Background The indications and efficacy after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus lesions (DMMLs) have been controversial. The purpose of this study was to identify predictors of unfavorable clinical and radiologic outcomes after APM for DMMLs and to choose appropriate indications and improve treatment efficacy. Methods A total of 86 patients with DMMLs undergoing APM were retrospectively reviewed. The mean follow-up time was 32.1 months. Clinical outcomes (including Lysholm score) and radiographic results (including Kellgren-Lawrence grade (K–L grade: 0/1/2/3/4) were evaluated at preoperative and final follow-up. Preoperative prognostic factors, including gender, age, Body Mass Index (BMI), Hip–Knee–Ankle (HKA), Medial Posterior Tibial Slope (MPTS), Medial Meniscus Extrusion (MME), K–L grade, occupational kneeling, and cartilaginous condition (Outerbridge grade ≤ 2, VS ≥ 3), for relatively unfavorable (fair or poor grade) Lysholm and progression of K–L grade, were investigated by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify a cutoff point for the extent of medial meniscal extrusion that was associated with the final Lysholm score. Results A significantly improved postoperative Lysholm score (84.5 ± 9.7) compared with the preoperative score (63.8 ± 9.3) (P < 0.001), but a progression of K–L grade (20/36/30/0/0–15/27/25/19/0) (P < 0.001). The adverse prognostic factor of Lysholm score was the advancing age (OR 1.109, P = 0.05) and HKA (OR 0.255, P < 0.001). The adverse prognostic factor of K–L grade progression was MME (OR 10.327, P < 0.001). The cutoff point for the relative value of preoperative medial meniscal extrusion associated with relatively unfavorable Lysholm scores was 2.05 mm (Area = 0.8668, P value < 0.0001, Sensitivity = 62.16%, Specificity = 93.88%). Conclusions Clinically, varus alignment, large MME, and older age were found to predict a poor prognosis after APM for DMMLs. The preoperative extent of MME can be used as a predictive factor for osteoarthritis in APM. Patients with varus and MME should avoid APM. High tibial osteotomy may be an effective treatment strategy.

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Degenerative medial meniscus lesions(DMMLs) is different from other meniscus injuries, which have a high incidence and easy to miss diagnosis in the middle-aged and elderly. The present study was designed to identify the risk factors for DMMLs among an Asian sample. The experimental group included 121 patients（ones partly confirmed during arthroscopic surgery) with DMMLs and the control group included 51 patients with no pathological changes identified by using 3.0-T magnetic resonance imaging (MRI) from January 2017 to January 2021 were analyzed retrospectively. By full-length anteroposterior radiographs of lower limbs in weight-bearing position of the two groups, the Hip-Knee-Ankle (HKA) angle in the coronal plane and the Medial Posterior Tibial Slope(MPTS) in the sagittal plane were measured by the MRI T1 sequence of the knee. The potential risk factors of DMMLs were analyzed by multivariate logistic regression. The independent variables included gender, age, body mass index (BMI), occupational kneeling, Kellgren-Lawrence (K-L) grade, HKA, and MPTS. T-test analysis between the Experimental Group and the Control Group showed statistically significant differences in age (t=10.718, p<0.001), BMI (t=7.300, p<0.001), HKA (t=8.677, p<0.001), and MPTS (t=5.025, p<0.001). Chi-square test analysis between the two groups showed no statistically significant differences in gender (t=0.183, p=0.669) and occupational kneeling (t=0.339, p=0.560). Non-parametric analysis showed statistically significant differences in K-L (z=5.857, p<0.001) between the two groups. Logistic regression analysis showed that age, BMI, HKA, and MPTS were risk factors for DMMLs among the above-mentioned variables with statistically significant differences. Varus, steep MPTS, advancing age and obesity were risk factors for DMMLs.

Background The arthroscopic Broström–Gould procedure (ABG) gained particular attention among clinicians and researchers due to its high rate of satisfactory results. There is a lack of evidence regarding the differences in clinical outcomes for the various suture techniques. The purpose of this study was to compare the differences in clinical effect in patients treated with one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture for chronic ankle instability (CAI). Methods This retrospective cohort study examined CAI patients who underwent either one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture ABG between January 2018 and January 2020. Patients were divided into two groups based on the suture knot type used and the associated number of anchors. The operative time, surgical cost, Visual Analog Scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) Score, Karlsson Ankle Functional Score (KAFS), the rate of return to sports, complications, and measured biomechanical strength using standardized equipment were compared between groups. Results Sixty-four CAI patients were included (one-anchor modified Mason–Allen suture group n = 30, two-anchor horizontal mattress suture group n = 34). Compared to the two-anchor horizontal mattress suture group, the one-anchor modified Mason–Allen suture group had significantly shorter operative time (p < .001) and lower surgical cost (p < .001). There were no postoperative complications in the two groups, and no significant differences in the VAS, AOFAS, KAFS, and rate of return to sports in postoperative follow-up between the two groups at 1 and 2 years after surgery. There was no statistically significant difference in biomechanical strength anterior drawer test displacement (p > .05) between the one-anchor modified Mason–Allen suture and two-anchor horizontal mattress suture at 2 years after surgery. Conclusion ABG using a one-anchor modified Mason–Allen suture showed comparable clinical results to a two-anchor horizontal mattress suture in the treatment of CAI at intermediate-term follow-up time. However, one-anchor modified Mason–Allen suture may be a faster, simpler, cost-effective substitute technology. Level of evidence Level III, comparative study.

BackgroundThe objective of this study was to evaluate the clinical results of arthroscopic medial patellofemoral ligament (MPFL) insertion reconstruction and plication for medial patellar retinaculum using suture anchor combined with lateral retinacular release in first acute patellar dislocation (APD) with MPFL insertion injury in adolescents.MethodsA prospective study was performed between January 2016 and July 2019. The series included 61 cases of adolescent patients with first APD. There were 7 males and 54 females with an average age of 15.5 years (10 to 22). All cases were treated with arthroscopic suture anchor plication for medial patellar retinaculum combined with lateral retinacular release. Congruence angle (CA), lateral patellar angle (LPA), and patellar tilt angle (PTA) are measured by CT scan between last follow-up and preoperative. In addition, the patients were evaluated with the Lysholm and Kujala scores.ResultsThe average follow-up time was 40.9 months (24-60 months). All 61 knees showed excellent or good results postoperatively. The Lysholm score increased significantly from 58.6±8.1 to 91.9±5.0 at the last follow-up postoperatively (P<0.001 ). The Kujala scores increased significantly from 60.4±7.3 to 88.9±4.8 at the last follow-up postoperatively (P < 0.001). CA in 0° extension position was improved significantly from 19.8±2.1° preoperatively to -6.7±1.7° at the last follow-up (P<0.001), LPA was increased from -7.4±2.2° to 5.7±1.8° (P<0.001), and PTA was increased from 23.8±2.9° to 12.3 ±2.3° (P<0.001). The postoperative mean Lysholm and Kujala scores were 91.9 (81–100) and 88.9 (79–100), respectively.ConclusionsWhen the first APD occurs associated with the MPFL avulsed from the patella, the presented technique could not only reattach MPFL at the patellar border but also strengthen the medial patellar retinaculum. This anatomical repair technique can significantly improve the stability of the patella and has the advantage of being less invasive by the full-arthroscopic approach.Trial registration: retrospectively registered