Injury to the Posterior Horn of the Lateral Meniscus from a Misplaced Tibial Tunnel for Anterior Cruciate Ligament Reconstruction: A Case Report

BACKGROUND Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. CASE REPORT A 32-year-old man presented with 1 year of right knee pain and instability following a non-contact twisting injury sustained while playing soccer. An ACL tear with no meniscal involvement was diagnosed at an outside institution. A double-bundle reconstruction was performed at that time. Three months after surgery, a medial partial meniscectomy was performed after a medial meniscal tear and failure to reduce initial symptoms during the index procedure. Advanced imaging at our institution 6 months later demonstrated an iatrogenic lateral posterior meniscal root avulsions after malpositioning of the transtibial tunnels. Given the ACL graft integrity upon arthroscopic evaluation, the root tear was repaired using a 2-tunnel transtibial pull-out technique. Advanced imaging 1 year after surgery showed a well-maintained meniscal repair with no extrusion. CONCLUSIONS Accurate transtibial tunnel placement during ACL reconstructive surgery is vital to avoid meniscal root detachment and the associated complications resulting in poor patient outcomes from this iatrogenic injury. Clinicians treating patients with a history of cruciate ligament reconstruction presenting with postoperative pain and instability should consider this pathology in their differential diagnosis. Conflict of interest statement Conflict of interest: ASV, JL, HS, SG, and KNK have no conflicts of interest. NNV reports being Board or committee member of American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America; research support from Arthrex, Inc., Breg, Ossur, Wright Medical Technology, Inc., Smith & Nephew; publishing royalties from Arthroscopy, Vindico Medical-Orthopedics Hyperguide; editorial or governing board of Knee, SLACK Incorporated; stock or stock options for Cymedica, Minivasive, Omeros; and paid consultant for Minivasive, Orthospace. JC reports personal fees from Arthrex, personal fees from CONMED Linvatec, personal fees from Ossur, and personal fees from Smith & Nephew, outside the submitted wor

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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A guide to appropriately planning and conducting meta-analyses—Part 1: indications, assumptions and understanding risk of bias

A meta-analysis is the quantitative synthesis of data from two or more individual studies and are as a rule an important method of obtaining a more accurate estimate of the direction and magnitude of a treatment effect. However, it is imperative that the meta-analysis be performed with proper, rigorous methodology to ensure validity of the results and their interpretation. In this article the authors will review the most important questions researchers should consider when planning a meta-analysis to ensure proper indications and methodologies, minimize the risk of bias, and avoid misleading conclusions

Supplemental Material, sj-pdf-1-ojs-10.1177_23259671221146815 - Propensity for Clinically Meaningful Improvement and Surgical Failure After Anterior Cruciate Ligament Repair

Supplemental Material, sj-pdf-1-ojs-10.1177_23259671221146815 for Propensity for Clinically Meaningful Improvement and Surgical Failure After Anterior Cruciate Ligament Repair by Jorge Pablo Batista, Rodrigo Maestu, Jose Barbier, Jorge Chahla and Kyle N. Kunze in Orthopaedic Journal of Sports Medicine</p

sj-docx-3-hss-10.1177_15563316231164138 – Supplemental material for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review

Supplemental material, sj-docx-3-hss-10.1177_15563316231164138 for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review by Laura M. Krivicich, Kyleen Jan, Kyle N. Kunze, Morgan Rice and Shane J. Nho in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p

sj-docx-1-hss-10.1177_15563316231164138 – Supplemental material for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review

Supplemental material, sj-docx-1-hss-10.1177_15563316231164138 for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review by Laura M. Krivicich, Kyleen Jan, Kyle N. Kunze, Morgan Rice and Shane J. Nho in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p

sj-docx-2-hss-10.1177_15563316231164138 – Supplemental material for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review

Supplemental material, sj-docx-2-hss-10.1177_15563316231164138 for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review by Laura M. Krivicich, Kyleen Jan, Kyle N. Kunze, Morgan Rice and Shane J. Nho in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p

sj-pdf-4-hss-10.1177_15563316231164138 – Supplemental material for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review

Supplemental material, sj-pdf-4-hss-10.1177_15563316231164138 for Machine Learning Algorithms Can Be Reliably Leveraged to Identify Patients at High Risk of Prolonged Postoperative Opioid Use Following Orthopedic Surgery: A Systematic Review by Laura M. Krivicich, Kyleen Jan, Kyle N. Kunze, Morgan Rice and Shane J. Nho in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p

Temporal Trends of Revision Etiologies in Total Knee Arthroplasty at a Single High-Volume Institution: An Epidemiological Analysis

Background: Temporal changes in revision total knee arthroplasty (rTKA) may have implications in determining the etiology for implant failure. The purpose of this study was to 1) perform an epidemiologic analysis of etiologies that required rTKA and 2) determine whether temporal changes existed for revision over the study period. Methods: All rTKA procedures performed at a single institution from 2009 to 2019 were analyzed. Revision procedures were stratified into 2 time periods, 2009-2013 and 2014-2019, to assess for changes over time. Patients’ electronic medical record, operative report, and radiographs were reviewed to ensure diagnosis information was accurately documented in relation to the predominate etiology necessitating the revision procedure. Results: Three thousand and nine patients undergoing rTKA between 2009 and 2019 were identified with a mean age of 64.6 years. A total of 1,666 (55.4%) patients were female, and the majority of patients were Caucasian (2,306, 76.6%). The 3 most frequent rTKA etiologies were aseptic loosening (35.1%), periprosthetic infection (33.2%), and instability (16.0%). A higher proportion of patients underwent rTKA for arthrofibrosis (5.1% vs 3.4%, P = .023) and periprosthetic joint infection (38.9% vs 28.6%, P < .001) between 2009 and 2013, while a significantly higher proportion of patients underwent rTKA for instability (12.6% vs 18.8%, P < .001) between 2014 and 2019. Conclusion: Aseptic loosening was the most common cause for rTKA over the last decade. rTKA for arthrofibrosis and periprosthetic joint infection was more frequent between 2009 and 2013, while a significantly higher proportion of patients underwent rTKA for instability in 2014-2019. Future studies will need to focus on identifying and reducing risk factors for the trending causes of rTKA