Cortical Suspensory Button Versus Aperture Interference Screw Fixation for Knee Anterior Cruciate Ligament Soft-Tissue Allograft: A Prospective, Randomized Controlled Trial.

Purpose: To compare anterior cruciate ligament (ACL) soft-tissue allograft reconstruction using suspensory versus aperture fixation.

Methods: After we performed prospective power analysis and obtained institutional review board approval, as well as patient consent, 64 patients were block randomized among 3 study sites to the aperture fixation group or suspensory fixation group. All patients underwent all-inside ACL reconstruction with soft-tissue allograft using either (1) femoral and tibial joint-line fixation with a femoral cannulated interference screw and a tibial cannulated interference retrograde screw (aperture) or (2) femoral and tibial cortical buttons (suspensory).

Risks, benefits, and evidence-based recommendations for improving anterior cruciate ligament outcomes.

Recently, injuries to the anterior cruciate ligament and subsequent surgical reconstructions have seen a great increase in interest from the perspectives of basic science, anatomy, mechanics, and clinical outcomes. Over the past few years, an emerging body of evidence has shown the importance of a more anatomic anterior cruciate ligament reconstruction, which uses sound anatomic and surgical principles, identifies an ideal graft for the patient, and ensures that all aspects of care (including postoperative rehabilitation) are fully addressed. It is helpful for orthopaedic surgeons to review the surgically relevant anatomy of the anterior cruciate ligament, graft choices, fixation techniques and constructs, and rehabilitation guidelines to optimize outcomes for their patients.

Minimally invasive posterior hamstring harvest.

Autogenous hamstring harvesting for knee ligament reconstruction is a well-established standard. Minimally invasive posterior hamstring harvest is a simple, efficient, reproducible technique for harvest of the semitendinosus or gracilis tendon or both medial hamstring tendons. A 2- to 3-cm longitudinal incision from the popliteal crease proximally, in line with the semitendinosus tendon, is sufficient.

Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel.

Purpose: The purpose of this investigation was to compare the clinical effectiveness of full-tunnel anterior cruciate ligament (ACL) reconstructive surgery with all-inside ACL reconstruction.

Methods: After statistical power analysis was performed and institutional review board approval and patient informed consent were obtained, 150 patients having ACL reconstruction were prospectively randomized to an all-inside or full-tibial tunnel technique. Outcome (International Knee Documentation Committee [IKDC] Knee Examination Form, IKDC Subjective Knee Evaluation Form, Knee Society Score [KSS], Short Form 12 [SF-12] score, femoral or tibial tunnel or socket widening, narcotic consumption, and visual analog scale [VAS] pain score compared with baseline) was measured and recorded preoperatively and at various postoperative time points with a minimum follow-up of 2 years.

Technique for creating the anterior cruciate ligament femoral socket: optimizing femoral footprint anatomic restoration using outside-in drilling.

Purpose: The purpose of this study was to investigate and optimize anterior cruciate ligament (ACL) femoral outside-in drilling technique with a goal of anatomic restoration of the footprint morphologic length, width, area, and angular orientation.

Methods: Ex vivo, computer navigation was used to create virtual 3-dimensional maps of femoral bone tunnels for ACL drill guide pin insertion paths on small, medium, and large models of averaged femora considering various pin insertion angles to the femur. We then determined which pin insertion angle resulted in an ACL femoral footprint optimally matching normal human anatomic length, width, area, and angular orientation of the footprint long axis.

Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction.

Purpose: The purpose of this study was to determine the cost-effectiveness of knee arthroscopy and anterior cruciate ligament (ACL) reconstruction.

Methods: Retrospective analysis of prospectively collected data from a single-surgeon, institutional review board-approved outcomes registry included 2 cohorts: surgically treated knee arthroscopy and ACL reconstruction patients. Our outcome measure is cost-effectiveness (cost of a quality-adjusted life-year [QALY]).

All-inside anterior cruciate ligament graft-link technique: second-generation, no-incision anterior cruciate ligament reconstruction.

We describe an anatomic, single-bundle, all-inside anterior cruciate ligament (ACL) graft-link technique using second-generation Flipcutter guide pins (Arthrex, Naples, FL), which become retrograde drills, and second-generation cortical suspensory fixation devices with adjustable graft loop length: femoral TightRope (Arthrex) and tibial ACL TightRope-Reverse Tension (Arthrex). The technique is minimally invasive using only four 4-mm stab incisions. Graft choice is no-incision allograft or gracilis-sparing, posteriorly harvested semitendinosus material.

A 3.5-mm-diameter anterior cruciate ligament tibial retrograde socket drilling pin is more accurate than a 2.4-mm-diameter pin.

Purpose: The purpose of this study was to evaluate the accuracy of a 3.5-mm-diameter anterior cruciate ligament (ACL) tibial retrograde socket drilling pin versus a standard, 2.4-mm drill-tipped guide pin.

Anterior cruciate ligament femoral tunnel length: cadaveric analysis comparing anteromedial portal versus outside-in technique.

Purpose: The purpose was to measure anterior cruciate ligament (ACL) femoral tunnel lengths comparing anteromedial (AM) portal and outside-in techniques.

Methods: ACL femoral guide pins were drilled into 12 cadaveric knees through the AM portal technique and then the outside-in technique in each specimen. Pin intraosseous distance was measured in millimeters by a MicroScribe 3-dimensional digitizer (Immersion, San Jose, CA).

Anterior cruciate ligament tibial guide pin accuracy and surgical precision: comparing 3.0-mm and 2.4-mm guide pins.

Purpose: The purpose of this study was to evaluate the accuracy of a 3.0-mm-diameter anterior cruciate ligament (ACL) tibial guide pin versus a standard, 2.4-mm drill-tipped guide pin.

All-inside ACL: retroconstruction controversies.

All-inside anterior cruciate ligament reconstruction is controversial because the technique is new; as a result, evidence-based clinical outcome studies have yet to be published. The purpose of this article is to consider the following controversies (considered alphabetically): anatomy, biomechanics, biology, bioabsorbables, divergence of the femoral interference screw, expansion or widening of tunnels, fixation, future considerations, graft choice, the learning curve, technique, tensioning, and tibia blow-out fracture. The technique should be learned in stages.

Magnetic resonance imaging of the postoperative meniscus.

Imaging of the postoperative meniscus is a challenge. Nevertheless, magnetic resonance imaging (MRI) of the symptomatic knee after meniscal surgery is a valuable diagnostic study of both the menisci and the entire joint. At present, symptomatic patients who have had partial meniscectomy of less than 25% may be evaluated by MRI.

Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions.

Creating the anterior cruciate ligament (ACL) femoral socket using the anteromedial (AM) portal technique has advantages. Furthermore, the technique is ideal for anatomic double-bundle (particularly posterolateral bundle) and all-inside ACL techniques. However, although the AM portal technique has advantages, the learning curve is steep when making the transition from familiar, transtibial reaming to the AM portal technique for ACL femoral tunnel creation.

Operative versus nonoperative treatment of anterior cruciate ligament rupture in patients aged 40 years or older: an expected-value decision analysis.

Purpose: Our purpose was to determine the optimal treatment of anterior cruciate ligament (ACL) rupture in patients aged 40 years or older.

Methods: Our method was expected-value decision analysis with sensitivity analysis, which is a systematic tool for quantitating clinical decisions. We evaluated 100 randomly selected individuals aged 40 years or older with regard to the following variables: age, gender, activity level (International Knee Documentation Committee form), and visual analog scale regarding potential outcome preferences.

Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis.

Background: The anterior cruciate ligament (ACL) has 2 anatomic bundles. Standard ACL reconstruction is with a single-bundle graft, but double-bundle reconstruction may better control knee rotational torque, a potential cause of failure after single-bundle reconstruction. The authors investigated outcomes of single-bundle versus double-bundle ACL reconstruction.

Current concepts review: comprehensive physical examination for instability of the knee.

A careful history and physical examination are the cornerstones of orthopaedic sports medicine. When evaluating a patient for ligamentous instability of the knee joint, an understanding of the contribution of anatomic structures to stability enhances a practitioner's ability to achieve an accurate clinical diagnosis. This article reviews the various types of knee instability and the associated anatomic structures.

Return to activity after knee arthroscopy.

Purpose: Although knee arthroscopy is described as minimally invasive, return to activity has been poorly quantitated. Our purpose is to test the hypothesis that most patients return to unrestricted activity within 4 weeks after knee arthroscopy.

Methods: After prospective power analysis, 72 consecutive patients who underwent arthroscopic knee partial medial meniscectomy, partial lateral meniscectomy, chondroplasty, loose body removal, or synovectomy (or some combination thereof) by a single surgeon were included.

Do anterior cruciate ligament allograft culture results correlate with clinical infections?

Purpose: In 1998, four cases of contaminated allografts for anterior cruciate ligament (ACL) reconstruction resulted in Clostridium infection, and a patient with Clostridium infection from a femoral condylar allograft died. It was subsequently published that implanting surgeons should culture ACL allografts so that action could be taken should highly pathogenic bacteria be encountered. The purpose of this study is to test the hypothesis that ACL allograft cultures correlate with clinical infections.

The superior-medial shoulder arthroscopy portal is safe.

Purpose: The superior-medial (SM) shoulder arthroscopic portal (Neviaser portal) is the portal anatomically closest to the suprascapular nerve, and any potential benefits of this portal would be mitigated if risk of suprascapular nerve injury were significant. The purpose of this study is to determine the safety of the SM arthroscopic shoulder portal. We hypothesize that the SM shoulder arthroscopic portal is safe.

Meniscus allograft transplantation: a current concepts review.

Meniscus allotransplantation represents the biological solution for the symptomatic, meniscus-deficient patient who has not developed advanced osteoarthritis. A growing body of evidence suggests that pain relief and functional improvement may reliably be achieved at short- and medium-term follow-up, and even, in some cases, at long-term (>10 years) follow-up. Future research must address the issue of optimal timing of the procedure and whether meniscal transplantation results in demonstrable long-term benefits, especially with regard to protection of articular cartilage.

Interference screw technique for arthroscopic reduction and internal fixation of compression fractures of the tibial plateau.

Arthroscopic reduction and internal fixation (ARIF) is recommended as state-of-the-art treatment for patients with pure compression fracture of the tibial plateau. We describe a new technique for ARIF of pure compression tibial plateau fractures that uses a cannulated, bioabsorbable interference screw. After a guide pin is placed in the center of the compressed fragment and a tamp is used to elevate the fracture (with bone grafting as desired), the interference screw is advanced over the guide pin, resulting in both elevation and buttressing of the fracture.

Complications in the treatment of medial and lateral sided injuries of the knee joint.

Complications may result from nonoperative and surgical management of medial or lateral sided knee injuries. Because these injuries are often associated with injury to the medial or lateral meniscus and the anterior or posterior cruciate ligaments (ACL and PCL, respectively), injury to these structures will also be considered. We group these complications in 3 categories: (1) complications associated with either operative or nonoperative management, (2) intraoperative complications, and (3) postoperative complications.

Thermal modification of the lax anterior cruciate ligament using radiofrequency: efficacy or catastrophe?

Alchemists dream of using energy to turn base metal to gold. "Shrinkers" use energy to transform laxity to stability. While alchemists search for the mechanism to achieve their goal, shrinkers have thermal energy (heat) and scientific ground for their pursuit.

Arthroscopic rotator cuff repair: the learning curve.

Purpose: The purpose of this study was to answer the question: How many cases are required for a surgeon to become proficient in performing arthroscopic rotator cuff repair? We hypothesize that as surgical experienced is gained, learning can be quantitatively shown by a significant decrease in operative time.

Type Of Study: Prospective case series.

Methods: Rotator cuff repair time (RCRT) in minutes (as well as other time components comprising total surgical time) was recorded for 100 consecutive patients having arthroscopic rotator cuff repair performed by a single surgeon beginning with his first case in private practice.

Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures.

Arthroscopic reduction and internal fixation (ARIF) of tibial intercondylar eminence fractures is the emerging state-of-the-art. ARIF is recommended for displaced type III fractures and should be considered for all cases of displaced type II fractures. Fractures without displacement after closed reduction require careful evaluation to rule out meniscal entrapment.