The Joystick Method: A Mini Open Technique for Repairing Patellar Osteochondral Fractures With Concomitant Medial Patellofemoral Ligament Reconstruction.

Fixation of osteochondral fractures after patellar dislocation is typically done using an open approach due to the location of the defect. This is traditionally performed through a medial parapatellar arthrotomy to allow adequate visualization. By using the joystick method, adequate visualization is achieved with a smaller arthrotomy. Careful placement of the joystick in the planned anchor site of the medial patellofemoral ligament reconstruction reduces the number of drill sites in the patella.

Biomechanical Comparison of All-Suture, All-Inside Meniscus Repair Devices in a Human Cadaveric Meniscus Model.

OBJECTIVE: Newer all-suture, all-inside meniscus repair devices utilize soft suture anchors. The purpose of this study was to compare the biomechanical performance of 4 meniscus repair devices in human cadaver menisci: the JuggerStitch (all-suture, all-inside), the FiberStitch (all-suture, all-inside), a polyether ether ketone (PEEK) all-inside, and an inside-out device. DESIGN: Forty human cadaver menisci were tested after creating 20 mm longitudinal tears in the posterior meniscus. Each knee was randomized to 1 of 4 meniscus repair groups: JuggerStitch (all-suture, all-inside), FiberStitch (all-suture, all-inside), FAST-FIX 360 (PEEK-based anchor all-inside), and inside-out (with BroadbandTM tape meniscus needles). For each meniscus, 2 devices were used to prepare vertical mattress repair construct. The specimens were tested by pre-conditioning 20 cycles between 5 N and 30 N and then the tear diastasis was measured, followed by distraction to failure phase after imposing a displacement at a rate of 0.5 mm/s. RESULTS: Ten menisci were tested in each of the 4 groups. After pre-conditioning, there was no significant difference in the gap formation among groups (P = 0.212). The average failure load for the JuggerStitch, FiberStitch, PEEK all-inside, and inside-out was 384 N, 311 N, 207 N, and 261 N, respectively, with a significant difference between groups (P = 0.034). Post hoc analysis showed the JuggerStitch failure load was higher than the PEEK all-inside and inside-out (P = 0.005, and P = 0.045, respectively). There was no significant difference between the failure load of the JuggerStitch and FiberStitch (P = 0.225). CONCLUSION: The JuggerStitch all-suture device, FiberStitch all-suture device, PEEK all-inside, and inside-out devices have similar biomechanical properties for gapping and stiffness. The JuggerStitch all-suture, all-inside device has superior failure load compared with the PEEK all-inside and inside-out repair for longitudinal meniscus tear repair.

In Vitro Evaluation of Lateral Femur Condyle Free Chondral Fragment Swelling after Soaking in Normal Saline.

OBJECTIVE: After traumatic knee injuries, chondral fragments can avulse off bone with the progeny fragment becoming a loose body. The loose fragment may be larger than expected when trying to surgically repair the fragment back to its original site. The purpose of this study was to determine whether a loose chondral fragment from the lateral femur condyle would increase in size and weight after soaking in normal saline (NS) for 14 days. DESIGN: Twelve 6-mm OAT (osteoarticular transfer) plugs were harvested from 6 cadaver knees on the lateral femoral condyle to simulate a chondral fragment. The chondral fragments were then placed inside an airtight specimen container with NS (0.9% sodium chloride) and were measured over 14 days. RESULTS: After 14 days, the chondral fragments showed no increase in diameter as they measured an average of 5.567 ± 0.448 mm on Day 1 and 5.702 ± 0.253 mm on Day 14 (P = 0.183). The chondral fragments showed an increase in mass from an average of 0.058 ± 0.012 g on Day 1 to 0.073 ± 0.012 g on Day 14 (P < 0.001) and an increase in thickness from an average of 2.038 ± 0.346 mm on Day 1 to 2.229 ± 0.297 mm on Day 14 (P = 0.033). CONCLUSIONS: Chondral fragments in NS increase in mass and thickness over time, but do not change in diameter. When surgeons are evaluating loose chondral fragments for fixation, they should consider that these fragments may appear thicker than the recipient location.

Medial Transmalleolar Portal Technique for Ankle Arthroscopic Headless Screw Fixation of Talar Osteochondritis Dissecans Lesions.

This article describes a technique for arthroscopic fixation of an osteochondritis dissecans (OCD) lesion of the medial talar dome with headless compression screws. This technique involves creation of a medial transmalleolar portal using a guide and drill. The medial transmalleolar portal grants perpendicular access for screw fixation of OCD lesions in addition to the potential for osteochondral autograft transplantation (OAT). Advantages include access to the medial talar dome without performing a medial malleolar osteotomy. After completion of OCD fixation, an inverted osteochondral plug can be used to backfill the portal.