The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.

Objective The aim of this retrospective study was to compare the clinical outcomes of anatomic single bundle ACL reconstruction using either a free quadriceps tendon autograft or a quadrupled hamstring autograft with a minimum follow-up of 24 months. Methods Consecutive patients undergoing ACL reconstruction using either a free quadriceps tendon autograft or hamstring tendon autograft from January 2013 to December 2014 were included. ACL reconstruction was done in all patients due to isolated ACL tears. Patients with associated cartilage lesions > Outerbridge III, meniscal lesions in need of meniscectomy or repair as well as patients with prior knee surgery on the affected or contralateral knee were excluded. The primary outcome evaluation was the side-to-side difference in instrumented Lachman testing. Secondary outcome evaluation consisted in the Lysholm, modified Cincinnati and SF-36 scores. Side-to-side difference in range of motion and thigh diameter was also documented. Results After applying the inclusion/exclusion criteria, a total of 82 patients were identified and 72 (87.8%) presented to the hospital for follow-up. There were 39 patients with quadriceps graft (30.64 ± 8.71, range: 18–53 years) and 33 patients with hamstrings (28.60 ± 6.74, range: 18–46 years). No statistically significant difference between groups was detected with regard to KT-1000 measurements (p = 0.326). No significant difference was found between the mean postoperative Lysholm (p = 0.299), the modified Cincinnati (p = 0.665) and the general SF-36 scores between groups (p = 0.588). Less side-to-side thigh diameter difference was noted in the quadriceps graft group (p = 0.026). Conclusion In conclusion, similar clinical results, in terms of stability and subjective measures, can be obtained after ACL reconstruction both with a free quadriceps and a 4-strand hamstring tendons autograft. Level of evidence Level III, Therapeutic Study.

The most commonly used autografts for anterior cruciate ligament reconstruction are the boneepatellar tendonebone and hamstring tendons. Each has its advantages and limitations. The boneepatellar tendonebone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.T he most commonly used autografts for anterior cruciate ligament (ACL) reconstruction are the boneepatellar tendonebone and hamstring tendons. Recently, there has been an increase in interest in the quadriceps tendon as an autologous graft option for ACL reconstruction. 1 Among the proposed advantages are low morbidity at the harvest site 2-4 ; predictable size and great versatility; and the ability to harvest grafts in different widths, thicknesses, and lengths. 5 The quadriceps tendon graft can be harvested with 6,7 or without a bone block. 8 To completely avoid possible patellar fracture and reduce morbidity at the harvest site, a free bone plug graft is the solution. We present our preferred method of free quadriceps graft harvest for ACL reconstruction and describe how we use a suspensory fixation device for femoral fixation with this type of graft. The harvest method is based on the technique described by Fulkerson and Langeland, 9 but to our knowledge, the cortical button technique has not been described previously. Surgical TechniqueUnder general or spinal anesthesia, the patient is positioned supine on the operating table and the knee flexed to 90 . The skin incision starts from the proximal pole of the patella and extends proximally, in a longitudinal midline fashion, for about 3.5 to 4 cm (Fig 1). After skin and subcutaneous fat incision, the underlying quadriceps tendon is visualized. Medial dissection is

Surgery of the arthritic hip was not an easy task in the previous centuries, lots of operations being followed very closely by complications and failures. Nowadays, hip arthroplasty is considered “the operation of the century”. This review follows the evolution of surgery on the arthritic hip, with emphasis on arthroplasty. Acknowledging the history of this operation, one can better prepare its evolution and future directions of research. The final chapter briefly describes the current trends and future perspectives.