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We, like some authors, have shown that the use of interference screws in tibial fixation despite being aperture fixation actually has a greater amount of tibial enlargement. This lends weight to the biological theory to tunnel enlargement.

Injectable scaffold augmentation is a promising modality for single-stage cartilage repair. According to published studies, cartilage repair with scaffold augmentation has improved clinical outcomes, radiological fill, and histological repair compared with microfracture alone. Injectable scaffolds have the versatility to be used in large and irregularly shaped lesions. With correct preparation, they can be applied to lesions on the femoral condyle that may be vertical, or even inverted lesions such as those in the patella. They can be combined with bone marrow aspirate concentrate (BMAC) to provide mesenchymal stem cells (MSCs), thereby avoiding the need for microfracture. This protects the subchondral plate, preventing biomechanical alteration and potentially resulting in improved long-term outcomes. In this article, we demonstrate the utility of injectable scaffolds and their combination with BMAC.

Recent advances in our understanding of knee biomechanics and load transmission have emphasized the need for meniscus preservation. However, the literature suggests that more needs to be done. The outside-in arthroscopic meniscus repair was first described by Warren in 1985. Despite the popularity of new all-inside meniscus repair devices, the outside-in meniscus repair technique is still used by many surgeons to preserve the meniscus. During the last 26 years, this technique has evolved and modified. However, its basic principles as being a minimally invasive, simple, and inexpensive meniscus repair technique have not changed. The results of outside-in meniscus repair have also stood the test of time, yielding healing rates and functional scores comparable to those of other meniscus repair techniques.

Background:The relationship between biological tissue healing following knee injury or surgery and long-term clinical outcome has come to the forefront of sports medicine practice. This has led many knee surgeons to incorporate biologically mediated healing factors into the management of knee injuries. In particular, the clinical use of mesenchymal stem cells has opened new horizons.Evidence Acquisition:Relevant studies were identified through a search of PubMed from January 2000 to April 2011, combining the term mesenchymal stem cells with articular cartilage, anterior cruciate ligament, and meniscus. Relevant citations from the reference lists of selected studies were also reviewed.Results:Knee injury treatment with mesenchymal stem cells shows potential. Most reports represent animal model studies; few advances have been translated to human clinical applications.Conclusion:Mesenchymal stem cell use to promote healing following knee injury is likely to increase. There are scientific methodological concerns and ethical and legal issues regarding mesenchymal stem cell use for treating knee injuries.