Arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament: A novel technique and mid-term outcomes.

Purpose: This study assessed the outcomes of arthroscopic management of avulsion fractures of the tibial attachment of the posterior cruciate ligament (PCL), with holding of the PCL with two ''cinch knots''. Methods: 15 patients with avulsion fractures of the tibial attachment of the PCL were treated with arthroscopic reduction and fixation with holding of the PCL with two ''cinch knots''. All patients were males with mean age of 28 (range, 15-44) years. Patients were assessed by the Lysholm Tegner knee scale and IKDC (International knee documentation committee) objective grade. Results: The mean follow-up period was 40 (range, 12-60) months. Mean postoperative flexion was 134.7° (range, 120-150). Mean Lysholm score was 90.27 (range, 67-99). Lysholm score was excellent in seven (46.7%) patients, good in six (40%) patients, fair in two (13.3%) patients, and none of the patients was poor. 11 (73.3%) patients had IKDC grade A, and four (26.7%) patients had IKDC grade B due to residual grade 1+ posterior drawer. Current Tegner activity level remained the same in nine (60%) patients, decreased one level in three (20%) patients, and decreased two levels in three (20%) patients as compared to the preinjury level. There wasn't any vascular or nerve complications. Conclusion: Arthroscopic treatment of PCL tibial avulsion fractures with the cinch knot technique has many advantages, and it proved to be safe and effective. The technique is simple and easy to be reproduced. Early results are promising to encourage surgeons to make this novel technique. Level of evidence: Therapeutic study, prospective case series with no comparison group, Level IV.

Economic Reliable Arthroscopic Technique for Reduction and Fixation of Acute Acromioclavicular Joint Dislocation.

Separation of the acromioclavicular joint (ACJ) is a common orthopaedic injury among athletes involved in contact sports and victims of motor vehicle accidents. ACJ disruptions are common in athletes. Treatment is guided by the level of injury; grade 1 and 2 injuries are managed nonoperatively. Grades 4-6 are managed operatively, whereas grade 3 is an area of controversy. Several operative techniques have been described to restore anatomy and function. We present a technique that's safe, economic, and reliable in the management of acute ACJ dislocation. It allows intra-articular glenohumeral assessment and relies on a coracoclavicular sling. This is an arthroscopic-assisted technique. It entails a small transverse or vertical incision over distal clavicle 2 cm away from ACJ, which enables us to reduce the ACJ and maintain reduction with a k-wire, checked by the C-arm. Diagnostic shoulder arthroscopy is then performed to assess the glenohumeral joint. The rotator interval is liberated and the coracoid base is exposed, and PROLENE sutures are then passed anterior to the clavicle medial and lateral to the coracoid. It is the used to shuttle polyester tape and ultrabraid as a sling under the coracoid. A tunnel is then made in the clavicle, then one end of suture is passed through the tunnel whereas the other end remains anterior. Several knots are made to ensure it is secured, then the deltotrapezial fascia is closed as a separate layer.

No correlation exists between coracoid tunnel widening and loss of reduction after arthroscopic acromioclavicular fixation using tightrope system.

PURPOSE: To detect the widening of the tunnel of the coracoid process after arthroscopic fixation of acute acromioclavicular joint (ACJ) dislocation using the TightRope system and its correlation with loss of reduction and functional scores. METHODS: From 2016 to 2018, a prospective study was performed on twenty-three patients with acute grade III-V ACJ dislocation. Arthroscopic TightRope repair of the ACJ was performed. Coracoid tunnel widening was measured by CT, and the coracoclavicular distance was measured on the radiographs immediately postoperatively and at 12 months. The Constant Shoulder Score, Oxford Shoulder Score, Nottingham Clavicle Score and Visual analog scale were used as outcome measures at 12 months. RESULTS: The coracoid tunnel diameter to horizontal coracoid diameter ratio increased from 22.8 ± 3.7% immediately postoperatively to 38.5 ± 5.5% at 12 months (p < 0.001). The coracoclavicular (CC) distance showed an increase from a mean of 10.8 ± 1.7 mm to a mean of 11.8 ± 2.5 at 12 months (p < 0.001). There was no correlation between the increase in the coracoclavicular distance and the patients' functional clinical scores or coracoid tunnel widening. CONCLUSION: Coracoid tunnel widening and radiological loss of reduction occur after arthroscopic fixation of acute ACJ dislocation with the TightRope system. However, they do not correlate with each other or with the functional scores of the patient. LEVEL OF EVIDENCE: Level IV.

Suprameniscal Portal for Repairing Meniscal Root Tears.

Several techniques and portals have been described for meniscal root repairs. Some authors describe using anterior portals for suture passing and manipulation of meniscal tissue, with some risk of iatrogenic chondral injuries reported. Other authors describe using posterior portals to avoid this risk. In this technique, we used a suprameniscal portal, which allowed a good trajectory for passing sutures in the meniscal tissue with minimal risk of iatrogenic chondral damage without the need to use posterior portals. The meniscal bed is first prepared. The suprameniscal portal is created in 15° of knee flexion and used to pass 2 sutures through the meniscus by a Lasso. The sutures are tied in a cinch configuration, shuttled through the tibial tunnel, and tied over a Dog Bone button.

Latarjet Procedure for Anterior Shoulder Instability Due to Tramadol-Induced Seizures: A Multicenter Study.

BACKGROUND: Seizures, commonly due to epilepsy, are known to cause shoulder instability. Tramadol addiction has recently been found to induce seizures in patients who exceed the recommended dose. Because of the easy accessibility and low cost of tramadol, an increasingly alarming phenomenon of tramadol abuse has been demonstrated in recent years. PURPOSE/HYPOTHESIS: The purpose of this multicenter study was to investigate shoulder instability resulting from tramadol-induced seizure (TIS) as well as to recommended management for such shoulder instability. The hypothesis was that TIS leads to anterior shoulder dislocations with major bony defects, which favors bony reconstructive procedures as a suitable method of treatment. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This prospective case series study was conducted on 73 patients (78 shoulders) who presented with anterior shoulder dislocations and a clear history of tramadol abuse. The mean age of the patients was 26.8 years, and the mean number of dislocations was 14. The mean duration of addiction was 17 months, with a mean dose of 752 mg of tramadol hydrochloride per day. Glenoid and humeral bone loss ranged from 15% to 35% and from 15% to 40%, respectively. The mean follow-up period was 28 months. All patients underwent an open Latarjet procedure. RESULTS: Postoperative mean Rowe score and American Shoulder and Elbow Surgeons score at final follow-up (24 months) improved significantly from 20 to 84 and from 44 to 91, respectively (P < .05). The patient satisfaction rate reached 95%, and the mean period of return to work was 12.8 weeks. Five patients (9%) had postoperative seizures due to relapse of the tramadol abuse, but only 3 patients (5%) had redislocations with nonunion or breakage of the graft or hardware. CONCLUSION: Tramadol addiction has evolved as an important cause of seizures that can result in shoulder dislocation. Anterior shoulder instability with TIS occurs mainly with higher levels of addiction and results in significant humeral and/or glenoid bone defects. The Latarjet procedure is recommended for these patients, after control of addiction, and provides 95% satisfaction at midterm follow-up.