Graft Reorientation and Lateral Extra-articular Tenodesis in Revision Surgery for Persistent Rotational Instability of a Verticalized Anterior Cruciate Ligament Graft.

Persistent rotational instability after anterior cruciate ligament reconstruction is a relatively common postoperative complication, typically associated with graft verticalization due to improper femoral tunnel placement, especially with classic transtibial femoral tunnel techniques. This article describes a technique designed to reorient a verticalized anterior cruciate ligament graft at its femoral insertion to a more anatomic position in the coronal and sagittal planes, aiming to restore knee stability without the need for a complete revision operation. Additionally, a lateral extra-articular tenodesis with fascia lata is added to reinforce rotational stability.

The Proportion of Meniscus Tears Considered Repairable, and Thus Repaired, Increased During a Single Surgeon's Practice of 20 Years.

Purpose: The purpose of this study was to evaluate practice patterns of a single surgeon with respect to meniscectomy and meniscal repair over a 20-year period at a single institution.

Methods: A cross-sectional descriptive study was carried out by reviewing the surgical data from the past 20 years (2002-2021) of patients who underwent arthroscopic primary meniscal surgery. Age, sex, knee and meniscus affected, morphology of the meniscal tear, meniscal radial location, location on the axial plane, tissue quality, and associated injuries were recorded.

Improved tibiofemoral contact restoration after transtibial reinsertion of the anterior root of the lateral meniscus compared to in situ repair: a biomechanical study.

Purpose: To compare biomechanical behaviour of the anterior root of the lateral meniscus (ARLM) after a transtibial repair (TTR) and after an in situ repair (ISR), discussing the reasons for the efficacy of the more advantageous technique.

Methods: Eight cadaveric human knees were tested at flexion angles from 0° to 90° in four conditions of their ARLM: intact, detached, reinserted using TTR, and reinserted using ISR. Specimens were subjected to 1000 N of compression, and the contact area (CA), mean pressure (MP), and peak pressure (PP) on the tibial cartilage were computed.

Anterior Cruciate Ligament Revision Surgery Associated to Lateral Collateral and Anterolateral Ligaments Reconstruction With Single Achilles Tendon Allograft and Single Femoral Tunnel.

Lateral collateral ligament (LC) injuries that go unnoticed when associated with an anterior cruciate ligament (ACL) tear can increase stress forces on the ACL graft causing its failure. Furthermore, it is a main stabilizer to varus stress and external rotation. On the other hand, the reinforcement of anterolateral structures during ACL reconstruction has regained popularity in recent years, because evidence has shown that it increases the control of rotational laxity and decreases ACL graft failures, especially in revision surgery.

Biomechanical consequences of anterior root detachment of the lateral meniscus and its reinsertion.

Treatment of posterior meniscal roots tears evolved after biomechanical evidence of increased pressures on the tibiofemoral cartilage produced by this lesion and the subsequent accelerated development of arthritis or osteonecrosis observed clinically. However, little is known about the consequences of the detachment of the anterior roots. This in-vitro study analyzes the biomechanical changes in the tibiofemoral joint caused by avulsion of the anterior root of the lateral meniscus.

Arthroscopic Superior Capsular Reconstruction with Achilles Tendon Allograft for Massive and Revision Rotator Cuff Tears.

Massive irreparable rotator cuff tears (RCT) in younger and active patients remain a significant clinical challenge to orthopaedic surgeons. Superior capsular reconstruction (SCR) has been presented as a way to restore the restraining effect of the superior joint capsule and the balanced force couples necessary for dynamic shoulder function; furthermore, it does not exclude future treatment options. The purpose of this article is to show a technical modification of the SCR in massive and revision RCT using Achilles tendon allograft as an effective static restraint to prevent superior migration of the humeral head due to its thickness and robustness, and performing a side-to-side repair on the greater tuberosity between the graft and the residual infraspinatus tendon to completely restore the superior stability of the shoulder joint.

Anterior Capsular Reconstruction With Proximal Biceps Tendon for Large to Massive Rotator Cuff Tears.

Massive rotator cuff tears (RCT) have traditionally been a challenging clinical problem for shoulder surgeons. A broad variety of treatment options have been proposed to address this problem, but outcomes have been as variable as the techniques themselves. Superior capsular reconstruction has been presented as a way to restore the restraining effect of the superior joint capsule and balanced force couples in massive tears of the superior rotator cuff.

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings.

A technique for augmentation of the anterior cruciate ligament (ACL) with hamstring graft and lateral extra-articular tenodesis is presented. The patient is positioned supine with the knee flexed 90°. First, intra-articular injuries are addressed arthroscopically, and then autologous hamstring tendons are harvested and measured; the present technique is a resource for cases with a very small graft diameter (less than 8 mm), due to thin tendons or to tendon breakage, even after tripling the hamstring graft, which is prepared using a facia lata strip long enough to fit the lengths of the femoral tunnel, the anterior cruciate ligament graft, and the tibial tunnel.

Physeal Sparing Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients Bridging the Tibial Physis With Two Divergent Tunnels.

A technique for anterior cruciate ligament (ACL) reconstruction in patients with open physis is presented. The patient is positioned supine with the knee flexed 90°. After intraarticular injuries are addressed, an autologous hamstring graft is harvested and prepared using a suspension device attached in its expansion device.

Assessment of fixation for anterior cruciate ligament reconstruction using oversized suspensory devices on full-length femoral tunnels.

Background: In ACL repair, full-length single-diameter tunnels facilitate anatomic femoral fixation with suspensory devices, especially with outside-in techniques, and are required after accidental cortical perforation. With tunnel diameters over 6 mm, fixation resistance using regular suspensory devices may not suffice. Oversized cortical footprint devices could be a solution to guarantee fixation performance in larger tunnel diameters.

The Finochietto Sign as a Pathognomonic Finding of Ramp Lesion of the Medial Meniscus.

Ramp lesions are considered hidden injuries of the medial meniscus and are very difficult to diagnose. The Finochietto jump sign is a very specific finding that could be considered pathognomonic regarding ramp lesions. This sign consists of a sudden jerk that appears when the free edge of the posterior horn of the medial meniscus is dislocated anteriorly due to the medial condyle interposition when an anterior drawer test is performed on a knee with a ramp lesion, especially when it is associated with an anterior cruciate ligament tear.

Initial Biomechanical Properties of Transtibial Meniscal Root Repair are Improved By Using a Knotless Anchor as a Post-Insertion Tensioning Device.

The importance of meniscal root integrity to preserve contact load distribution and stability at the knee joint is recognised. Transosseous suture technique is commonly used to repair meniscal root tears. However, clinical results are not completely satisfactory.

Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study.

The purpose of this study was to analyze the effect of obesity and other clinical factors on the outcome of meniscal allograft transplantation (MAT) with transosseous fixation. A retrospective cohort study was performed on patients who underwent a MAT between 2002 and 2017. All the participants had a minimum follow-up period of 24 months.

Non anatomic reinsertion after amputation of the anterior horn of the lateral meniscus.

Anatomical reinsertion is the optimal treatment for meniscal root injuries. However, in chronic settings, tissue fraying of the meniscal root may impede it. This study describes a salvage technical procedure performed in 3 cases of chronic anterior root avulsion of the lateral meniscus with profuse tissue degeneration in which remnant debridement resulted in amputation of the root.

One-Third of Meniscal Tears Are Repairable: An Epidemiological Study Evaluating Meniscal Tear Patterns in Stable and Unstable Knees.

Purpose: To analyze, in a long series of patients with knee injuries, the meniscal tear patterns in both stable and unstable knees to ascertain the exact proportion of such injuries that could have been repaired.

Methods: A descriptive cross-sectional study was undertaken by reviewing the clinical reports of arthroscopic knee operations carried out in 1 hospital. A total of 2,066 consecutive patients were included in the study.

Arthroscopic Treatment of Concurrent Avulsion Fracture of Anterior and Posterior Cruciate Ligament with Suspension Device.

Introduction: Simultaneous avulsion fractures of the insertion of both cruciate ligaments of the knee are extremely uncommon lesions and their treatment remains difficult. The purpose of this paper is to show an arthroscopic repair technique of simultaneous tibial avulsion fracture of both cruciate ligaments of the knee such by using an adjustable length suspension device.

Case Report: A 25-year-oldmale patient was treated by arthroscopic reduction and fixation of both bony avulsion of cruciate ligaments of the knee with a sliding and adjustable length suspension device (ZipTight, Biomet, Warsaw, IN, USA).

Associated Anterior Cruciate Ligament and Fibular Collateral Ligament Reconstruction With Single Femoral Tunnel and Asymmetric Hamstring Tendon Graft.

A technique for associated anterior cruciate ligament and fibular collateral ligament reconstruction is shown, using a single hamstring tendon graft, which is prepared asymmetrically, leaving one-third of the length with a single diameter and two-thirds with a double diameter. A single femoral tunnel is created, using an interference screw for fixation and isolation of the grafts. A suspension device is used for tibial fixation, allowing for length adjustment according to the graft's length.

"Over the Top" Augmentation for Partial Anterior Cruciate Ligament Tears Using Suspension Device for Tibial Fixation.

A technique for augmentation of the partial anterior cruciate ligament is presented. The patient is positioned supine with the knee flexed 90°. After addressing intra-articular injuries, the autologous semitendinosus tendon is harvested and measured in a doubled manner; after that, the tibial tunnel is performed in the outside-in direction, of the same diameter of the doubled graft.

Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft.

The anterior cruciate ligament (ACL) rupture is a common disease that accounts for 250,000 cases/year in the United States. The anterolateral ligament (ALL) has been suggested to be an important restraint for rotational instability, and its reconstruction provides a reinforcement to the ACL reconstruction in this aspect, especially in high-demand athletes and in knees with high-grade pivot shift. Different techniques for associated ACL and ALL reconstruction have been described, but the ideal technique remains unclear.

The role of suture cutout in the failure of meniscal root repair during the early post-operative period: a biomechanical study.

Purpose: To assess the role of suture cutout in the mechanics of failure of the repaired posterior meniscal root during the early post-operative period when using sutures of different shape.

Methods: Twenty medial porcine menisci were randomized in two groups depending on the suture shape used to repair the posterior root: thread or tape. The sutured menisci were subjected to cyclic loading (1000 cycles, (10, 30) N) followed by load-to-failure testing.

Transosseous Posterior Meniscal Root Reinsertion Using Knotless Anchor for Tibial Fixation.

A technique for posterior meniscal root reinsertion is presented. With the arthroscope in the central transtendinous portal for a better view, a 5-mm transtibial tunnel is created with the aid of an anterior cruciate ligament guide open to 45°. A suture device, which consists of a long needle with an eyelet on its tip, is introduced through the tunnel with a suture thread inserted through the eyelet, while the meniscus is stabilized with a grasper inserted through the anterior portal.

Posterior Cruciate Ligament Reconstruction With Hamstring Tendons Using a Suspensory Device for Tibial Fixation and Interference Screw for Femoral Fixation.

A technique for posterior cruciate ligament reconstruction is presented. Autologous hamstring tendons are selected as a graft. An interference screw is used for femoral fixation.

Comparative Biomechanical Study on Contact Alterations After Lateral Meniscus Posterior Root Avulsion, Transosseous Reinsertion, and Total Meniscectomy.

Purpose: To compare the effects of lateral meniscus posterior root avulsion left in situ, its repair, and meniscectomy on contact pressure distribution in both tibiofemoral compartments at different flexion angles.

Methods: Eight cadaveric knees were tested under compressive 1000 N load for 4 lateral meniscus conditions (intact, posterior root avulsion, transosseous root repair, and total meniscectomy) at flexion angles 0°, 30°, 60°, and 90°. Contact area and pressure distribution were registered using K-scan pressure sensors inserted between menisci and tibial plateau.

Anatomic outside-in anterior cruciate ligament reconstruction using a suspension device for femoral fixation.

Cortical suspension is one of the most frequently used methods of femoral fixation in anterior cruciate ligament reconstruction. We present a simple technique for anterior cruciate ligament reconstruction using a suspension device for femoral fixation. The purposes of this technique are to ensure greater contact between the graft and the tunnel walls-a goal that is achieved by using the femoral fixation device with the shortest possible loop-to avoid the flip step and the need for hyperflexion, and in short, to minimize the risk of complications that can occur when using the anteromedial portal to drill the femoral tunnel.

Outcomes after repair of chronic bucket-handle tears of medial meniscus.

Purpose: The purpose of this study was to determine the outcomes after repair of chronic bucket-handle medial meniscal tears by use of magnetic resonance imaging, clinical examination, and patient-reported outcomes.

Methods: A retrospective review of patients with chronic bucket-handle medial meniscal tears that had been repaired with meniscal sutures was undertaken. The following criteria for inclusion were adopted: minimum tear length of 2 cm and chronic medial meniscal tear identified at the time of arthroscopy.