Bone-Patellar Tendon-Bone Augmentation With Gracilis Tendon: The Bone-Patellar Tendon-Bone Plus Technique.

The bone-patellar tendon-bone (BPTB) autograft or allograft is a well-established option for primary or revision anterior cruciate ligament (ACL) reconstruction. However, although the length and width of the graft are relatively consistent, its thickness is unpredictable and can impact the biomechanical properties of the ACL graft. This technical note describes a technique for arthroscopic ACL reconstruction called the "BPTB-plus" technique, which consists of a BPTB graft augmented by the gracilis tendon.

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database.

BACKGROUND: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. PURPOSE: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. RESULTS: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). CONCLUSION: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.

How To Avoid Suture Damage in Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Posterior Root Reinsertion With the Transtibial Pullout Technique: A Technical Note.

Lateral meniscus posterior root tears (LMPRTs) are estimated to occur in 7% to 12% of anterior cruciate ligament (ACL)-injured knees. This topic is of great interest because of their biomechanical consequences in terms of interruption of hoop stress distribution. If left unrepaired, the corresponding compartment is exposed to unfavorable contact dynamics, similar to those resulting from a total meniscectomy. This Technical Note describes a transtibial LMPRT repair using a Knee Scorpion and an 18-gauge spinal needle. It is a reproducible arthroscopic LMPR reinsertion technique combined with concomitant standard ACL + anterolateral ligament reconstruction with hamstring tendons and it describes how to safely avoid damage to root traction sutures during the ACL independent tibial tunnel drilling.

Reduction of a Depressed Femoral Lateral Notch at the Time of Lateral Extra-articular Tenodesis.

We present a surgical technique to address severe lateral femoral notch depressions using a small extension in the lateral approach for Lemaire extra-articular tenodesis in anterior cruciate ligament reconstruction. Through this approach, the surgeon is able to obtain good exposure of the lateral femoral condyle, with straightforward access for subchondral reduction, without adding any significant morbidity.

[Total knee replacement without patellar resurfacing: about 60 cases]. / Prothèse totale du genou sans resurfaçage de la rotule: à propos de 60 cas.

During total knee replacement, one of the main problems of surgeon is to choose between preservation of the patella or resurfacing with prosthetic replacement of patellar cartilage. This issue continues to be a subject of controversy within the orthopaedic community. There is no clear consensus on the optimal approach to the patella during total knee arthroplasty (TKA). We conducted a retrospective study of 60 patients undergoing total knee replacement without resurfacing of the patella. These procedures were performed in the Department of Orthopedics and Trauma-Surgery (B) at the University Hospital Hassan II, Fez, since January 2009 to December 2015. The average age of patients was 58 years, ranging between 20 years and 80 years. Female prevalence was clear (41 women, 72% and 16 men, 28%). Clinically, the majority of patients had mechanical pain and all patients underwent clinical and radiological examination. The IKS score was used to assess knee condition before and after surgery. The surgical procedure was based on total knee arthroplasty without patellar resurfacing. Post-operative complications included 7 cases of anterior knee pain, 2 cases of infection of superficial skin treated with appropriate antibiotic therapy and 3 cases of stiffness. No cases of hematoma, phlebitis or sepsis were reported. Clinical results after a follow-up period of 18 months were satisfactory. Given these results, the preservation of the patella allowed for very satisfactory middle term results regarding pain relief and restoration of function. In addition, potential complications of patella prosthesis were avoided. One limitation of these replacements without resurfacing is the occurrence, or sometimes the persistence, of anterior knee pain; hence the need for secondary resurfacing. Current data from the literature show that there is no consensus on the approach to the patella during total knee replacement. Finally, patella resurfacing is an approach that the surgeon should choose on the basis of current data. This said, the debate can continue focusing on a single issue: which approach should be used to the patella.