All-Arthroscopic Treatment of Combined Posterior Cruciate Ligament and Posterolateral Corner Instability.

Injuries to the posterolateral corner (PLC) of the knee are uncommon, and usually associated with other ligamentous injuries. A combined posterior cruciate ligament (PCL) and PLC tear is the most frequent combination. Several studies describe anatomic reconstructive techniques using an open approach with large incisions and extensive exploration of the posterolateral structures. This Technical Note describes an all-arthroscopic technique as a safe and efficient treatment of combined PCL and PLC instability using the trans-septal approach.

Incidence of Meniscal Ramp Lesion in Anterior Cruciate Ligament Reconstructions.

Objective To evaluate the incidence and epidemiological profile of meniscal ramp lesions in patients undergoing anterior cruciate ligament (ACL) reconstruction surgery, and to determine the related risk factors. Methods In total, 824 patients undergoing ACL reconstruction surgery were retrospectively analyzed. Patients who presented medial meniscal instability were submitted to evaluation of the posteromedial compartment of the knee. In case of injury, surgical repair was performed. Potential risk factors associated with the lesions were analyzed. Results The overall incidence of ramp lesions in the population studied was of 10.6% (87 lesions in 824 patients). The multivariate analysis through the Chi-squared test showed that the presence of meniscal ramp lesions was significantly associated with the following risk factors: right laterality and chronic lesions. Gender, age and sports activity were not statistically significant. Soccer was the most frequent cause of ramp injuries related to sport, with 78.2% of the cases. However, it was not shown to be a risk factor. The annual incidence from 2014 to 2019 ranged from 4.0% to 20.6%. Conclusion The incidence of meniscal ramp lesions was of 10.6% in ACL reconstruction surgeries, being more frequent among patients with chronic lesions. The increasing annual incidence ranged from 4.0% in 2014 to 20.6% in 2019.

Incidence of Meniscal Ramp Lesion in Anterior Cruciate Ligament Reconstructions / Incidência de lesões da rampa meniscal nas reconstruções do ligamento cruzado anterior

Abstract Objective To evaluate the incidence and epidemiological profile of meniscal ramp lesions in patients undergoing anterior cruciate ligament (ACL) reconstruction surgery, and to determine the related risk factors. Methods In total, 824 patients undergoing ACL reconstruction surgery were retrospectively analyzed. Patients who presented medial meniscal instability were submitted to evaluation of the posteromedial compartment of the knee. In case of injury, surgical repair was performed. Potential risk factors associated with the lesions were analyzed. Results The overall incidence of ramp lesions in the population studied was of 10.6% (87 lesions in 824 patients). The multivariate analysis through the Chi-squared test showed that the presence of meniscal ramp lesions was significantly associated with the following risk factors: right laterality and chronic lesions. Gender, age and sports activity were not statistically significant. Soccer was the most frequent cause of ramp injuries related to sport, with 78.2% of the cases. However, it was not shown to be a risk factor. The annual incidence from 2014 to 2019 ranged from 4.0% to 20.6%. Conclusion The incidence of meniscal ramp lesions was of 10.6% in ACL reconstruction surgeries, being more frequent among patients with chronic lesions. The increasing annual incidence ranged from 4.0% in 2014 to 20.6% in 2019.

Resumo Objetivo Avaliar a incidência e o perfil epidemiológico das lesões da rampa meniscal nos pacientes submetidos a cirurgia de reconstrução do ligamento cruzado anterior (LCA), e determinar os fatores de risco relacionados. Métodos Foram analisados retrospectivamente 824 pacientes submetidos a cirurgia de reconstrução do LCA. Os pacientes que apresentaram instabilidade meniscal medial foram submetidos a avaliação do compartimento posteromedial do joelho. Em caso de lesão, o reparo cirúrgico foi realizado. Potenciais fatores de risco associados às lesões foram analisados. Resultados A incidência geral de lesões da rampa na população estudada foi de 10,6% (87 lesões em 824 pacientes). A análise multivariada pelo teste do Qui-quadrado demonstrou que a presença de lesões da rampa meniscal foi significativamente associada aos seguintes fatores de risco: lateralidade direita e lesões crônicas. Sexo, idade e atividade esportiva não foram estatisticamente significantes. O futebol foi a causa mais frequente de lesões da rampa relacionadas ao esporte, com 78,2% dos casos. No entanto, não se mostrou ser um fator de risco. De 2014 a 2019, a incidência anual variou de 4,0% a 20,6%. Conclusão A incidência das lesões da rampa meniscal foi de 10,6% nas cirurgias de reconstrução do LCA, sendo mais frequente em pacientes com lesões crônicas. A incidência anual foi crescente, e variou de 4,0%, em 2014, a 20,6%, em 2019.

Femoral Physeal-Sparing Anterior Cruciate Ligament Reconstruction Using the Iliotibial Band: Over-The-Top Technique.

Anterior cruciate ligament injuries are increasingly frequent in skeletally immature patients. However, treatment within this subpopulation remains controversial. Conventional transphyseal reconstruction techniques have been questioned because of potential physeal injuries. Conservative treatment, on the other hand, may lead to degenerative meniscal and chondral lesions. This Technical Note describes the femoral physeal-sparing over-the-top technique using an iliotibial band. It is a safe and effective method for anterior cruciate ligament reconstruction in skeletally immature patients.

Ultrasound-Guided Electrocoagulation of Neovessels for Chronic Patellar Tendinopathy.

Chronic patellar tendinopathy remains a challenging problem. The first line of treatment is conservative; when this fails, surgical treatment is indicated. Several open and arthroscopic techniques have been described. We describe an alternative technique using ultrasound-guided electrocoagulation of neovessels that leaves the patellar tendon intact.

Excision of a Posterior Cruciate Ligament Cyst Using an Arthroscopic Trans-septal Approach.

Posterior cruciate ligament (PCL) cysts are rare. Although they are usually asymptomatic and benign, in a few cases they may cause knee discomfort and restricted movements. Nonsurgical treatment is the initial approach, with medication and corticosteroid injections. However, there may be treatment failures, with some cysts needing to be excised surgically. Arthroscopic excision of PCL cysts located in the posterior compartment of the knee can be technically challenging. We describe the arthroscopic excision of a PCL cyst using a trans-septal portal, which is an easy and safe method for accessing and completely removing the lesion under direct vision.

No difference in patellar position between mobile-bearing and fixed-bearing total knee arthroplasty for medial osteoarthritis: a prospective randomized study.

PURPOSE: Total knee arthroplasty (TKA) is the treatment of choice for severe osteoarthritis of the knee. Many studies have been performed comparing mobile- and fixed-bearing designs; however, there are insufficient data regarding the patellar position in either system. This study aimed to compare the resultant patellar position with a mobile- versus a fixed-bearing TKA and the influence of both designs on clinical outcomes. MATERIALS AND METHODS: In this prospective randomized study, between 2007 and 2009, 160 TKA patients were assessed; 79 received a mobile-bearing and 81 received a fixed-bearing implant, for medial compartment osteoarthritis. A posteriorly stabilized, HLS Noetos knee prosthesis (Tornier, Saint-Ismier, France) was used in all cases. The only difference between the groups was whether the tibial component incorporated a fixed or mobile bearing. The patella was resurfaced in all cases. The International Knee Society Score (KSS) and the patellar tilt and translation were compared post-operatively. Patellar translation and patellar tilt analyses were subdivided into two subgroups (< 5 mm vs > 5 mm and < 5° vs > 5°). RESULTS: The KSS was not statistically different between the groups at a mean follow-up of 7.4 years (range 5-11 years). Patellar translation and patellar tilt were not statistically different between the groups. When considering the patellar translation subgroup analysis, a significantly increased risk of patellar translation, greater than 5 mm, was found in the mobile-bearing group compared to fixed-bearing group (OR = 2.3; p = 0.048) without generating any meaningful difference in clinical outcomes. CONCLUSION: The theoretical advantages of mobile-bearing implants compared to fixed-bearing implants were not demonstrated in this randomized study, at mid-term follow-up. In daily practice, the choice between mobile-bearing and fixed-bearing designs should be based on the experience and clinical judgment of the surgeon. LEVEL OF EVIDENCE: Prospective randomized study, level I.

Professional Athletes Are at Higher Risk of Septic Arthritis After Anterior Cruciate Ligament Reconstruction: An Analysis of 4421 Consecutive Patients Including 265 Elite Athletes From the SANTI Study Group.

BACKGROUND: Professional athletes are reported to be at greater risk of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) than the nonprofessional population. However, this finding has been controversial, and confusion has arisen in the literature owing to the underpowering of previous studies. PURPOSE/HYPOTHESIS: The purpose was to report the differences in the rate of SA after ACLR in a large series of patients and to perform pooled data analysis including previously published studies. The hypothesis was that professional athletes have a significantly higher risk of SA than nonprofessional athletes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A retrospective analysis of prospectively collected data was performed. Patients who underwent ACLR between January 2009 and July 2017 (with a minimum follow-up of 12 months) were considered for study eligibility. The rate of SA was determined, and multivariate analysis was used to evaluate potentially important risk factors, including participation in professional sport. Furthermore, a literature search was performed, and data were extracted from all identified relevant studies. A pooled data analysis was performed to determine differences in the risk of SA between professional and nonprofessional populations. RESULTS: The current series comprised 4421 anterior cruciate ligament surgical procedures with 265 professional athletes. There were 15 cases of SA diagnosed over the study period (0.34%; 95% CI, 0.19%-0.56%). Ten cases occurred in professional athletes (3.8%; 95% CI, 1.82%-6.83%). The percentage of SA was 0.12% (95% CI, 0.04%-0.28%) in the nonprofessional population. Being a professional athlete was associated with a significantly increased risk of SA after ACLR (odds ratio, 21.038; 95% CI, 6.585-75.789; P < .0001). This finding was confirmed in the pooled data analysis comprising 11,416 patients including 1118 professional athletes (odds ratio, 5.03; 95% CI, 1.17-21.61). CONCLUSION: Professional athletes are at greater risk of SA after ACLR than nonprofessional athletes. The results of previous studies may have been conflicting owing to underpowering. The current study confirms the elevated risk by using a large clinical series and pooled data analysis to avoid the limitations of previous studies.

Figure-of-4 Cruciate Remnant Objective Assessment Test Reducibility of Anterior Cruciate Ligament Stump for Feasibility of Arthroscopic Primary Anterior Cruciate Ligament Repair.

Suture of the anterior cruciate ligament (ACL) has reemerged as a treatment option for proximal ACL tears. Preoperative imaging can provide insight into the feasibility of performing arthroscopic primary ACL repair, but the final decision is taken only after confirming with arthroscopy that the ACL remnant is reducible. We describe a test called the Figure-of-4 Cruciate Remnant Objective Assessment test that objectively interprets the reducibility of the ACL remnant for arthroscopic primary ACL repair.

Lateral Meniscus Repair Using Posterolateral Portal: Suture Hook Technique.

Lateral meniscus lesions result in loss of meniscus hoop stresses and can lead to lateral compartment overload and early degenerative changes. Arthroscopic suture repair provides good long-term results. However, posterior vertical tears in the peripheral area of the meniscus can be technically challenging to resolve. This Technical Note describes the suture hook technique using an accessory posterolateral portal. We believe it is a safe, effective method for repairing full vertical tears of the lateral meniscus.

Anterior Closing-Wedge Osteotomy for Posterior Slope Correction With Tibial Tubercle Preservation.

An excessive posterior tibial slope has been identified as a potential risk factor for anterior cruciate ligament tears. Anterior closing-wedge osteotomy decreases the posterior slope and can eliminate this risk factor in patients with recurrent instability and greater than 12° posterior slope. We will describe an anterior closing-wedge osteotomy technique performed at the tibial tubercle (TT), in which the TT is not detached to preserve the extensor mechanism attachment. A vertical cut is performed in the sagittal plane just posterior to the TT, leaving a distal cortical hinge. Two proximal parallel K-wires and 2 distal parallel K-wires convergent to the proximal ones are inserted from the anterior cortex on both sides of the tubercle toward the tibial posterior cortex at the posterior cruciate ligament's tibial insertion. Proximal and distal cuts are performed to remove the bone wedge. Reduction is achieved by gentle knee extension. Fixation is completed with 2 staples placed medially and laterally to the TT.

Síndrome do túnel carpal: resultados do tratamento cirúrgico com a técnica de mini-incisão / Carpal tunnel syndrome: results of surgical treatment with mini-incision technique

Introdução: A síndrome do túnel carpal é constituída por um conjunto de sinais e sintomas característicos como parestesia, formigamento, dor e perda da força nas mãos. Inicialmente os sintomas são brandos, progredindo ao longo do tempo. Objetivo: Apresentar os resultados do tratamento cirúrgico com mini-incisão, bem como discutir a relação entre os resultados e a técnica cirúrgica utilizada. Método: Esta pesquisa foi realizada na Faculdade de Medicina do ABC, onde foram avaliados 79 punhos de 71 pacientes, todos submetidos ao tratamento cirúrgico da síndrome do túnel carpal por ?mini-incisão?, entre janeiro de 1996 e maio de 2007. A média de idade entre os pacientes foi de 52,4 anos, sendo a idade mínima 27 e a máxima 80 anos. Sessenta e cinco pacientes eram do sexo feminino e seis do masculino. Quanto ao lado acometido, foram obtidos 36 punhos do lado direito e 27 do lado esquerdo, sendo 8 bilaterais. Resultados: Os resultados clínicos mostraram que 60 pacientes ficaram satisfeitos com os sintomas, com os resultados estéticos e funcionais e com a melhora da força muscular para apreensão. Dois pacientes apresentaram complicações cutâneas com infecção superficial e necessitaram de antibioticoterapia oral. Conclusões: Concluímos que o tratamento cirúrgico por ?mini-incisão? é uma técnica segura, com poucas complicações e resultados clínicos e estéticos satisfatórios para o tratamento da síndrome do túnel do carpo.

Introduction: The carpal tunnel syndrome is composed of signs and characteristic symptoms as parestesis, tingling, pain and hand power loose. Initially, the symptoms appear softly, progressing along the time. Objective: To present the results of surgical treatment using mini-incision, as well as to discuss the relationship between the results and the surgical technique used. Method: This study was accomplished at Faculdade de Medicina do ABC where 79 wrists of 71 patients were evaluated. All of them were submitted to the surgical treatment of the carpal tunnel syndrome using ?mini-open? technique between January 1996 and May 2007. The mean age of the patients was 52.4 years old, the minimum age was 27 years old and the maximum was 80 years old. Sixty-five patients were females and six were males. Thirty-six subjects had the right side affected and 27 had the left side, though 8 patients presented both sides affected. Results: The clinical results showed that 60 patients were satisfied with the symptomatic, aesthetic and functional results, as well as with the muscular power improvement for apprehension. Two patients presented cutaneous complications with superficial infection and were treated with oral antibiotic therapy. Conclusions: The surgical treatment using ?mini-incision? is a safe technique, with few complications and satisfactory clinical and aesthetic results for the carpal tunnel syndrome treatment.