Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in recent years as another significant driver of degenerative disease. These injuries lead to an increase in average contact pressure in the medial compartment, along with increases in peak contact pressure and a decrease in contact area relative to the intact state. Loss of the root attachment impairs the function of the entire meniscus and leads to meniscal extrusion, thus impairing the force-dissipating role of the meniscus. Anatomic meniscus root repairs with a transtibial pullout technique have been shown biomechanically to restore mean and peak contact pressures in the medial compartment. However, nonanatomic root repairs have been reported to be ineffective at restoring joint pressures back to normal. Meniscal extrusion is often a consequence of nonanatomic repair and is correlated with progression of OA. In this study, the authors will describe the biomechanical basis of the natural history of medial meniscal root tears and will support the biomechanical studies with a case series including patients that either underwent non-operative treatment (5 patients) or non-anatomic repair of their medial meniscal root tears (6 patients). Using measurements derived from axial MRI, the authors will detail the distance from native root attachment center of the non-anatomic tunnels and discuss the ongoing symptoms of those patients. Imaging and OA progression among patients who were treated nonoperatively before presentation to the authors will be discussed as well. The case series thus presented will illustrate the natural history of meniscal root tears, the consequences of non-anatomic repair, and the findings of symptomatic meniscal extrusion associated with a non-anatomic repair position of the meniscus.

The posterior cruciate ligament (PCL) is the largest intra-articular ligament in the knee and is the primary stabilizer to posterior tibial translation. Historically, the PCL’s functional dynamics and appropriate management after injury have been controversial. However, recent biomechanical and anatomic studies have elucidated a better understanding of PCL function, which has led to development of more anatomic reconstruction techniques. The larger anterolateral bundle and the smaller posteromedial bundle of the PCL exhibit a codominant relationship and have a wide femoral attachment footprint. For these reasons, the native kinematics of the knee is better restored with a double-bundle PCL reconstruction (DB-PCLR) technique than with a single-bundle PCL reconstruction (SB-PCLR). Likewise, clinical studies have demonstrated excellent outcomes for DB-PCLR compared to SB-PCLR, with decreased posterior knee laxity on stress radiography and improved International Knee Documentation Committee scores. This review will provide a detailed overview of the clinically relevant anatomy, biomechanics, injury evaluation, and treatment options, with an emphasis on arthroscopic DB-PCLR.

A bipartite patella usually presents as an incidental finding on radiographs because most cases are asymptomatic. However, some patients may present with pain and functional limitations. Conservative treatment is sufficient to resolve symptoms in most cases; however, a small minority of patients may require surgical management. Recent studies have reported excellent results with an arthroscopic approach. This Technical Note details our procedure for treating a symptomatic bipartite patella that has not resolved with conservative care.

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