Pretzel knot compared with standard suture knots.

PURPOSE: Aim of this paper is to compare the biomechanical properties of the Pretzel knot with the selected arthroscopic knots and to test the mechanical safety of this knot. The hypothesis was that the Pretzel knot may have equal or better mechanical properties than the arthroscopic knots tested in this study. METHODS: SMC, Giant, Dines, Nicky's, Tennessee Slider knots were chosen for comparison. Original and backed configuration of knots were prepared with no. 2 braided polyester sutures. Cyclic loading and load to failure tests were performed. Parameters tested were loop security, maximum elongation and load at failure. Number of steps needed for preparation of each knot was also recorded. One-way ANOVA for repeated measures was performed for all knots. RESULTS: Steps needed for preparation were 2 for Pretzel and Tennessee Slider, 3 for Nicky's, SMC and Dines and 4 for Giant. The Pretzel knot in original configuration had significantly better loop security compared to SMC, Dines, Nicky's and Tennessee knots (P = 0.01). Loads at failure were not significantly different between knots in their original configurations. Giant and Dines knots showed better maximum elongations in cyclic loading (P = 0.0059) and load to failure tests (P = 0.0001). Backing up the knots with 3-RHAPs eliminated most of these significant differences. CONCLUSIONS: Clinically, simplicity and safety are two important components in arthroscopic knot tying. Despite its simple configuration, Pretzel knot has some similar and increased mechanical properties compared to the tested knots that are widely used.

A basic arthroscopy course based on motor skill training.

Aim of this study is to introduce, evaluate, and propose a basic arthroscopy training course with interactive methods as using bovine knees, joint models but mainly focusing on practices with motor skill-learning devices. This study presents the results of a skill training program which is based on "motor skill training" theory and using "bovine knees" to simulate a specific task as arthroscopy both in education and evaluation. The participants gave feedback regarding their expectations, fulfillment, and self-evaluation on the degree of their improvement levels, after which their skills were evaluated by an expert while they performed the arthroscopic procedure. During this evaluation of the task, a four-dimensional checklist which was prepared previously by the consensus of three experts was used, and a global grading of each rater was added at the end of the checklist. In this 2-day course, small group teaching sessions are integrated with active and experiential learning methods consisting of short presentations by the educators, demonstrations using joint models and audio-visual teaching material, and significant continuous feedback by the teachers during the proceedings. Participants' expectations and post-course feedback results were obtained using a brief questionnaire which involved mostly open-ended questions. The self-rating of "own basic diagnostic arthroscopy skill" on a scale of 0-10 was completed by the participants both previous to and following the course to establish a student-centered learning environment. Overall rating of the course was asked on a 1-5 (poor-excellent) Likert scale. The questioning of the participants who took part in the course during the last five terms involved a 100% feedback. The overall rating of the course was 4.36 ± 0.47 on the 1-5 scale. The majority of the participants (90%) mentioned that the course met their expectations. The most beneficial activities were accepted to be the arthroscopic procedure applications on bovine knee, repetition of the manipulations under the supervision of the trainers, continuous feedback by experienced staff, and chance for immediate correction during the procedures (35/64). Pre- and post-course self-ratings of the participants inquiring about their ability to perform an arthroscopy alone showed significant improvement (4.2 vs. 7.7 P = 0.000, paired samples t test). All participants were found to be competent in the evaluation of their diagnostic arthroscopy skills on bovine knees. To design a skill teaching course based on the needs of the trainees, focusing on basic motor skill training exercises, and using bovine knee as a simulator is a safe, inexpensive, humanistic, and replicable method that proves a foundation for basic arthroscopic skills learning prior to patient encounter.

Effect of partial medial meniscectomy on the proprioceptive function of the knee.

INTRODUCTION: The aim of this study was to assess the proprioception of the partial meniscectomized knee and to assess if there is an effect on the knee proprioception. MATERIALS AND METHODS: We performed a case-control study involving patients with meniscus tear at the posterior horn of medial meniscus. Group 1 composed of 19 patients, with an average age of 26.3 years, who were enrolled after sustaining an injury to the medial meniscus. Twenty healthy individuals, with an average age of 25.1, without history of knee injury, constituted Group 2. In order to document the proprioceptive capabilities of the knee, angle reproduction tests were performed. RESULTS: At a mean of 2 years after the surgery, there was no difference between the meniscectomized and healthy knee regarding the angle deviations in the lower flexion angles (15 degrees , 30 degrees , 45 degrees ). However, mean knee joint position sense (KJPS) at 60 degrees reproduction in Group 1 and 2 was 64.3 (SD 5.3) and 69.2 (SD 4.9), respectively. Concomitantly, mean KJPS at 75 degrees reproduction in Group 1 and 2 were 80.1 (SD 6.59) and 74.4 (SD 5.6), respectively. Paired t test showed a statistically significant difference between Group 1 and 2 when compared to control angle deviations at 60 degrees and 75 degrees reproductions (P < 0.05). CONCLUSION: KJPS of the patients in meniscectomized group was poorer than the patients in healthy knee group at 60 degrees and 75 degrees knee flexion degrees. Those results indicated that even a partial absence of menisci causes a deterioration of proprioceptive functions of the knee.

Dislocation of os trigonum presenting as a loose body in the ankle.

UNLABELLED: Dislocation of the os trigonum presenting as a loose body is a rare clinical entity. In this report, we describe the case of a 34-year-old male who presented with symptoms of acute left ankle pain that was aggravated by motion and weight bearing. He also displayed lateral collateral ligamentous laxity, without the presence of an effusion. Radiographic inspection revealed a 10 x 15-mm loose body within the ankle joint cavity. Arthroscopic intervention showed the loose body to be round and smooth, and it could not be deformed with the tip of a probe, although it could be displaced up to 5 mm with ankle manipulation, in particular with inversion stress of the ankle. The loose body was removed with an arthroscopic forceps. Based on its location within the ankle, and the lack of any articular cartilage on the removed joint fragment, we determined the loose body to represent a dislocated os trigonum. The rarity of this case presentation makes one consider the association of symptomatic os trigonum with ankle instability. LEVEL OF CLINICAL EVIDENCE: 4.

[Approach to cartilage lesions and algorithm for treatment]. / Kikirdak lezyonlarina yaklasim ve tedavi algoritmasi

Cartilage symptoms in the knee may be encountered in various forms in orthopedic practice. The first stage from history to treatment is to establish the diagnosis; if the diagnosis is made as a cartilage lesion in the knee, priority must be given to current treatment approaches. The surgeon must provide information regarding etiology, defect thickness, lesion size, the containment of cartilage, localization, stability, meniscal integrity, anatomic alignment of the knee, previous assessments, radiological assessment (direct radiography, magnetic resonance imaging), and general, medical, and systemic conditions, and family history. In this review, a treatment algorithm is presented for the management of articular cartilage lesions.

Modified Fulkerson osteotomy in recurrent patellofemoral dislocations.

OBJECTIVES: We evaluated the results of a modified Fulkerson technique performed for the treatment of recurrent patellofemoral dislocations. METHODS: The study included 17 knees of 16 patients (11 males, 5 females; mean age 25 years; range 15 to 43 years) who were operated on by the same surgeon for patellofemoral alignment disorders. The mean duration of complaints was 3.4 years (range 1 to 12 years). Preoperatively, the number of recurring dislocations were 1 to 5 in three knees, 6 to 10 in five knees, and more than 10 in nine knees, and all the patients had a positive apprehension test and a Q angle exceeding 15 degrees. All the knees were assessed by preoperative and postoperative radiographs and computed tomography, which showed both subluxation and patellar tilt in all the knees, and trochlear dysplasia in two knees preoperatively. During surgery, diagnostic arthroscopy was performed in all the patients. The skin incision consisted of two horizontal incisions for cosmetic reasons. Surgical treatment was comprised of lateral patellar release to correct patellar tilt, and a modified Fulkerson osteotomy to correct patellofemoral malalignment, and medial plication in three knees. The patellofemoral congruity following lateral release, and the position of the patella following osteotomy and anteromedialization of the tibial tuberosity were checked arthroscopically. On control examinations, the patients were administered functional scoring questionnaires developed by Kujala et al. and Crosby and Insall. Radiographic grading of osteoarthritis was made according to the classification developed by Iwano et al. and modified by Palmer et al. The mean follow-up period was 2.6 years (range 24 to 53 months). RESULTS: During arthroscopy, eight knees had severe (Outerbridge grade III-IV) and nine knees had moderate (grade I-II) retropatellar cartilage damage. Follow-up evaluations showed effusion in two knees, subluxation in two knees, and a positive apprehension test in three knees. The mean flexion loss was 8 degrees (range 0 degrees to 20 degrees ). One patient who had an extension loss of 10 degrees regained full extension following a six-week physical therapy program. Postoperative computed tomography scans showed that patellar tilt and subluxation were corrected in all but two knees. Preoperative radiographies showed degenerative arthritis in the tibiofemoral joint in one knee (5.9%), and in the patellofemoral joint in seven knees (41.2%). The number of knees with degenerative changes increased postoperatively to three knees (17.3%) in the tibiofemoral joint, and to 11 knees (64.7%) in the patellofemoral joint. According to the Crosby-Insall scoring system, five knees had excellent, seven knees had good, and five knees had moderate scores. The mean Kujala score was 82.6 (range 44 to 100) postoperatively. CONCLUSION: Our results show that, with appropriate indications, the modified Fulkerson method is associated with successful results in the treatment of recurrent patellofemoral dislocations.