Visualization and reduction of a mensical capsular junction tear in the knee: an arthroscopic surgical technique.

Meniscal injuries commonly occur concomitantly with anterior cruciate ligament (ACL) injuries. Although many types of meniscal injuries have been described in the literature, there has not been much focus on meniscal capsular junction (MCJ) tears. This lack of attention is concerning given that, in a survey of 67 orthopedic surgeons, 88% indicated that MCJ tears could be a source of chronic pain. In addition, we reviewed 781 ACL reconstructions at our clinic and found a 12.3% incidence of MCJ tear with primary ACL injury and a 23.6% incidence of MCJ tear with revision ACL reconstruction. In this article, we describe an arthroscopic repair technique for MCJ tears at the posterior aspect of the medial meniscus root. The repair uses an accessory posterior medial portal. The technique can also be used for significant posterior medial capsular tears.

Pseudoaneurysm of the distal thigh after manipulation of a total knee arthroplasty.

The authors describe a unique complication after manipulation of a stiff total knee arthroplasty in a 47-year-old man. Four days after undergoing manipulation under anesthesia (MUA), the patient presented with increasing pain and swelling of the affected knee and decreased hemoglobin/hematocrit. Computed tomographic angiogram revealed a ruptured pseudoaneurysm of a segmental branch of the deep femoral artery that was treated with embolization and anterior thigh compartment fasciotomy. Although many complications of MUA have been described, we present a novel finding of a ruptured pseudoaneurysm. Ruptured pseudoaneurysm should be included in the differential diagnosis whenever a patient presents with pain and swelling of the thigh after MUA given its potential morbidity.

Unipolar vs bipolar hemostasis in total knee arthroplasty: a prospective randomized trial.

The purpose of this study was to investigate whether unipolar or bipolar hemostasis is more effective in reducing blood loss associated with primary total knee arthroplasty. We randomized 113 consecutive patients undergoing primary total knee arthroplasty into unipolar and bipolar hemostasis treatment groups. The mean postoperative drain output in the unipolar group was 776.5 mL compared with 778.7 mL and was not statistically significant (P = .97). There were no statistically significant differences in postoperative day 1 through 3 hemoglobin level (P = .2-.6) or hematocrit (P = .17-.46) values. The transfusion requirement in the unipolar group was 36% and 40% in the bipolar group (P = .67). Use of bipolar sealer compared with standard unipolar electrocauterization showed no significant difference in postoperative drain output, postoperative hemoglobin level and hematocrit values, or transfusion requirements.

Isolated intra-articular pseudorheumatoid nodule of the knee.

The authors describe a case of an isolated intra-articular pseudorheumatoid nodule of the knee in an 18-year-old male patient without a diagnosis of rheumatoid arthritis. The patient initially presented with a 3 year history of anterior knee pain and was found to have a 2.8 × 2.1 cm lobulated soft-tissue mass. Histologic findings showed fibrinoid necrosis and chronic inflammatory changes that were consistent with those of a pseudorheumatoid or rheumatoid nodule, and surgical excision of the nodule was curative. A review of the literature revealed no prior cases of an intra-articular pseudorheumatoid nodule or rheumatoid nodule in a patient without clinical or serologic evidence of rheumatoid arthritis.