Background: Delayed anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with an increased risk of meniscal injury. Limited data are available regarding the relationship between surgical delay and meniscal repairability in the setting of ACLR in young patients. Purpose: To determine whether time from ACL injury to primary ACLR was associated with the incidence of medial and/or lateral meniscal repair in young athletes who underwent meniscal treatment at the time of ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Records were retrospectively reviewed for patients aged 13 to 25 years who underwent primary ACLR between January 2017 and June 2020 by surgeons from a single academic orthopaedic surgery department. Demographic data were collected, and operative reports were reviewed to document all concomitant pathologies and procedures. Univariable and multivariable logistic regression analyses were used to determine factors associated with meniscal repair, including time elapsed from ACL injury to surgery. Results: Concomitant meniscal tears were identified and treated in 243 of 427 patients; their mean age was 17.9 ± 3.3 years, and approximately half (47.7%) of patients were female. There were 144 (59.3%) medial tears treated and 164 (67.5%) lateral tears treated; 65 (26.7%) patients had both medial and lateral tears treated. Median time from ACL injury to ACLR was 2.4 months (interquartile range, 1.4-4.7 months). Adjusted univariate analysis showed a statistically significant correlation between medial meniscal repair and time to surgery, with a 7% decreased incidence of medial meniscal repair per month elapsed between injury and surgery (odds ratio, 0.93 per month; 95% CI, 0.89-0.98; P = .006). No similar relationship was found between lateral meniscal repair and time to surgery (odds ratio, 1.02; 95% CI, 0.99-1.06; P = .24). Conclusion: In the setting of concomitant ACL and meniscal injuries, surgical delay decreased the incidence of medial meniscal repair in young athletes by 7% per month from time of injury.

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

The authors assessed the effects of forearm rotation on the proximity of the radial nerve and medial collateral ligament (MCL) to a proximal and a more distal arthroscopic anterior elbow capsulectomy. Arthroscopy was performed on 10 cadaveric specimens. Sutures were passed lateral to medial at the level of the radiocapitellar joint and at the proximal edge of the annular ligament. Dissection measured the distance to the radial nerve from the lateral starting point and to the MCL from the medial exit point in varying degrees of forearm rotation. The extent of brachialis muscle coverage of the radial nerve was documented. The distance from the starting point to the radial nerve increased in pronation at both levels. The medial extent of the capsulectomy remained a safe distance from the MCL. Brachialis muscle covered the radial nerve at both levels. Pronation increases the capsulectomy safe zone, including more distally, before encountering the radial nerve; the MCL is not at risk. [ Orthopedics . 2020;43(5):e399–e403.]

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Category: Arthroscopy; Ankle; Sports; Trauma Introduction/Purpose: Osteochondral Lesions of the Talus (OLT) are now a commonly encountered pathology resulting in ankle pain and disability. Because of growing interest and support for arthroscopic management, it has become increasingly important to develop pre-operative evaluation methods to determine which lesions are amenable to standard arthroscopic evaluation and treatment versus the use of alternative strategies including posterior ankle arthroscopy, open arthrotomy, or malleolar osteotomy. Recently a CT scan protocol has been developed with the maximum ankle plantarflexion to estimate which lesions are accessible by standard anterior ankle arthroscopy based on the location of the lesion relative to the anterior tibial plafond. We present a simplified alternative method using a clinic-based lateral ankle radiograph with maximal plantarflexion to attain similar information for surgical planning. Methods: A 25-year-old female presented to clinic approximately 3 years after an initial injury to the left ankle sustained while skiing, with prior conservative treatment. After examination and review of available imaging, discussion was held with the patient regarding continued conservative management of her left ankle OLT versus surgical intervention with ankle arthroscopy, OLT debridement, and microfracture due to the lesion size of less than 150 mm2 based on previously described treatment algorithms. To determine the best approach for ankle arthroscopy, anterior versus posterior, a left ankle non-weight-bearing maximal plantar flexion radiograph was performed in the clinic. This showed that with plantarflexion, the anterior margin of the medial based OLT was adjacent to the anterior lip of the tibial plafond. Based on the clinical experience of the treating surgeon, this serves as an indication that the lesion can be adequately accessed using standard anterior ankle arthroscopy with plantarflexion and/or non- invasive distraction. Results: The patient underwent standard ankle anterior tibiotalar arthroscopy with non-invasive distraction. Following diagnostic arthroscopy and limited debridement, with the ankle manually plantarflexed by an assistant, the OLT leading edge was easily identified. The remaining joint was intact without cartilage injury. There was moderate synovitis noted anterior and medial. An arthroscopic shaver and curette was used to debride the unstable articular cartilage back to sharp, stable borders, and all loose cartilage fragments were removed from the joint. This left approximately 8 x 15 mm of exposed subchondral bone. The subchondral plate was intact without bone loss or evidence of collapse. Using an arthroscopic microfracture awl, several microfracture holes were created through the subchondral plate and into the underlying metaphyseal bone until marrow fat was identified. Postoperatively, she was non weight bearing for six weeks with range of motion as tolerated, and advanced to full activity at three months without residual symptoms. Conclusion: In the management of OLTs, the limits of anterior arthroscopy have been pushed with time, due to the added complexity and possible morbidity associated with posterior arthroscopy and medial malleolus osteotomies for an open approach. Many factors have an impact on the intraarticular access using anterior ankle arthroscopy, with the posterior talus being the most challenging site to access. As seen in this case presentation, this simple and cost-effective radiographic technique can be employed by the clinician, among other clinical and imaging tools, to help guide appropriate surgical technique for lesions in the posterior half of the talar body.