Knee Posterolateral Corner Reconstruction Shows Low Failure and Complication Rates.

High-grade knee posterolateral corner (PLC) injuries are potentially devastating, and often associated with high energy mechanisms. Failure of PLC injury diagnosis or treatment can lead to residual instability after combined cruciate ligament reconstruction due to increased risk of graft failure, and varus malalignment may lead to early osteoarthritis and meniscal injuries. PLC reconstruction has consistently shown superiority over PLC repair. Biomechanical studies have compared reconstruction techniques, specifically evaluating rotational and varus laxity. Some studies have demonstrated no difference between techniques whereas other studies have reported improved stability with techniques that include a separate tibial tunnel for reconstruction of the popliteus tendon and PFL. Yet many have suggested that there is less technical difficulty with techniques that do not use a tibial tunnel, and this may be an important consideration in certain settings. Recent reviews showing no differences in clinical outcomes when comparing techniques for PLC reconstruction are based on heterogeneous, low level of evidence, high-risk-of-bias literature. It is well-recognized that PLC injuries are heterogeneous, with approximately three quarters occurring in combination with anterior and/or posterior cruciate ligament tears. Further, laxity patterns vary for these injuries including high-grade posterior laxity and knee hyperextension as well as proximal tibial-fibular joint laxity, and these findings may necessitate use of an anatomic (separate tibial tunnel) PLC reconstruction technique. Reassuringly, both techniques show low complication and failure rates.comparison.

Editorial Commentary: Medial Meniscal Ramp Lesions in the Setting of Anterior Cruciate Ligament Tears Contribute to High-Grade Anterior and Rotatory Laxity That Are Normalized by Repair.

Meniscal ramp lesions are reported to occur in 9% to 42% of anterior cruciate ligament tears. Biomechanical research shows that the presence of a meniscal ramp lesion, in the setting of an anterior cruciate ligament tear, leads to increased knee anteroposterior and rotatory laxity when compared with an uninjured medial meniscus. This finding also has been verified clinically. Repair of ramp lesions has been shown to improve biomechanics. Accordingly, the influence of meniscal ramp lesions on knee laxity necessitates a comprehensive physical examination, imaging review, and diagnostic arthroscopy to support identification and treatment of these injuries. Arthroscopic probing is required to assess ramp lesion stability. It is generally accepted that up to 30% of ramp lesions are unstable and warrant repair, as determined by tear ≤1 cm, displacement into the medial compartment with probing, and extension beyond the lower pole of the femoral condyle.

Acetabular Insufficiency Fractures in the Setting of Graft vs Host Disease: A Report of Two Cases.

We report a case series of 2 patients with unilateral acetabular insufficiency fractures who received allogeneic peripheral blood stem cell transplantation for hematologic malignancies complicated by chronic graft vs host disease. These were managed with uncemented cup and cage total hip arthroplasty and stabilization of posterior column with plating. Osteonecrosis of the acetabulum is an uncommon musculoskeletal complication of chronic graft vs host disease. The orthopedic impact of this disease should not be overlooked. Surgical intervention with this construct can provide necessary stability to improve patient function.