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2.
Knee Surg Sports Traumatol Arthrosc ; 27(2): 445-459, 2019 Feb.
Article in English | MEDLINE | ID: mdl-30083969

ABSTRACT

PURPOSE: To investigate the influence of injury and treatment factors on clinical/functional outcomes in multiligament knee injuries (MLKI). METHODS: Thirty-nine consecutive patients with confirmed and surgically treated MLKI who met inclusion criteria were scheduled for a follow-up visit to obtain: SF-12 and subjective feeling of normalcy between the operated and healthy knee, and IKDC, active range of motion (ROM), and stability exam (Lachman test, posterior drawer, and dial test at 30°). A chart review was used to obtain data on injury and treatment factors. RESULTS: The postoperative mean (SD) outcomes were: IKDC score 62.7 (25.9), flexion-extension ROM 125° (29°), and percentage of normalcy 74% (20%). The postoperative normal/nearly normal stability exam was: Lachman test 36 (95%) patients, posterior drawer at 90° 38 (97%) patients, and dial test of 39 (100%) patients. There were 24 (61.5%) and 23 (59%) patients with complications and reoperations, respectively. The presence of bicruciate injuries was associated with worse Lachman (p = 0.03) and posterior drawer tests (p = 0.03). Presence of injury to meniscal structures was associated with worse Lachman test (p = 0.03), lower percentage of normalcy (p = 0.02) and extension lag (p = 0.04). Injury to cartilage structures was associated with worse IKDC scores (p = 0.04). IKDC was lower in cases of posterolateral corner reconstruction (p = 0.03) and use of allograft tendons for reconstruction (p = 0.02); ROM was lower in allograft reconstruction (p = 0.02) and need for meniscal repair (p = 0.01). Bicruciate reconstruction led to worst posterior drawer test (p = 0.006). CONCLUSIONS: The outcomes of MLKI might be negatively influenced by bicruciate ligament, meniscal, and cartilage injuries; with regards to treatment characteristics, need for posterolateral corner or bicruciate ligament reconstruction, use of allografts, or need for meniscal repair may similarly diminish outcomes. While surgical treatment provides good overall function, ROM and stability, it rarely results in a "normal" knee and the chances of complications and reoperations are high. LEVEL OF EVIDENCE: Cross-sectional comparative study, Level III.


Subject(s)
Anterior Cruciate Ligament Reconstruction/statistics & numerical data , Knee Injuries/surgery , Ligaments, Articular/injuries , Posterior Cruciate Ligament Reconstruction/statistics & numerical data , Adult , Cross-Sectional Studies , Female , Humans , Joint Instability/surgery , Knee Injuries/diagnosis , Knee Joint/surgery , Ligaments/surgery , Ligaments, Articular/surgery , Male , Meniscus/surgery , Middle Aged , Postoperative Complications , Range of Motion, Articular , Reoperation/statistics & numerical data , Tendons/surgery , Transplantation, Homologous , Treatment Outcome
3.
Knee Surg Sports Traumatol Arthrosc ; 25(8): 2474-2480, 2017 Aug.
Article in English | MEDLINE | ID: mdl-26718637

ABSTRACT

PURPOSE: To evaluate the safety for neurovascular structures and accuracy for tunnel placement of the posterolateral portal tibial tunnel drilling technique in posterior cruciate ligament (PCL) reconstruction. METHODS: Fifteen fresh-frozen human cadaveric knees were used. The tibial tunnel for the PCL was created using a flexible reamer from the posterolateral portal. Then, the flexible pin was left in place, and the distance from the posterolateral portal, the flexible pin, and the tibial tunnel to the peroneal nerve and popliteal artery was measured. Additionally, the distance between the tibial tunnel and several landmarks related to the PCL footprint was measured, along with the distance from the exit point of the flexible pin to the superficial medial collateral ligament and gracilis tendon. RESULTS: The peroneal nerve and the popliteal neurovascular bundle were not damaged in any of the specimens. The median (range) distance in mm from the peroneal nerve and popliteal artery to the posterolateral portal and flexible pin was: 52 (40-80) and 50 (40-61), and 35 (26-51) and 22 (16-32), respectively. The median (range) distance from the tibial tunnel to the popliteal artery was 21 mm (15-38). The tibial tunnel was located at a median (range) distance in mm of 3 (2-6), 6 (3-12), 5 (2-7), 4 (1-8), 9 (3-10), 10 (4-19), and 19 (6-24) to the champagne-glass drop-off, lateral cartilage point, shiny white fibre point, medial groove, medial meniscus posterior root, lateral meniscus posterior root, and posterior aspect of the anterior cruciate ligament, respectively. CONCLUSIONS: The posterolateral portal tibial tunnel technique is safe relative to neurovascular structures and creates an anatomically appropriate tibial tunnel location. The clinical relevance of study is that this technique may be safely and accurately used in PCL reconstruction to decrease the risk of neurovascular damage (avoid use of a posteriorly directed pin), avoid the use of intraoperative fluoroscopy, and avoid the sharp turn during graft passage.


Subject(s)
Posterior Cruciate Ligament Reconstruction/methods , Posterior Cruciate Ligament/surgery , Tibia/surgery , Aged , Aged, 80 and over , Anterior Cruciate Ligament/anatomy & histology , Cadaver , Female , Femur , Gracilis Muscle/anatomy & histology , Humans , Male , Menisci, Tibial/anatomy & histology , Middle Aged , Peroneal Nerve/anatomy & histology , Popliteal Artery , Posterior Cruciate Ligament/anatomy & histology , Tendons/anatomy & histology , Tibia/anatomy & histology
4.
J Knee Surg ; 29(7): 604-612, 2016 Oct.
Article in English | MEDLINE | ID: mdl-26716639

ABSTRACT

The purpose was to evaluate which meniscal repair technique for radial tears of the midbody of the lateral meniscus demonstrates the best biomechanical properties. An electronic literature search was conducted using PubMed, EMBASE, CINAHL, and ScienceDirect databases. Biomechanical studies investigating the repair characteristics of radial tears in the midbody of the lateral meniscus were included. After appropriate screening, a total of 54 studies were reviewed in detail (full text), and 6 met inclusion criteria. The most common cause of exclusion was the investigation of longitudinal tears. Only two studies could be meta-analyzed. Stiffness was significantly higher for all-inside compared with inside-out repair techniques (p = 0.0009). No significant differences were observed between both suture methods for load to failure (p = 0.45). However, both studies used different all-inside devices and suture constructs. No clear conclusions can be drawn from the comparison of both types of repairs for displacement, site of failure, or contact pressure changes. Overall, there are no conclusive data to suggest that inside-out or outside-in suture repair has better load to failure or stiffness, less displacement, or different site of failure compared with all-inside repair. According to biomechanical data, it is under surgeon's preference to elect one repair technique over the other.


Subject(s)
Knee Injuries/surgery , Menisci, Tibial/surgery , Tibial Meniscus Injuries/surgery , Biomechanical Phenomena , Humans , Knee Injuries/physiopathology , Menisci, Tibial/physiopathology , Suture Techniques , Tibial Meniscus Injuries/physiopathology
5.
J Shoulder Elbow Surg ; 24(11): 1834-43, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26209913

ABSTRACT

BACKGROUND: The purpose of this study was to conduct a systematic review of the literature to evaluate the characteristics of injury and treatment outcomes of rotator cuff tears in young patients. METHODS: A systematic electronic search was performed for clinical studies evaluating rotator cuff tears in patients younger than 40 years with special emphasis on reporting of injury characteristics and treatment outcomes with a minimum 1-year follow-up. RESULTS: Twelve studies (involving 336 patients) met inclusion criteria. The mean age of the patients was 28 years (range, 16-40 years), with a mean follow-up of 39 months. There were 2 distinct subgroups. The majority of studies (7 of 10) showed that patients typically had a full-thickness tear with an acute traumatic etiology. However, within the subgroup of elite throwers, 5 of 6 studies demonstrated a majority of tears that were partial thickness stemming from chronic overuse. Rotator cuff repair improved pain and strength in almost all studies reporting on these parameters. Eighty-seven percent of patients reported they were satisfied. However, all studies examining elite throwers showed significant difficulty in returning to play (25%-97%). CONCLUSIONS: In young patients with rotator cuff tears, there are 2 primary groups. (1) A majority group with rotator cuff tears of traumatic origin responded well to both arthroscopic and open rotator cuff repair in terms of pain relief and self-reported outcomes postoperatively. These patients reported high levels of satisfaction and return to preinjury level of play. (2) A unique subpopulation composed of elite throwers had improved outcomes but suboptimal return to play.


Subject(s)
Rotator Cuff Injuries , Rotator Cuff/surgery , Age Factors , Arthroscopy , Cumulative Trauma Disorders/complications , Humans , Patient Satisfaction , Return to Sport , Return to Work
6.
Arthrosc Tech ; 4(5): e537-44, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26900551

ABSTRACT

Posterior cruciate ligament (PCL) reconstruction using the transtibial drilling or arthroscopic tibial-inlay technique has a risk of injury to the popliteal neurovascular bundle because a pin is drilled anterior to posterior. Intraoperative fluoroscopy is used to decrease the risk of neurovascular injury. In addition, graft passage in the transtibial technique may be problematic because of a sharp turn when placing the graft into the tibial tunnel, which may damage graft fibers. In the surgical technique described in this report, the posteromedial portal is used for visualization and the posterolateral portal is used for debridement of the PCL tibial footprint and the synovial fold closest to the PCL. A curved guide is placed from the posterolateral portal to the tibial footprint, and a flexible pin is drilled across the tibia. The tibial tunnel is then created using a flexible reamer under direct visualization up to the desired length, and a graft can be positioned in the tibial tunnel through the posterolateral portal. This technique has the potential advantages of decreasing the risk of injury to the popliteal neurovascular bundle (use of anteriorly directed, inside-out drilling), avoiding a sharp turn during graft passage, and allowing accurate and anatomic tibial tunnel placement without intraoperative fluoroscopy.

7.
Case Rep Orthop ; 2015: 262187, 2015.
Article in English | MEDLINE | ID: mdl-26881160

ABSTRACT

Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA). In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction) can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA.

8.
J Surg Orthop Adv ; 20(1): 62-6, 2011.
Article in English | MEDLINE | ID: mdl-21477536

ABSTRACT

After the devastating earthquake in Haiti, the United States Air Force deployed multiple medical units as part of the disaster response. Air Force Special Operations Command medical teams provided initial medical response and assisted in the organization of medical assets. A small portable expeditionary aeromedical rapid response team with the assistance of a mobile aeromedical staging facility team stabilized patients for flight and coordinated air evacuation to the United States. An expeditionary medical support hospital was set up and assisted in patient movement to and from the USNS Comfort hospital ship. These units were able to adapt to the unique circumstances in Haiti and provide great patient care. The lessons learned from these experiences may help the United States better respond to future disasters.


Subject(s)
Earthquakes , Medical Missions/organization & administration , Military Medicine , Mobile Health Units/organization & administration , Relief Work/organization & administration , Altruism , Haiti , Humans , Surgical Procedures, Operative , United States , Workforce
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