Capsulodesis Versus Bone Trough Technique in Lateral Meniscal Allograft Transplantation: Graft Extrusion and Functional Results.

PURPOSE: To compare the radiographic results (in terms of graft extrusion) and the functional results of lateral meniscus allograft transplantations (MAT) performed with a bony fixation technique or with a soft tissue fixation technique after capsulodesis. METHODS: A prospective series of 29 consecutive lateral MAT was analyzed. The inclusion criterion for MAT was lateral joint line pain due to a previous meniscectomy. Malalignment, patients who had an Ahlback grade greater than II, and patients with a body mass index over 30 were considered as the exclusion criterion to prevent confounding results. Fifteen of the grafts were fixed with a bony fixation technique (group A). The remaining 14 cases (group B) were fixed with sutures through bone tunnels after lateral capsular fixation (capsulodesis). All patients were studied with magnetic resonance imaging to determine the degree of meniscal extrusion at an average of 18 months of surgery (range, 12-48 months). Meniscal extrusion was measured on coronal magnetic resonance imaging. To standardize the results, the percentage of meniscus extruded for each group was also calculated and compared. The functional results were analyzed by means of standard knee scores (Lysholm, Tegner, and visual analog scale). RESULTS: If we consider the first 4 cases of group B as the learning curve of the new technique, we observe that group A had 8 cases (53.3%) of major extrusion, whereas group B had 1 case (7.1%) (P = .02). When comparing the degree of meniscal extrusion with the type of fixation employed, an even lower percentage of extruded menisci was found in group B (P = .01). The final follow-up Lysholm score in group A was 94.33 ± 5.96 (P < .001) and 91.43 ± 6.19 (P < .001) in group B. The median follow-up Tegner score significantly improved from 4 (range, 2-5) to 7 (range, 6-9) in group A (P < .001) and from 4 (range, 3-5) to 7 (range, 6-8) in group B (P < .001). The average visual analog scale score dropped down 5.87 and 7.29 points in groups A and B, respectively (P < .001). The Knee Injury and Osteoarthritis Outcome Score improved from 51.98 ± 2.84 to 90.88 ± 7.53 in group A (P < .001) and from 50.44 ± 2.32 to 92.01 ± 6.71 in group B (P < .001). Patient satisfaction with regard to the procedure stood at a mean of 3.6 ± 0.2 points out of a maximum of 4 in group A and 3.8 ± 0.4 in group B. There were no complications in this series. CONCLUSIONS: The capsulodesis technique in lateral MAT proved not to be statistically different at decreasing the degree of meniscal extrusion with respect to the bone-bridge fixation. If the first 4 cases using the new capsulodesis technique had not included in the results, the capsulodesis technique would have effectively presented better results relative to the degree of meniscal extrusion compared with the bone-bridge fixation technique. In addition, the functional results were similar. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Primary lipoma arborescens of the knee may involve the development of early osteoarthritis if prompt synovectomy is not performed.

BACKGROUND: Primary lipoma arborescens (LA) is a rare, benign intra-articular hyperplastic tumor that has been associated with osteoarthritis (OA). The aim of this study was to determine whether prompt synovectomy could avoid progressive joint degeneration in cases of primary LA of the knee. MATERIALS AND METHODS: A review of currently available literature about the disease was carried out. The clinical, histological and radiological records of a series of nine knees with primary LA diagnosed and treated between 2002 and 2012 were retrospectively reviewed. Eight of the knees had histological confirmation of LA and none had evidence of condropathy on the initial magnetic resonance image or degenerative changes at the initial radiographic examination. RESULTS: At the final follow-up no evidence of OA was found in the three knees that underwent synovectomy when symptoms did not last more than 1 year. The five knees in which synovectomy was delayed developed progressive joint degeneration. CONCLUSION: In this series, primary LA of the knee involved the development of early osteoarthritis when prompt synovectomy was not performed. Timely synovectomy is strongly recommended, if not mandatory. LEVEL OF EVIDENCE: IV.

Promising short-term results following selective bundle reconstruction in partial anterior cruciate ligament tears.

BACKGROUND: The different functions of the two anterior cruciate ligament (ACL) bundles have increased interest in tears of only one of these two bundles. The purpose of this study was to assess the outcome of selective reconstruction of an injured bundle of isolated anteromedial bundle (AMB) or posterolateral bundle (PLB) tears. METHODS: Consecutive series of 147 ACL reconstructions was prospectively analyzed. Patients with partial ACL tears who underwent selective bundle reconstructions were studied. Stability was assessed with the Lachman, anterior-drawer and pivot-shift tests and KT-1000. Functional assessment was performed with Lysholm and Tegner questionnaires. The preoperative MRI was analyzed to detect differences from arthroscopic findings. RESULTS: Twenty-eight patients (19%) were included. The minimum follow-up period was 30months. Eighteen had AMB and 10 PLB tears. Only 19% of their MRI's were categorized as partial ACL tears. The Lysholm score improved from 66.1/65.5 to 96.6/95.2 in the AMB/PLB groups, respectively (p<0.001). The same or no more than one level lower Tegner score was restored. The pivot-shift, Lachman and anterior-drawer tests were negative in all cases (p<0.001). Two reconstructed AMBs developed extension loss due to Cyclops lesions and were resolved surgically. CONCLUSIONS: The technique provided excellent functional scores with normalized stability and a return to previous level of activity with a low rate of minor complications at a minimum 2.5years' follow-up. Arthroscopic examination was the most reliable tool for properly diagnosing and treating a condition observed in almost one out of every five ACL reconstructed knee in this series. LEVEL OF EVIDENCE: Therapeutic case series; level 4.

Prospective comparative study between two different fixation techniques in meniscal allograft transplantation.

PURPOSE: To compare the functional and radiographic results between two different horn fixation techniques for meniscal allograft transplant. METHODS: This is a prospective study of 88 meniscal allograft transplants with a mean 5-year follow-up. Forty transplants were performed on the medial compartment and 48 on the lateral compartment. The same surgeon performed all surgeries. Thirty-three grafts were fixed only with sutures (Group A) and 55 only with bony fixation (Group B). Both groups were comparable in terms of age, laterality, time since meniscectomy and preoperative functional and radiographic status. Functional assessment was done with Lysholm and Tegner scores and the Visual Analogical Scale for pain. Joint space narrowing was evaluated in the Rosenberg view. RESULTS: There was a significant improvement in Lysholm, Tegner and VAS scores without differences between Group A and Group B (n.s.). Radiographic evaluation did not show any joint space narrowing (n.s.). No differences in the comparison of all the variables of the two compartments were found. There were complications in 33.3 % of patients in Group A that including 7 graft tears (21.4 %) and in which there was an allograft failure rate of 9 %. Group B showed complications in 16.4 % of the patients and included 4 graft tears (7.3 %, n.s.) with an allograft failure rate of 3.6 %. CONCLUSIONS: Meniscal allograft transplantation with either technique provided good functional and radiographic results at mid-term follow-up. Both graft fixation methods showed no differences relative to functional and radiographic results. There was a considerably higher rate of complications in transplantations performed with the only-suture technique than those with bony fixation, although the difference was not statistically significant with the numbers available. The results suggest that similar functional results should be expected whether the meniscal graft includes bone plugs or not. However, graft tears seem to happen more frequently if the MAT is performed without bony fixation. LEVEL OF EVIDENCE: Prospective comparative study, Level II.

Allogenic labral transplantation in hip instability following arthroscopic labrectomy.

The acetabular labrum augments femoral head coverage within the acetabulum and contributes to hip joint stability. This has led to an increasing interest in procedures dedicated to preservation of the labrum. An allogenic labral transplantation performed in a patient who had previously undergone a partial labral resection is presented.