Lateral Knee Compartment Portals: A Cadaveric Study Defining a Posterolateral Viewing Safety Zone.

PURPOSE: This study attempted to define a reproducible "safe zone" based on extra- and intra-articular knee anatomy for placing one or 2 accessory portals in the lateral tibiofemoral compartment for posterolateral region viewing. METHODS: Standard portals were created in 10 cadaveric knees to enable posterolateral region arthroscopic lateral tibiofemoral joint compartment viewing. After identifying the lateral knee surface tissue "soft spot," an accessory posterolateral portal (A) was created using an 18-gauge spinal needle and 4-mm cannula under direct visualization of a 70° arthroscope through the anteromedial portal. A second accessory portal (B) was then created 1 cm posterior and 1 cm superior to portal A. Accessory portal locations were measured relative to capsular fold and popliteus tendon locations. Distances from the peroneal nerve, lateral collateral ligament, popliteus tendon, and the biceps tendon were determined. Statistical analysis compared portal location differences from key anatomical structures (P < .05). RESULTS: Accessory portal A (mean ± 95% confidence interval) was located 8.8 ± 2.7 mm from the popliteus tendon, 11.6 ± 2.7 mm from the lateral collateral ligament (LCL), 26.8 ± 2.3 mm from the peroneal nerve, and 4.9 ± 2.5 mm from the biceps tendon. Accessory portal B was located 17.3 ± 2.8 mm from the popliteus tendon, 20 ± 2.8 mm from the LCL, 30.3 ± 3.3 mm from the peroneal nerve, and 7.0 ± 4.8 mm from the biceps tendon. Accessory portal B was located a greater distance from the LCL and the popliteus tendon than portal A (P < .0001). CONCLUSIONS: Using intra- and extra-articular anatomic landmarks, both accessory portals could be safely placed in the lateral tibiofemoral joint compartment to enable posterolateral region viewing. Accessory portals used individually or in combination may enable easier posterolateral region viewing for arthroscopic repair of lateral tibiofemoral compartment structures. CLINICAL RELEVANCE: Lateral tibiofemoral compartment portals can be safely created to enable improved visibility for complex arthroscopic procedures in the posterolateral viewing region.

Midterm results of hybrid cement technique in revision total knee arthroplasty.

While the number of revision total knee arthoplasties (TKA) performed in the United States continues to rise annually, controversy exists whether intramedullary stems should be cemented or press-fit. Retrospective analysis of midterm survivorship rate of revision TKA using hybrid stem fixation in 119 patients was performed. Revision was performed predominantly for aseptic loosening (78) and infections (28). Average follow-up was 62months (range, 46-80). Knee Society Pain and Function scores improved from 39 and 58 to 68 and 79 (P<.05). Fifty-eight tibial offsets and 28 femoral offsets were utilized. Three knees (2.5%) required revision without any cases of aseptic loosening. Radiographic complete or progressively advanced (>2mm) radiolucent lines were not observed in any patient. At mid-term follow-up, revision hybrid TKA provides excellent fixation with extremely low rates of aseptic loosening and avoids the inherent complications of extensive intramedullary cement.

"Figure 8" single socket double bundle ACL technique.

Using single femoral and tibial tunnels, we describe a technique of anatomically recreating the anteromedial and posterolateral anterior cruciate ligament (ACL) bundles. Transtibial, flexible reamers are utilized to create a "Figure 8" notched tunnel thereby recreating the anatomic footprint of the femoral insertion of the ACL. Rotational control of the individual bundles is created via the notched tunnel and each bundle is tensioned to 80 N individually. Anatomic double bundle ACL reconstruction is created in a reproducible modified single-bundle technique without the inherent risks associated with drilling four tunnels.

Ceramic-on-ceramic total hip arthroplasty.

Ceramic bearing surfaces have been introduced to prevent bone loss after osteolysis seen with conventional polyethylene bearing surfaces. One hundred three ceramic-on-ceramic total hip arthroplasties in 97 patients were retrospectively reviewed. Average follow-up was 50.4 months. Preoperative Harris Hip Score was 49.5 points, which improved to 87.2 postoperatively (P < .05). Pain score improved from 13.7 points preoperatively to 40.6 points postoperatively (P < .05). Functional score improved from 30 points preoperatively to 41 points postoperatively (P < .05). No fractures, dislocations, infections, or osteolysis was observed on radiographs. Five patients (4.9%), at 11, 16, 30, 38, and 60 months postoperatively, presented with "squeaky" hips that continue to perform well. Long-term studies will be required to determine the true efficacy of these hard bearing surfaces.

Routine Examination of Pathology Specimens Following Knee Arthroscopy: A Cost-Effectiveness Analysis.

BACKGROUND: While the clinical value of routine pathologic examination of tissues removed during orthopaedic procedures has not been determined, limited cost-effectiveness and a low prevalence of findings that alter patient management have been previously demonstrated with arthroscopy. The purpose of this study was to examine the clinical value and cost-effectiveness of routine histological examination of knee arthroscopy specimens. METHODS: Retrospective chart analysis of 3797 consecutive knee arthroscopies by two surgeons from 2004 to 2013 at three affiliated hospitals within one health-care system was undertaken. Pathology reports regarding tissue removed during partial meniscectomies and anterior cruciate ligament reconstructions were reviewed to determine if the results altered patient care. The total costs of histological examination were estimated in 2012-adjusted U.S. dollars. The cost per health effect was determined by calculating the cost per discrepant and discordant diagnosis. RESULTS: The prevalence of concordant diagnoses was 99.3% (3769 of 3797), the prevalence of discrepant diagnoses was 0.7% (twenty-seven of 3797), and the prevalence of discordant diagnoses was 0.026% (one of 3797). The total cost of histological examinations was estimated to be $371,810. The total cost of the pathology cost per discrepant diagnosis was $13,771, and the cost per discordant diagnosis was $371,810. CONCLUSIONS: Routine pathological examination of surgical specimens from patients undergoing knee arthroscopy had limited cost-effectiveness because of the low prevalence of findings that altered patient management. Histological examination of surgical specimens from arthroscopic knee surgery did not alter patient care and increased costs. We suggest that gross and histological examination of tissue removed during knee arthroscopy should be done at the discretion of the orthopaedic surgeon rather than being mandatory.

Thromboembolic complications in arthroscopic surgery.

Venous thromboembolism (VTE) is a relatively rare complication of arthroscopic surgery but has the potential to cause significant morbidity and even mortality. VTE has been reported after shoulder and knee arthroscopy prompting controversial guidelines to be proposed. More limited studies are available regarding hip and ankle arthroscopy and 1 case of deep venous thrombosis in the contralateral leg status after hip arthroscopy exists. No reports have been published regarding VTE after elbow or wrist arthroscopy to these authors' knowledge. In this article, a systematic review of the literature was conducted to analyze the incidence, treatment, and prevention of thromboembolic complications in arthroscopy.

Hip dislocations--epidemiology, treatment, and outcomes.

Traumatic dislocations of the hip appear to be on the rise in North America. Multidetector CT, hip arthroscopy, and high field MRI have further defined the pathoanatomy of hip dislocations. They can be divided into simple and complex dislocations. At the University of Louisville, an algorithm has been developed to facilitate rapid and accurate diagnosis and treatment of simple hip dislocations. In contrast to the treatment of simple hip dislocations, the treatment of complex hip dislocations (fracture-dislocations) is generally predicated on specific treatments of the associated fracture (e.g., femoral head fracture, femoral neck fracture, acetabular fracture, etc.). This review includes the mechanism of injury, epidemiology, associated injuries, evaluation, treatment, and functional outcomes of simple hip dislocations.