Needle arthroscopy in anatomical reconstruction of the lateral ankle: a report of three cases with a parallel comparison to the standard arthroscopy procedure.

PURPOSE: This study evaluates the use of the needle arthroscopy in anatomical reconstruction of the lateral ankle. We hypothesized that the needle arthroscopy would allow anatomical reconstruction to be performed under arthroscopy. METHODS: Three patients underwent treatment of chronic ankle instability. The comparative procedure was performed in the following four steps: 1) anteromedial articular exploration (medial/lateral gutter/anterior chamber/syndesmosis); 2)creation of the talar tunnel via the anteromedial arthroscopic approach; 3) anterolateral fibular tunneling; and 4) positioning of the graft by the anteromedial arthroscopic approach. For each of these steps, the planned procedure using the needle arthroscope was compared to the standard arthroscope. For each step, the planned procedure using the needle arthroscopy was compared to the standard arthroscope and the act was classified based on level of difficulty: facilitated, similar, complicated and impossible. RESULTS: The exploration of the medial and lateral gutter, the creation of the tunnel of the talus and graft positioning were not accomplished using the needle arthroscope. While the syndesmosis visualization was facilitated by the needle arthroscope in comparison to the standard arthroscope. CONCLUSION: The anatomical reconstruction of the lateral ankle, using the needle arthroscopy-only approach, was impossible in all three cases, regarding: ankle joint exploration, creation of the tunnel of the talus and graft positioning. The needle arthroscope should not be considered as a "mini arthroscope" but as a new tool with which it is necessary to rethink procedures to take advantage of the benefits of this instrument.

Iterative Rupture of the Patellar Tendon: A Case Report of an Original Technique for Revision Reconstruction Using an Adjustable Loop and an Artificial Ligament.

Chronic rupture of the patellar tendon is a severe injury that leads to dramatic functional consequences including lack of extension and walking difficulty. Surgery is the gold standard to treat this type of injury, but revision reconstructions are problematic because an ipsilateral graft was often harvested for the initial surgery. Because fibrotic tissues on the patellar tendon need to be debrided, another graft must be added to reinforce the tendon. We reported the case of a former semiprofessional handball player, a 29-year-old man who presented an iterative rupture with the fracture of the transverse patellar tunnel 6 months after reconstruction using a semitendinosus graft and suture repair. We performed revision reconstruction surgery using an artificial ligament placed between the extensor mechanism and the tibia for extra-articular reinforcement to maintain extensor mechanism continuity. Two adjustable loops were also used to repair the patellar tendon tear. At 2-year follow-up, the patient was able to resume the practice of handball at a competitive level with good clinical and functional results. This technique can therefore be used as a salvage procedure for chronic iterative rupture of the patellar tendon.

Comparative reproducibility of TELOS™ and GNRB® for instrumental measurement of anterior tibial translation in normal knees.

BACKGROUND: TELOS™ is among the reference tools for the instrumental measurement of anterior tibial translation during the initial work-up and follow-up of patients with injuries to the anterior cruciate ligament (ACL). GRNB(®) is a non-irradiating but recently developed tool for which only limited data are available. HYPOTHESIS: The GRNB(®) offers better reproducibility than TELOS™ for measuring anterior tibial translation without rotation in normal knees. MATERIAL AND METHODS: We retrospectively evaluated instrumental laxity measurements in normal knees. Data were available for 60 TELOS™ measurements (9kg load) and 57 GNRB(®) measurements (89N and 134N loads). For each instrument, we compared the absolute variation in anterior tibial translation between two measurements performed 6 months apart. For each GNRB(®) measurement, patellar pressure was recorded. RESULTS: No significant differences were found between mean (± SD) variations in translation between the two instruments. A greater than 2.5mm variation between the two measurements was significantly more common with TELOS™ than with GRNB(®) (P<0.05, Chi(2) test). GRNB(®) translation values did not correlate with patellar pressure. DISCUSSION: The GNRB(®) device offers greater reproducibility than TELOS™ when used to quantitate anterior tibial translation. The limited sample size may have prevented the detection of a significant difference between mean values. In addition, disadvantages of the TELOS™ include radiation exposure of the patient, operator-dependency of measurements made on the radiographs, and absence of a biofeedback system to limit hamstring contraction. GNRB(®) does have hamstring contraction biofeedback control but uses another parameter, namely, patellar pressure, for which the optimal value is unknown. Quadriceps and hamstring co-contraction induced by excessive patellar pressure may influence anterior tibial translation. The optimal patellar pressure value needs to be determined.

Localized form of pigmented villonodular synovitis of the knee: the meniscal mime.

The localized form of pigmented villonodular synovitis of the knee is a rare condition with non-specific symptoms. This makes diagnosis especially difficult when the meniscus is affected. A full assessment with several imaging modalities can help support the preoperative diagnosis. But in the case reported here, the full clinical and paraclinical assessment (X-rays, CT arthrography and MRI) was wrong--the localized form of pigmented villonodular synovitis had mimicked a lateral meniscus injury and was only detected during arthroscopy. The lesion was excised surgically and the diagnosis was confirmed through postoperative histopathology.

Isolated anterior unilateral sacroiliac dislocation without pubic arch disjunction.

Sacroiliac joint dislocations frequently occur in a context of high-energy polytrauma. When there is disruption of the pelvic ring, sacroiliac joint displacements are more often posterior and combine two lesions: either lesions of the pubic arch as well as the posterior arch or bilateral lesions. The case we report here lacks these two characteristics. This is an isolated unilateral sacroiliac dislocation with no opening lesion of the pubic symphysis or fracture of ilio- or ischiopubic rami and with anterosuperior displacement. After emergency reduction of the dislocation, the secondary fixation was not performed, due to initial hemodynamic instability compounded by deteriorating central nervous system condition.