Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. In previous reports an arthrotomy was used to accomplish this repair; in this paper an arthroscopic technique is presented. The potential risks are significant and include damage to the peroneal nerve and popliteal vascular structures, failure of meniscal healing and the usual complications of arthroscopy. The procedure is recommended only for the advanced arthroscopist who is advised first to establish clearly by cadaver dissections the anatomical relationships.

Metal, plastic, and biodegradable implants can all cause problems. The advantage of the biodegradable implant is clarity in postoperative imaging, easier revision, and fewer concerns about associated tissue damage. Although biodegradable implants do degrade over time, this time varies considerably, depends upon the polymer present, and is often measured in years. Before that occurring, the implant is a rigid device. Problems in the operative or immediate postoperative period include implant breakage during insertion, loss of initial fixation, incompletely buried or "proud" implants within a joint that could damage articular cartilage, and possible implant migration. Later occurring problems include the development of inflammatory reactions leading to lytic changes, cyst formation, intra-articular granuloma formation along with swelling, and sterile pretibial abscesses. Despite this list of potential problems on balance biodegradable implants are safe and effective and present no greater concerns (and arguably fewer ones) than metal or plastic implants.

The iliotibial band syndrome is most often diagnosed in runners but can be found in athletes who participate in other sports. From our experience most patients are high mileage runners with shoes either worn out or with insufficient cushioning. A total of 19 athletes with this condition have been seen in the past 3 years. Treatment consisted of rest or decreased distance, shoe changes, modification in exercise technique, anti-inflammatory medication, steroid injections and stretching. Surgery was not required.

Meniscal cysts are commonly seen in the knee. Symptomatic meniscal cysts tend to be located on the lateral side but magnetic resonance imaging studies indicate that medial cysts are more common. Meniscal cysts are commonly associated with horizontal meniscal tears. The arthroscopic management of symptomatic cysts should include debriding the horizontal meniscal tear (if nonrepairable) to fully decompress the cyst and the creation of a 5-mm channel from the joint into the cyst. If a vertical peripheral meniscal tear exists or is created, meniscal repair for appropriately selected cases should be performed.

Biodegradable implants allow clarity in postoperative imaging, easier revision, and fewer concerns about associated tissue damage. It is important to appreciate that different biodegradable materials have different properties and different degradation rates. Faster degradation can be associated with a greater inflammatory response. However, inflammation is a normal part of the degradation process. The concern arises when the inflammation is clinically significant.

No abstract

The objective of this study was to prospectively evaluate the clinical effectiveness and radiographic response of a poly (l-lactide co-glycolide)/β-tricalcium phosphate (PlLA/PGA/β-TCP) interference screw used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. A prospective, consecutive series of 104 patellar tendon bone-tendon-bone ACL reconstructions fixed with PLLA/PGA/β-TCP biocomposite screws were studied. After receiving the approval from the Institutional Review Board, the following data were collected preoperatively from all patients: physical examination, Lysholm score, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores, and standard knee radiographs. In addition to these, follow-up assessments included Lachman and pivot-shift tests, Tegner scores, and KT side-to-side differences. Surgical failure was defined by a 2+ Lachman test, positive pivot-shift test, side-to-side KT difference of greater than 5 mm or subsequent ACL revision surgery. Approximately 95% of patients (99 of 104) with an average follow-up of 36 months (range, 24 to 68) are reported. The average age was 30 years (range, 13 to 57 years). Postoperatively, four patients demonstrated +1 Lachman score and one patient demonstrated a +2 Lachman score. Postoperative pivot-shift tests were a trace positive in one patients and +1 in two patients. The average KT side-to-side difference was 0.65 mm. All, but five patients, demonstrated KT side-to-side measurements of 3 mm or less and those five demonstrated measurements of 5 mm or less. No revision reconstructions were performed. Significant improvements in Cincinnati score (41 to 85 postoperative) and Lysholm score (46 to 90) were observed. The average postoperative Tegner score was 7. IKDC activity score increased from 2.3 to 3.1. Approximately 4% of patients (4 of 99) met the criteria for failure. A PLLA/PGA/β-TCP biocomposite interference fixation screw provides good graft fixation, with good radiographic incorporation, without adverse events.The level of evidence of the study is IV.