Arthroscopic anterior cruciate ligament reconstruction using quadriceps tendon autograft and bioabsorbable cross-pin fixation.

We describe a technique for arthroscopic anterior cruciate ligament (ACL) reconstruction using the middle third of the quadriceps tendon without a patellar bone block and absorbable tibial and femoral cross-pin fixation. The central part of the quadriceps tendon is harvested through a 5-cm long anterior skin incision without a patellar bone block. Tibial and femoral tunnels are prepared, the graft is passed up the tunnels, and is fixed both in the femur and the tibia using absorbable cross pins (Rigid Fix; Mitek, Johnson & Johnson, Norwood, MA). In this way, the graft is stabilized near the joint line, providing outlet fixation. In our practice, very good results have been obtained with the use of this technique.

Intraoperative arthroscopic suture anchor reloading.

The success of an arthroscopic procedure depends considerably on the successful and secure tying of arthroscopic knots, which reapproximate and stabilize avulsed or torn soft tissues to their original bed. Failure to perform appropriate knot tying may jeopardize the success of the operation. We describe a simple and reliable technique for intraoperative arthroscopic replacement of the suture through the eyelet of an already-inserted bone anchor. This technique allows for replacement of a fretted suture or a loose knot with a new suture, offering the opportunity to repeat the knot tying procedure with a new intact suture.

Inter-rater reliability of Rolimeter measurements between anterior cruciate ligament injured and normal contra lateral knees.

The Rolimeter device can provide measurements of anterior/posterior tibial displacement using maximal manual force. The Rolimeter reliability is still under research when used as an independent knee tester. The purpose of this study is to determine the inter-rater reliability of the Rolimeter measurements between anterior cruciate ligament (ACL) injured and normal contra lateral knees. Twelve male patients with ACL deficiency participated in this study. Three physical therapists (PT) performed the Rolimeter measurements in supine position with an approximate 25 degrees flexion of the knees. Each therapist performed three trials on each knee and the difference in results in millimeters between injured knee and normal contra lateral knee was determined. Spearman's rho correlations showed weak relationships between the PT 1, 3 and 2, 3 (PT 1 vs. PT 3 r=0.55, PT 2 vs. PT 3 r=0.57) and the high relation between 1, 2 (PT 1 vs. PT 2 r=0.96) of Rolimeter measurements. Intraclass correlation coefficient showed no significant reliability coefficients among the three PT Rolimeter measurements between ACL injured and normal contra lateral knees (R=0.24, p=0.05). These results reflect the variations among the means of the three physical therapists' Rolimeter measurements between ACL injured and normal contra lateral knees.

A simplified arthroscopic outside-in meniscus repair technique.

A simple and reproducible technique for meniscus tear repair is described. The technique requires the use of a 16-gauge intravenous catheter, a suture hook, and a knot pusher. The catheter is used for perforation of the meniscus and the tear site in two adjacent locations, then the two free suture ends are retrieved and passed along a small arthroscopic cannula placed at the ipsilateral joint space, and finally a sliding arthroscopic knot is tied and advanced to the meniscus surface with a knot pusher. This simple technique provides secure fixation of the meniscus tear during the healing period and has been proven successful and without complications in the patients in whom it has been used.

Interdigital neuromas: current state of the art--surgical.

Several reports demonstrated that the interdigital neuroma is a form of entrapment neuropathy. Nonoperative measures may provide satisfactory results to some patients, but surgical treatment seems to provide more predictable results and lasting pain relief. Neurectomy remains the most commonly used procedure for the treatment of interdigital neuritis through a plantar or a dorsal approach. Outcome results after neurectomy note a failure rate of 2% to 35%.

Late disengagement of a knotless anchor.

The knotless anchor is a new type of suture anchor that eliminates the need to perform arthroscopic knots, thus facilitating the performance of arthroscopic shoulder surgery. We report our experience in the use of this type of anchor in arthroscopic Bankart repair and discuss a complication related to using this type of fixation device.