RESUMEN
We report a case of a 12-years-old boy that underwent anterior cruciate ligament (ACL) reconstruction and lateral meniscus repair. The all-epiphyseal, all-inside technique, with quadriceps tendon autograft and adjustable suspensory button fixation was utilized due to the open physes. Intraoperative fluoroscopy confirmed optimal position of the buttons, while arthroscopic evaluation of the graft showed proper tension, with full range of motion and knee stability. Nevertheless, routine radiographic evaluation of the knee, 6 âh postoperatively, revealed tibial button migration through the tunnel into the knee joint, while the knee was unstable in clinical examination. The graft was removed and reloaded with extended buttons. The femoral socket was retained in the revision surgery while a new tibial socket was drilled with the transphyseal technique (all-inside technique). The postoperative course was uneventful. The patient returned to unrestricted activities at twelve months after revision surgery and remains fully active two years postoperatively. This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior , Artroscopía , Reoperación , Tibia , Humanos , Masculino , Niño , Reconstrucción del Ligamento Cruzado Anterior/métodos , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Tibia/cirugía , Artroscopía/métodos , Artroscopía/efectos adversos , Reoperación/métodos , Articulación de la Rodilla/cirugía , Lesiones del Ligamento Cruzado Anterior/cirugía , Rango del Movimiento Articular , Migración de Cuerpo Extraño/cirugía , Resultado del Tratamiento , Ligamento Cruzado Anterior/cirugía , Suturas/efectos adversos , Tendones/cirugía , Fluoroscopía , Técnicas de Sutura , Trasplante Autólogo/métodosRESUMEN
Non-union and refracture of fifth metatarsal fractures are common and devastating complications in the athletic population. Stem cell application at the fracture site, for biologic enhancement, is utilized to address this challenge. We present a simple technique to approach both the endosteum and the periosteum percutaneously, under a local anesthetic, in cases of cannulated screw intramedullary fixation.