In young ACL reconstruction, adding lateral extra-articular tenodesis was linked to fewer revisions whatever the tibial slope

The edition in brief

Today's orthopaedics edition leads on anterior cruciate ligament reconstruction in young, high-risk patients. An AJSM cohort of 780 patients aged 25 or under at three centres found 10.8% needed revision. Posterior tibial slope of 12° or more was present in 28.2%. With a steep slope, revision occurred in 21.0% without lateral extra-articular tenodesis and 9.2% with it (number needed to treat 9); with a normal slope, 13.2% and 5.4% (number needed to treat 13). Tenodesis was independently associated with lower odds of revision (OR 0.37), and each degree of slope with higher odds (OR 1.09). A propensity-matched cohort of about 3900 matched pairs in Clinical Orthopaedics and Related Research found adding a genicular nerve block to adductor canal block and IPACK gave no clinically meaningful improvement in pain, opioid use or physiotherapy clearance after knee replacement. A Korean national cohort of 20,707 matched pairs found Parkinson disease before knee replacement was associated with a slightly higher five-year hazard of cerebrovascular events (HR 1.11) but not with periprosthetic fracture or infection. A Bone & Joint Journal cohort of 297 robotic knee replacements found that moving two CPAK phenotypes, or changing the distal femoral angle by more than 4°, was associated with smaller early Oxford Knee Score gains. The pearl covers timing of hip fracture surgery.