An All-Inside Repair for Full Radial Posterior Lateral Meniscus Tears.

There is controversy about the treatment for unstable full radial posterior lateral meniscus tears, particularly that involving the posterior root. Some surgeons have advocated repairing these types of meniscus tears using various techniques, but their methods are somewhat technical. We developed the technique for an all-inside repair for full radial posterior lateral meniscus tears using the Meniscal Viper (Arthrex, Naples, FL). A doubled thread is passed through 1 edge of the radial tear by the Meniscal Viper and is kept in place without tying the knot. The Meniscal Viper is used again to set a new thread, repeating the same procedure to another edge of the tear. At this step, 2 doubled threads are passed through each stump of the tear, and both a loop end and 2 free ends of each thread are located outside of the joint. Then, 2 doubled threads pass the third thread into its own loop, pulling it out. Finally, the third thread becomes the mattress suture over the radial tear site and is fastened by sliding knot techniques. This procedure makes it easy to strictly, smoothly, and less invasively shorten the gap by drawing each stump of the meniscus in the direction of the circumference.

Inducement of semitendinosus tendon regeneration to the pes anserinus after its harvest for anterior cruciate ligament reconstruction-A new inducer grafting technique.

PURPOSE: To investigate the usefulness of the "inducer grafting" technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. METHODS: Twenty knees of 20 patients (mean age at the time of surgery, 23.1 years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients)."Inducer grafting" techniqueAfter harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15 months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. RESULTS: One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. CONCLUSION: These results suggest that the "inducer grafting" technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes anserinus. However, this technique couldn't improve the deficits in knee flexion torque after ACL reconstruction.

Relationship between thickness of the anteromedial bundle and thickness of the posterolateral bundle in the normal ACL.

PURPOSE: Since the development of the anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, many studies have focused on excursion and/or tension of each graft. However, no studies to date have adequately investigated thickness of the graft in anatomic double-bundle ACL reconstruction. To obtain basic knowledge from which an ideal graft thickness can be inferred, thicknesses of the anteromedial bundle (AMB) and posterolateral bundle (PLB) was measured in the normal ACL. METHODS: The right knees of 50 cadavers donated for anatomy instruction were studied. Each ACL was separated into the AMB and PLB, and circumferences at the mid-substance and cross-sectional area at the femoral and tibial footprints were measured in each. RESULTS: Cross-sectional areas of the AMB and PLB were 36 ± 10 and 32.1 ± 10.2 mm² at the femoral footprint, and 60.9 ± 21.8 and 52.2 ± 17.3 mm² at the tibial footprint, respectively. Circumferences at the mid-substance were 14.3 ± 3.3 mm for the ALB and 10.8 ± 3.1 mm for the PLB. A positive correlation was seen between AMB and PLB at each of the three sites. CONCLUSION: The AMB is thicker than the PLB, showing a constant correlation in the normal ACL. This suggests that the anteromedial graft must be thicker than the posterolateral graft at least in actual operations.

Cartilage change after arthroscopic repair for an isolated meniscal tear.

To investigate the direct effect to the cartilage caused by the meniscal repair, we examined patients who underwent an isolated meniscal repair without any other abnormalities by arthroscopic examination. A total of 17 patients were examined by second-look arthroscopy after an average interval of 9 months from the meniscal repair, and have been evaluated the status of the repaired meniscus and of the relative femoral condylar cartilage. Changes in the severity of the cartilage lesion between at the time of meniscal repair and the time of the second-look arthroscopy were considered based on the status of the repaired meniscus. Regardless of the healing status of the repair site, it was possible to prevent degeneration in the cartilage in 9 of the 10 patients who demonstrated no degeneration in the meniscal body. Of the 7 patients who demonstrated degeneration in the meniscal body, progression in cartilage degeneration was noted as 1 grade in 2 patients and 2 grades in another 3 patients. Even in those in which stable fusion of the repair site was achieved, the condition of the inner meniscal body was not necessarily maintained favorably in all cases, indicating that degeneration in the meniscal body was a risk factor for cartilage degeneration. It was concluded that recovery could not be expected even at 9 months after the repair if the lesion had already demonstrated degeneration in the meniscal body at the time of repair.

A long-term follow-up study of four cases who underwent curettage and autogenous bone grafting for steroid-related osteonecrosis of the femoral condyle.

We performed curettage followed by autogenous bone grafting in several cases of steroid-related osteonecrosis of the femoral condyle, and reviewed the outcome of this procedure after a mean follow-up of 9.5 years. The number of patients was 4; the mean age at the time of the operation was 30.5 years. The mean Knee Society Objective Score was 52.5 before the operation and had increased to 87.5 at the time of the review. The pre-operative radiographic stages were stage 2 in 2 patients and stage 3 in the other 2 patients. Progression in the disease stage was observed in 3 patients. MRI revealed survival of the grafted bone in only one case, and collapse of the articular surface in all cases. In conclusion, though the clinical results showed improvement, the autogenous bone graft failed to answer the purpose of preventing the progression in disease stage.