Anterior cruciate ligament reconstruction using quadiple hamstring graft

This study evaluated the graft as regards its stability and donor site morbidity as compared with the results mentioned in literature of bone patellar tendon bone [BPTB] graft. Twenty-seven patients had quadruple hamstring anterior cruciate ligament [ACL] reconstructions following the study protocol were included in the study. Twenty-four patients were available for the final follow up [minimum of 27 months]. They were evaluated using Lysholm score, international Knee Documentation Committee [IKDC], Lachman test, anterior drawer test, pivot-shift test and KT-1000. The average Lysholm score improved from 66-89.2 points and the final average IKDC was severely abnormal in two cases, abnormal in two cases, nearly normal in eleven cases and normal in nine cases. Anterior drawer test and KT-1000 were improved. Of the 24 ACL reconstructions, 4 failed. One of these reconstructions failed from new later injury, one from technical error and two from patient non-adherence to rehabilitation protocol. An anterior knee pain was present in seven patients [comparable with the opposite side] and four experienced some numbness over the hamstring graft site that did not interfere with athletic activity

Subchondral drilling for stages [I] and [I I] of osteochondritis dessicans of the dome of the talus under arthroscopic guidance

Purpose: Reviewing the clinical and radiological results of subchondral drilling aiming at revisualization and new bone formation in the early stages of osteochondritis dissicans of the dome of the talus. Consecutive sample. Over a 2.2- year period, subchondral drilling under arthroscopic guidance in stages I and II of osteochondral lesions of the dome of the talus was performed for 9 cases with at least 26 months of follow-up. They were 5 males and 4 females. Their average age at the time of surgery was 32 years [19 to 43]. The average follow-up was 2.6 years. Six had the lesion at the lateral aspect of the talus, while 3 were at the medial aspect. In 5 cases the pain and limping disappeared with regaining of the full range of motion together with no feeling of insecurity [instability] in the ankle. Recurrent effusion, though much less, persisted over another 6 months after disappearance of pain. In 3 cases pain was reduced and limping improved with little improvement in the range of motion, but with persistence of the sense of insecurity in the ankle and with recurrent effusion. The pain-free walking distance was more than doubled in the 3 cases. One patient complained of persistence of pain, limping and recurrent effusion together with additional occasional catching feeling in the ankle. On MRI examination she had loosening of the fragment. This case was treated by arthroscopic removal of the loose fragment with mild improvement in symptoms. Improvement can be expected through drilling of the subchondral bone in symptomatic stage I and II osteochondral lesions of the dome of the talus under arthroscopic guidance, but long-term success of this line of treatment has yet to be determined

Arthroscopic meniscal repair using vertical sutures: a simple, safe and efficient procedure

Reviewing the clinical results of meniscal repair using modified outside-in meniscal suturing technique and reporting on the safety and efficacy of this technique. Retrospective, consecutive sample. Over a 2.5-year period, medial meniscal repairs were performed using No 1 PDS II sutures. All patients underwent meniscal repair with at least 37 months of follow-up. Thirty four patients had a meniscal repair performed and 29 were available for final follow-up. The average age at surgery was 27 years. There were 22 male and 7 female patients. Sixteen patients had an anterior cruciate ligament [ACL] reconstruction with the meniscal repair and 13 repairs were performed in ACL stable knees. The average follow-up was 42 months. The average Lysholm knee scores for ACL-intact and ACL-deficient knees that underwent ACL reconstruction, improved from 47and 35, respectively, to 91 and 96 postoperatively. Tegner activity scores improved from 2.7and 0 respectively, to 7.4 and 4.5 after surgery. There were no surgical complications, no infections, and no neurovascular injuries. One patient had mild subcutaneous irritation caused by the No 1 PDS II knot, which was managed by removing the subcutaneous knot 6 months postoperatively. There were 2 failures [7%] that required later arthroscopy and partial meniscectomy. One failure was in an ACL-deficient knee, and the other was in an ACL-reconstructed knee. Although the data presented in this report are based on mid-term clinical follow-up, the results of the modified outside in meniscal suturing repair technique are extremely good and comparable with the results present in literature. It is also a cheap, efficient and a relatively safe method

Abrasion and intrameniscal needling for meniscal partial tears during arthroscopicaly assisted ACL reconstruction

This study included a retrospective review of 26 patients with stable longitudinal partial medial meniscal tears who were treated with parameniscal synovial abrasion and intrameniscal needling using 18 gage spinal needle at the time of anterior cruciate ligament reconstruction. The morphology of the meniscal tears was 24 single longitudinal tears and 2 double longitudinal tears. Twenty-one tears were located in the posterior third of the meniscus, while five were present in the middle third. The distance between the tear and the meniscocapsular junction [rim width] was 3 mm in 22 tears and >3 mm in 4. In this study, failure was defined as symptomatic medial meniscal tear requiring subsequent arthroscopic management. The overall failure rate at an average follow up of 2.45 years was 11.54%. The median time to failure was 8.85 months, with one of the failures occurring secondary to a significant re-injury