehabilitate the shoulder. Future directions should prioritise injury prevention, early diagnosis with clinic-radiological cues and targeted interventions to mitigate risk.

Extended Medial Coronal Plane Plica Formed by a Rare Fusion of Medial Patellar and Biblike Plicae in the Knee: A Case Report.

The traditional plicae of the knee have been updated recently with reports of new variants in the coronal plane. We report another variant, an extended medial coronal plane plica (EMCPP), previously unreported, in a 70-year-old lady with osteoarthritis of the knee and a loose body. The preoperative symptoms after the excision of the plica and loose body were temporarily relieved for 11 months before she underwent total knee arthroplasty (TKA) for associated osteoarthritis. Excision of the EMCPP could resolve symptoms, but resultant internal scarring or the plica itself could cause difficulty in exposure during TKA.

High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury.

PURPOSE: The purpose of this study was to assess the frequency of medial collateral ligament (MCL), posterior oblique ligament (POL) and anterolateral ligament (ALL) tears and different types of RAMP lesions of patients with verified acute anterior cruciate ligament (ACL) tears by magnetic resonance imaging (MRI). METHODS: MRI was performed on patients with a clinical diagnosis of acute ACL injury. Patients were eligible for inclusion if they had an initially clinically noted ACL tear confirmed on MRI within 30 days of trauma. RESULTS: A total of 146 patients were included in the study, 42 (28.8%) females and 104 (71.2%) males. The mean age at MRI was 27.2 ± 9.4 years, and the mean time from injury to MRI was 15.7 ± 7.8 days. Thirty-four (23.3%) patients had a complete MCL lesion, 32 (21.9%) had a complete POL lesion and 28 (19.2%) had a complete ALL lesion. One hundred and fourteen patients (78.1%) presented with RAMP lesions, while 20 (13.7%) patients reported other meniscal lesions. The mean medial and lateral tibial slopes were 4.0° ± 2.7° and 4.0° ± 3.1°, respectively. Only 10 (6.8%) patients reported no lesions associated with ACL rupture. The most common injuries were isolated RAMP type 3 (18-12.3%) and isolated RAMP type 1 (17-11.6%). Thirteen (8.9%) patients had a combination of MCL, POL and ALL rupture. CONCLUSIONS: Isolated lesions of the ACL are extremely rare. In most cases, a single RAMP lesion should be investigated. In the presence of MCL injury, POL injury should always be suspected as well, while nearly 20% of patients present a rupture of the ALL. About one in 10 patients had three lesions (MCL, ALL and POL), and most of them had a combined RAMP lesion. LEVEL OF EVIDENCE: Level IV.

Italian research on anterior cruciate ligament: a bibliometric analysis.

INTRODUCTION: This study analysed the trend of publications on anterior cruciate ligament (ACL) in Italy. It was hypothesised that publications on this topic have quickly increased in recent years due to increased knowledge of both clinical and radiological pathology. METHODS: PubMed and Scopus were accessed on 29/11/2023. This retrieved 838 articles from PubMed and 1050 from Scopus. We analysed the top 10 authors, and journals in publication numbers, citation numbers, and citations per year. We have also looked at the top 10 institutions publishing on anterior cruciate ligament from Scopus as PubMed does not give this information in the output. Data mining was performed using the Orange software, Mac version 3.32.0 ( https://orangedatamining.com/ ) from the titles of all articles. A word cloud analysis of titles, authors, journals and universities was performed. RESULTS: The peak of citations was in 2017 with 1529, whilst the peak of publications was in 2019 with 59 articles published. Analysing the number of publications and citations for the journal, the most impacted journal is Knee Surgery, Sports Traumatology, Arthroscopy with 5472 citations and 183 articles, followed by The American Journal of Sports Medicine, with 2722 citations and 56 articles and Arthroscopy with 1990 citations and 62 articles. Considering also international collaborations, the most cited author is Della Villa F. in 2020 with 43.67 citations per year. The Italian author with the major number of publications is Zaffagnini S. with 39 articles, whilst the author with the higher number of citations is Aglietti P. with 1612 citations. CONCLUSIONS: ACL reconstruction has gained growing interest amongst the scientific community. Publications and citations presented a rising trend, the majority of the highly cited papers were contributed by few centres, and clinical trials were the most cited study designs. The long-term outcomes of ACL lesions have attracted interest. The authors hypothesised that shortly there will be an increase in articles analysing the results of ACL revisions, the use of lateral extra-articular tenodesis, and meniscus transplants. LEVEL OF EVIDENCE IV: Cross-Sectional Study.

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature.

Purpose: The aim of the present systematic review was to quantitatively synthesize the best literature evidence regarding osteoarthritis developing after anterior cruciate ligament reconstruction (ACLR), including only studies with a follow-up duration of at least 20 years. Material and Methods: A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on four electronic databases (PubMed, Scopus, EMBASE and Cochrane Library). The outcome measures extracted from the studies were failure rate, subsequent knee surgery on the same knee, radiographic development of osteoarthritis measured with Kellgren-Lawrence, International Knee Documentation Committee (IKDC) radiographic score and Ahlbäck classification. The health of both the ACLR knee and the contralateral knee was compared. Results: A total of 1552 patients were included in the study, of which 1290 (83.11%) were operated on using a patellar tendon graft, 190 (12.24%) with hamstrings, 27 (1.73%) with an iliotibial band and 45 (2.89%) with patellar tendon plus a ligament augmentation device (LAD). The mean age at the time of surgery was 25.18 ± 1.91 years, and the mean follow-up time was 23.34 ± 2.56 years. Analysing IDKC Score at final follow-up, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 33.2% (324/976) of the patients showed a moderate to severe degree (Grade C or D) of osteoarthritis, while for Kellgren-Lawrence, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 28.9% (196/678) of the patients showed a moderate to severe degree (Grade III or IV) of osteoarthritis. In total, 1552 patients were registered, 155 reruptures (9.98%) and a total of 300 (19.3%) new surgeries, of which 228 meniscectomy (14.69%), 21 (1.35%) knee arthroplasty and 17 (1.09%) hardware removal were recorded. Conclusions: ACL reconstruction appears to result in mild osteoarthritis in the long term in most of the patients and only less than 33.2% develop a moderate to severe degree of knee OA according to IKDC radiographic score. A slight degree of osteoarthritis appears to be present in ACLR knees compared with contralateral healthy knees. Level of Evidence: Level IV.

The "Golden Age" of quadriceps tendon grafts for the anterior cruciate ligament: a bibliometric analysis.

IMPORTANCE: Bibliometric research is a statistical analysis of publications to measure the scientific output in a specific field in order to highlight medical developments or knowledge gaps and to direct future scientific research. The quantity of orthopedic papers on the internet is astounding and is steadily growing as a result of recent advancements in technology and medicine. This is why choosing the right information is essential. AIM: The purpose of this study was to analyze the current literature for trends in publications regarding quadriceps tendon (QT) grafting of the anterior cruciate ligament (ACL). EVIDENCE REVIEW: PubMed was searched on August 28, 2023. References were collected from PubMed, and trends were analyzed using this information. This search retrieved 405 articles regarding human and animal studies. We analyzed the top 10 authors and journals in terms of publication numbers, citation numbers, and citations per year. The PubMed-by-year feature was used to compare the number of publications regarding ACL reconstruction by quadriceps grafting with all publications in PubMed. FINDINGS: The number of yearly publications averaged 10 or less up to 2018, starting from 1982 when the first paper on the QT was published. However, the number of publications increased from 2018. While the total number of publications on this topic was 405, 260 were published from 2018 alone. The number of citations was 8262 in total overall years. It is expected that the last five years' publications, especially those for the last year, will be low in number, as it takes time for citations to accrue. The journal Arthroscopy published the most articles on this topic, with 57 papers and 1884 citations, followed by the American Journal of Sports Medicine, with 39 articles and 1576 citations. The top three journals on this topic were Arthroscopy, AmericanJournalofSportsMedicine, and KneeSurgery, SportsTraumatology, Arthroscopy. The most published author was Musahl V (with 24 articles), and the most cited author was Xerogeanes JW (with 570 citations). CONCLUSIONS AND RELEVANCE: Global trend analysis suggests that research on anterior cruciate ligament reconstruction with the quadriceps has significantly increased in the last 5 years and that the number of papers on this topic is increasing steadily. We found that the publications and citations are exhibiting a rising trend, Arthroscopy is the most impactful journal, and Musahl V is the most impactful author on the topic. Xerogeanes JW is the author with the most citations on the topic. The promising clinical results of anterior cruciate ligament reconstruction with the QT have attracted the most research interest. LEVEL OF EVIDENCE: Level IV.

TikTok content as a source of health education regarding epicondylitis: a content analysis.

PURPOSE: This study aimed to assess the validity and informational value of TikTok content about epicondylitis. The hypothesis tested herein was that TikTok video content would not provide adequate and valid information. METHODS: The term "epicondylitis" was used as a keyword to comprehensively search for TikTok videos, and the first 100 videos that were retrieved were subsequently included for analysis. The duration, number of likes, number of shares and number of views were recorded for each video. Furthermore, the videos were categorized on the basis of their source (medical doctor, physiotherapist, or private user), type of information (physical therapy, anatomy, clinical examination, etiopathogenesis, patient experience, treatment, or other), video content (rehabilitation, education, or patient experience/testimony), and the presence of music or voice. Assessments of video content quality and reliability were conducted using the DISCERN tool, the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). RESULTS: A total of 100 videos were included in the analysis: 78 (78.0%) were published by physiotherapists, 18 were published by medical doctors (18.0%), and 4 were published by private users (4.0%). Most of the information pertained to physical therapy (75; 75.0%) and most of the content was about rehabilitation (75; 75.0%). The mean length of the videos was 42.51 ± 24.75 seconds; the mean number of views was 193,207.78 ± 1,300,853.86; and the mean number of comments, likes, and shares were 22.43 ± 62.54, 1578.52 ± 8333.11, and 149.87 ± 577.73, respectively. The mean DISCERN score, JAMA score, and GQS were 18.12 ± 5.73, 0.80 ± 0.53, and 1.30 ± 0.52, respectively. Videos posted by medical doctors/private users had higher scores (p < 0.05) than videos posted by physiotherapists. Videos that focused on education or patient experience had higher scores (p < 0.05) than videos based on rehabilitation. CONCLUSIONS: TikTok can be an unreliable source of information regarding epicondylitis treatment. It is common to find nonphysicians who share medical advice on the platform, with medical treatments demonstrating the weakest level of supporting evidence. Elbow surgeons should advise their patients that treatment recommendations from TikTok may not align with established guidelines. LEVEL OF EVIDENCE: Level IV-Cross-sectional study.

The pandemic is gone but its consequences are here to stay: avascular necrosis following corticosteroids administration for severe COVID-19.

BACKGROUND: In patients with COVID-19 infection and respiratory insufficiency, corticosteroid (CCS) administration is recommended. Among the wide range of complications and interactions, time-limited high-dose CCS administration might promote avascular necrosis (AVN) in a cumulative dose. This systematic review updated the current evidence and characterises the trend of AVN following time-limited high-dose CCS administration in patients who had severe COVID-19, discussing management strategies and outcomes. METHODS: This systematic review was conducted according to the 2020 PRISMA statement. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Scopus restricting the search to the years 2019 to 2023. All the clinical studies which investigated the association between time-limited high-dose CCS administration in patients with severe COVID-19 infection and AVN were accessed. RESULTS: A total of 245 patients (9 studies) who experienced AVN following COVID-19 were included in the present investigation. 26% (63 of 245 included patients) were women. The mean age of the patients was 42.9 ± 17.7 years. Four studies focused on AVN of the hip and two on the knee, and the other studies included patients with AVN from mixed areas of the body (spine, pelvis, and shoulder). The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was 79.4 ± 59.2 days (range, 14 to 166 days). CONCLUSION: It is possible that even time-limited high-dose CCS administration in patients with severe COVID-19 infection increased the incidence of AVN. The mean time elapsed from COVID-19 infection to the development of symptomatic AVN was approximately 80 days. Given the high risk of bias in all the included studies, the quality of recommendations of the present investigation is low, and no reliable conclusion can be inferred.

Validity of Material Related to the Anterior Cruciate Ligament on TikTok.

Background: Video material is one of the most common types of digital information on social media platforms. Purpose: To assess the validity and informational value of TikTok videos with regard to the anterior cruciate ligament (ACL). Study Design: Cross-sectional study. Methods: Using the terms "anterior cruciate ligament" AND/OR "ACL," 420 TikTok videos were retrieved, of which 100 videos were included in the analysis. The video duration and the number of likes, shares, and views were recorded. Videos were categorized based on the source (private user, physical therapist, surgeon, and researcher), subject type (patient experience, physical therapy, injury mechanism, anatomy, clinical test, and surgical technique), content (patient experience/testimony, education, and rehabilitation), and any background audio (music or voice). Video quality assessments were conducted using the DISCERN instrument, The Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Score (GQS). Associations between quantitative variables were tested using the Spearman rank correlation. One-way analysis of variance or Mann-Whitney test was performed to assess whether video quality differed by video characteristics. Results: A total of 41 videos were published by private users (41%), 34 by physical therapists (34%), 23 by surgeons (23%), and 2 by researchers (2%). Most of the information regarded patient experience (34%), followed by physical therapy (20%), injury mechanism (19%), anatomy (11%), clinical test (9%), and surgical technique (7%). The mean video length was 40.55 ± 41.58 seconds. The mean number of views was 151,084.39 ± 487,150.02, while the mean numbers of comments, likes, and shares were 72.80 ± 249.68, 6781.49 ± 29,163.96, and 98.71 ± 307.76, respectively. The mean DISCERN, JAMA, and GQS scores were 15.73 ± 1.44, 0.19 ± 0.39, and 1.16 ± 0.37, respectively, indicating the poorest quality on all 3 indices. The number of views, likes, shares, comments, and video lengths were all positively correlated with DISCERN (except the number of shares), JAMA, and GQS scores (P < .05). A significant difference was found in DISCERN scores between videos by private users and those by surgeons (15.37 ± 0.98 vs 16.22 ± 1.57; P = .007). Conclusion: Our analysis has demonstrated that the educational value of these videos on the ACL on TikTok is poor. Given the rapid growth of TikTok, further research is needed.

Trends in unicompartmental knee arthroplasty among 138 international experienced arthroplasty knee surgeons.

Purpose: Unicompartmental knee arthroplasty (UKA) is an established option for treating isolated unicompartmental knee osteoarthritis (OA), but controversies still exist about patient selection, indications, perioperative management and alignment goals. This survey was designed to understand the current trends of experienced arthroplasty knee surgeons performing UKA. Methods: An online questionnaire was created with SurveyMonkey® to assess global tendencies in the utilization of UKA. A link to the survey was shared with all ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) members. The questionnaire consisted of free and multiple-choice questions and was divided into four sections: demographic information, the surgical activity of the respondents, indications for surgery and postoperative alignment goals. Results: A total of 138 ESSKA members from 34 different countries completed the survey. A total of 81 % of the responders performed fewer than 50 UKAs per year; 53 % of UKAs represented less than 20 % of their knee replacements; 71 % used mainly or only fixed-bearing implants; 81 % performed UKA in a shorter time compared to TKA; and 61 % and 72 % were interested in custom-made UKA and robotics, respectively. Thirty-six percent considered a minimum postoperative alignment of 0° for medial UKA, and 32 % considered 10° as the maximum valgus deformity for lateral UKA. Fifty-five percent had no minimum age cut-off, 47 % had no BMI cut-off, and 57 % believed TKA was better than UKA in knees with concomitant high-grade patellofemoral OA. Approximately 50 % of the surgeons desired a coronal alignment that was the same as the predegeneration alignment. Conclusion: A high level of agreement was reached regarding the following: preference for fixed-bearing UKAs, lower surgical time for UKA compared to TKA, interest in custom-made and robotic UKAs, no age and weight cut-off, TKA preferred in the presence of patellofemoral OA, and a final alignment goal of the predegenerative state both for medial and lateral. There was no agreement regarding length of stay, rehabilitation protocol, preoperative varus and valgus cut-off values, and treatment in cases of absence of anterior cruciate ligament or previous osteotomy.

Learning curve of Persona Partial Knee (PPK) arthroplasty: a clinical trial.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) procedures are considered to be more technically demanding than conventional total knee arthroplasty (TKA), requiring a longer learning curve and more expert surgical skills. Despite some clear advantages of UKA over TKA (such as lesser blood loss, greater bone stock, greater knee performances, etc.), UKA evidenced a greater rate of revision. OBJECT: This study investigated the learning curve of Persona Partial Knee (PPK) arthroplasty for primary medial UKA performed by a single, non-designer surgeon. PPK is a fixed-bearing, compartment-specific implant. The primary outcome of interest for this study was to evaluate the learning curve of the surgical duration. The secondary outcome of interest was to evaluate the learning curve of radiological implant positioning. METHODS: Patients who underwent primary medial UKA using PPK (Zimmer-Biomet, Warsaw IN, USA) were prospectively enrolled for the study. All surgeries were performed by a single, non-designer surgeon experienced in knee and hip arthroplasty. The primary outcome of interest was to evaluate the surgical duration. The secondary outcome of interest was to evaluate the implant positioning. The learning curve was estimated using an appropriate nonlinear polynomial regression model with a lower Akaike Information Criterion (AIC). RESULTS: One hundred twenty five patients were enrolled in the study. 59% of them (74 of 125 patients) were women. The patients' mean age at the time of surgery was 70.1 ± 9.5 years and their mean body mass index (BMI) was 27.8 ± 4.2 kg/m2. Curve stabilisation of the surgical time was at the 94th patient, of the tibial angle at the 47th patient, of the tibial slope at the 54th patient, of the anterior protrusion at the 29th patient, and of the posterior protrusion at the 51st patient. CONCLUSIONS: The learning curve for component positioning was achieved in approximately 50 cases. The curve of the surgical time achieved a plateau at 94 Persona Partial Knee. Additionally, the factors directly correlated with earlier stabilization of the learning curve in terms of component positioning were: male gender, younger age, right side, and larger components.

Revision ACL reconstruction in female athletes: current concepts.

The challenge of revision anterior cruciate ligament (ACL) reconstruction lies in its complexity, varied presentation, and technical intricacies. A successful ACL reconstruction should allow patients to safely return to preinjury activities. However, it is only sometimes simple, and many risk factors and concurrent pathologies come into play. Evaluating and analysing the cause of failure and associated conditions is paramount to addressing them effectively. Despite a plethora of research and improvements in knowledge and technology, e gaps exist in issues such as optimal techniques of revision surgery, graft options, fixation, concurrent procedures, rehabilitation and protocol for return to sports of high-level athletes. Female athletes need additional focus since they are at higher risk of re-injury, suboptimal clinical outcomes, and lower rates of return to sport following revision reconstruction. Our understanding about injury prevention and the protection of ACL grafts in female athletes needs to be improved. This review focuses on the current state of revision ACL surgery in female athletes and provides recommendations and future directions for optimising outcomes in this high-risk group.