Percutaneous Intramedullary Application of Stem Cells for Fifth Metatarsal Fractures Treated With a Cannulated Screw.

Non-union and refracture of fifth metatarsal fractures are common and devastating complications in the athletic population. Stem cell application at the fracture site, for biologic enhancement, is utilized to address this challenge. We present a simple technique to approach both the endosteum and the periosteum percutaneously, under a local anesthetic, in cases of cannulated screw intramedullary fixation.

Gross Measurement of Intraarticular Graft Length in All-Inside Anterior Cruciate Ligament Reconstruction.

Intra articular length (IAL) of the graft has not been measured yet in anatomic, single bundle, anterior cruciate ligament (ACL) reconstruction. Especially in the all-inside ACL reconstruction technique, the IAL of the graft is of great importance due to the philosophy of the technique and the risk of graft "bottoming out". We present a simple arthroscopic measurement of the IAL of the ACL graft in anatomic, single bundle ACL reconstruction, that will allow optimal application of the all-inside technique.

Clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults.

PURPOSE: The purpose of this study was to evaluate the clinical outcome of arthroscopic suture fixation for tibial eminence fractures in adults. METHODS: Twelve patients with a mean age of 29.9 years (range, 18 to 45 years) were prospectively followed up after arthroscopic suture fixation for tibial eminence fractures. Along with clinical examination, Lysholm, Tegner, and International Knee Documentation Committee (IKDC) rating scales were used to evaluate the patients. Anteroposterior knee laxity was measured with a Rolimeter (Aircast, Vista, CA), and range of motion was measured with a goniometer. RESULTS: Patients were followed up for a mean of 50 months (range, 25 to 69 months). There were no detectable signs or symptoms of instability postoperatively. The mean preinjury Tegner score was 6.1 (range, 3 to 9), and at follow-up, the mean Tegner score was 5.8 (range, 3 to 9). No Lysholm or IKDC scores were obtained and no range-of-motion measurements were performed preoperatively because all injuries were acute. The mean Lysholm score was 98 (range, 94 to 100), and the mean IKDC score was 94.7 (range, 89.1 to 100). Anterior translation of the tibia, measured with the Rolimeter, was 0.58 mm on average (range, 0 to 3 mm) compared with the healthy side. Postoperatively, the mean extension deficit was 1° (range, 0° to 5°) and the mean flexion deficit was 2.7° (range, 0° to 10°) compared with the unaffected side. Overall, knees were graded as normal or nearly normal in 11 patients and abnormal in 1. CONCLUSIONS: Tibial eminence fractures in adults can be effectively treated with arthroscopic suture fixation. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation.

Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction has been well studied and recognized as the cause of unsatisfactory clinical results. Various anterolateral techniques have been described as an adjunct to the ACL reconstruction to improve clinical outcomes. Modified deep Lemaire lateral extra-articular tenodesis has been tested both biomechanically and clinically and proved an efficient solution in controlling tibia internal rotation, when performed in conjunction with ACL reconstruction. We describe a simple, versatile, effective, and reproducible technique of lateral extra-articular tenodesis, using common suspensory femoral fixation, with no additional cost and surgical risk.

Isolated Popliteus Tendon Avulsion: Fully Arthroscopic Repair with Suture Anchor: A Case Report.

CASE: Isolated popliteus tendon avulsion is an extremely rare injury with no consensus in the literature, regarding the therapeutic approach. In our case, the patient presented with rotational instability of the knee, and he was treated surgically. A fully arthroscopic technique with suture anchors was used, and this is the first report of such a repair in the literature. Knee stability was successfully restored, and the patient remains asymptomatic 2 years postoperatively. CONCLUSION: Isolated popliteus tendon avulsion can result in knee instability. Arthroscopic repair with suture anchors is an efficient way of treatment.

Oxidative stress and inflammatory responses following an acute bout of isokinetic exercise in obese women with knee osteoarthritis.

BACKGROUND: Obesity is associated with osteoarthritis and it is accompanied by chronic inflammation and elevated oxidative stress. Strengthening-type exercise is used in knee osteoarthritis (KOA) rehabilitation. This study determined how acute isokinetic exercise influences inflammatory responses of obese middle-aged women with KOA. METHODS: Ten obese women with KOA and 10 age/weight-matched controls performed an isokinetic exercise protocol. Assessment of performance (knee extensor/flexor torque), muscle soreness (DOMS), knee flexibility (KJRM), and pain, and blood collection were performed pre-exercise, post-exercise, and at 24h post-exercise. Blood was analyzed for creatine kinase activity (CK), lactate dehydrogenase activity (LDH), CRP, leukocytes, uric acid, IL-6, TBARS, lipid hydroperoxides (LPX), protein carbonyls (PC), oxidized (GSH) and reduced glutathione (GSSG), total antioxidant capacity (TAC), catalase activity, and glutathione peroxidase activity (GPX). RESULTS: Physical function remained unaltered by exercise (only torque at 90°/s decreased at 24h). Exercise increased DOMS throughout recovery but KJRM and pain remained unchanged. CK, LDH, and uric acid increased similarly in both groups. CRP remained unaffected by exercise while IL-6 increased only post-exercise. TBARS, PC, LPH, GSSG, and TAC increased only post-exercise in both groups. GSH and GSH/GSSG declined post-exercise and normalized thereafter. Catalase and GPX increased only in patients post-exercise. CONCLUSION: Isokinetic exercise induces only a mild inflammatory response of very short duration (<24h) without affecting physical function and pain in KOA patients suggesting that moderate strengthening-type exercise may be safe for this patient cohort. These results indicate that KOA patients may be able to receive another exercise stimulus after only 48h. CLINICAL RELEVANCE: Isokinetic exercise produces minimal inflammation and pain in knee osteoarthritis patients, could be performed every 48h during rehabilitation, and up-regulates patients' antioxidant system.