The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction.

Allergy to metal, especially to titanium, is a poorly known subject in orthopedic surgery and is mostly found after arthroplasty. Here, we describe an original case of titanium allergy that developed after an anterior cruciate ligament (ACL) reconstruction of the left knee in a patient with a history of severe atopic dermatitis. Three years after the surgery, he returned to the clinic with the femoral cortical button in his hand; he removed the device from the wound when the skin spontaneously opened at the lateral part of the thigh. The wound healed with dressings without use of any antibiotics. Clinical and functional results were favorable and magnetic resonance imaging signal of the graft was normal. We ruled out the possibility of infection and the final diagnosis was allergy to titanium. This case demonstrates the need to investigate the presence of allergy to metal, including titanium, before an ACL reconstruction.

Incorporation of Hamstring Grafts Within the Tibial Tunnel After Anterior Cruciate Ligament Reconstruction: Magnetic Resonance Imaging of Suspensory Fixation Versus Interference Screws.

BACKGROUND: The success of anterior cruciate ligament (ACL) reconstruction requires solid graft incorporation within the tunnels to enable graft remodeling. Resorbable interference screws (RIS) provide limited tendon-bone contact because much of the tunnel circumference is occupied by the screw itself, while adjustable suspensory fixation (ASF) systems provide larger contact zones, which favor ligamentization. PURPOSE: To evaluate ligamentization of a 4-strand semitendinosus (4ST) graft fixed with ASF compared with RIS within the tibial bone tunnel at 6 months postoperatively using magnetic resonance imaging (MRI). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: We prospectively enrolled 121 consecutive patients undergoing primary ACL reconstruction using a single-bundle 4ST graft. The femoral end of the graft was fixed using suspensory fixation in all knees. The tibial end of the graft was fixed using ASF in 67 knees and RIS in 54 knees. Six months postoperatively, knee laxity measurements were taken, and MRI was performed to assess graft incorporation within the tibial tunnel. RESULTS: At 6-month follow-up, MRI scans of 109 knees were available for analysis. The mean tibial tunnel enlargement in the ASF group was 2.3 ± 1.1 mm (range, 0.5-6.0 mm), while in the RIS group, it was 4.7 ± 2.8 mm (range, 0.5-19.0 mm) (P < .001). The Howell graft signal assessment findings were excellent in 97% of knees in the ASF group and in 25% of knees in the RIS group (P < .001). The mean signal-to-noise quotient (SNQ) was 0.078 ± 0.62 in the ASF group and 0.671 ± 0.83 in the RIS group (P < .001). CONCLUSION: ASF provides more favorable conditions than RIS for the incorporation and ligamentization of 4ST grafts within the tibial tunnel. The ASF system used showed very little tunnel widening, which suggests that it grants stabilization. The SNQ was also considerably better in the ASF group.

Endoscopic treatment of intrasheath peroneal tendon subluxation.

Intrasheath subluxation of the peroneal tendons within the peroneal groove is an uncommon problem. Open exploration combined with a peroneal groove-deepening procedure and retinacular reefing is the recommended treatment. This extensive lateral approach needs incision of the intact superior peroneal retinaculum and repair afterwards. We treated three patients with a painful intrasheath subluxation using an endoscopic approach. During this tendoscopy both tendons were inspected. The distal muscle fibers of the peroneus brevis tendon were resected in two patients. A partial tear was debrided in the third patient. All patients had a good result. No wound-healing problems or other complications occurred. Early return to work and sports was possible. An endoscopic approach was successful in treatment of an intrasheath subluxation of the peroneal tendons.

Endoscopic calcaneoplasty combined with Achilles tendon repair.

Endoscopic calcaneoplasty is a minimally invasive technique for resection of inflamed retrocalcaneal bursa as well as the posterosuperior part of the calcaneus. A relative contra-indication for this technique is a tear of the Achilles tendon. In this report, we describe the treatment of a patient with Haglund's deformity associated with a tear of the Achilles tendon. Both the lesions are treated endoscopically. The technique is described and the pitfalls are discussed.

Two-bundle, four-tunnel anterior cruciate ligament reconstruction.

We reviewed 33 patients who underwent anterior cruciate ligament (ACL) reconstruction using a two-bundle, four-tunnel technique. The posterolateral bundle (PLB) and anteromedial bundle (AMB) were individually reconstructed with gracilis and semitendinosus tendon auto-grafts, respectively, using separate tibial and femoral tunnels. At final follow-up (24 months post surgery, range 18-31) the International Knee Documentation Committee's (IKDC) objective final evaluation scores were 69 A, 19 B, 12% C. The mean global subjective IKDC score was 86+/-12 points. Ninety-four percent of the patients had returned to sport after an average of 9 months following surgery and 75% returned to their preinjury sporting level. One patient had suffered a graft rupture as a result of a further sports injury. Eighty-four percent of the patients had a negative pivot shift (IKDC A), 9% a glide (IKDC B), and 6% a "clunk" (IKDC C). The mean postoperative side-to-side laxity, measured with KT1000 arthrometry at manual maximum, was 0.9 mm (SD 1.9). Eighty-one percent of the patients had less than 3 mm difference, with only one patient having greater than 5 mm. Our early experience with this new technique appears to demonstrate satisfactory results that are at least equivalent to other techniques and show an apparent trend towards improved control of anterior laxity.