Luis Fernando Zukanovich Funchal

Purpose: To assess the impact of platelet-rich plasma (PRP) on imaging-based structural outcomes in patients with knee osteoarthritis (OA). Methods: PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) published up to May 2026 evaluating imaging-based structural effects of PRP in knee OA. Risk ratio (RR) was used to evaluate binary outcomes and standardized mean differences (SMDs) or mean differences (MDs) for continuous endpoints, with 95% confidence intervals (CIs). Results: A total of 12 RCTs involving 1,200 patients were included. PRP was associated with greater improvement in patellofemoral cartilage thickness/volume compared with control treatments (SMD 0.94; 95% CI, 0.53 to 1.34), whereas no significant differences were observed for medial tibial cartilage thickness/volume or cartilage defect progression. Magnetic resonance imaging (MRI)-based structural scores showed no between-group differences in Whole-Organ Magnetic Resonance Imaging Score (WORMS) osteophytes or subchondral cysts, although PRP demonstrated a significant reduction in bone marrow edema (SMD − 0.40; 95% CI, − 0.71 to − 0.09). Synovitis did not differ overall between groups (SMD − 0.22; 95% CI, − 0.43 to 0.00). Conclusion: In this systematic review and meta-analysis, PRP demonstrated limited and inconsistent effects on imaging-based structural outcomes in knee OA, and did not confer significant and consistent benefits in medial tibial cartilage measurements, cartilage defect progression, synovitis, or most WORMS domains. The favorable findings observed for patellofemoral cartilage and bone marrow edema should be interpreted with caution. Thus, the findings do not provide clear evidence supporting PRP as a structural disease-modifying treatment, and additional high-quality RCTs using standardized imaging endpoints are warranted.

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is one of the most commonly performed procedures in sports medicine. Although international surveys have described global trends in graft selection, extra-articular procedures, and meniscal management, contemporary nationwide data from Brazil remain limited. Hypothesis/Purpose: To characterize current ACLR practices among Brazilian knee surgeons, including graft choice, use of lateral extra-articular procedures, meniscal management, and return-to-sport (RTS) strategies. We hypothesized that Brazilian surgeons would adhere to contemporary evidence regarding meniscal preservation and RTS timing, with distinctive patterns in graft selection and extra-articular augmentation. Study Design: Cross-sectional study. Methods: A nationwide, web-based survey was distributed to board-certified orthopaedic surgeons performing ACLR. The questionnaire included 60 items addressing surgeon characteristics, surgical technique, graft selection, use of lateral extra-articular procedures, meniscal management, and RTS criteria. Responses were analyzed descriptively, with exploratory association analyses evaluating relationships between surgeon characteristics (age, region, and surgical volume) and selected surgical practices. Results: Of 1545 invited surgeons, 382 completed the survey. Hamstring tendon autografts were the primary graft choice for 90.1% of respondents, followed by bone-patellar tendon-bone autografts (5.8%). Lateral extra-articular procedures were used at least occasionally by 94.5% of surgeons in primary ACLR and frequently or always by 74.6% in revision cases. Increased rates of meniscal repair were reported by 82.2% of respondents, and unrestricted RTS was most commonly authorized between 9 and 12 months (74.1%). Higher surgical volume was associated with more frequent use of lateral extra-articular procedures in primary ( P = .001) and revision settings ( P = .046), as well as increased meniscal repair rates ( P = .016). Regional and age-related differences in lateral extra-articular tenodesis/anterolateral ligament use were also observed. Conclusion: Brazilian ACLR practices appear broadly consistent with contemporary international trends, particularly regarding meniscal preservation and RTS timing. Distinctive features include a predominant preference for hamstring autografts and a high rate of lateral extra-articular procedure use. Surgeon characteristics were associated with variation in selected surgical practices.

Purpose: This cohort study aimed to evaluate the outcomes of patients with combined anterior cruciate ligament (ACL) and grade II medial collateral ligament (MCL) injuries who exhibited the floating meniscus sign during arthroscopy and were treated with ACL and medial compartment reconstruction surgery. Methods: Patients with combined ACL and grade II MCL injuries who underwent ACL and MCL reconstruction surgery between January 2019 and December 2022 were included in this study. The instability was classified as a grade II MCL injury, based on findings from magnetic resonance imaging and clinical examination. The Tegner activity scale and Lysholm score were collected preoperatively, 6, 12, 24, 36, 48 and 60 months postoperatively. Additionally, the number of patients with ACL reconstruction failure or residual MCL laxity at each follow‐up time point was recorded. Results: A total of 197 patients underwent simultaneous reconstruction of the ACL and grade II MCL injuries. The mean age was 29 ± 9 years, and 83% were male. Six cases of ACL reconstruction failure were observed over 60 months, with no residual MCL valgus laxity at the final follow‐up. Significant improvements in both the Tegner activity scale and Lysholm knee scoring scale were noted at all follow‐up points compared to preoperative scores ( p < 0.001). Conclusions: The floating meniscus sign proved to be a valuable finding in guiding the surgical management of combined ACL and grade II MCL injuries. Our results suggest that, in physically active patients presenting with this sign, performing both ACL and MCL reconstruction leads to excellent mid‐term outcomes, with significant functional improvement and a low rate of graft failure or residual valgus instability. This supports the surgical indication of MCL reconstruction in selected grade II injuries when the floating meniscus sign is present, potentially preventing long‐term instability and suboptimal recovery. Level of Evidence: Level III, retrospective cohort study.

Purpose: Several posterior medial meniscal root (PMMR) repair techniques have been developed to restore the load‐bearing function of the meniscus and reduce extrusion. The medial meniscotibial ligament (MMTL) has been shown to play a significant role in meniscal stability. This study evaluates the stabilising function of the MMTL by directly influencing the force exerted on the PMMR during weight‐bearing and valgus motion of the knee. Our aim is to investigate whether loss of MMTL integrity is a determining factor in PMMR subluxation.Methods: Using a 3D model of the knee with parameters from experimental studies, compressive and valgus loading scenarios were simulated using the finite element method to analyse the mechanical response of different knee structures. To investigate the correlation between the integrity of the MMTL and the force acting on the PMMR, different degrees and types of injuries to both structures were modelled for comparison with the healthy joint, providing insights into their importance in preventing or correcting extrusion.Results: During compressive loading, tears in the MMTL and PMMR result in a 5.8% and 30.9% increase in meniscal extrusion, respectively, while a combined injury results in a 43.9% increase, indicating that the MMTL provides a secondary constraint against extrusion. Moreover, the importance of the MMTL in restraining extrusion becomes more pronounced as the PMMR weakens, as is typical in degenerative tears. Finally, during valgus motion, the MMTL prevents separation of the meniscus from the tibial plateau and reduces strain/stress on the PMMR.Conclusion: The integrity of the MMTL plays a crucial role in reducing meniscal extrusion and PMMR overload, particularly when the root is affected by degenerative tears. Therefore, surgical repair of the MMTL can improve meniscal function, potentially reducing the risk of osteoarthritis and should be considered as a better treatment strategy for PMMR tears.Level of Evidence: Level III.

Background: Injury to the medial collateral ligament (MCL) is common. MCL injuries, with impairment of its superficial portion, associated with the deep portion, lead to valgus instability and extrusion of the medial meniscus, resulting in instability and increased pressure in the medial compartment, with consequent damage to the cartilage. We can synthesize this set of structures as the medial meniscocapsular complex. Treating medial, superficial, and deep capsular meniscal complex together aims to restore the normal anatomy, stability, and function of the medial meniscus. Indications: • Anterior cruciate ligament with MCL grade III or MCL grade II • MCL grade III or grade II with clinical instability Technique Description: An arthroscopic examination was performed to assess the “floating meniscus” sign and to confirm a tear of the MCL. The gracilis tendon is harvested in a usual fashion, leaving its distal insertion pedicle fixed to the tibial bone. An incision over the medial epicondyle is made, and a 6-mm drill is used to create a 2.5-cm bone tunnel. The passage of the medial subfascial graft is made toward the medial epicondyle. At this point, its fixation is performed with an interference screw. After fixing the anterior arm, we will return with the free portion of the graft in the most posterior portion and also percutaneously. This posterior arm is biologically fixed, closing the sartorius fascia over the 2 arms of the reconstruction with periosteal stitches. Results: Reconstruction tests were performed on cadaver models, obtaining a graft tension without compromising the range of motion (ROM) and a good result in their final analysis. We ended up publishing our results in a clinical study, with good functional results in both the Lysholm and Tegner scores, at a follow-up of 2 years. Discussion/Conclusion: We present an arthroscopic-assisted technique for a medial, percutaneous, aesthetic, and extremely functional approach. A technical limitation of our procedure is the absence of a biomechanical test for the gracilis double reconstruction: a strong point is that we performed some reconstruction tests on cadaver models, obtained good visual results and graft tension without compromising the ROM, and performed a positive clinical study with a minimum follow-up of 2 years. In conclusion, a simple and inexpensive technique that uses known anatomic principles of graft placement, without compromising ROM was performed. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Purpose: (1) To evaluate the biomechanical properties of a porcine flexor digitorum superficialis tendon graft with preserved muscle fibers and (2) to compare these results with the biomechanical properties of a porcine tendon graft after removal of associated muscle.Methods: Eighty‐two porcine forelegs were dissected and the flexor digitorum superficialis muscle tendons were harvested. The study comprised of two groups: Group 1 (G1), harvested tendon with preserved muscle tissue; and Group 2 (G2), harvested contralateral tendon with removal of all muscle tissue. Tests in both groups were conducted using an electro‐mechanical material testing machine (Instron, model 23‐5S, Instron Corp., Canton, MA, USA) with a 500 N force transducer. Yield load, stiffness, and maximum load were evaluated and compared between groups.Results: The behavior of the autografts during the tests followed the same stretching, deformation, and failure patterns as those observed in human autografts subjected to axial strain. There were no significant differences in the comparison between groups for ultimate load to failure (p = 0.105), stiffness (p = 0.097), and energy (p = 0.761).Conclusion: In this porcine model biomechanical study, using autograft tendon with preserved muscle showed no statistically significant differences for yield load, stiffness, or maximum load compared to autograft tendon without preserved muscle. The preservation of muscle on the autograft tendon did not compromise the mechanical properties of the autograft.Level of evidence: Level III Controlled laboratory study