A Balanced Arthroscopic Debridement of the Inner Layer of the Knee Retinaculum Increases the Tibiofemoral Joint Space Width.

INTRODUCTION: Traditional techniques can enlarge the medial tibiofemoral joint space width (JSW) for meniscal repairs, but a remnant ligament laxity may be developed. Alternatively, the debridement of the inner retinaculum layer may result in a balanced JSW without causing extra-ligament damage (retinaculum layers II and collateral ligament). PURPOSE: The purpose of this study was to determine whether a concentric arthroscopic debridement of the inner retinaculum layer increases the tibiofemoral JSW in patients with meniscal injuries. Secondarily, we determine whether the increase in JSW is symmetrical between compartments and describe the rate of complications and patient satisfaction. METHOD: Twenty middle-aged (15 male and five female) patients diagnosed with acute meniscal injury aged 36 ± 12 years were enrolled. The patients were submitted to an arthroscopic debridement of the inner layer of the knee retinaculum for both the medial and lateral compartments. The tibiofemoral JSW was measured intra-articularly using a custom instrument. A two-way ANOVA for repeated measures was used to compare the JSW. A Bland-Altman analysis and test-retest analysis were performed. RESULTS: The JSW increased following the debridement of the inner retinaculum layer, for both the medial and lateral compartments (p < 0.001). No complications were identified, and the patients were satisfied with the intervention. The minimal detectable change and bias of the custom instrument were 0.06 mm and 0.02 mm, respectively. CONCLUSION: The debridement allows a clinically important (>1 mm) symmetric tibiofemoral JSW enlargement. The technique suggests favoring the diagnosis of meniscus injuries and manipulating arthroscopic instruments without secondary complications after one year.

Achilles Tendon Allograft Preparation Technique for Anterior Cruciate Ligament Reconstruction: A Technical Note.

Several factors associated with graft preparation for the surgery of the anterior cruciate ligament (ACL) like the wrong thawed, prophylaxis, bone cuts, excessive bone removal as well as positioning problems like a tunnels-graft mismatch, insufficient harvesting of the donor's tendon, size graft limitations (length and diameter), uncontrolled rotation of graft in their longitudinal axis, over or under tensioned graft, fixation mistakes, bone defects, secondary arthrofibrosis or morbidity of the donor site, and others factors importantly affect the outcomes of the ACL surgery. In this sense, the Achilles tendon Allograft is an advantageous technique where many of the previous limitation factors described can be controlled during an appropriate preparation. However, to obtain the maximum potentialities of the graft a detailed knowledge of the preparation is required. Hence, we aimed to describe how to prepare the Achilles tendon Allograft to control the graft's length and diameter, bone removal, and fixation requirements.

Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements.

BACKGROUND:: Tendon overuse injuries are an issue in elite footballers (soccer players) and may affect tendon function. Achilles and patellar tendinopathy are the most frequent pathologies. Tendon stiffness, the relationship between the force applied to a tendon and the displacement exerted, may help represent tendon function. Stiffness is affected by training and pathology. Nevertheless, information regarding this mechanical property is lacking for elite soccer athletes. HYPOTHESIS:: Achilles and patellar tendon stiffness assessed using myotonometric measurements will be greater in elite soccer athletes than in control participants. STUDY DESIGN:: Cross-sectional study. LEVEL OF EVIDENCE:: Level 4. METHODS:: Forty-nine elite soccer athletes and 49 control participants were evaluated during the 2017 preseason. A handheld device was used to measure Achilles and patellar tendon stiffness. Dominant and nondominant limbs were assessed for both groups. RESULTS:: A significantly stiffer patellar tendon was found for both the dominant and the nondominant limb in the elite soccer athletes compared with the control group. Nevertheless, no differences were found in Achilles tendon stiffness between groups. When comparing between playing positions in soccer athletes, no significant differences were found for both tendons. CONCLUSION:: Greater patellar tendon stiffness may be related to an improvement in force transmission during muscle contraction. On the other hand, it seems that after years of professional training, Achilles tendon stiffness does not change, conserving the storing-releasing function of elastic energy. The nonsignificant differences between positions may be attributable to the years of homogeneous training that the players underwent. CLINICAL RELEVANCE:: The present study shows another technique for measuring mechanical properties of tendons in soccer athletes that could be used in clinical settings. In the future, this technique may help clinicians choose the best exercise protocol to address impairments in tendon stiffness.

Inestabilidad posterolateral de rodilla: evaluación clínica de tres técnicas quirúrgicas / Posterolateral inestability of the knee: clinical evaluation of 3 surgical techniques

Objetivo: Definir cual es la mejor técnica quirúrgica para tratar la inestabilidad rotacional posterolateral es aun motivo de debate. El objetivo de este estudio es comparar tres técnicas quirúrgica utilizadas: Reparación anatómica primaria. Tenodésis del bíceps femoral. Reconstrucción del complejo posterolateral con técnica de Clancy modificada. Método. Evaluamos en forma retrospectiva y prospectiva el resultado clínico obtenido en el tratamiento 19 pacientes, 21 rodillas (dos de ellos bilateral), con lesiones capsuloligamentosas múltiples de rodillas entre las cuales siempre estaba comprometida la esquina posterolateral. Estos pacientes fueron tratados entre marzo de 1994 y junio del 2000 en el Hospital Dipreca o en la Clínica Las Condes. Las lesiones combinadas en las 21 rodillas analizadas son: ruptura de LCA-PL: 5, ruptura de LCP-PL: 7; ruptura de LCA-LCP y PL: 9. Los pacientes se dividieron en tres grupos: Grupos A: 12 rodillas a las que se les realizó un reparación anatómica primaria. Grupo B: 9 rodillas tratadas con una tenodesis del biceps. Grupo C: 5 rodillas sometidas a una reconstrucción posterolateral de Clancy modificada, en la cual el injerto se dividió en dos o tres bandas. El análisis estadístico se realizó utilizando el test de student. Resultados: Grupo A: doce rodillas, 11 hombres y 1 mujer. La edad mediana fue de 30 años. El seguimiento mínimo fue de 27 meses con un rango de 18 a 96 meses. Ocho de doce (66 por ciento) describieron restricciones importantes para realizar actividades de la vida diaria y estaban insatisfechos con el procedimiento quirúrgico. La escala IKDC presentaba a pacientes en la categoría más baja: D (anormal). Cinco pacientes requirieron de un nuevo procedimiento quirúrgico. Grupo B: Constituido por nueve rodillas, todos de sexo masculino. La edad mediana fue de 29 años. El seguimiento mínimo fue de 29 meses con un rango de 12 a 96 meses. Siete de 9 (77 por ciento) refirieron no tener ninguna restricción para efectuar actividades de la vida diaria y laboral. El 89 por ciento estaban satisfechos con su tratamiento. La escala IKDC fue D (cercano a normal) con un puntaje promedio de 86,7 (rango 20,9 a 96,6). Grupo C: Formado por 5 rodillas, hombres. La edad mediana fue de 29 años. El seguimiento mínimo fue de 17 meses con un rango de 12 a 96 meses. Todos ellos (100 por ciento) retornaron a sus trabajos originales sin restricciones