Platelet-Rich Plasma Injections in Chronic Lateral Ankle Instability: A Case Series.

The platelet-rich plasma (PRP) approach may be an effective treatment for joint and cartilage pathologies. However, the rationale for its effectiveness on joint instability is limited. This study aimed to assess the safety and effectiveness of PRP injections in patients with chronic lateral ankle instability (CLAI). This retrospective study was performed at a single-center outpatient clinic between January 2015 and February 2023 and included pre-intervention assessment and short-term follow-up. Patients were excluded if they had received previous surgical treatment or had constitutional hyperlaxity, systemic diseases, or grade II or III osteoarthritis. The clinical and functional evaluation consisted of the Karlsson score, the Cumberland Ankle Instability Tool (CAIT), Good's grading system, the patient's subjective satisfaction level, and the time required to return to exercise. The entire PRP therapy regime consisted of three PRP administrations at 7-day intervals and follow-up appointments. PRP was administered both intraarticularly and into talofibular ligaments. A total of 47 consecutive patients with CLAI were included, 11 were female (23.4%), with a mean age at intervention of 31.19 ± 9.74 years. A statistically significant improvement was found in the CAIT and Karlsson scores at 3 months (27.74 ± 1.68 and 96.45 ± 4.28, respectively) relative to the pre-intervention status (10.26 ± 4.33 and 42.26 ± 14.9, respectively, p < 0.000). The mean follow-up of patients with CLAI was 17.94 ± 3.25 weeks. This study represents successful short-term functional and clinical outcomes in patients with CLAI after PRP treatment, with no adverse effects. It demonstrates the feasibility of a randomized controlled trial to further assess this therapy.

Meniscal Ramp Lesion Repair Without the Need for a Posteromedial Portal.

Medial meniscal ramp injury has gained the attention of orthopaedic surgeons in recent years. It consists of a tear of the peripheral insertion of the posterior horn of the medial meniscus. Its prevalence in anterior cruciate ligament reconstruction varies between 9% and 40% according to different studies. Ramp lesions cannot always be diagnosed using magnetic resonance imaging scans. To identify ramp lesions, the arthroscope should be introduced into the posteromedial compartment of the knee during the routine examination of the knee (Gillquist maneuver). Not all authors advocate systematically repairing ramp injuries of the medial meniscus, especially when these injuries are small and stable. They have historically been repaired using an outside-in technique using a hook-type suture passed through a posteromedial portal. In this study, we present our all-inside suture technique without the use of a posteromedial portal.

Outcomes of "Over the Top" Anterior Cruciate Ligament Reconstruction Associated with a Lateral Extra-Articular Tenodesis in Children.

(1) Purpose: The incidence of anterior cruciate ligament (ACL) ruptures in children and adolescents has considerably increased during the last decades due to higher levels of competitive athletic activity, and early sport specialization and professionalization. Contemporary ACL reconstruction techniques have recently been subject to renewed interest in this population. The objective of this study is to report the short- and mid-term results of our physis-sparing ACL reconstruction technique using an "over the top" technique associated with a modified Lemaire procedure. (2) Methods: A retrospective series of 12 junior soccer players who presented to our clinic with a torn ACL between January 2019 and September 2021 was reviewed. The inclusion criteria were patients under 15 years with open tibial and femoral physes, with a stable contralateral knee, a minimum follow-up of 6 months, and a time frame from injury to surgery of <3 months. Patients with previous knee surgery, structural concomitant injuries, muscular, neurological, or vascular abnormalities, or hypersensitivity to metal alloys were excluded. The functional evaluation was performed using the International Knee Documentation Committee (IKDC) rating, Lysholm score, and Tegner activity level. Moreover, clinical and radiological assessments were also performed, including KT-1000 and knee X-rays. (3) Results: We identified 1 female and 11 male patients with ACL tears, with a mean age of 13.17 ± 0.9 months. Concomitant injuries include isolated vertical and bucket-handle tears of the medial meniscus, lateral meniscus tears, bilateral tear of both menisci. The mean follow-up time was 26 ± 12.6 months. The average IKDC, Lysholm and Tegner scores were 93.29 ± 11.04, 95.08 ± 13.2 and 9 ± 0.0 points, respectively. The average KT-1000 score of the participants was 0.96 ± 1.6 points. None of the included patients reported post-surgical complications or required additional surgeries. (4) Conclusions: Our novel ACL reconstruction with LET technique is a safe procedure that resulted in good clinical outcomes, lower failure rate and return to sports in skeletally immature patients.

"Over-the-Top" Anterior Cruciate Ligament Reconstruction Associated With a Lateral Extra-Articular Tenodesis in Children.

Anterior cruciate ligament (ACL) tears are one of the most frequent injuries in growing children, and they are often associated with other injuries such as meniscal and chondral injuries. In the past, treatment of ACL tears in growing patients relied on activity modification and bracing. However, surgical treatment has prevailed over conservative treatment in recent years. A surgical technique is presented for ACL reconstruction using an "over-the-top" technique associated with a lateral extra-articular tenodesis procedure in children. An extra-articular lateral tenodesis is done first. The gracilis and semitendinous tendons are then extracted using a tenotome without releasing their distal desinsertions. The tibial guide is then centered over the ACL tibial footprint under arthroscopic vision and an image intensifier, proximal to the physis. Then, a Kocher-type forceps is used to pass a suture "over the top" from the posterolateral window to the tibial tunnel. The double-bundle graft and iliotibial tract graft are fixed within the tunnel in full extension and neutral rotation with an interference screw.

Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series.

Meniscal injuries are among the most frequently encountered conditions in the knee joint. Therapeutic approaches are diverse and are largely dependent on the extent and location of the injury. The purpose of this study was to describe the clinical and functional outcomes of an intraarticular and percutaneous platelet-rich plasma (PRP) injection regime in patients with stable meniscal injuries. Demographics, the type of tear, affected knee, surgical procedure, type of intervention, follow-up period, and outcomes were recorded in all cases. Patient-reported outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale. Overall patient satisfaction, quality of life, and pain intensity were also assessed. A total of 38 cases (8 females) had sustained a stable meniscal lesion (32 medial, 6 lateral) and met the inclusion criteria. All of them received three intraarticular and percutaneous PRP injections. Patients receiving the PRP injection regime reported clinically (p = 0.000) and functionally (p = 0.000 and p = 0.001) significant improvement in all outcome measures during this interval. All patients reported they were very satisfied or satisfied with the outcome. The results of this study suggest that the treatment of stable meniscal injuries with percutaneous-intraarticular PRP injections can achieve a significant clinical and functional improvement.

Obesity and Meniscal Transplant Failure: A Retrospective Cohort Study.

The purpose of this study was to analyze the effect of obesity and other clinical factors on the outcome of meniscal allograft transplantation (MAT) with transosseous fixation. A retrospective cohort study was performed on patients who underwent a MAT between 2002 and 2017. All the participants had a minimum follow-up period of 24 months. The variables assessed were age at the time of the transplant, side, sex, transplanted meniscus (lateral/medial), body mass index (BMI), smoking status, and previous surgeries. Lysholm, Tegner, and International Knee Documentation Committee (IKDC) test outcomes, and patient satisfaction were recorded. Image assessment was performed using plain standing X-rays and a follow-up magnetic resonance imaging scan. Thirty-five patients fulfilled the inclusion criteria. The mean follow-up time was of 75.7 standard deviation (SD) 43.4 months. Patients with a BMI ≥ 30 underwent medial meniscal transplants (88.9 vs. 42.3%, p = 0.022, respectively) more frequently. Obese patients had a significantly lower IKDC (48.6 SD 19.9 vs. 61.7 SD 13.1, p = 0.038, power: 57.5%) and Lysholm (60.3 SD 19.2 vs. 79.4 SD 14.3, p = 0.004, power: 88.7%) scores compared with nonobese patients. The satisfaction and Tegner scores were also lower in obese patients (55.6 vs. 80.7%, p = 0.136, and 2.8 SD 1.0 vs. 4.0 SD 1.9, p = 0.104, respectively); however, these differences were not statistically significant. Obese patients had higher rates of meniscal transplant failure compared with nonobese patients (adjusted hazard ratio: 11.8 [95% confidence interval: 1.5-91.4]). No differences were observed between obese and nonobese patients regarding age, sex, side, smoking status, and follow-up time. In this study, a BMI ≥ 30 kg/m2 resulted in higher MAT failure rates. Nonobese patients had better knee functional results compared with obese individuals.

Non anatomic reinsertion after amputation of the anterior horn of the lateral meniscus.

Anatomical reinsertion is the optimal treatment for meniscal root injuries. However, in chronic settings, tissue fraying of the meniscal root may impede it. This study describes a salvage technical procedure performed in 3 cases of chronic anterior root avulsion of the lateral meniscus with profuse tissue degeneration in which remnant debridement resulted in amputation of the root. Reinsertion of the meniscus at the remaining healthy tissue was performed using an all-inside anchoring technique.

Avulsion Fractures of Posterior Calcaneal Tuberosity: Identification of Prognostic Factors and Classification.

Avulsion fractures of the posterior calcaneal tuberosity are rare injuries, and little is known about the underlying factors, outcomes, and prognosis. Furthermore, classifications described previously focus on fracture morphology, with uncertain clinical utility. We present the results of a retrospective study of 21 patients treated for this pathology from January 2002 to December 2015. Features analyzed were age; sex; mechanism of injury; medical comorbidities; type of fracture, as proposed by Beavis; fracture displacement; fragment size; type of treatment; complications; need for secondary surgery; and the American Orthopaedic Foot and Ankle Society score after treatment and follow-up care. Mean age was 56.95years. A total of 61.9% were females, and 71.4% were secondary to low-energy trauma. In addition, 19% were diabetic. Mean follow-up was 57.24 months. Surgery was performed in 81%. Complications rate was 61.9%, and secondary surgery was needed in 38.1%. Mean fracture displacement was significantly higher when complications occurred (25.91mm versus 7.61 mm) (p = .03) and when soft tissues complications appeared (30.65mm versus 14.68 mm) (p = .02). Female gender was associated with the secondary loss of reduction (p = .04). The Beavis classification was not related significantly with any outcome variable. When fracture displacement was ≥2cm, complication rate increased from 30% to 90.9% (p = .008) and soft tissue compromise increased from 0% to 45.45% (p = .035). A new classification system with prognostic value is described, based on fracture displacement. We present 1 of the largest series published to date; fracture displacement is a major variable that influences the outcomes of these injuries, and a new classification attending to a prognostic factor is developed.

Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft.

The anterior cruciate ligament (ACL) rupture is a common disease that accounts for 250,000 cases/year in the United States. The anterolateral ligament (ALL) has been suggested to be an important restraint for rotational instability, and its reconstruction provides a reinforcement to the ACL reconstruction in this aspect, especially in high-demand athletes and in knees with high-grade pivot shift. Different techniques for associated ACL and ALL reconstruction have been described, but the ideal technique remains unclear. Several facts of these techniques may entail a concern to the surgeon, such as the need for several grafts or several bone tunnels. A technique for associated ACL and ALL is presented, using a single hamstring tendons graft, which is prepared asymmetrically, leaving one-third of the length with single diameter and two-thirds with double diameter. A single femoral tunnel is created, using a screw for fixation and differentiation of the grafts. A suspension device is used for tibial fixation, allowing for length adjustment according to the graft's length. The objective of this Technical Note is to provide the orthopaedic surgeon with a resource for ACL and ALL reconstruction even with relatively short grafts, saving bone stock and avoiding the need for allografts.

Resultados de la reparación quirúrgica de las roturas agudas del tendón distal del bíceps braquial a medio plazo: influencia de la vía de abordaje quirúrgica / Mid-term results of surgical repair of distal biceps rupture: influence of surgical approach

Objetivo: Describir los resultados funcionales y las complicaciones a medio plazo de la reparación quirúrgica de la avulsión del tendón distal del bíceps braquial y establecer una relación con la vía de abordaje empleada. Métodos: 17 pacientes consecutivos fueron intervenidos. Se registró la vía de abordaje empleada. Se recogieron los valores postoperatorios de rango de movilidad articular, capacidad funcional medido como puntuación del cuestionario Quick - DASH score y se registraron las complicaciones. Resultados: En 14 pacientes se reparó el tendón distal del bíceps. En 3 se confirmó su integridad. En 3 casos se empleó una vía anterior y en 11 una doble vía. Flexión media: 131'43º; extensión: - 3'21º pronación: 70'71º; supinación: 74’29º; puntuación Quick - DASH score: 17'04. Seguimiento: 25'5 meses. Aparecieron complicaciones en el 57’14%. La más frecuente fueron las parestesias locales, con resolución espontánea en todos los casos. Los pacientes intervenidos por doble vía obtuvieron resultados mejores en comparación con los intervenidos por vía única. Conclusiones: La reparación quirúrgica de las roturas agudas del tendón distal del bíceps braquial presenta aceptables resultados postoperatorios con una alta tasa de complicaciones, si bien estas últimas son en su mayoría de escasa relevancia. Estos resultados mejoran cuando se emplea la técnica de doble vía descrita por Boyd Anderson y modificada por Morrey

Purpose: Describe mid-term functional results and complications rate after surgical reattachment of acute distal biceps tendon ruptures and relate them with the surgical approach employed. Methods: 17 consecutive patients were evaluated. Surgical approach employed was registered, as well as post-operative range of motion of the elbow, physical function measured as Quick - DASH Score and complications. Results: Complete rupture of biceps tendon was observed in 14 cases during surgery. The anterior approach was used in 3, the double incision technique was used in 11. Average flexion: 131'43º; extension: -3'21º; pronation: 70'71º; supination: 74'29º; Quick - DASH Score: 17'04. Average follow - up: 25'5 months. Complication rate was 57'14%. The more frequent complications were local paresthesias which were solved spontaneously in all cases. The double incision technique group of patients had overall better results compared to the anterior approach group. Conclusions: Reattachment of acute distal biceps tendon ruptures shows acceptable postoperative results and high complications rate with low clinical relevance. These results seem to be better when the Boyd - Anderson double incision technique modified by Morrey is employed