Arthroscopic debridement of loose bodies from a popliteal cyst.

To our knowledge, arthroscopic removal of loose bodies from a popliteal cyst has never been reported in the medical literature. This article describes our technique for removing loose bodies from a popliteal cyst and verifies that the procedure can be performed safely and effectively.A 52-year-old man had progressively worsening right knee pain and swelling of 3 years' duration that had been treated conservatively for 6 months. On physical examination, there was boggy swelling, a palpable popliteal cyst, crepitus with range of motion, and diffuse discomfort and tenderness about the knee. Magnetic resonance imaging showed synovitis of unclear etiology. Arthroscopic intervention was performed after conservative measures failed. An accessory posteromedial portal was used to gain access into the popliteal cyst through the posterior joint capsule. An electrocautery device was used to penetrate into the cyst through the posterior capsule after identifying the correct location of the cyst by passing a needle percutaneously through the posterior aspect of the cyst into the joint. Multiple loose bodies along with a large cartilaginous mass were identified in the popliteal cyst and removed. The patient remained symptom free at 2-year follow-up.As long as the instruments are kept in view and medial to the midline of the knee joint, the neurovascular structures lateral to the cyst are safe. Keeping the shaver suction on low during debridement will avoid pulling in any unvisualized tissue. To avoid injury to the superficial saphenous vein and nerve when making the posterior portal, the surgeon should incise through skin only, then use blunt dissection and a blunt obturator to enter into the joint. Simple decompression of large popliteal cysts can be accomplished in a similar manner.

Improvement in bone homeostasis following autologous chondrocyte implantation of the knee.

This retrospective review and clinical follow-up demonstrates the effectiveness of autologous chondrocyte implantation of the knee. From September 1995 to June 2001, 24 patients with average follow-up of 26.5 months were evaluated. The mean Lysholm score improved from 43.58 before surgery to 71.42 at most recent follow-up, the modified Cincinnati knee score for overall clinician evaluation improved from 2.96 to 6.92, and the mean modified Cincinnati knee score for overall patient evaluation improved from 3.21 to 6.13 at P <.05. Seventy-nine percent of patients responded that they would have the same knee surgery again and 83% rated the results of their knee surgery as good to excellent. Limited radionuclide bone scans with single photon emission computed tomography were completed in 11 of the patients to assess the physiology and homeostasis of subchondral bone adjacent to treated articular cartilage defects. A trend was identified suggesting improvement in subchondral bone scores at a mean of 29.6-months follow-up compared to preoperative bone scan assessment. There also was a trend towards greatest improvement correlating with the patients with the best clinical scores. The results of this study suggest that autologous chondrocyte implantation of the knee can be successful in improving pain and function in patients with articular cartilage defects.

Arthroscopic meniscal repair using the BioStinger.

PURPOSE: Biodegradable devices are available for all-inside meniscal repairs. One device, the BioStinger (Linvatec, Largo, FL), is made of molded poly-L-lactic acid. The purpose of this study was to evaluate the effectiveness of and any adverse events associated with meniscus repair using this device. TYPE OF STUDY: Nonrandomized prospective cohort study. METHODS: A prospective, consecutive, 3-center meniscal repair series using BioStingers (group 1), vertical inside-out sutures (group 2), or hybrid repairs combining BioStingers and sutures (group 3) was studied. Lysholm, Tegner, Cincinnati, and IKDC activity scores were obtained and clinical outcomes and adverse events documented. RESULTS: There were 85 patients who underwent 89 meniscus repairs with an average 26.5 months of follow-up. There were 47 BioStinger repairs (group 1), 29 suture repairs (group 2), and 13 hybrid repairs (group 3). The tear length was statistically greater for the hybrid repair group (P < .5). There were 73 repairs associated with anterior cruciate ligament reconstructions and 12 repeat arthroscopies were performed. Meniscal healing failed in 6 knees (4 in group 1, 0 in group 2, and 2 in group 3). The meniscal healing failed in 7% of those associated with anterior cruciate ligament reconstructions. Mean Tegner scores improved from 2.8 to 6.3, the final IKDC activity score was 3.2 out of 4, the mean Lysholm score improved from 51 to 88, and the mean Cincinnati score improved from 44 to 84. Two BioStinger repair cases had joint-line tenderness from device migration confirmed by magnetic resonance imaging. No tenting of the skin or articular cartilage scuffing was observed. CONCLUSIONS: The success rate for the 29 suture repairs was 100% and for the 47 BioStinger repairs was 91%. These preliminary results are consistent with other repair techniques. LEVEL OF EVIDENCE: Level II, Therapeutic Prospective Cohort Study.

Long-term failure of thermal shrinkage for laxity of the anterior cruciate ligament.

BACKGROUND: Appropriate treatment for anterior cruciate ligament laxity, owing to partial tears of the native ligament or lax reconstruction, is unclear. Studies suggest that a significant percentage of these untreated tears may progress to complete tears or the patient may develop additional injuries to the meniscus or articular cartilage. Shrinkage of the ligament or graft using thermal energy has been proposed as a solution for this problem. PURPOSE: To evaluate the long-term results using thermal energy to shrink laxity of the anterior cruciate ligament. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Nineteen patients with partial tears of the anterior cruciate ligament (n = 14) or stretched anterior cruciate ligament grafts (n = 5) underwent thermal shrinkage treatment. Fourteen were available for follow-up at 1 and 5 years. At 1 year, there were 12 partial tears and 2 grafts available for evaluation. At 5 years, there were 10 partial tears and 4 grafts. Preoperative, postoperative, and intraoperative stability testing was performed using the KT-1000 arthrometer. Clinical results were evaluated using the Cincinnati and Lysholm scoring systems. RESULTS: Intraoperative shrinkage averaged 2.12 mm (17%, P < .0001). At 1 year, 12 of the 14 patients remained stable (86%) with a negative Lachman test result and mean KT-1000 arthrometer maximum side-to-side score of 1.29 mm (P < .001). The 2 failed shrinkages were partial tears of the native anterior cruciate ligament. For these 12 patients, Cincinnati scores improved from 53 to 89 (P < .0001), and Lysholm scores improved from 55 to 89 (P < .0003). At 5-year follow-up, 11 of 13 patients had gone on to complete failure (85%, P < .002; 8/9 partial tears and 3/4 grafts). CONCLUSION: Thermal shrinkage provides short-term benefit in the treatment of anterior cruciate ligament laxity but leads to catastrophic failure in the majority of patients at long-term follow-up. We can no longer recommend this procedure for the treatment of anterior cruciate ligament laxity.