Meniscus tears are among the most common knee injuries in the general population and often are treated arthroscopically with a meniscus repair. Of the various meniscus repair techniques available, the inside-out meniscus tear is considered the gold standard due to its versatility and good clinical outcomes. The purpose of this Technical Note and accompanying video is to describe an inside-out bucket-handle meniscus repair using a single handed, self-advancing meniscus repair device with an interchangeable zone-specific multicannula system to decrease the technical difficulty and operative time of the repair.
Purpose The purpose of this study was to evaluate whether there was a diference in clinical outcomes between patients who underwent primary ACL reconstruction (ACLR) with all-soft tissue quadriceps tendon (sQT) autograft versus QT with bone block (bQT). Methods A retrospective cohort study of 708 patients who underwent QT ACLR was conducted. Primary ACLR patients with at least 1 year of follow-up were identiied and those who received sQT were compared to those who received bQT. Data collection entailed patient demographics, surgical variables, patient reported outcomes (PROs), knee stability testing, and complications. The primary outcome of interest was International Knee Documentation Committee (IKDC) score, reported as mean score, pre-and postoperative diference, and number who met minimum clinically important diference (MCID). Secondary outcomes included Lachman and pivot shift grade, other patient reported outcomes (PROs), complication rates, and return to sport (RTS). Results A total of 195 patients (147 sQT, 48 bQT) who underwent primary QT ACLR met criteria for analysis, with mean follow-up of 17.0 ± 7.9 months. No diference was detected between cohorts with respect to postoperative IKDC score (sQT: n = 120, 81.0 ± 18.9, bQT: n = 10, 80.9 ± 20.4, n.s.), proportion of patients who met MCID (sQT: 68/78 [87%], bQT: 6/7 [86%], n.s.), or results of stability testing. In the sQT cohort, 86% (106/123) of athletes achieved full RTS, compared to 85% (34/40) in the bQT cohort (n.s.). Time to RTS was less than a year in both cohorts (sQT: 10.5 ± 3.8 months [n = 106], bQT: 11.1 ± 3.9 months [n = 31], n.s.). Graft rupture occurred in 7 (5%) sQT patients and 3 (6%) bQT patients (n.s.), and all clinical failures were due to graft rupture (n.s.). No diferences were detected for rates of postoperative complications. Conclusion No diferences in clinical outcomes were detected between patients who underwent primary ACLR with sQT autograft versus bQT autograft. Currently, the decision to employ sQT or bQT is largely determined by surgeon preference. This study demonstrates excellent outcomes with both preparations and supports the use of either graft type at the discretion of the treating surgeon. Level of evidence III KeywordsACL reconstruction • Anterior cruciate ligament • Knee • Quadriceps tendon autograft • Sports medicine * Joshua C. Setlif
Total shoulder arthroplasty (TSA) has evolved over the years and is used for a variety of indications, with arthritis being the most common. Stemless TSA is a unique bone-preserving design that can eliminate rotational malalignment. Additionally, recent literature has found utility in the use of biological mesh and a platelet-rich plasma injection to improve healing. The purpose of this article is to outline the process of TSA using a stemless system and how to incorporate the use of amnion matrix and platelet-rich plasma into the surgical technique.
Horizontal cleavage tears of the medial and lateral meniscus can be difficult to treat using the standard anteromedial or anterolateral arthroscopy portals. In this Technical Note, we present a new surgical technique to better manage the inferior leaflet of horizontal cleavage tears of the medial and lateral meniscus and their associated parameniscal cysts.
Background: Lateral epicondylitis usually stems from overuse and failed tendon healing. Following attempt of conservative management, surgery is often considered, although there is variation in techniques and outcomes cited in the literature. Methods: This retrospective review analyzed 293 operative patients for lateral epicondylitis following conservative management. The primary outcome was change in pain from preoperative status, including pain-free, improved, unchanged, or worse. Positive outcomes included pain-free or improved symptoms postoperatively. Negative outcomes were unchanged or worse pain. Patients returned 2 weeks, 6 weeks, and 3 months postoperatively. We analyzed patients’ profession, handedness, operating surgeon, surgical technique, sex, magnetic resonance imaging findings, concomitant procedures, age, race, revisions, and complications. One surgeon repaired the common extensor using a suture anchor, whereas 2 surgeons performed a side-side repair of the extensor carpi radialis longus and extensor digitorum communis interval. Results: By the 3-month visit, 41% were pain-free and 52% improved compared with preoperatively. None were worse, and 7% were unchanged. Mean pain scores at the 2-week, 6-week, and 3-month visits were 4.22/10, 3.61/10, and 3.44/10, respectively. There were 7 revisions (2.4%) and 6 complications (2%). Manual laborers experienced more negative outcomes than sedentary workers ( P = .04). The remaining parameters were insignificant, including the operative technique. Conclusions: Surgery is successful for both techniques, with 93% positive outcomes by 3 months. There was no statistical difference in postoperative pain between patients who had suture repair versus anchor repair. Therefore, surgeons should consider suture-only repair given the cost of anchors.
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