Robert F LaPrade

• MD, PhD
• Complex Knee Surgeon at Twin Cities Orthopedics

Ligaments have been extensively studied in anatomy and are traditionally defined as structures that connect bones and contribute to joint stability. However, a universally accepted definition of “ligament” remains elusive. Many structures classified as ligaments do not connect bones, such as the ligamentum arteriosum, raising questions about the cr...

Purpose The aim of part one of this EU‐US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Preventi...

Purpose The aim of part-one of this EU-US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Preventi...

Purpose of review The purpose of this review is to synthesize current science on meniscus anatomy and biomechanics and repair techniques to create an empirical foundation for postoperative rehabilitation precautions and guidelines, including timelines, clinical and performance-based criteria for return to activity, to maximize both meniscal healing...

Purpose To evaluate practices and preferences among expert sports knee surgeons regarding biologic augmentation techniques in meniscal repair. Methods A 12‐question multiple‐choice survey was distributed to the Meniscus International Network (MenIN) Study Group. It covered biologic augmentation techniques for various meniscal tear types, both in i...

Purpose The purpose of this study was to evaluate potential predictive diagnostic variables on magnetic resonance imaging (MRI) for medial meniscus ramp tears in the presence of an anterior cruciate ligament (ACL) tear. Methods Patients aged ≥16 years undergoing arthroscopic anatomic hamstring single‐bundle ACL reconstruction between July 2016 and...

Purpose To provide a comprehensive, systematic review on the relationship and effects of smoking on clinical outcomes after meniscus surgery. Methods The following combination of keywords was entered into the electronic search engines: meniscus, meniscus repairs, meniscectomy, meniscal tear, meniscus excision AND (smoke OR smoking OR nicotine OR t...

Background and Aims Multiligament knee injuries (MLKIs) are complex, high-stakes injuries often resulting from high-energy trauma, requiring precise diagnosis, tailored surgical planning, and structured rehabilitation to restore stability and function. This review examines strategies for MLKI management, highlighting Schenck’s classification system...

Background and Aims Posterolateral corner (PLC) injuries are complex knee injuries that compromise stability due to damage to critical stabilizing structures, requiring accurate diagnosis, effective surgical techniques, and structured rehabilitation for optimal outcomes. This review explores the anatomy, biomechanics, and diagnostic strategies for...

Purpose: The aim of this study was to carry out a scoping review to investigate the use of biologic augmentation strategies for arthroscopic meniscal repair. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O'Malley frameworks were followed. The studies were obtained and...

Purpose: External snapping hip syndrome (ESHS) was historically attributed to isolated iliotibial band (ITB) contracture. However, the gluteus maximus complex (GMC) may also be involved. This study aimed to intraoperatively identify the ESHS origin and assess the outcomes of endoscopic treatment based on the identified aetiological type. Methods: F...

Background and Aims Meniscus tears are among the most common sports medicine knee injuries. Proper diagnosis and treatment of ramp, root, and radial meniscus tears is critical to ultimately help improve patient outcomes. Each type of meniscus tear has unique tear locations and patterns, requiring different surgical repair techniques and rehabilitat...

Purpose Through an analysis of findings from a survey about the use of artificial intelligence (AI) in orthopaedics, the aim of this study was to establish a scholarly foundation for the discourse on AI in orthopaedics and to elucidate key patterns, challenges and potential future trajectories for AI applications within the field. Methods The Inte...

Purpose The purpose of this study was to assess the efficacy of arthroscopic intervention on the treatment of pigmented villonodular synovitis (PVNS) patients, with a focus on the potential advantages of this approach in lowering the risk of disease recurrence. Methods We performed a systematic review and meta‐analysis following the PRISMA 2020 pr...

Background A paucity of data exists to guide surgical management of the medial collateral ligament (MCL). High-grade MCL injuries are often treated with surgical repair or reconstruction; however, guidelines for choosing one or the other technique remain unclear. Purpose To systematically review the literature to determine whether repair versus re...

Background The development of posttraumatic osteoarthritis (PTOA) of the knee after anterior cruciate ligament (ACL) reconstruction (ACLR) leads to additional morbidity in adults. Purpose To determine the 5-year incidence of and risk factors for PTOA diagnoses after primary ACLR in pediatric patients. Study Design Case control study, Level of evi...

Background: Medial meniscus ramp lesions (MMRLs) are commonly associated with anterior cruciate ligament (ACL) injuries and may increase the risk of graft failure after ACL reconstruction (ACLR) if undiagnosed or left untreated. Although MMRLs have been extensively reported in adults, there are limited studies describing them in pediatric patients...

Background The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known. Purpose/Hypothesis The purpose of this systematic review was to identify the clinical examination testing that correlates with o...

Background Ice hockey players have a high rate of hip pathology, which can lead to hip arthroscopy. Previous studies have not utilized team-based advanced performance statistics in the setting of hip arthroscopy in National Hockey League (NHL) players. Purpose/Hypothesis The purpose of this study was to use team-based advanced performance statisti...

Background Contamination of sterilized surgical instruments is not a typically suspected source of increased infection rate, especially if no abnormalities in the sterilization process are detected. Purpose/Hypothesis The purpose of this study was to report increased infection rates after knee ligament reconstructions due to undetectable steriliza...

Background A lateral extra-articular tenodesis (LET) is increasingly being utilized to augment an anterior cruciate ligament reconstruction because it has been shown to reduce the risk of postreconstruction graft failure or recurrent rotatory instability. Various femoral fixation techniques are available, including the use of an interference screw,...

Background Anterior cruciate ligament (ACL) stress techniques—including single-leg stress radiographs, Telos, and KT-1000 arthrometer—are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on ma...

Tears of the posterior medial meniscus root (PMMR) are common in older patients and reportedly contribute to rapid joint degeneration over time. Recognition of these tear types and the appropriate diagnosis through clinical exam and diagnostic imaging have improved significantly in recent years, as have surgical techniques to address them. Standard...

Background Multiligament knee injuries (MLKIs) are heterogeneous, and bicruciate knee ligament injuries are considered a serious form of this injury. The current literature tends not to distinguish between single and bicruciate MLKI when reporting outcomes. Purpose To investigate patient-reported outcomes after surgical treatment of MLKI comparing...

Background A new “terrible triad” has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well kn...

Background Fibular collateral ligament (FCL) injuries are uncommon incidents, with less favorable healing rates compared to medial collateral ligament injuries, often necessitating repair or reconstruction as the predominant treatment approach. Indications Using a partial-thickness biceps femoris tendon (PTBFT) autograft for FCL reconstruction or...

Impaction fractures of lateral femoral condyle (LFC-IF) are challenging entities following anterior cruciate ligament tears. Anatomic reduction and restoration of the native LFC curvature is crucial in their treatment, because if they are neglected, it may potentially lead to incongruence in the lateral knee compartment with subsequent cartilage de...

Quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is a well-known phenomenon, with more persistent quadriceps weakness observed after ACLR with a bone-patellar tendon-bone or quadriceps tendon autograft than with a hamstring tendon autograft. Longstanding quadriceps weakness after ACLR has been associated with suboptimal po...

Objectives To evaluate the displacement, stiffness after cyclical loading, and load to failure for a continuous vertical inside-out meniscal suture compared to a traditional vertical inside-out meniscal suture in a porcine medial meniscus. Methods Twenty-eight porcine knees were divided into 2 groups of 14 medial menisci each. A 2.0-cm longitudina...

Artificial intelligence (AI) implementation has begun to revolutionize healthcare and has the potential to improve many aspects of orthopedic care. Specifically, minimally invasive knee arthroscopic procedures utilize small incisions and an arthroscope to visualize and repair internal structures of the knee joint. Although relatively streamlined an...

Purpose Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix‐induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta‐an...

Nearly two decades ago, the posterolateral corner (PLC) was commonly referred to as the “dark side” of the knee due to our limited anatomical understanding, no anatomic-based reconstruction techniques, and high rates of clinical failures. During this time, non-anatomic PLC reconstruction techniques, or “fibular slings”, gained popularity early on d...

Purpose Posterior elongation of the physiological terminal sulcus (TS) due to lateral femoral condyle impaction fracture (LFC‐IF) after an anterior cruciate ligament (ACL) tear could potentially decrease the weight‐bearing area of the tibiofemoral joint, decrease the tension on lateral meniscus and cause flattening of the LFC which would influence...

Multiligament knee injuries (MLKIs) are complex and heterogeneous, often associated with concomitant injuries, and necessitates precise treatment strategies. Effective preoperative management in MLKIs requires comprehensive evaluation, starting with a detailed patient history to identify the mechanisms of injury and prior treatments. Physical exami...

Objectives Anterior cruciate ligament (ACL) reconstruction is the gold standard treatment for ACL tears. ACL graft reconstruction is commonly performed with an autograft. Common autograft modalities include bone-patellar tendon-bone (BPTB), quadriceps tendon (QT), and hamstring tendon (HT) grafts. This study sought to evaluate the general populatio...

Background Medial meniscal ramp lesions are disruptions at the meniscocapsular junction and/or meniscotibial attachment of the posterior horn of the medial meniscus, and occur in up to 42% of all acute anterior cruciate ligament (ACL) tears 1,3–5 . Ramp lesions are frequently missed because of the limited diagnostic sensitivity of magnetic resonanc...

Ramp lesions (RLs) are peripheral lesions that occur in the posterior part of the medial meniscus or where it attaches to the joint capsule. The classification of the medial meniscus RLs has been the focus of numerous studies and publications. This review provides an overview of RL's current classification and treatment options in anterior cruciate...

Heterotopic ossification (HO) and arthrofibrosis are known complications after medial collateral ligament (MCL) reconstruction and other arthroscopic procedures. They can result in clinically significant symptoms such as pain, swelling, and ankylosis. Surgical removal of HO and adhesions may provide relief of symptoms, as well as increased knee ran...

Background and Objective Anterior cruciate ligament reconstruction (ACLR) failures occur for various reasons including residual laxity, untreated concomitant injuries, poor graft quality, and high tibial slope. Various additional procedures can help to decrease revision ACLR failures including anterolateral complex (ALC) procedures and slope-reduci...

Background The menisci are critical for knee stability and cushioning and tears of the menisci have been linked to the acceleration of osteoarthritis. Horizontal cleavage tears split the meniscus into a top and bottom portion and are notoriously difficult to repair due to their localization in the avascular zone of the meniscus. Repair augmentation...

Background Patellar tendinopathy is a multifactorial condition characterized by micro-degenerative changes in the patellar tendon. This results from repeated stress to the knee extensor mechanism from explosive movement, axial malalignment, and/or abnormal patellar height. Currently, there is no standard surgical procedure for the treatment of seve...

Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies...

Background Little is known regarding the opinions of the general population on anterior cruciate ligament (ACL) graft options. Purpose To evaluate the general population's perception of the use of allografts versus autografts in ACL reconstruction using a previously validated online marketplace platform. Methods A prospective 34-question survey w...

Objectives The purpose of this paper was to compare patient reported outcomes (PROMs) between isolated anterior cruciate ligament (ACLR) and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs and compare PROMs between different medial meniscus ramp and lateral meniscus root repair techniques. Methods All patients with iso...

Objectives The purpose of this study was to radiographically assess changes in 1) patellar height, 2) anterior tibial translation (ATT), and 3) posterior tibial slope following supratubercle ACW-PTO and to compare changes in patellar height to a cohort of medial opening proximal tibial osteotomies (MOW-PTO). Methods Patients who underwent supratub...

Objectives The purpose of this study is to use standing anterior cruciate ligament (ACL) stress radiographs to evaluate how posterior tibial slope (PTS) compared to anterior tibial translation (ATT) in an injured knee. A secondary purpose was to determine how posterior tibial slope (PTS) affects ATT side-to-side difference. Our hypothesis was that...

Background In adults with anterior cruciate ligament (ACL) tears, bone bruises on magnetic resonance imaging (MRI) scans provide insight into the underlying mechanism of injury. There is a paucity of literature that has investigated these relationships in children with ACL tears. Purpose To examine and compare the number and location of bone bruis...

Various surgical techniques for medial patellofemoral ligament (MPFL) reconstruction have been described, commonly using hamstring auto- or allografts. Despite their widespread use, these techniques have limitations due to the tubular structure of the hamstring tendons, which does not match the flat, sail-like anatomy of the MPFL. Furthermore, over...

Recurrent multiligament knee injuries present unique challenges when performing revision ligament reconstructions. Bone tunnel widening is relatively common and considered a multifactorial condition that involves both biomechanical and biologic factors. When indicated, two-stage procedures ensure optimal revision reconstruction tunnel sizes and loc...

Background The fabella is a sesamoid bone that is a normal anatomic variant yet a rare cause of pathology in the posterolateral portion of the knee. The fabella can cause chronic knee pain in patients with knee osteoarthritis and athletes at all levels and in rare cases can cause neuropathy. Initially, treatment for a painful fabella includes conse...

Multi-ligament knee injuries (MLKI) are serious and challenging to manage. This study aimed to elucidate the impact of surgical timing on both early and long-term outcomes following an MLKI. A comprehensive search strategy was employed across PubMed, Scopus, Web of Science, and the Cochrane Library. Studies were identified using a combination of re...

Adhesions in the deep infrapatellar region may occur as iatrogenic complications (e.g., after boneepatellar tendonebone grafting), as part of arthrofibrosis or infrapatellar contracture syndrome, or owing to specific diseases such as Osgood-Schlatter disease. Described adhesions may limit the length of the functional portion of the patellar tendon...

Background Because of the increased prevalence of revision anterior cruciate ligament (ACL) reconstruction, there has been a desire to understand the role of posterior tibial slope on increased anterior tibial translation and increased ACL graft forces. One potential concern in supratubercle anterior closing wedge proximal tibial osteotomy (ACW-PTO...

Fibular collateral ligament (FCL) tears rarely occur in isolation and are typically injured in conjunction with another ligament, including the anterior cruciate ligament (ACL). Reconstruction of both ACL and the FCL is critical to restore proper knee biomechanics and stability. This technique describes an anatomic reconstruction of both the ACL us...

Background Anterior cruciate ligament reconstructions (ACLRs) are performed to restore knee biomechanics, increase knee stability, and slow the progression of osteoarthritis. After ACLRs, many patients still have residual anterolateral instability which is a risk factor for ACL graft failure. An anterolateral ligament reconstruction (ALLR) attempts...

Multiple ligament injuries are severe and complex injuries that commonly occur in the setting of trauma. A combination of history, physical exam, and diagnostic imaging should be used to fully assess the extent of the injury and identify any damage to the associated meniscal, articular, and neurovascular structures. Varus, valgus, and PCL stress ra...

Background Symptomatic genu recurvatum is defined as greater than 5° of knee hyperextension and can be caused by osseous deformity, soft tissue laxity, or a combination. Common symptoms include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee. I...

Multiple risk factors for anterior cruciate ligament (ACL) reconstruction graft failure have been reported, including improper tunnel placement, unrepaired meniscus or ligamentous injuries, and coronal/sagittal malalignment. Various biomechanical studies have reported on the increased forces experienced by the ACL graft when there is valgus malalig...

While infrequently reported, isolated injuries to the proximal tibiofibular (TF) joint primarily occur in young, athletic patients participating in sporting activities requiring explosive, high impact movements, increasing the risk for potential twisting injuries, especially across a hyperflexed knee. The proximal TF joint is stabilized by bony, mu...

Purpose The purpose of this study was to perform a scoping review of clinical practice guidelines (CPGs) concerning the use of functional anterior cruciate ligament (ACL) braces and to clarify the nomenclature for bracing relevant to ACL injury treatment in order to support prescribing clinicians. Methods A PubMed search for CPGs for the use of br...

Purpose The purpose of the present study was to perform a survey administered to members of the Meniscus International Network (MenIN) Study Group, seeking to delineate the most contentious aspects of meniscal extrusion classification and provide a foundation for new, more comprehensive definitions and treatments for these pathologies. Methods Men...

Background The popliteus tendon is a primary stabilizer of external knee rotation and has been described as the “fifth ligament of the knee.” Injuries involving the posterolateral corner of the knee commonly involve the popliteus tendon; isolated injury to the popliteus tendon is relatively rare and usually involves a rotatory injury mechanism and...

Anterior cruciate ligament (ACL) tears are one of the most common sport-related injuries and occur in greater than 3% of athletes in a four-year window of sports participation. Non-contact injuries are the most common mechanism for ACL injury in elite-level athletes, especially with increased valgus and external rotation of the knee when loading ec...

Background: Contributors to knee degeneration include mechanical axis malalignment, patellar maltracking, meniscal deficiency, and tibiofemoral instability. Full-thickness osteochondral defects in young, active patients can lead to significant pain and instability. The gold standard treatment for large (>2 cm2) osteochondral defects is an osteochon...

Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observe...

Background Medial meniscus root tears often lead to knee osteoarthritis. The extent of meniscal tissue changes beyond the localized root tear are unknown. Purpose To evaluate if 7 Tesla 3D T2*-mapping can detect intrasubstance meniscal degeneration in patients with arthroscopically verified medial meniscus posterior root tears (MMPRTs), and assess...

Background Anatomically, native posterior tibial slope (PTS) ranges from 6° to 10° and have significant effects on cruciate ligament stability. PTS <6° is correlated with increased posterior tibial translation (PTT) and force on the posterior cruciate ligament (PCL), predisposing individuals to PCL injuries and an increased risk of PCL graft attenu...