Outcomes after Anatomic Double-Bundle Posterior Cruciate Ligament Reconstructions Using Transtibial and Tibial Inlay Techniques.

Surgical reconstruction is recommended for symptomatic posterior cruciate ligament (PCL) deficiency. While anatomic double-bundle PCL reconstruction (PCLR) has been reported to be associated with biomechanical and clinical advantages over other methods, there is still debate regarding the optimal technique for tibial positioning and fixation. Based on reported advantages and disadvantages, we employed two tibial fixation techniques, transtibial (TT) and tibial inlay (TI) for anatomic double-bundle PCLR with technique selection based on body mass index, comorbidities, and primary versus revision surgery. This study aimed to compare clinical outcomes following PCLR utilizing either TT or TI techniques to validate relative advantages, disadvantages, and indications for each based on the review of prospectively collected registry data. For 37 patients meeting inclusion criteria, 26 underwent arthroscopic TT PCLR using all-soft- tissue allograft with suspensory fixation in the tibia and 11 patients underwent open TI PCLR using an allograft with calcaneal bone block and screw fixation in the tibia. There were no significant preoperative differences between cohorts. Success rates were 96% for TT and 91% for TI with all successful cases documented to be associated with good-to-excellent posterior stability and range of motion in the knee at the final follow-up. In addition, patient-reported outcome scores were within clinically meaningful ranges for pain, function, and mental health after PCLR in both cohorts, suggesting similarly favorable functional, social, and psychological outcomes. Patient-reported pain scores at 6 months postoperatively were significantly (p = 0.042) lower in the TT cohort, which was the only statistically significant difference in outcomes noted. The results of this study support the use of TT and TI techniques for double-bundle anatomic PCLR in restoring knee stability and patient function when used for the treatment of isolated and multiligamentous PCL injuries. The choice between tibial fixation methods for PCLR can be appropriately based on patient and injury characteristics that optimize respective advantages for each technique.

Lateral Extra-articular Tenodesis with Iliotibial Band Using Knotless All-Suture Anchor Femoral Fixation.

Common injuries, such as anterior cruciate ligament (ACL) tears, can result in both anterior and rotational instability of the knee. An arthroscopic anterior cruciate ligament reconstruction (ACLR) method has been shown to be effective in restoring anterior translational stability, but this could be followed by persistent rotational instability by means of residual pivot shifts or repeat instability episodes. Alternative techniques, such as a lateral extraarticular tenodesis (LET), has been proposed as a technique for preventing persistent rotational instability following ACLR. This article presents a case of a LET using an autologous central slip of iliotibial (IT) band with fixation to the femur using a 1.8-mm knotless all-suture anchor.

Anomalous Posterior Tibial Artery Course-Anatomic Considerations for the Posterolateral Ankle Approach: A Case Report.

CASE: We report a unique anatomical case of an anomalous course of the posterior tibial artery found on dissection during the posterolateral approach to the ankle. To the best of our knowledge, no such case has been documented. CONCLUSION: The vascular bundle consistent with that of the posterior tibial artery and vein was encountered in the far lateral aspect of the deep posterior compartment, which suggests physicians should proceed with caution when performing the posterolateral approach to the ankle so as to avoid iatrogenic injury of this named anatomic structure.

Tibial Tubercle Osteotomy With Anteriorization and Distalization for Treatment of Patellar Instability With Patella Alta.

Patellofemoral instability is a common cause of knee pain that can lead to long-standing pain, chondral injury, recurrent dislocations, and degenerative changes if not treated appropriately. Tibial tubercle osteotomy is indicated when there is anatomy predisposing to patellar maltracking and instability, namely abnormal patellar height or tibial tubercle location. In this Technical Note, we describe a technique for tibial tubercle anteriorization and distalization as part of the overall treatment algorithm for patellar instability with associated patella alta. This method of tibial tubercle osteotomy reliably produces anterior and distal translation of the patella to correct patellar height and decrease contact pressure across the patellofemoral joint.

Double-Bundle Posterior Cruciate Ligament Reconstruction.

The optimal surgical technique for posterior cruciate ligament (PCL) reconstruction is a topic of debate among knee surgeons. There are many variables to consider including graft selection, graft fixation method, and single- versus double-bundle reconstruction. While there is a need for ongoing research to elucidate which technique yields the best results, this article discusses recent literature on the topic of single- versus double-bundle PCL reconstruction as well as the senior author's preferred reconstruction method.