Medial meniscus root tears: mechanics, management, and techniques.

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Abstract

Conflict of interest statement: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-25-30/coif). The series “The Medial Knee at Risk” was commissioned by the editorial office without any funding or sponsorship. A.J.T. has received hospitality payments from Stryker, Arthrex, Medical Device Business Services, and Zimmer Biomet Holdings. A.K. has received consulting fees from Arthrex, JRF, Vericel, and Responsive Arthroscopy; royalties from Arthrex and Responsive Arthroscopy; grants from DJO and Exactech; and research support from Aesculap/B.Braun, Ceterix, and Histogenics. The authors have no other conflicts of interest to declare. 7. J ISAKOS. 2025 Aug;13:100900. doi: 10.1016/j.jisako.2025.100900. Epub 2025 May 29. Assessment and surgical correction of posterior tibial slope in revision anterior cruciate ligament surgery: An international expert Delphi consensus statement. Wackerle AM(1), Marcaccio S(2), Apseloff N(3), Getgood A(4), Musahl V(2), Tapasvi S(5); Posterior Tibial Slope Consensus Group. Collaborators: Alaia MJ(6), Amendola A(7), Becker R(8), Brown CH Jr(9), Chahla J(10), Clatworthy M(11), Dawson MJ(12), Dejour D(13), Frosch KH(14), Gelber PE(15), Godshaw BM(16), Guenther D(17), Heard SM(18), van Heerwaarden R(19), Hirschmann MT(20), Hughes JD(21), Imhoff FB(22), Khakha RS(23), Kley K(24), LaPrade RF(25), Levy BA(26), Lowe WR(27), Lustig S(28), Maestu R(29), Menetrey J(30), Neyret P(31), Ollivier M(32), Parker DA(33), Petersen W(34), Ranawat AS(35), Schröter S(36), Seil R(37), Sherman SL(38), Słynarski K(39), Sonnery-Cottet B(40), Spalding T(41), Verdonk R(42), Vidal AF(43), Waterman BR(44), Weiler A(45), Williams A(46), Wilson A(47), Zaffagnini S(48). Author information: (1)Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany. Electronic address: anja.wackerle@mri.tum.de. (2)Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. (3)The Ohio State University Wexner Medical Center, Columbus, OH, USA. (4)Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; University of Western Ontario, London, Ontario, Canada. (5)The Orthopaedic Specialty Clinic, Pune, India. (6)NYU Langone Orthopedic Hospital, Division of Sports Medicine, 333 E 38th Street, New York, NY 10016, USA. (7)Department of Orthopaedic Surgery, Duke University, Durham, NC, USA. (8)Department of Orthopaedic and Trauma Surgery, University Hospital Brandenburg, University Theodor Fontane, Brandenburg an der Havel, Germany. (9)International Knee and Joint Centre, Abu Dhabi, United Arab Emirates. (10)Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA. (11)Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand. (12)North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK. (13)Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ramsay Santé, Lyon, France. (14)Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany. (15)ReSport Clinic, Hospital de la Santa Creu, i Sant Pau, Barcelona, Spain. (16)Ochsner Sports Medicine Institute, New Orleans, LA, USA. (17)Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany. (18)Department of Surgery, University of Calgary, Calgary, Canada. (19)Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, the Netherlands. (20)Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Laufen, Liestal, Switzerland. (21)Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, USA. (22)Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland. (23)Guys and St Thomas' Hospitals, London, UK. (24)London Knee Osteotomy Centre, Orthopaedic Specialists, Harley Street Specialist Hospital, London, UK. (25)Twin Cities Orthopedics, Edina, MN, USA. (26)Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA. (27)Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, TX 77401, USA. (28)Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 69004 Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France. (29)Centro de Tratamiento de Enfermedades Articulares, Buenos Aires, Argentina. (30)Centre de Medecine du sports et de l'Exercice (CMSE), Hirslanden Clinique La Colline, Geneva, Switzerland; Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland. (31)Infirmerie Protestante, Orthopaedic Department, 3 rue Penthod, Caluire-et-Cuire, 69300, France. (32)Aix-Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Marseille, France. (33)Sydney Orthopaedic Research Institute, St Leonards, Sydney, Australia. (34)Martin Luther Hospital, Caspar They Strasse 27-31, 14193 Berlin, Germany. (35)Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA. (36)Department of Orthopedics and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany. (37)Department of Orthopaedic Surgery, Hopital Municipal et Clinique d'Eich, Luxembourg City, Luxembourg. (38)Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA. (39)Słynarski Knee Clinic, Warsaw, Poland. (40)Groupe Ramsay-Santé, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean-Mermoz, Lyon, France. (41)Cleveland Clinic London, England, UK. (42)ULB Erasmus University Hospital, Brussels, Belgium. (43)Steadman Philippon Research Institute, Vail, CO, USA. (44)Department of Orthopaedic Surgery and Rehabilitation, Wake Forest University School of Medicine, Winston-Salem, NC, USA. (45)Sporthopaedicum Berlin, Berlin, Germany. (46)Fortius Clinic, London, UK. (47)Orthopaedic Specialist Group, Harley Street Specialist Hospital, Queen Anne St, London, UK. (48)Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. PURPOSE: The aim was to provide international guidelines to enhance decision-making regarding the definition and evaluation of increased posterior tibial slope (PTS) and the role of anterior closing wedge high tibial osteotomy (ACWHTO) in the setting of revision anterior cruciate ligament reconstruction (ACLR). METHODS: This guideline is based on responses from 46 international orthopaedic surgeons with expert experience in knee pathologies and osteotomy. Based on a literature review, each expert drafted and commented on a set of core statements. The provided comments were blinded and discussed within the working group to refine the statements. In a subsequent round of surveys, all experts discussed with the final 32 statements. Consensus was achieved when at least 80 ​% of survey respondents fully agreed. RESULTS: With respect to ACWHTO for PTS reduction, there was consensus achieved for using the medial plateau as a measurement for PTS measuring, aiming for PTS correction of 5-7°, individualizing osteotomy wedge thickness, and performing ACWHTO and revision ACLR in a single stage. There was no consensus on the type of radiographs to be used, a cut-off value for increased PTS, an absolute indication for ACWHTO the osteotomy technique, nor type of fixation. The International consensus statements aim to bridge the gap between research and clinical application to enhance clinicians' decision-making in revision ACLR management and to focus future areas of required research. CONCLUSION: The literature review confirmed a paucity of evidence to guide clinicians in the diagnosis and surgical management of increased PTS. An agreement could be achieved for 25/32 statements (78 ​%) on the definition and assessment of PTS, indication, planning, surgical decision-making, and peri- and postoperative management for ACWHTO. While no consensus could be achieved for the definition of a cut-off value for pathological PTS, consensus was reached for a variety of statements on diagnostic and surgical aspects. LEVEL OF EVIDENCE: V, expert opinion. Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jisako.2025.100900