Posterior Horn Repair Augmented With the Central Portion of Thickened Meniscus for Large Posterolateral Corner Loss Type of Discoid Lateral Meniscus.

Large posterolateral corner loss type of discoid lateral meniscus tear is unsalvageable. Therefore, subtotal meniscectomy has been the only treatment option in this case. However, long-term results of subtotal or total meniscectomy have shown a high prevalence of early degenerative changes. Persistent symptoms, such as increased pain, snapping, giving way, locking, and limited extension, can be attributed to progressive loss of posterior tibial meniscal attachment and meniscal degeneration, especially in the posterior horn. The purpose of this technique-based article is to describe a partial repair, posterior horn repair augmented with the central portion of the discoid lateral meniscus that would have been removed if a subtotal meniscectomy were performed and bone marrow stimulation in the intercondylar notch to improve meniscal healing.

Lateral meniscus allograft transplantation: an arthroscopically-assisted single-incision technique using all-inside sutures with a suture hook.

We present an arthroscopically-assisted single-incision technique using all-inside sutures with a suture hook in the lateral meniscus allograft transplantation. Although this technique is technically demanding, it provides vertically oriented and secure sutures with good tissue approximation without the accessory skin incision.

The safe establishment of a transseptal portal in the posterior knee.

PURPOSE: The aims of this study were as follows: (1) to determine the dimensions of the posterior compartments and the location of the popliteal artery with regard to the posterior septum by magnetic resonance arthrography; (2) to assess the effect of demographic factors on the measurements taken; and (3) to find a safe means of establishing the transseptal portal. METHODS: Thirty magnetic resonance arthrographies taken in 90° of flexion were evaluated to simulate knee position during arthroscopic surgery. Coronal and axial images were obtained in positions parallel and perpendicular to the long axis of the tibia, respectively. The anterior-to-posterior dimensions of the posteromedial and posterolateral compartments and popliteal artery locations were measured in the safe zone to establish transseptal portals. These dimensions were measured in axial images corresponding to the mid-PCL level. RESULTS: The average anterior-to-posterior dimension was 11.7 ± 2.9 mm in the posteromedial compartment versus 7.9 ± 1.8 mm in the posterolateral compartment. The anterior-to-posterior dimension was consistently greater in the posteromedial compartment, and the average ratio of the two dimensions was 1.5 ± 0.3. The average posterior deviation of the popliteal artery from the PCL was 27.1 ± 4.8 mm. The popliteal artery was always located lateral to the septum, and the lateral deviation on averaged measured 10.2 ± 4.0 mm. CONCLUSIONS: The safe margin of the posteromedial compartment is consistently wider than that of the posterolateral compartment, and the popliteal artery is consistently located lateral to the posterior septum. Therefore, injury to the popliteal artery can be avoided when penetrating the septum lateral to medial direction, even if the penetrating stick slips posteriorly. LEVEL OF EVIDENCE: Diagnostic study, Level IV.

Is correctional osteotomy crucial in primary varus knees undergoing anterior cruciate ligament reconstruction?

BACKGROUND: Valgus high tibial osteotomy (HTO) has been recommended for ligament stability and enhanced function after anterior cruciate ligament (ACL) reconstruction in varus-angulated knees. However, it is not clear whether HTO should be performed in patients undergoing ACL reconstruction who have primary varus knees without medial compartment arthrosis. QUESTIONS/PURPOSES: We therefore asked whether stability and function differed in patients having ACL reconstruction with differing degrees of preoperative alignment. PATIENTS AND METHODS: We retrospectively reviewed 201 patients who had primary, single-bundle ACL reconstructions with primary varus knees based on the preoperative mechanical axis deviation (MAD) on preoperative standing hip-knee-ankle radiographs. Patients were categorized into four groups according to the MAD: Group 1: 0 mm to 4 mm, Group 2: 5 mm to 9 mm, Group 3: 10 mm to 14 mm, and Group 4: greater than 15 mm. A total of 201 patients, 67 in Group 1, 53 in Group 2, 38 in Group 3, and 43 in Group 4, were assessed. Ligament stability was determined with the Lachman test, pivot shift test, and KT 2000™ arthrometer. Functional scores were assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) score. The minimum followup was 24 months (mean, 45 months; range, 24-96 months). RESULTS: We observed no differences in the side-to-side KT 2000™ measurements, Lysholm score, or IKDC functional scores based on the preoperative MAD. CONCLUSIONS: The stability and functional scores after ACL reconstruction were not adversely altered by primary varus alignment. Thus, if there is no medial compartment arthritis or varus thrust, we do not believe a correctional tibial osteotomy is crucial in primary varus knees undergoing ACL reconstruction.

A biomechanical comparison of 3 reconstruction techniques for posterolateral instability of the knee in a cadaveric model.

PURPOSE: The objective of this study was to compare the varus and external rotatory laxity of reconstructed knees by use of 3 different reconstruction techniques that address posterolateral instability of the knee: popliteus tendon (PT) and lateral collateral ligament (LCL) reconstruction, PT and popliteofibular ligament (PFL) reconstruction, and PFL and LCL reconstruction. METHODS: We divided 36 fresh-frozen cadaveric knees into 3 groups of 12, and each group was assigned to a reconstruction technique: PT-LCL reconstruction with the posterior tibialis tendon, PT-PFL reconstruction with the patellar tendon and bone (Warren technique), and PFL-LCL reconstruction with the semitendinosus tendon (Larson technique). Each specimen was fixed with an Ilizarov external fixator and mounted on a custom-designed apparatus that was made to measure posterolateral instability of the knee, that is, external rotatory and varus laxity in the intact state, after cutting, and in the postoperative state at every 30 degrees from 0 degrees to 90 degrees . RESULTS: There were no significant differences between the 3 techniques with external rotation and varus laxity in all specimens. CONCLUSIONS: PT-LCL reconstruction was comparable to the other 2 established techniques: PT-PFL reconstruction (Warren technique) and PFL-LCL reconstruction (Larson technique). However, the original strength of the native knee could not be achieved with any of the techniques. CLINICAL RELEVANCE: All techniques restored the posterolateral stability of the knee to near normal, with none of them being superior.

A combined transglenoid and suture anchor technique for bony Bankart lesions.

We present a modified hybrid technique that is a combination of a transglenoid and suture anchor technique. Three-dimensional CT reconstruction is indicated for patients with bony fragments larger than 10 mm. First, a transglenoid technique is performed to reduce the bony fragment and then a suture anchor technique is performed to achieve a stable fixation. This combined technique is a useful arthroscopic procedure for the easy reduction and stable fixation of bony Bankart lesions.

Is the transglenoid suture technique recommendable for recurrent shoulder dislocation? A minimum 5-year follow-up in 59 non-athletic shoulders.

The aim of this retrospective study is to compare the clinical outcomes following arthroscopic Bankart repair employing the transglenoid technique versus suture anchors in non-athletic shoulders of patients 30 years or older at the time of surgery. Fifty-nine consecutive patients who were available for a minimum of 5 years follow-up after arthroscopic Bankart repair were included. The transglenoid technique was employed in 27 patients whose age and follow-up period were 37 years (range 30-58) and 82 (range 61-109) months. Suture anchor was used in 32 patients whose age and follow-up period were 38 years (range 30-62) and 72 months (range 65-89). The Rowe scores of the transglenoid and suture anchor groups were 90 (range 35-100) and 90 (range 35-100), respectively, and there was no statistically significant difference between the two groups (p > 0.05). The Constant score of both groups was 92 (range 64-100) and 95 (range 62-100) without a significant difference (p > 0.05). Moreover, there were no significant differences between the recurrence rates (7%-transglenoid, 6%-suture anchor) (p > 0.05) and positive apprehension signs (7%-transglenoid, 3%-suture anchor) (p > 0.05). In non-athletes over 30-years-old, the results of the transglenoid technique in arthroscopic Bankart repair were comparable to those of the suture anchor. We suggest that the transglenoid technique is a viable alternative for older, non-athletic shoulder if the suture anchors are not available.