No abstract

The purposes of this study were to establish the technique to arthroscopically identify the resident's ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 x 10 mm was created just behind the ridge. At 3-4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7-10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident's ridge. The resident's ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction.

Bone union was not always achieved after arthroscopic bony Bankart repair, and union was often delayed. Recurrence of instability was significantly more frequent when bone union failed. The size of the glenoid defect decreased significantly in shoulders with bone union.

Bone fragment absorption was seen in all of the shoulders with bony Bankart lesions. Most bone fragments showed severe absorption within 1 year after the primary traumatic episode. Before arthroscopic Bankart repair, not only glenoid defects but also bone fragment absorption should be assessed.

This article describes second-look arthroscopic evaluation of the transplanted grafts after anatomical two-bundle ACL reconstruction, which had been performed between December 2000 and March 2004. Using two double-looped semitendinosus tendon grafts via separate femoral and tibial tunnels in the anatomical ACL footprints, 65 patients (mean age of 24 years) underwent anatomical two-bundle ACL reconstruction. The evaluation was performed for those who had undergone the procedure 5-29 months (mean 16.5) previously, with emphasis on graft tension and the presence of graft damage by meticulous probing. None of the anteromedial (AM) grafts showed rupture, while 11% of the posterolateral (PL) grafts showed substantial damage around the femoral tunnel aperture. Both the AM and PL grafts were evaluated as lax without apparent graft rupture in 9% of the knees. These results suggest that the currently performed anatomical two-bundle ACL reconstruction and postoperative regimen still remain to be improved to achieve better postoperative graft morphology.