Patellar Tendon Imbrication for Patella Alta.

Patella alta is a significant contributor to patellar instability. Historically, distalizing tibial tubercle osteotomy has been recommended for this problem; however, complications such as nonunion, fracture and hardware irritation are concerning. Additionally, the procedure cannot be performed on skeletally immature patients without violation of the proximal tibial physis. The authors describe a technique of patellar tendon imbrication that does not involve hardware or osteotomy. This technique allows for reliable correction of patella alta and provides patellar stability without the complications associated with osteotomy.

Discoid Lateral Meniscus Saucerization and Treatment of Intrasubstance Degeneration Through an Accessory Medial Portal Using a Small Arthroscope.

Discoid lateral meniscus (DLM) is a rare meniscal variant characterized by an increased amount of meniscal tissue that resembles the shape of a disc as opposed to the typical crescent shape of the lateral meniscus. Surgical intervention is recommended for symptomatic DLM with persistent pain, mechanical symptoms, or motion impairment. The technique described is a reliable and reproducible method to identify and treat intrasubstance degeneration (ID) in the setting of DLM. A small arthroscope is used that allows more room for a meniscal repair device, as well as improved visualization and access of the lateral compartment. An accessory medial portal is used that allows perpendicular access to the anterior half of the body, as well as the posterior aspect of the anterior horn for repair. Successful surgery with this technique preserves meniscus and produces a strong reliable all-meniscal based repair of ID that allows early weight bearing and range of motion postoperatively.

Medial Patellofemoral Ligament Reconstruction and Lateral Retinacular Lengthening from a Lateral Approach.

The medial patellofemoral ligament (MPFL) is frequently torn and attenuated in patients with acute or chronic patellar instability. The mainstay for surgical treatment has become MPFL reconstruction to reestablish the checkrein to lateral patellar translation. The authors describe a technique for MPFL reconstruction with concomitant lateral retinacular lengthening with a gracilis allograft and adjustable loop cortical femoral fixation performed chiefly from a lateral parapatellar approach. This technique allows for reliable retensioning of the medial and lateral patellar soft tissues while avoiding complications associated with techniques that use interference screw fixation. Successful execution of this procedure provides a strong MPFL construct that allows patients to undergo early aggressive rehabilitation and return to activities.

Osteochondral Fracture Fixation With Fragment Preserving Suture Technique.

Osteochondral fractures are relatively uncommon injuries that typically present after an acute or subacute traumatic injury. Osteochondral fracture fixation is traditionally performed in the acute setting with internal fixation procedures using pins or compression screws through the fragment. Outcomes have generally been good, but cartilage thinning, subchondral remodeling, and tissue reactions can occur after internal fixation through the fragment. This article describes osteochondral fracture fragment fixation with a fragment-preserving technique that does not violate the articular cartilage of the fragment. This technique minimizes risk to articular cartilage that has already sustained injury and also provides superior fixation.

Retroarticular Core Decompression with Biologic Augmentation for Juvenile Osteochondritis Dissecans of the Knee.

Juvenile osteochondritis dissecans (OCD) of the knee is a rare condition of subchondral bone that has secondary effects on articular cartilage as the condition advances. Traditional treatment for early-stage OCD involves different types of drilling procedures that work to stimulate healthy bone formation via creeping substitution. This article describes a technique that involves a complete removal, or decompression of an early-stage OCD, while preserving the overlying articular cartilage that is augmented with bone grafting and bone marrow aspirate concentrate. This allows for quicker and more reliable healing of early-stage OCD and can minimize the chance for reoperation.

Medial Patellofemoral Ligament Reconstruction and Lateral Retinacular Lengthening in the Skeletally Immature Patient.

Patellar instability remains a ubiquitous and troublesome problem in orthopaedics and represents a challenge in the pediatric population. Reconstruction of the medial patellofemoral ligament (MPFL) has become a mainstay of patellar instability management in recent years. As with any procedure at or around the physes, there is concern among surgeons regarding safe placement of hardware and drilled tunnels. The authors describe a technique for anatomic MPFL reconstruction with the aid of fluoroscopic guidance to maintain a "safe zone" without violating the distal femoral physis. This technique allows for reliable MPFL reconstruction in the skeletally immature population with concomitant lateral lengthening, while requiring only minor deviations from the procedure in a skeletally mature patient.