Knee Meniscus Posterior Root Repair with FiberTak.

Repair of medial meniscal root tear is nowadays a validated procedure in order to restore knee biomechanics and to prevent early development of arthritis. There are various techniques described, without any being considered superior. This article describes a technique with a knotless suture anchor design, using a high posteromedial portal to insert the anchor and a meniscal suture passer device from the anteromedial portal.

Quadruple Semitendinosus Graft Construct With Double Cortical Suspensory Fixation for Anterior Cruciate Ligament Reconstruction: A Biomechanical Study.

The purpose of this study was to evaluate the biomechanical properties of a graft construct with quadrupled Semitendinosus and two cortical buttons with adjustable loops concerning elongation, stiffness and resistance. A total of 15 fresh human cadaveric semitendinosus tendons were quadrupled over the two adjustable loops and stitched at the tibial tip with a cerclage type suture. They underwent pre-tensioning at 300 N for 2 minutes followed by cyclic loading (1000 cycles between 50-250 N) and finally a load-to-failure test.

Rotational alignment in patient-specific instrumentation in TKA: MRI or CT?

Purpose: To compare CT-guided and MRI-guided patient-specific instrumentation in total knee arthroplasty (TKA).

Methods: Forty-four patients underwent primary TKA using either CT-guided or MR-guided Signature™ patient-specific instrumentation. They were prospectively assigned into two groups: 23 patients into the MR-guided instrumentation (group A) and 21 patients into the CT-guided patient-specific instrumentation (group B).

Quadruple Semitendinosus Graft Construct and Suspensory Button Fixation for Anterior Cruciate Ligament Reconstruction.

Surgical techniques for anterior cruciate ligament reconstruction are evolving, becoming less invasive, with fewer and smaller incisions, preservation of knee bone stock and tendons at the donor site, and better graft positioning and fixation. We describe an anterior cruciate ligament reconstruction technique that aims to preserve bone stock and spares the gracilis. The semitendinosus graft construct is prepared in a quadruple way and fixed with a cortical button in both tunnels, with increased stiffness and resistance of the graft construct.

Patient-specific instrumentation improves tibial component rotation in TKA.

Purpose: To compare the femoral and tibial components rotational alignment in total knee arthroplasty (TKA) performed either with conventional or with patient-specific instrumentation.

Methods: Forty-five patients underwent primary TKA and were prospectively randomized into two groups: 22 patients into the conventional instrumentation group (group A) and 23 patients into the Signature™ patient-specific instrumentation group (group B). All patients underwent computed tomography of the operated knee in the first week after surgery to measure the components rotation.

Is there a role for adult non-cultivated bone marrow stem cells in ACL reconstruction?

Purpose: To assess by magnetic resonance imaging (MRI) if adult non-cultivated bone marrow stem cells accelerate tendon-to-bone healing in the femoral tunnel, after hamstring anterior cruciate ligament (ACL) reconstruction.

Methods: Forty-three patients underwent ACL reconstruction and were prospectively randomized into two groups: 20 patients in the experimental group (group A) with adult non-cultivated bone marrow stem cells and 23 patients in the control group (group B) without adult non-cultivated bone marrow stem cells. All patients underwent MRI of the knee at three months after surgery to evaluate the signal-to-noise ratio of the interzone.

ACL reconstruction: effect of bone dowel on tibial tunnel enlargement.

Purpose: To evaluate prospectively if the impaction of a bone dowel in the tibial tunnel prevents the tunnels from enlarging beyond their original diameter.

Methods: Seventeen patients underwent arthroscopically assisted ACL reconstruction with hamstring autologous graft. All patients underwent CT of the knee on the day of surgery, at 3 months and 12 months post-op.

ACL reconstruction: comparison between transtibial and anteromedial portal techniques.

Purpose: The purpose of this study was to compare the transtibial reconstruction technique of the anterior cruciate ligament (ACL) with the anteromedial (AM) portal technique in their ability to place the femoral and tibial tunnels within the ACL footprints.

Methods: Forty patients were sequentially enrolled in two different surgical techniques, 20 patients in the transtibial and 20 patients in the AM portal technique. All patients underwent computed tomography scan of the operated knee.

Anterior lateral meniscofemoral ligament with congenital absence of the ACL.

Purpose: to describe agenesis of the anterior cruciate ligament (ACL) with an anterior lateral meniscofemoral ligament.

Methods And Results: case report of a 13-year-old girl with an absent ACL and with an anterior lateral meniscofemoral ligament instead, as well as absence of the anterior insertion of the lateral meniscus in the tibia and a discoid ring-like lateral meniscus, with hypoplasia of the lateral femoral condyle. At arthroscopy, the anterior lateral meniscofemoral ligament was found to arise from the anterior horn of the lateral meniscus and insert into the posterolateral aspect of the intercondylar notch, mimicking the course of the native ACL on magnetic resonance imaging (MRI).

Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction.

Two different approaches for drilling the femoral tunnel are commonly used in single-bundle anterior cruciate ligament (ACL) reconstruction: creating the femoral tunnel through the tibial tunnel or drilling the tunnel through a low anteromedial arthroscopy portal. When using a transtibial drilling technique, the location of the femoral tunnel is restricted by the angulation of the tibial tunnel in the coronal plane and may lead to a high placement of the femoral tunnel in the intercondylar notch. However, some authors refer that the femoral tunnel can be positioned correctly in the center of the femoral ACL footprint by means of a transtibial technique if the tibial tunnel forms an angle between 60 degrees and 65 degrees to the medial joint line of the tibia in the coronal plane.

Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem?

Tunnel enlargement after anterior cruciate ligament (ACL) reconstruction may compromise revision surgery. The cause of this tunnel enlargement is not yet fully understood, but it is thought to be multifactorial, with biomechanical and biological factors playing a role. Tunnel enlargement has been described particularly in patients who underwent ACL reconstruction with hamstring tendons with extracortical fixation devices.

Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?

Recently, the use of hamstring tendons in anterior cruciate ligament repair has been increasing. However, tendon-to-bone healing occurs slowly, which can be a problem to an early return to sport activities. The use of growth factors from platelets seems to improve tissue healing.