A Comparison of Outcomes After Endoscopic Repair of Partial- Versus Full-Thickness Tears of the Gluteus Medius Tendon.

PURPOSE: The purpose of this study was to evaluate and compare the functional outcomes after endoscopic repair of partial or full-thickness gluteus medius tears at a minimum 2 years' follow-up. METHODS: Patients with isolated tears of the gluteus medius tendon repaired endoscopically between 2012 and 2017 were evaluated at a minimum 2 years of follow-up. Patients with large, retracted and/or irreducible tears, advanced atrophy, or fatty degeneration or with concomitant other hip pathology were excluded. Functional outcomes were assessed using the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain preoperatively and at the last follow-up RESULTS: Forty-six patients, 3 men and 43 women with a mean (SD) age of 63 (9; range, 43-82) years, were included. Thirty-three patients (72%) had partial-thickness tears and 13 (28%) had full-thickness tears. Pain was reduced significantly from a median of 8 (IQR: 6-8) at the preoperative visit to a median of 2 (IQR: 15) at the most recent follow-up (P < .0001). The mHHS and NAHS improved significantly from a median of 44 (IQR: 35-52) to 80 (IQR: 64-87) (P < .0001) and 52 (IQR: 43-56) to 75 (IQR: 66-94) (P < .0001), respectively. These improvements were clinically relevant and surpass the reported minimal clinically important difference. Patients with partial tears had significant functional gains in the mHHS in comparison with patients with full-thickness tears (P = .02). No other statistically significant difference between groups of tear grade was observed. CONCLUSIONS: Endoscopic repair of gluteus medius tendon tears yields excellent functional outcomes at a minimum follow-up of 2 years. A lower functional improvement for full-thickness tears was observed; this difference was statistically significant for 1 of the 2 scores evaluated. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort.

Posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes.

INTRODUCTION: The past 2 decades have been marked by substantial progress in our knowledge of meniscus anatomy, function, and biomechanics, and also by the shifting of the surgical treatment of meniscal lesions from traditional meniscectomy towards arthroscopic repair to get away from the early osteoarthritis associated with meniscectomy. Posterior horn injuries of the lateral meniscus (LM) have been less studied due to their lower incidence and also due to the historical technical complexity of performing a repair in the posterolateral compartment. MATERIALS AND METHODS: A retrospective analysis of prospectively collected data was performed of all athletic patients who had a peripheral longitudinal tear of the lateral meniscal posterior horn and who underwent at least one repair procedure with a posterolateral approach between 2014 and 2018. The type of injury, extent of lateral meniscal tear, and characteristics of sutures placed were assessed. Clinical assessment included objective and subjective IKDC ratings. The Tegner activity level score was determined before the injury and at the last follow-up visit. Failure was defined as a need for revision surgery. All complications were documented. RESULTS: The study population comprised 24 athletes with a mean follow-up of 25.2 ± 10 months. The Tegner activity level was exactly the same before the injury as after the surgery. The mean IKDC score significantly increased from 41.8 (12.2) before the surgery to 94.5 (9.1) after. There were four reoperations for failure (16.6%) that required a new suture repair. None of these revised repairs sustained a new failure as of the last follow-up. CONCLUSION: Despite the long learning curve, the posterolateral approach is a safe and effective technique for longitudinal tears of the posterior horn of the LM. The results of all-inside suture repair through a posterolateral portal are comparable to other techniques.

The effect of anterolateral ligament reconstruction on knee constraint: A computer model-based simulation study.

BACKGROUND: To determine the influence of anterolateral ligament reconstruction (ALLR) on knee constraint through the analysis of knee abduction (valgus) moment when the knee is subjected to external translational (anterior) or rotational (internal) loads. METHODS: A knee computer model simulated from a three-dimensional computed tomography scan of healthy male was implemented for this study. Three groups were designed: (1) intact knee, (2) combined Anterior Cruciate Ligament (ACL) and Antero-Lateral Complex (ALC) deficient knee, and (3) combined ACL and Antero- lateral Ligament (ALL) reconstructed knee. The reconstructed knee group was subdivided into four groups according to attachment of reconstructed anterolateral ligament to the femoral epicondyle. Each group of simulated knees was placed at 0°, 10°, 20°, 30°, 40° and 50° of knee flexion. For each position an external anterior (drawer) 90-N force or a five-newton meter internal rotation moment was applied to the tibia. The interaction effect between the group of knees and knee flexion angle (0-50°) on knee kinematics and knee abduction moment under external loads was tested. RESULTS: When reconstructed knees were subjected to a 90-N anterior force or a five-newton meter internal rotation moment there was significant reduction in anterior translation and internal rotation compared with deficient knees. Only the ALLR procedure using posterior and proximal femoral attachment sites for graft fixation combined with ACL reconstruction allowed similar mechanical behavior to that observed in the intact knee. CONCLUSIONS: Combined ACL and ALLR using a minimally invasive method in an anatomically reproducible manner prevents excessive anterior translation and internal rotation. Using postero-proximal femoral attachment tunnel for reconstruction of ALL does not produce overconstraint of the lateral tibiofemoral compartment.