PurposeTo identify the structural integrity of the healing site after arthroscopic repair of a posterior root tear of the medial meniscus by second-look arthroscopy and to determine the clinical relevance of the findings.Materials and MethodsFrom January 2005 to December 2010, 20 consecutive patients underwent arthroscopic modified pull-out suture repair for a posterior root tear of the medial meniscus. Thirteen patients were available for second-look arthroscopic evaluation. The healing status of the medial meniscus was classified as complete healing, lax healing, scar tissue healing, and failed healing. We evaluated the correlation between the clinical symptoms and second-look arthroscopic findings. Clinical evaluation was based on the Lysholm knee scores and Hospital for Special Surgery (HSS) scores.ResultsThere were 4 cases of complete healing, 4 lax healing, 4 scar tissue healing, and 1 failed healing. The healing status of the repaired meniscus appeared to be related to the clinical symptoms. Patients who achieved complete tissue healing had no complaint. The healing status exhibited no relationship with age, mechanical axis, degree of subluxation, and symptom duration. The mean Lysholm score improved from 34.7 preoperatively to 75.6 at follow-up and the mean HSS score also significantly increased from 33.5 to 82.2.ConclusionsWe achieved 4 complete and 8 partial healing (lax or scar) of the medial meniscus in this retrospective case series of posterior horn meniscus root repairs performed by 1 surgeon. Further research is needed to clarify why all patients showed clinical improvement despite findings of partial healing on second-look arthroscopy.
PurposeTo compare the clinical outcomes between the open posterior approach and arthroscopic suture fixation for displaced posterior cruciate ligament (PCL) avulsion fractures.MethodsA literature search was performed on MEDLINE, EMBASE, and the Cochrane Library databases. The inclusion criteria were as follows: papers written in English on displaced PCL avulsion fractures, clinical trial(s) with clear description of surgical technique, adult subjects, a follow-up longer than 12 months and modified Coleman methodology score (CMS) more than 60 points.ResultsTwelve studies were included with a mean CMS value of 72.4 (standard deviation, 7.6). Overall, 134 patients underwent the open posterior approach with a minimum 12-month follow-up, and 174 patients underwent arthroscopic suture fixation. At final follow-up, the range of Lysholm score was 85–100 for the open approach and 80–100 for the arthroscopic approach. Patients who were rated as normal or nearly normal in the International Knee Documentation Committee subjective knee assessment were 92%–100% for the open approach and 90%–100% for the arthroscopic approach. The range of side-to-side difference was 0–5 mm for both approaches.ConclusionsBoth arthroscopic and open methods for the treatment of PCL tibial-side avulsion injuries resulted in comparably good clinical outcomes, radiological healing, and stable knees.
PurposeIn anatomical single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, the traditional transtibial approach can limit anatomical placement of the femoral tunnel.Surgical TechniqueWe present a novel three-point freehand technique that allows for anatomic SB ACL reconstruction with the transtibial technique.Materials and MethodsBetween January 2012 and December 2012, 55 ACL reconstructions were performed using the three-point freehand technique. All the patients were followed for a minimum of 12 months post-operatively. Clinical evaluation was done using the Lysholm score and International Knee Documentation Committee (IKDC) grade. All patients were analyzed by 3-dimensional computed tomography (3D CT) at 1 week after surgery.ResultsThe mean Lysholm score improved from 68.2±12.7 points preoperatively to 89.2±8.2 points at final follow-up. At final follow-up, the IKDC grade was normal in 42 patients and nearly normal in 13 patients. None of the patients had a positive pivot shift test, anterior drawer test and Lachman test at final follow-up. The anatomical position of the femoral tunnel was confirmed on 3D CT scans.ConclusionsThe three-point freehand technique for SB transtibial ACL reconstruction is a simple, anatomic technique showing good clinical results.
Purpose:To analyze the possible causes and incidence of the chronic anterior knee pain follow after closed intramedullary nailing for the tibial shaft fractures, in a retrospective aspect. Materials and Methods: 52 patients who treated with intramedullary nailing for the tibial shaft fractures from January 2001 to October 2008 were reviewed. We analyzed the relationship between knee pain and the variables (sex, age, types of fracture, protrusion extent of intramedullary nailing on proximal tibia). The aspects of pain, its onset and relieving time, and how much it influences on daily living were analyzed retrospectively. For categorical variables, group variences were estimated using Chi-square test. Results: 34 patients of 52 (65%) complaint of anterior knee pain followed after intramedullary nailing, and there were no statistical differences between pain and sex/age (p>0.05). Incidence of anterior knee pain becomes higher as the severity of fracture increases, but there was no statistical difference between pain and intramedullary nailing protrusion. Pain severity was mostly not influencing on daily living, and it mostly responded to conservative treatment. Conclusion:The incidence of anterior knee pain followed after intramedullary nailing was 65%, and its severity was mostly not influencing on daily living. There were no significant differences between pain and sex, age, protrusion extent of intramedullary
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