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Clinical Application of Knee Arthroscopy
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Clinical Application of Knee Arthroscopy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 May 2026 | Viewed by 5903

Special Issue Editors

Dr. Francesco Bosco

E-Mail Website
Guest Editor
1. Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90133 Palermo, Italy
2. Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, 90131 Palermo, Italy
Interests: knee surgery; knee injuries; knee arthroscopy; sport medicine; knee arthroplasty; hip and knee arthroplasty; orthopedics; trauma surgery; biomechanics
Dr. Alessandro Carrozzo

E-Mail Website
Guest Editor
Department of Life Sciences, Health, and Health Professions, Link Campus University, Via del Casale di San Pio V, 00165 Rome, Italy
Interests: anterolateral ligament; knee; arthroscopy; ACL; sports medicine; knee arthroplasty
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Knee arthroscopy has revolutionized diagnosing and treating various knee pathologies, offering minimally invasive solutions with reduced recovery times. Despite its widespread adoption, challenges remain regarding optimal surgical techniques, patient selection, postoperative rehabilitation, and long-term outcomes. This Special Issue aims to consolidate current advancements, address existing gaps, and explore innovative approaches in knee arthroscopy.

The scope includes original research, systematic reviews, and surgical techniques on ligament reconstruction, meniscal repair, cartilage restoration, and emerging technologies such as robotic-assisted arthroscopy and bioengineered scaffolds. Studies on rehabilitation protocols, patient-reported outcomes, and complication management are also encouraged.

This Special Issue seeks to foster interdisciplinary collaboration, refine surgical indications, and improve patient outcomes in knee arthroscopy by mobilizing orthopedic surgeons, researchers, and rehabilitation specialists.

Dr. Francesco Bosco
Dr. Alessandro Carrozzo
Guest Editors

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Keywords

  • knee surgery
  • arthroscopy
  • orthopedics
  • sport medicine
  • clinical outcomes
  • ligament reconstruction
  • meniscal repair
  • cartilage
  • postoperative rehabilitation
  • knee joint
  • tissue repair
  • joint preservation

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Published Papers (5 papers)

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Research

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11 pages, 492 KB  
Article
Bridging the Gap: Do Patient-Reported Outcome Measures Reflect Objective Knee Function After Cartilage Repair?
by Tizian Heinz, Niklas Wegerich, Sebastian Frischholz, Ioannis Stratos, Konstantin Horas, Stephan Reppenhagen, Maximilian Rudert and Manuel Weißenberger
J. Clin. Med. 2025, 14(22), 7895; https://doi.org/10.3390/jcm14227895 - 7 Nov 2025
Viewed by 578
Abstract
Background/Objectives: Focal cartilage defects of the knee are a common cause of pain and functional impairment. While several patient-reported outcome measures (PROMs) and objective scores have been developed to assess clinical knee status and functional impairment, the correlation between subjective PROMs and [...] Read more.
Background/Objectives: Focal cartilage defects of the knee are a common cause of pain and functional impairment. While several patient-reported outcome measures (PROMs) and objective scores have been developed to assess clinical knee status and functional impairment, the correlation between subjective PROMs and objective clinical findings after cartilage repair surgery remains unclear. A better understanding of this relationship could enhance the interpretation of registry data and improve clinical decision-making. Methods: This study analyzed 52 patients from the German Cartilage Registry (KnorpelRegister DGOU) who underwent cartilage repair surgery of the knee at a single orthopedic university center in Germany. All patients were re-evaluated in a standardized follow-up examination. PROMs from either the registry or the follow-up examination and objective findings, summarized using a modified objective International Cartilage Repair Society [ICRS] score, derived from the International Knee Documentation Committee (IKDC) 2000 knee examination form, were correlated using Spearman’s rank correlation coefficient. Results: Moderate and statistically significant negative correlations were observed between the objective ICRS score and Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (ρ = −0.420, p = 0.005), KOOS Quality of Life (QoL) (ρ = −0.377, p = 0.013), and the subjective IKDC score (ρ = −0.305, p = 0.028) The subjective IKDC score (IKDC–Subjective Knee Form) was also moderately and significantly correlated with the objective ICRS score (ρ = –0.305, p = 0.028). Other KOOS subscales (Pain, Activities of Daily Living (ADL), Sport) did not show statistically significant correlations with the objective ICRS score. Conclusions: PROMs provide valuable insights into patients’ perceived outcomes after cartilage repair surgery, but do not fully reflect objective functional recovery, underlining the importance of combining them with clinical assessments. Level of Evidence: III. Full article
(This article belongs to the Special Issue Clinical Application of Knee Arthroscopy)
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13 pages, 1710 KB  
Article
Short-Term Outcomes After Transtibial Repair of Medial Meniscus Posterior Root Tears: A Case Series
by Dan Viorel Nistor, Samuel Piu, Diana Raluca Mihu and Romana von Mengershausen
J. Clin. Med. 2025, 14(20), 7440; https://doi.org/10.3390/jcm14207440 - 21 Oct 2025
Viewed by 1660
Abstract
Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results [...] Read more.
Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results after transtibial pull-out (TPO) repair of isolated MMPRT and to explore the influence of patient age and postoperative physiotherapy volume. Methods: A retrospective single-center case series with 14 adults (64% women, age 59 years, body mass index (BMI) 31.0 kg/m2) who underwent TPO repair (April 2022–June 2024). Mean follow-up was 18.4 months. Outcomes included range of motion (ROM), pain levels using visual analog scale (VAS), International Knee Documentation Committee (IKDC), the Western Ontario Meniscal Evaluation Tool (WOMET), the 36-Item Short Form Survey (SF-36), and MRI-based ME, cartilage grade, and root-healing status. Postoperative PT volume was assessed with a self-developed, custom questionnaire. Correlations and subgroup analyses (<60 vs. ≥60 years) were performed. Results: Mean postoperative ROM was 121° and IKDC 63.4. Median PT exposure was 25.9 h, and the mean duration from symptom to repair was 215 days. MRI demonstrated complete healing in 70% of cases. A positive correlation was observed between postoperative ME and ROM (p = 0.008), while higher PT volume was associated with greater pain scores. Conclusions: TPO repair appears to be a viable treatment option for selected patients with MMPRT, showing acceptable early outcomes, even in older individuals with higher BMIs or delayed repair. Meniscal healing was frequent, although extrusion progression remained common and may influence the function. The observed links between ME, ROM, and PT-related pain highlight the need for standardized rehabilitation assessment. Larger, prospective studies are warranted to validate these exploratory findings and refine postoperative management. Full article
(This article belongs to the Special Issue Clinical Application of Knee Arthroscopy)
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Review

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24 pages, 564 KB  
Review
Arthroscopic Management of Patellar Instability in Skeletally Immature Patients: Current Concepts and Future Directions
by Alexandria Mallinos and Kerwyn Jones
J. Clin. Med. 2025, 14(19), 7085; https://doi.org/10.3390/jcm14197085 - 7 Oct 2025
Viewed by 1389
Abstract
Background/Objectives: Patellar instability is a common orthopedic condition affecting pediatric and adolescent populations, particularly during periods of rapid growth and increased sports participation. Recurrent patellar dislocation in skeletally immature patients is frequently associated with underlying anatomical risk factors such as patella alta, [...] Read more.
Background/Objectives: Patellar instability is a common orthopedic condition affecting pediatric and adolescent populations, particularly during periods of rapid growth and increased sports participation. Recurrent patellar dislocation in skeletally immature patients is frequently associated with underlying anatomical risk factors such as patella alta, trochlear dysplasia, or increased tibial tubercle–trochlear groove distance. Methods: This narrative review summarizes the current evidence on the epidemiology, diagnostic approach, and arthroscopic management of patellar instability in skeletally immature patients. Results: Arthroscopy has become an essential tool in both the diagnosis and treatment of patellar instability, allowing for minimally invasive assessment of patellofemoral alignment, chondral pathology, and ligament integrity. It also enables precise surgical interventions such as physeal-sparing medial patellofemoral ligament reconstruction, which remains the preferred stabilization technique for patients with open physes due to its safety and efficacy. Emerging innovations, including robotic-assisted tunnel placement, bioengineered scaffolds for cartilage repair, and three-dimensional modeling for surgical planning, have the potential to improve outcomes and arthroscopic surgical precision in this population. Despite these advances, major challenges such as a lack of pediatric-specific outcome measures, variability in surgical indications and rehabilitation protocols, and limited long-term follow-up data remain. Conclusions: Optimizing outcomes in pediatric and adolescent patients with patellar instability requires individualized growth-aware strategies and multidisciplinary collaborations. By integrating technological innovation with patient-centered care, clinicians can continue to refine the arthroscopic management of patellofemoral instability in young patients. Full article
(This article belongs to the Special Issue Clinical Application of Knee Arthroscopy)
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Other

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16 pages, 627 KB  
Systematic Review
The Role of Tourniquet Use in Arthroscopic Meniscectomy: A Systematic Review
by Cosmin Ioan Faur, Dennis Cicio, Andrea Pasquini, Edna Iordache, Jenel Marian Patrascu, Jenel Marian Patrascu, Jr., Alessandro Iatarola, Horea Benea, Octav Russu and Vlad Predescu
J. Clin. Med. 2026, 15(5), 2086; https://doi.org/10.3390/jcm15052086 - 9 Mar 2026
Viewed by 321
Abstract
Background and Objectives: The role of tourniquet use in arthroscopic partial meniscectomy remains debatable. While traditionally adopted to enhance visualization and reduce intraoperative bleeding, concerns were raised regarding its impact on postoperative outcomes and potential adverse effects, such as muscle damage or delayed [...] Read more.
Background and Objectives: The role of tourniquet use in arthroscopic partial meniscectomy remains debatable. While traditionally adopted to enhance visualization and reduce intraoperative bleeding, concerns were raised regarding its impact on postoperative outcomes and potential adverse effects, such as muscle damage or delayed recovery. This systematic review aimed to evaluate whether the use of a tourniquet offers advantages in terms of surgical efficiency, patient recovery and complication rates in arthroscopic partial meniscectomy. Materials and Methods: A systematic review was conducted following PRISMA guidelines and registered in the PROSPERO database (CRD42025644740). A comprehensive literature search was performed in 5 databases including studies from the past 20 years. Only randomized controlled trials (RCTs) comparing tourniquet-assisted versus non-tourniquet procedures in adolescent and adult patients undergoing isolated arthroscopic partial meniscectomy matched our inclusion criteria and the analysis was performed on those. Methodological quality was assessed using the Cochrane RoB 2.0 tool. Data were synthesized either quantitatively or narratively, depending on the availability of statistical details. Results: Three RCTs with a total of 243 patients met the inclusion criteria. Operative time was shorter in tourniquet-assisted procedures in one study (p = 0.001), though comparable outcomes were achieved in non-tourniquet groups when pharmacological agents such as intra-articular adrenaline were used. No significant differences were observed between groups regarding postoperative pain (p = 0.22, p = 0.43), knee effusion (p = 0.96), range of motion (p = 0.91, p = 0.96), or time to return to functional activities (p = 0.9, p = 0.34, p = 0.23). Muscle damage, assessed by serum creatine phosphokinase CPK levels, did not differ between groups (p = 0.3, p = 0.093, p = 0.079). Intraoperative visibility and surgeon satisfaction rated higher in tourniquet groups (p = 0.002), although this was subjective and reported variably. No major tourniquet-related complications were recorded. Conclusions: The routine use of a tourniquet in arthroscopic partial meniscectomy provides limited intraoperative advantages and does not improve postoperative outcomes. Current evidence supports a selective rather than routine use of tourniquets, especially when pharmacological alternatives are available. Further high-quality studies are needed to define standardized protocols and assess long-term outcomes. Full article
(This article belongs to the Special Issue Clinical Application of Knee Arthroscopy)
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12 pages, 495 KB  
Systematic Review
Postoperative Weight-Bearing, Range-of-Motion Protocols and Knee Biomechanics After Concomitant Posterolateral Meniscal Root Repair with ACL Reconstruction: A Systematic Review
by Thibaut Noailles, Julien Behr, Nicolas Bouguennec, Loïc Geffroy, César Tourtoulou and Alain Meyer
J. Clin. Med. 2026, 15(2), 542; https://doi.org/10.3390/jcm15020542 - 9 Jan 2026
Viewed by 1360
Abstract
Background/Objectives: Meniscal root tears, particularly those of the posterolateral root, are frequently associated with anterior cruciate ligament (ACL) injuries and significantly alter load distribution and knee stability. Surgical repair of the posterolateral meniscal root (PLMR) aims to restore normal biomechanics; however, postoperative [...] Read more.
Background/Objectives: Meniscal root tears, particularly those of the posterolateral root, are frequently associated with anterior cruciate ligament (ACL) injuries and significantly alter load distribution and knee stability. Surgical repair of the posterolateral meniscal root (PLMR) aims to restore normal biomechanics; however, postoperative rehabilitation strategies remain heterogeneous. The objective of this systematic review was to describe and analyze postoperative weight-bearing (WB) and range-of-motion (ROM) protocols following concomitant PLMR repair and anterior cruciate ligament reconstruction (ACLR), integrating both clinical and biomechanical perspectives. Methods: This systematic review followed PRISMA guidelines and analyzed biomechanical and clinical studies assessing postoperative WB and ROM management following PLMR repair combined with ACLR. Results: Eleven studies were included, describing heterogeneous postoperative rehabilitation protocols for WB and ROM following posterolateral meniscal root repair with ACLR. Biomechanical data consistently showed that root section increased tibial internal rotation and contact pressure on the lateral tibial plateau, whereas repair restored near-native load sharing. Clinically, most authors recommended non-weight-bearing or toe-touch loading for 4–6 weeks and flexion limited to 0–90° during early rehabilitation. Gradual progression to full loading and motion between 8 and 12 weeks was the most consistent strategy. Conclusions: Although the current evidence is limited and mainly based on low-level studies, available data suggest that a cautious and progressive rehabilitation protocol after PLMR repair with ACLR early controlled motion and delayed full loading may optimize repair healing while protecting graft integrity. Full article
(This article belongs to the Special Issue Clinical Application of Knee Arthroscopy)
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