Arthroscopic identification of the popliteofibular ligament.

PURPOSE: The popliteofibular ligament has recently received recognition as a distinct structure with a significant contribution to posterolateral stability of the knee. The popliteofibular ligament plays a key role in stabilizing the posterolateral corner of the knee by limiting posterior translation, varus angulation, and external rotation (coupled and primary). During arthroscopic procedures, the senior author (R.D.P.) has observed vertically oriented fibers descending from the inferior surface of the intra-articular portion of the popliteus tendon at the popliteal hiatus. This study was performed to determine if these fibers were actually the popliteofibular ligament. TYPE OF STUDY: This is an anatomic study using a cadaveric knee model to identify the popliteofibular ligament both arthroscopically and through gross anatomic dissection. METHODS: Eight fresh human cadaveric knees were examined arthroscopically and the vertically oriented fibers from the inferior surface of the popliteus tendon at the popliteal hiatus were identified and marked with a suture using an arthroscopic suture passer. A dissection of the lateral side of the knee was then performed to identify the marked structure. RESULTS: In all specimens, the dissection revealed that the fibers identified and marked arthroscopically had firm attachments to the popliteus tendon superiorly and inserted distally into the posterior aspect of the fibular head. The labeled structure was, therefore, the popliteofibular ligament. The popliteofibular ligament bifurcated distally with 2 insertion sites onto the fibular head. CONCLUSIONS: From this study, we concluded that the vertically oriented fibers descending from the inferior surface of the intra-articular portion of the popliteus tendon at the popliteal hiatus identified during arthroscopy are indeed those of the popliteofibular ligament. It is hoped that this knowledge will lead to improved outcomes in the treatment of injuries to the posterolateral corner of the knee.

Anterior cruciate ligament reconstruction in adolescents with open physes.

The purpose of this study was to evaluate anterior cruciate ligament reconstructions performed in adolescents with open physes and a skeletal age of at least 14 years. At one center, from 1992 to 1996, 19 adolescents (ages, 11 to 15 years) with open physes and a skeletal age of at least 14 years underwent arthroscopic anterior cruciate ligament reconstruction using an Achilles tendon allograft placed through drill holes across the open physes in both the distal femur and proximal tibia. Fifteen patients returned for reevaluation at an average of 25 months postoperatively (range, 12 to 60 months); the remaining four patients were interviewed by telephone. There were no significant leg-length discrepancies or angular deformities as determined by scanograms and anteroposterior and lateral radiographs of the femur and tibia. The mean Lysholm knee score was 97 (range, 94 to 100) and the mean KT-1000 arthrometer side-to-side difference at 20 pounds of anterior force was 1.7 mm (range, 0.0 to 3.0). All patients were satisfied with the results of surgery, and 16 of 19 patients returned to the same sport they were participating in before the injury. This study demonstrates that anterior cruciate ligament reconstruction using an Achilles tendon allograft is a viable treatment option for skeletally immature patients with a skeletal age of 14 years who have sustained midsubstance tears of the anterior cruciate ligament.

Closed tendon injuries of the hand and wrist in athletes.

Closed-tendon injuries of the hand and wrist are very common in the athletic population. Most of these injuries, if seen acutely, can be treated successfully with nonoperative management, although some do require operative treatment. It is those injuries, however, that go undiagnosed until the end of the season, which may result in permanent disability.

Outpatient ACL reconstruction using intraoperative local analgesia and oral postoperative pain medication.

Thirty-five consecutive anterior cruciate ligament (ACL) reconstructions were performed in an ambulatory surgical unit using a bone-patellar tendon-bone autograft. Patients were evaluated postoperatively to determine the amount of pain medication used, the readmission rate, postoperative complications, and cost. Outpatient ACL reconstruction led to a savings of $4700 compared with the cost of performing the same procedure in a hospital operating room with an overnight admission. This study demonstrates that outpatient ACL reconstruction, using local analgesia intraoperatively and oral narcotic pain medication postoperatively, is a safe and cost-effective procedure with minimal to no morbidity.

The role of a self-help clearinghouse.

As the number of self-help groups continues to proliferate, the formation of an umbrella body is suggested. A Self-Help Clearinghouse would serve as such an umbrella through the establishment of an information, referral and research service for mutual aid groups in an area. It would also be available to offer technical assistance to existing groups and assistance in the formation of new self-help groups. As a prevention service, it can be integrated into a comprehensive community mental health service system or operated under other auspices. In either case, it is a barometer of community stressors and offers great promise in strengthening social supports, coping skills, and competence provided by self-help groups.