Optimization of Graft Position at the Tibia Footprint in Anterior Cruciate Ligament Revision-Lasso Technique.

In anterior cruciate ligament (ACL) revision cases, the resultant bigger aperture at the tibia footprint can cause graft instability. The increased movement hinders bone-graft integration and leads to graft abrasion. This article describes a technique to optimize graft stability when using a soft tissue graft for ACL revision. The technique is used when there is suspicion of size mismatch between the new tibia footprint aperture and the graft. The first stage involves passing a suture via an anterolateral tibial tunnel connecting with the revision tibia tunnel distal to the tibia footprint aperture. The new graft is subsequently deployed, and the potential discrepancy between graft diameter and aperture is confirmed. The second stage involves placing 2 pulling sutures on the new graft and passing them into the anterolateral tibial tunnel. The tensioned and anchored pulling sutures secure graft stability at the tibia footprint, and the graft distal to that is fixed routinely. The lasso technique stabilizes the new graft at the tibia footprint by tensioning it in a distal and anterolateral direction. For selected cases, this technique enables a 1-stage ACL revision with a soft tissue graft when faced with graft instability at the tibia footprint.

A systematic review and meta-analysis of hybrid vs. cemented stems - which method is more optimal for revision total knee arthroplasty?

INTRODUCTION: The number of primary and revision Total Knee Arthroplasty (TKA) cases are expected to increase in future. There are various advantages and disadvantage to employing either of the two main types of stem fixation methods - cemented or hybrid technique. This review aimed to study the most optimal fixation method for revision TKAs by comparing radiological outcomes and re-revision rates. METHODS: A systematic review and meta-analysis was performed using PubMed and Cochrane Library from 2010 to identify studies explicitly comparing outcomes between cemented against hybrid fixation revision TKA techniques, with a minimum follow up of at least 24 months. A total of 8 studies was included in this review. Egger's test and visual inspection of the funnel plot did not reveal publication bias. RESULTS: There was no statistically significant difference in radiological failure and loosening (OR 0.79, CI 0.37-1.66, I2 = 29%, p = 0.22), all causes of re-revision (OR 1.03, CI 0.73-1.44, I2 = 0%, p = 0.56) and aseptic revision (OR 0.74, CI 0.27-2.02, I2 = 0%, p = 0.41) between cemented and hybrid techniques. Functional and pain outcomes compared between the two fixation techniques were largely similar across the studies included in this meta-analysis. CONCLUSION: Despite a trend favouring hybrid stems in revision TKA, current evidence revealed that radiological outcomes and re-revision rates are largely similar between cemented and hybrid fixation techniques.

An Approach to Chronic and Displaced Bucket Handle Meniscal Tear-Assessment, Repair (Push-and-Pull Technique), or Salvage.

Meniscal repairs are preferred to meniscectomies to preserve meniscal function and mitigate the risk of degeneration. However, repair of a chronic and displaced bucket handle tear of the meniscus can be technically challenging. We introduce a systematic method for assessment, reduction, repair, or salvage in this situation with an aim of reducing operating time and improving the chance of a favorable outcome. This technique describes repair of a bucket handle tear on the medial meniscus with displacement into the intercondylar notch. An arthroscopic probe is used for reduction and suture tension (push-and-pull technique) when using an all-inside suture device (FAST-FIX 360 repair system; Smith & Nephew) on the middle and posterior part of the tear. The anterior part of the tear is repaired with an outside-in method. If reduction is not possible, then a salvage reduction and hybrid repair is carried out instead. Postoperatively, patients will be nonweight-bearing on the operated limb, and range of motion restricted from 0 to 90° for 6 weeks, with the aim of resuming running by 6 months.