Optimal Release Timing of Drain Clamping to Reduce Postoperative Bleeding after Total Knee Arthroplasty with Intraarticular Injection of Tranexamic Acid.

Background and Objectives: Intraarticular injection of tranexamic acid (IA-TXA) plus drain-clamping is a preferred method of reducing bleeding after total knee arthroplasty (TKA). However, no consensus has been reached regarding the timing of the clamping. The purpose of this study was to determine the optimum duration of drain-clamping after TKA with IA-TXA. Materials and Methods: We retrospectively reviewed 151 patients that underwent unilateral TKA with IA-TXA plus drain-clamping for 30 min, 2 h, or 3 h. The total drained volume was reviewed as the primary outcome, and hematocrit (Hct) reductions, estimated blood loss (EBL), transfusion rates, and wound complications were reviewed as secondary outcomes. Results: The mean total drained volume, Hct reduction, and EBL were significantly less in the 3 h group than in the 30 min group. Between the 2 h and 3 h groups, there was no statistical difference in the mean total drained volume, Hct reduction, or EBL. The proportion of patients who drained lesser than 300 mL was high in the 3 h group. No significant intergroup difference was observed for transfusion volume, transfusion rate, and wound related complications. Conclusions: In comparison of the IA-TXA plus drain-clamping after TKA, there was no difference in EBL between the 2 h group and the 3 h group, but the amount of drainage volume was small in the 3 h group.

Arthroscopic Transtibial Pull-Out Repair of Medial Meniscus Posterior Root Tear With a Whip Running Suture Technique.

Medial meniscus posterior root tear is a disruptive injury causing significant sequelae. Several techniques to repair and maintain the native function of the medial meniscus have been introduced, but limitations have been reported in terms of their results. In this current note, the authors introduce the arthroscopic transtibial pull-out repair with whip running suture technique, which may not only avoid the potential risk of meniscus cut-through by the suture material but also optimize the reduction of the extruded meniscus. By suturing the posteromedial capsule and peripheral meniscus, more medialization force can be directly applied to the extruded part of the meniscus, and normal hoop tension can be restored.

Revision Anterior Cruciate Ligament Reconstruction After Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Series of 40 Patients.

PURPOSE: To evaluate the surgical methods according to the status of tunnels at the time of revision anterior cruciate ligament reconstruction (ACLR) and to evaluate clinical outcomes of revision ACLR in patients who underwent primary ACLR with the anatomic 4-tunnel double-bundle (DB) technique. METHODS: A total of 487 patients who underwent primary anatomic DB ACLR from April 2010 to July 2016 were retrospectively reviewed, and among those knees, the patients who underwent revision ACLR were included in the study. The patients with concomitant posterior cruciate ligament injuries were excluded. Forty patients (40 knees) were identified and enrolled. The surgical methods were reviewed. The range of motion, objective laxity using KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score after revision ACLR were compared with those after primary ACLR in the same patient using paired t-test with Bonferroni correction. RESULTS: The timing of reinjury after primary ACLR and mean interval between primary and revision ACLR were 18 months (range 1.5-80 months) and 24 months (range 4-82 months), respectively. Among 40 patients, 38 patients (95%) underwent 1-stage revision with the DB technique using pre-existing tunnels without compromised positioning of the grafts, and the other 2 patients (5%) underwent 2-stage revision. The postrevision range of motion, KT-2000, Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, and Tegner score were 137 ± 7°, 2.4 ± 1.2 mm, 91.4 ± 5.8, 98.9 ± 2.2, 78.6 ± 11.5, and 5.5 ± 1.2, respectively, and did not show any differences from those after primary ACLR. CONCLUSIONS: In the revision setting after primary anatomic DB ACLR, most of the cases could be managed with 1-stage revision with DB technique using pre-existing tunnels, and the objective laxity and clinical scores after revision DB ACLR were comparable with those after primary DB ACLR. LEVEL OF EVIDENCE: Case series, Level IV.

Clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for osteonecrosis of the femoral head: a minimum 5-year follow-up.

PURPOSE: There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH. MATERIALS AND METHODS: Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis. RESULTS: At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results. CONCLUSION: The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions, this procedure generated clinical results comparable to those of other head preserving procedures.