Is repeated repair of the meniscus worthwhile?

Meniscal injuries are one of the most commonly encountered problems by orthopaedic surgeons. It is well established that meniscectomy will result in increased joint surface contact forces and the predictable progression of arthritis. The management of meniscal tears has evolved and current evidence would suggest that every attempt should be made to repair meniscal tears when appropriate. The reported success rate of meniscal repair is encouraging, but relatively little is known about the outcome of repeated repair of a re-torn meniscus. This review presents an illustrative case of a recurrent lateral meniscal tear in a young female, that has required surgical repair on three occasions over a fourteen year period. Despite recurrent tears of her lateral meniscus, the patient was symptom-free in the intervening periods and at her latest operation, her articular cartilage showed minimal evidence of chondral damage. Longer-term follow-up is required to determine whether repair of a re-torn meniscus prevents the progression of degenerative changes within the knee joint that is associated with meniscectomy.

Bilateral ganglion cysts of the cruciate ligaments: a case report.

Symptomatic ganglion cysts of the cruciate ligaments are rare, and bilateral cases are extremely rare, with only one reported case in the literature. We report a case of bilateral cruciate ligament ganglion cysts successfully treated with arthroscopic resection, and review the literature regarding aetiology, diagnosis and management.

Adductor tenotomy: its role in the management of sports-related chronic groin pain.

PATIENTS AND METHODS: Chronic adductor-related groin pain in athletes is debilitating and is often challenging to treat. Little is published on the surgical treatment when conservative measures fail. This single center study reviews the outcomes of 48 patients (68 groins) who underwent percutaneous adductor tenotomy for sports-related chronic groin pain. Questionnaire assessments were made preoperatively and at a minimum follow-up of 25 months. RESULTS: Mean pre-injury Tegner activity scores of 8.8 reduced to 6.1 post-injury and these improved to 7.7 following surgery (p < 0.001). Sixty percent of patients regained or bettered their pre-injury Tegner activity scores after the adductor surgery; however, mean post-surgical Tegner scores still remained lower than pre-injury scores (p < 0.001). No patient had been able to engage in their chosen sport at their full ability pre-operatively, and 40% had been unable to participate in any sporting activity. The mean return to sports was at 18.5 weeks postoperatively, with 54% returning to their pre-injury activity levels, and only 8% still unable to perform athletic activities at latest follow-up. Seventy-three percent patients rated the outcome of their surgery as excellent or very satisfactory, and only three patients would not have wished to undergo the procedure again if symptoms recurred or developed on the opposite side. No patients reported their outcome as worse. A 78.1% mean improvement in function and an 86.5% mean improvement in pain were reported, and these two measures showed statistically significant correlation (p = 0.01). Groin disability scores improved from a mean of 11.8 to 3.9, post-operatively (p < 0.001). Bruising was seen in 37% of procedures, 3 patients developed a scrotal hematoma and 1 patient had a superficial wound infection. One patient developed recurrent symptoms following re-injury 26 months post-surgery, and fully recovered following a further adductor tenotomy. CONCLUSIONS: Adductor tenotomy provides good symptomatic and functional improvement in chronic adductor-related groin pain refractory to conservative treatment.

The outside-in subcutaneous arthroscopically assisted lateral retinacular release: a new technique.

Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment of patellar pain and instability. The release can be performed using a number of techniques, but achieving access to the retinaculum can often be difficult, particularly in obese patients. We describe a simple modification of an arthroscopically assisted method, which utilises electrosurgery through a subcutanous channel to perform an outside-in release.

Anterior cruciate ligament graft preparation: a new and quick alternative to the whipstitch.

Anterior cruciate ligament reconstruction is a common procedure in orthopaedic practice. Hamstring autograft is increasingly becoming the graft of choice; however, there is little consensus as to the best method of graft preparation and, in particular, the efficacy of the use of a whipstitch with all tibial fixation systems. We propose a new, quick, and economical method of preparing the hamstring graft that involves securing a double loop of suture material around the tendon. This is achieved by passing a loop of No. 2 braided suture under the tendon; the free suture ends are then subsequently passed through the loop twice and tightened. This "loop-the-loop" traction suture allows the surgeon to apply adequate traction to the graft for tensioning while not compromising graft fixation. This new technique is faster than conventional whipstitching and has cost savings, because no needles are necessary. It is of particular help when using a central 4-quadrant sleeve-and-screw fixation device.

Managing shoulder pain in general practice--the value of academic detailing.

After low back pain and neck pain, shoulder pain is the third musculoskeletal reason for presentation to general practice, with a self reported prevalence of 16-26%. Approximately 1% of the adult population is expected to visit a general practitioner annually for shoulder pain. Shoulder complaints are more common in women and despite the fact that 50% of acute shoulder pain resolves in 8-10 weeks, many patients present with the anticipation of being referred for imaging.

Biceps tenodesis: a biomechanical study of fixation methods.

Rupture of the biceps tendon occurs predominantly in the middle-aged and elderly, being predisposed through bicipital tendinitis and rotator cuff lesions. Surgical repair may be an option for those requiring strength in supination. This study compared the initial fixation strength of keyhole tenodesis (n = 7) and interference screw fixation by use of cadaveric specimens. Two interference screws were evaluated (n = 7 x 2): the round-headed cannulated interference screw (RCI) and a bioresorbable screw (Sysorb). All specimens failed at the fixation site but one. This study found that overall there was a significant effect as a result of study group (keyhole vs Sysorb vs RCI, P =.034). The post hoc comparisons revealed that the keyhole was significantly stronger than the RCI screw (P =.033) but not significantly different compared with the Sysorb screw (P =.129). No significant difference was observed between the Sysorb and RCI screws (P =.762). Interference screw fixation failed by tendon slippage at the screw-tendon-bone interface; keyhole fixation failed by tendon splitting and slippage out of the restraining keyhole. Keyhole tenodesis may permit earlier postoperative mobilization when compared with tenodesis by use of interference screw fixation.