Mucoid Degeneration of Anterior Cruciate Ligament-A Systematic Approach for Debulking.

Anterior cruciate ligament (ACL) mucoid degeneration is an underdiagnosed condition that occurs when mucinous material develops in the ACL in the absence of synovial lining. Several authors have diagnosed this condition, discussed their own personal observations, and put forward their own suggestions for management. When diagnosed, one important strategy for management entails "debulking" the ACL using an arthroscopic debridement. No protocol has been described on the sequence of steps for ACL debridement during arthroscopy. We present our own in this Technical Note, with the addition of video footage that describes our arthroscopic technique for ACL mucoid degeneration debridement using radiofrequency ablation and the sequence of steps. This Technical Note aims to demonstrate the procedure needed for arthroscopic debulking of a mucoid ACL, which will lessen ACL impingement while maintaining a stable knee.

Bailout Options for Intra-operative Implant and Instrumentation Related Incidents and Complications During Arthroscopic Knee Surgery-A Retrospective Study.

Background: Arthroscopic knee procedures are one amongst the common surgical interventions for problems in the knee. It is technically more demanding than an open procedure and is associated with several potential complications. During arthroscopy procedures, several technical challenges may arise, and even experienced surgeons may encounter new issues. However, careful attention to the surgical technique can help prevent or resolve them. Methodology: The study was conducted on all patients who underwent knee arthroscopy procedure during study period. We recorded details of the implants used and any unexpected situations related to them, as well as how they were managed. Instrumentation-related parameters such as screwdriver issues, radiofrequency ablator issues, scope damages, shaver complications, probe complications, and meniscus suture passing devices were also assessed. Results: In total, there were 12 (3.73%) implant and instrument-related incidents and complications, of which 5 (1.55%) were implant-related and 7 (2.17%) were instrument related. Among the instrumentation-related incidents and complications, two (0.62%) were screwdriver breakage incidents, two (0.62%) were radiofrequency ablator-related incidents, one was arthroscopic probe (0.31%) related incident, one (0.31%) was meniscus suture passing device related complication and one (0.31%) was arthroscope related incident. Conclusion: Surgeons must be ready to anticipate and effectively manage any technical difficulties that may arise during the procedure, maintaining composure in the face of unexpected challenges and guiding the team. In most cases, incidents can be addressed intra operatively and may not have long-term effects on patient outcomes. It is crucial to have multiple implant and instrument backup options available for successful surgery.

Periosteum-Augmented Soft-Tissue Graft for Anterior Cruciate Ligament Reconstruction.

Soft-tissue grafts are an option for anterior cruciate ligament reconstruction. One of the major drawbacks of soft-tissue grafts is the delay in the osteointegration and ligamentization of the implanted graft. Enveloping the ends of the graft with periosteum sleeves can hasten the osteointegration process and help in quicker rehabilitation of the patient. This article describes a simple and unique way to augment the soft-tissue graft with periosteum for anterior cruciate ligament reconstruction.