Anterior cruciate ligament (ACL) repair was first reported in 1895 by Sir Arthur Mayo-Robson. Open primary ACL repair was performed throughout the 1970s and 1980s; however, rerupture rates were as high as 50% at mid-term follow-up. Throughout the 1980s and 1990s, synthetic graft materials received consideration; however, the outcomes were abysmal. Recently, with a better understanding of ACL healing and improvement in technique, there has been renewed interest in ACL repair. The potential advantages of ACL repair include improvements in knee kinematics and proprioception, avoiding graft harvest, and preserving bone stock. Although recent data on short-term outcomes suggest potential in properly indicated patients, medium- and long-term outcomes are largely unknown. ACL repair has the greatest potential in cases of proximal ACL rupture (modified Sherman type I and II proximal tears). Repair of midsubstance tears (modified Sherman type III tears) should be avoided. Caution is advised in athletes and younger patients because of higher failure rates. Today, ACL repair remains controversial and should be performed with caution because of limited medium- and long-term outcomes.

Background: Few studies have reported the long-term outcomes of patellar stabilization surgery in an active duty military cohort. Purpose: To evaluate the long-term results of a combined open and arthroscopic patellar stabilization technique for the treatment of recurrent lateral patellar instability in members of a military population. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of a consecutive series of 63 patients who underwent operative management for patellar instability at a tertiary military medical center between 2003 and 2017. All cases were performed by a single sports medicine fellowship–trained orthopaedic surgeon. Patients with recurrent lateral patellar instability whose nonoperative management failed were included. All patients underwent arthroscopic imbrication of the medial patellar retinaculum, an open lateral retinacular release, and an Elmslie-Trillat tibial tubercle osteotomy. Outcome measures at final follow-up included recurrent instability, need for surgical revision, subjective assessments, and military-specific metrics. We also analyzed anatomic risk factors for failure: patella alta, coronal plane alignment, trochlear dysplasia, and tibial tubercle–trochlear groove distance. Results: A total of 51 patients were included (34 men, 17 women; mean ± SD age at surgery, 27.2 ± 5.8 years; mean follow-up, 5.3 years). The mean postoperative SANE score (Single Assessment Numeric Evaluation) was 75.0 ± 17.7, and the mean visual analog scale pain score was 2.5 ± 2.1. Four patients (7.8%) reported redislocation events, and 4 underwent revision surgery. Twenty-five patients (49.0%) reported a decrease in activity level as compared with preinjury, while 10 (19.6%) cited restrictions in activities of daily living. Of the 21 patients remaining on active duty, 6 (28.6%) required an activity-limiting medical profile. Of the 48 active duty patients, 12 (25.0%) underwent evaluation by a medical board for separation from the military. Differences in the Caton-Deschamps Index and tibial tubercle–trochlear groove distance between surgical success and failure were not statistically significant. Conclusion: Surgical management of patellar instability utilizing a multifaceted technique resulted in low recurrence rates and may be independent of predisposing anatomic risk factors for instability. At 5-year follow-up, most patients retained their active duty status, although nearly half experienced a decrease in activity level.

The importance of the menisci in providing joint stability and their role in load transmission within the knee are well understood. A growing body of literature has emerged on 2 distinct injury patterns to these crucial anatomic structures, ramp lesions and root tears. Ramp lesions may be characterized as tears at the posterior meniscocapsular junction, while root tears involve bony or soft tissue avulsion of the meniscal insertions at the anterior or posterior intercondylar regions. In this 2-part review, we present an overview of the current available literature on ramp lesions and meniscal root tears, summarizing the unique anatomic considerations, etiology, biomechanics, management decisions, clinical outcomes pertinent to these very distinct injuries.