Arthroscopic ACL Avulsion Fixation With Adjustable Loop Length Cortical Endobutton.

Various surgical management techniques have been introduced to treat anterior cruciate ligament avulsion fractures. There is disagreement among orthopedic surgeons about which fixation device to use during arthroscopy. Recently, there has been an increase in the use of arthroscopic techniques for fixation, and different devices such as sutures, screws, and fiber wires are being considered. The development of fiber wires has made it possible to use them in comminuted avulsions with satisfactory stability, whereas screws cannot be used in such cases. Sutures do not provide adequate stability for early range of motion compared to other methods. The article then goes on to describe a specific arthroscopic fixation technique that uses an adjustable loop cortical button to manage the avulsed fragment and provide stability.

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution.

The anterior cruciate ligament (ACL) is often vulnerable to sports-related injuries, leading to numerous ACL reconstructions (ACLRs) annually in the United States. Although largely successful, these procedures face the risk of recurrent instability due to graft failure. ACLR failures are typically attributed to technical errors and patient-related factors, with improper positioning of the tibial and femoral tunnels as the most common technical mistake. Current 2-stage revision techniques involve primary bone grafting followed by secondary tendon graft placement, resulting in increased costs and extended rehabilitation times. This article proposes a single-stage revision strategy involving simultaneous tunnel grafting and ACLR revision. The method employs double suspensory fixation by adjustable loop buttons, thereby eliminating the dependence on metaphyseal bone stock for stable graft fixation. This new procedure may offer a more efficient and cost-effective approach, reducing the need for a second surgery and potentially allowing patients to return to normal activities more quickly.

Distal Kaplan Fiber Tenodesis Surgical Technique.

Anterior cruciate ligament tears are a common knee injury, and even after reconstruction, some patients may still experience instability in their knee. To address this, extra-articular reinforcement may be necessary to prevent anterior translation and internal rotation of the tibia. Kaplan fibers (KFs), which are the attachments of the iliotibial band to the distal femur, can help improve anterolateral rotatory stability in the knee, especially in greater degrees of knee flexion. Our technique for KF reconstruction involves making a 10-cm incision in the skin and subcutaneous tissue of the distal and lateral thigh. We release a 10-cm × 1-cm strip of the iliotibial band while maintaining its tibial insertion and then stitch the free end of the strip before attaching it to the distal femur using a ToggelLoc (Zimmer Biomet). The advantage of this technique is that the tension of the iliotibial band strip can be adjusted using the ToggelLoc, allowing the surgeon to increase tension in the graft as needed to achieve ideal tension in knee flexion.

Treatment of Simultaneous Femoral Supracondylar Nonunion and Tibial Plateau Malunion along with Stiff Knee in a Young Patient: A Case Report.

A 41-year-old man underwent Total Knee Arthroplasty with NexGen Legacy Constrained Condylar Knee (LCCK) system to treat his nonunion of distal femur, stiff knee, and malunion of tibia plateau. The treatment involved femoral and tibial stems and PS polyethylene. As a result, his knee range of motion improved, and he no longer experienced pain. After two years, he resumed work without any signs of loosening or stiffness.

Genicular Artery Embolization for Knee Osteoarthritis: A Comprehensive Review.

¼ Genicular artery embolization (GAE) is a promising treatment option for patients with knee osteoarthritis who are unresponsive to nonsurgical treatments and not yet candidates for surgery.¼ Current evidence supports the effectiveness of GAE in reducing pain and synovitis, with few reported major adverse events.¼ The cost-effectiveness and long-term results of GAE compared with other treatment options require further investigation.¼ Limitations of existing studies include small sample sizes, single-center trials, and lack of comparison between embolic agents and other treatments.¼ Future research should focus on larger, multicenter trials with longer follow-up periods and head-to-head comparisons with alternative treatment modalities to establish the role of GAE in the management of knee osteoarthritis.

Bilateral primary synovial chondromatosis in the knee joint.

Primary synovial chondromatosis is a disorder characterized by the metaplasia of the synovial membrane and the formation of loose bodies floating in the joint. We described a 30-year-old woman without any past medical history complaining of bilateral progressive knee pain who was later discovered to have bilateral synovial chondromatosis.

Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction Using Double Suspensory Technique and Medial Open-Wedge, High Tibial Osteotomy.

Anterior cruciate ligament reconstruction (ACLR) is generally performed regardless of knee malalignments. However, there are some indications for either staged or simultaneous ACL reconstruction and realignment procedures, such as high tibial osteotomy (HTO). Simultaneous HTO-ACL reconstruction has the apparent benefit of a single surgical procedure with a faster recovery than a staged procedure, and it produces good clinical outcomes. Several techniques have been described for simultaneous ACLR and medial open wedge HTO. The tibial tunnel preparation and graft fixation are the most challenging part of the procedure. Recent studies on comparison of fixation of tibial tunnel graft using suspensory fixation versus bioabsorbable screws have shown superior results of more bone preservation and less graft rupture. We assumed suspensory fixation on the tibial side with bone preservation might be more reliable in patients who received ACLR and open wedge HTO at the same time. Therefore, we described our technique of simultaneous open-wedge HTO and ACLR using double suspensory graft fixation.

Medial Collateral Ligament Injury of the Knee: A Review on Current Concept and Management.

The medial collateral ligament (MCL) is a major stabilizer of the knee joint, providing support against rotatory and valgus forces; moreover, it is the most common ligament injured during knee trauma. The MCL injury results in valgus instability of the knee and makes the patient susceptible to degenerative knee osteoarthritis. Although it has been nearly a dogma to manage MCL injury nonoperatively, recent literature has suggested operative MCL management as a suitable option for specific patient populations. The present review aimed to assess the current literature on the management of MCL injuries of the knee. In this regard, we go over the anatomy, physical examination, and MCL imaging.

Comparison between Patellar Resurfacing and Retention in Total Knee Arthroplasty Regarding the Postoperative Satisfaction of Patients and Patellar Crepitus.

BACKGROUND: Patellar crepitus after total knee arthroplasty (TKA) is not uncommon. The choice between patellar resurfacing or retention in TKA has remained controversial. Therefore, this randomized controlled trial aimed to evaluate the impact of patellar resurfacing on the incidence of patellar crepitus. In addition, we compared the clinical outcomes and satisfaction between the patients who underwent patellar retention or resurfacing. METHODS: A total of 63 patients randomly received patellar resurfacing or non-resurfacing TKA by one surgeon at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Iran during May 2014-February 2017. Finally, 29 patients in the resurfaced group and 44 subjects with retained patella were evaluated pre-op and in an average follow-up period of 8.68 months using the clinical Knee Society Score (KSS), functional KSS, and Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Our findings demonstrated no significant difference between the two groups regarding the satisfaction of patients, KSS, and KOOS. It was shown that the latter scores improved in both groups in the follow-up period. Nonetheless, patellar crepitus was not statistically different between the two groups. CONCLUSION: According to the results of the present study, patellar resurfacing did not lead to decreased patellar crepitus or enhanced clinical outcomes of TKA.

Acute Compartment Syndrome After Knee Synovectomy in a Patient with Hemophilia A: A Case Report.

CASE: A 19-year-old man with severe hemophilia A underwent open surgical synovectomy to treat recurrent hemarthrosis of the knee. He developed symptoms and signs of acute compartment syndrome (ACS) despite receiving full-dose factor replacement. Arthrotomy was performed twice, and massive hemarthrosis was evacuated. The symptoms subsided after supplementing clotting factor with prednisone. CONCLUSIONS: ACS may complicate hemophilia. Diagnosis is mainly based on clinical judgment. Proper factor replacement is the mainstay of treatment. Surgery is reserved for patients with no improvement following factor administration.