A new method for arthroscopic treatment of tibial eminence fractures with eyed Steinmann pins.

This report describes a new and simple method to treat tibial eminence fractures. We treated these fractures arthroscopically by using eyed Steinmann pins and pullout sutures of 1-0 polydioxane or 1-0 polypropylene monofilament under local anesthesia. From March 1993 to February 1997, we treated 16 patients with tibial eminence fractures. There were 12 cases of type II and 4 cases of type III fractures, according to the classification of Meyers and McKeever. All of the patients had good results according to the International Knee Documentation Committee and Müller's knee scoring systems, and had good stability by anterior stress radiographs compared with the uninjured side. Advantages of this method are minimal arthrotomy, simple technique, short operation and hospitalization times, early rehabilitation, no need for metal fixation removal, and, this procedure can be done under local anesthesia.

Anomalous insertion of the medial menisci.

Many types of meniscal anomalies have been reported. The authors encountered two cases of anomalous insertion of the anterior horn of the medial menisci to the lateral femoral condyle, which ran up along the course of the anterior cruciate ligament (ACL), but was independent of the ACL. These anomalies were noted during arthroscopic examination and surgery of the ipsilateral knee for a torn discoid meniscus and a patellar fracture. A 34-year-old woman had a horizontal tear of the lateral discoid meniscus. We performed arthroscopic partial meniscectomy of the inner torn portion of the lateral discoid meniscus and contoured it to resemble a normal meniscus. An anomalous insertion of the medial meniscus was found on examination of the joint during surgery. A 32-year-old man had a patellar fracture and we performed reduction under arthroscopy and internal fixation with cannulated screws. The same anomalous insertion of the medial meniscus was also found on examination of the joint during surgery. We report the cases with a review of the literature.

Arthroscopic second look findings of an anterior cruciate ligament bone-patellar tendon-bone autograft.

Nineteen patients who had undergone reconstruction of a deficient anterior cruciate ligament (ACL) by a bone-patellar tendon-bone (BPTB) autograft 12 months or more before (mean: 15.8 months) were evaluated by second-look arthroscopy. Prior to the arthroscopic evaluation the patients underwent a clinical evaluation of the results of ACL reconstruction: Muller's knee rating score and the radiographic results from lateral radiographs of the full extended knees were used. The location of the center of the tibial tunnel from the anterior end of the line of the tibial plateau was 35.2% (range: 22% to 47%) on average. The average intercondylar roof angle was 36.6 degrees (range: 28 degrees to 45 degrees). The mean percentage of roof impingement was -13.5% (range: -55% to +23%; the negative value implies no impingement, while the positive value suggests the presence of impingement). During the second-look arthroscopy the ACL graft had one or more of the following features: nearly normal appearance, incomplete synovial coverage, partially torn fibers at the femoral tunnel site, parallel fragmentation with cyclops lesion, and impingement without the damage of the ACL graft. Biopsy specimens were obtained from the nearly normal ACL graft during the second-look arthroscopy and light microscopic findings showed dense collagen fibers and spindle-shaped fibroblasts with a relatively regular arrangement (H&E, X 200). The electron microscopic findings showed that the fibroblasts had prominent indented nuclei and an abundant rough endoplasmic reticulum (X 10,200) and that the longitudinal sections of extracellular collagen fibrils demonstrated a type I collagen banding pattern (X 50,000).