Meniscocapsular release technique to reduce chronic and challenging bucket-handle meniscus tear.

Several surgical procedures for the repair of bucket handle meniscus tears have been reported in the literature. However, even the most skilled surgeon can find it difficult to treat chronic and locked lesions, which typically result in meniscectomies. Therefore, a repair method for bucket-handle meniscus tears that are chronic and locked is shown, along with a case series where this procedure was used. The technique consists of a release of the joint capsule attachment to the meniscal body, which increases the mobility of the meniscus and facilitates the reduction of the injury, allowing subsequent repair through a combination of both all-inside and inside-out repair techniques. The main objective of this technique is to reduce the need for meniscectomies in difficult cases of bucket-handle meniscus tears, protect the meniscal tissue, and slow the progression of osteoarthritis in the process.

Novel surgical technique for soft tissue distal avulsion of the anterior cruciate ligament: Technical note.

The most popular surgical treatment for anterior cruciate ligament (ACL) injuries is reconstruction. However, different native tissue preservation and repair techniques have recently become popular. Among the different types of ACL injuries, the least frequent is the tibial-sided soft-tissue avulsion type. Which can be managed with primary repair as an alternative to reconstruction. However, there aren't many procedures reported for treating these rare injuries. As a result, a repair technique is presented using a suture anchor in the tibial footprint with a double-row construct. We present a prospective intervention cohort of two cases where this procedure was used with adequate clinical evolution and stable fixation at 24 months of follow-up. Likewise, there were no complications or reinterventions performed during follow-up. To our knowledge, this technique had not been reported before in the literature for these lesions and combines the benefits of using a suture anchor with a double-row construct and preserves the native tissue and ACL insertion site. Therefore, in these uncommon lesions, a double-row suture anchor technique can be useful to repair acute distal soft tissue avulsion-type ACL injuries.

Acute massive rotator cuff rupture with posterior shoulder dislocation: arthroscopic novel repair of a rare injury. A case report.

Acute massive rotator cuff tears and posterior shoulder dislocations are an extremely rare association, and a vast majority are treated by open surgery. We present a case of a man in his 20s who suffered closed left shoulder trauma after a road traffic accident. He was initially diagnosed with posterior shoulder dislocation and a reduction was successfully performed. However, the patient still complained of persistent weakness during active movements. We found a massive rotator cuff tear involving all the rotator cuff tendons, with significant supraspinatus retraction and persistent posterior shoulder subluxation. He underwent an all-arthroscopic repair of the rotator cuff with a double-row technique in the subscapularis, supraspinatus and infraspinatus muscles. Capsular repair and tenodesis of the biceps tendon were also performed. The patient had good recovery, reaching full preinjury function 3 months after surgery with a successful return to his regular activities.

Satisfactory clinical outcomes using a novel arthroscopic technique for fixation of tibial spine avulsion fractures: technical note.

This research aims to present a novel arthroscopic fixation technique that uses a double-row suture anchor for tibial spine avulsion and to evaluate its short-term clinical outcomes. The surgical technique is described and a retrospective case series is presented. Patients who presented with tibial spine avulsion type III and IV fractures according to the Meyers and McKeever classification and received the same surgical treatment from 2013 to 2018 in two specialised hospitals in Medellín City were included. All interventions were performed by an experienced surgeon. To determine outcomes during clinical follow-up, the Lysholm score and objective and subjective International Knee Documentation Committee scores were obtained before and at least 12 months after surgery. A total of 24 patients were followed, with a mean age of 31 years; 12 patients were female. The median time between trauma and surgical fixation was 12 days (IQR=7-23), with a median follow-up period of 13.5 months (IQR=9.5-31.5). When comparing patients' state initially and during the postoperative period, statistically significant differences were found in all the scores analysed (p<0.05). Likewise, there were no complications and no reinterventions performed during follow-up, and all patients were satisfied with the outcomes of the procedure. Fixation of tibial spine avulsion fractures using the double-row suture anchor technique results in improvement in patients' function, pain and activity level. The main conclusion is that the procedure is an anatomical technique that requires minimal access and leads to satisfactory clinical evolution of patients. Level of evidence: Level V, case series.

Reparación transtibial de la raíz posterior del menisco lateral en lesiones agudas: técnica quirúrgica y seguimiento clínico a corto plazo / Transtibial repair of posterior root of the lateral meniscus in acute lesions: surgical technique and short-term clinical follow-up

Introducción Las lesiones de la raíz posterior del menisco lateral (RPML) afectan la transferencia de la carga axial de la rodilla, lo cual genera una sobrecarga con el posterior deterioro del cartílago articular. Se han descrito numerosas técnicas quirúrgicas en la literatura para su tratamiento, pero aún no se ha demostrado superioridad de alguna, por ende, existen controversias sobre cual técnica es la más indicada para estas lesiones. El objetivo del estudio es describir la técnica quirúrgica y la evolución clínica de pacientes intervenidos con fijación transtibial de la RPML en una clínica especializada, durante el periodo 2016-2017. Materiales & Métodos Se realizó una descripción de la técnica quirúrgica y una serie de casos retrospectiva. Se incluyeron pacientes con lesiones agudas en la RPML, los cuales fueron intervenidos quirúrgicamente utilizando una nueva variación a técnica transtibial. Para determinar la evolución cínica de los pacientes se realizaron las escalas Lysholm e IKDC, antes y después de la cirugía. Resultados Se intervinieron seis pacientes con lesión aguda de la RPML, cuatro de sexo masculino. El tiempo entre el trauma y la cirugía fue en promedio 2,5 meses. Todos los pacientes presentaron lesión concomitante de ligamento cruzado anterior. Al comparar el estado inicial de los pacientes y el postoperatorio mediante las escalas de Lysholm e IKDC, se encontraron diferencias estadísticamente significativas (p<0,05). Asimismo, no se realizaron reintervenciones durante el seguimiento. Discusión La reparación de la RPML con la nueva variación de la fijación transtibial proporciona una mejoría en la función, el dolor y el nivel de actividad de los pacientes, lo que puede ayudar a retrasar la progresión de la osteoartrosis en la rodilla. Igualmente, este procedimiento se puede realizar de forma segura aún en casos de lesiones ligamentarías concomitantes. Nivel de evidencia: IV

Background injuries of posterior lateral meniscus root (PLMR) affect the transfer of the axial load of the knee. Several surgical techniques have been described for it treatment, but still none has demonstrated superiority. Consequently, there are controversies about which technique is most indicated for these injuries. The aim is to describe the a surgical technique and the clinical follow up of patients operated with transtibial fixation of PLMR in a specialized clinic, during the 2016-2017. Methods Retrospective case series and description of the surgical technique. We included patients with acute injuries in the PLMR, who were operated using a new variation to the transtibial technique. For the clinical follow-up, the IKDC and Lysholm scores were performed before and after surgery. Results Six patients with acute lesion in the PLMR were intervened, four were male. The time between trauma and surgery was on average 2.5 months. All the patients presented a concomitant lesion of the anterior cruciate ligament. When comparing the initial state of the patients and the postoperative period, statistically significant differences were found (p <0.05). Likewise, reinterventions were not performed during follow-up. Discussion The repair of PLMR with the new variation of the transtibial fixation provides an improvement in the function, the pain and the level of activity of the patients, which can help to delay the progression of osteoarthrosis in the knee. Likewise, this technique can be performed safely even in cases of concomitant ligament injuries. Level of clinical evidence: Level IV

Reconstrucción del ligamento patelofemoral medial. descripción de técnica quirúrgica. estudio retrospectivo / Medial patellofemoral ligament reconstruction. surgical technique

Introducción: la luxación de la patela es una patología relativamente frecuente sin embargo, su manejo es controversial. En los últimos años la tendencia a realizar reconstrucciones que asemejen más la anatomía nativa, ha generado un renovado interés por las reconstrucciones del ligamento patelofemoral medial (LPFM). De las estructuras que permiten mantener la patela en adecuada posición, el LPFM es la estructura más importante y su lesión es reconocida como esencial para que se origine una luxación de patela. Objetivo: La reconstrucción del LPFM con la técnica de doble haz fijada anatómicamente y verificada por artroscopia pretende acercarse a los parámetros actuales de reconstrucción. Este estudio busca describir los resultados del tratamiento quirúrgico con esta técnica en pacientes con luxación de patela tratados entre mayo de 2010 y mayo de 2016 mediante la aplicación de escalas funcionales establecidas en la literatura, para identificar la mejoría de los síntomas y la no recidiva un año posterior a finalizar el período de rehabilitación. Resultados: Se intervinieron 16 rodillas en 15 pacientes (una de las pacientes con compromiso bilateral), de las cuales el 81,2% fueron de sexo femenino. El tiempo entre la primera luxación y la intervención quirúrgica fue en promedio 11,81 meses. Al año se encontraron diferencias estadísticamente significativas para las escalas funcionales Lisholm, Tegner, y Kujala y no se realizaron reintervenciones durante el seguimiento. Conclusión: La reconstrucción del LPFM, con doble fijación en patela y fijación asistida por artroscopia, es una variación a la técnica abierta tradicional que, teniendo en cuenta parámetros anatómicos, se puede realizar de forma segura. La evolución clínica de los pacientes es satisfactoria teniendo en cuenta que las escalas funcionales medidas en estos pacientes mejoraron estadísticamente significativo con respecto a los puntajes iniciales.

Introduction: dislocation of the patella is a relatively frequent pathology, however, its handling is controversial. In the recent years the tendency to perform reconstructions that more closely resemble native anatomy has generated a renewed interest in reconstructions of the medial patellofemoral ligament (LPFM).1,2 Of the structures that maintain the patella in a suitable position, LPFM is the most important one and its lesion is recognized as essential for the origin of a patella dislocation.3 Objective: The reconstruction of the LPFM with the anatomically fixed and double-beam technique, which was verified by arthroscopy, aims to approach the current reconstruction parameters. This study looks at the results of the surgical treatment with this technique in patients with patellar dislocation treated between May 2010 and May 2016, through the application of functional scales established in the literature to identify the improvement of symptoms and non-recurrence, one year after the end of the rehabilitation period. Results: 16 knees were involved in 15 patients (one of the patients with bilateral involvement), of whom 81.2% were female. The time between the first dislocation and the surgery had an average of 11.81 months. There were found statistically significant differences for the Lisholm, Tegner, and Kujala functional scales and there were no interventions performed during the year of follow-up. Conclusion: The reconstruction of LPFM, with double fixation in patella and fixation assisted by arthroscopy is a variation to the traditional open technique, taking into account anatomical parameters can be performed safely. The clinical evolution of the patients is satisfactory considering that the functional scales measured in these patients improved compared to their initial scores.

Evaluación de la cicatrización del primer episodio de luxación anterior de hombro de origen traumático mediante resonancia magnética en pacientes tratados con inmovilizador en rotación externa: reporte de dos casos / Magnetic resonance imaging outcome of first traumatic shoulder dislocation episode managed by an external rotation inmobilizer

Aunque no es un tratamiento usado frecuentemente en nuestro medio, la inmovilización con inmovilizador en rotación externa y abducción es un tratamiento no quirúrgico que puede ser utilizado en los pacientes con primer episodio de luxación anterior traumática del hombro. Se reportan los casos de dos pacientes jóvenes, uno deportista y otro militar, que se manejaron ortopédicamente con reducción cerrada inmediata a su episodio de luxación e inmovilización con inmovilizador en rotación externa y abducción por cuatro semanas. Se realizaron controles de resonancia magnética al momento de la luxación y al terminar el periodo de inmovilización. Se describen los hallazgos imaginológicos y se hacen sugerencias acerca del tiempo y el tipo de inmovilización que se puede usar en este tipo de casos.