The outside-in, percutaneous release of the medial collateral ligament (MCL) is a technique used to increase the medial tibiofemoral joint space during arthroscopy to facilitate the use of instrumentation and improve visualization without causing iatrogenic cartilage damage. A recent systematic review of the literature has shown this technique to be efficacious and safe, with no evidence of associated short-or long-term complications. This technique has been used for this indication by the senior author without requiring any deviation from our institution's standard protocol for knee arthroscopy. In an attempt to standardize this technique's utilization and allow for further evaluation in the literature, the senior author's method for this percutaneous, outside-in approach of "pie crusting" the MCL is described.
-Authentic, real-world problem solving is an integral part of the engineering profession. Yet, research suggests that engineering education is primarily focused on welldefined and well-structured problems, which do not provide students the real-world relevance, context, or experience in solving the types of problems required as a professional engineer. The addition of problem-based service learning (PBSL) to engineering curricula provides an opportunity to introduce students to a variety of real-world projects in a community-based context. Numerous studies have shown the importance and impacts of integrating service learning and problem-based learning into engineering education. Herein, the results of a mixed-methods, longitudinal study on cognitive and affective learning during a PBSL sophomore design experience are presented and discussed. The goals are to demonstrate how both qualitative and quantitative data can be used to measure student learning during a PBSL experience and to provide a framework for assessment of such experiences.
Background: Large (4.5 mm) and/or transpatellar bone tunnels have been associated with patellar fracture after medial patellofemoral ligament (MPFL) reconstruction. To avoid this outcome, many surgeons now employ suture anchors to affix the MPFL graft to the patella. Purpose: To evaluate the risk of patellar fracture and other outcomes associated with smaller (3.2-mm), short, oblique patellar tunnels as compared with suture anchor fixation in MPFL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A single institution’s electronic medical record was queried for all patients undergoing MPFL reconstruction between March 2010 and December 2018. A chart review of operative reports was utilized to identify those who had undergone MPFL reconstruction. Patients undergoing revision MPFL reconstruction or reconstruction with fully transpatellar bone tunnels were excluded. The incidence of patellar fracture and outcomes were evaluated from chart review. The mean duration of follow-up was >2 years. Results: A total of 384 knees in 352 patients undergoing primary MPFL reconstruction were identified. Small (3.2-mm), short, oblique tunnels were used for patellar fixation in 215 cases, and suture anchors were utilized in 169 cases. The small, oblique tunnels and suture anchor techniques both resulted in a low incidence of patellar fracture, with rates of 0.47% and 0%, respectively. The use of suture anchors was associated with an increased risk of subluxation or dislocation compared with small, oblique tunnels (odds ratio, 3.98; P = .028). No significant difference was found in the need for revision MPFL reconstruction surgery with suture anchors (odds ratio, 1.925; P = .66). Conclusion: The use of small, oblique tunnels with hamstring autograft is a safe means of patellar fixation in MPFL reconstruction. The use of small, oblique tunnels for patellar fixation versus 2 suture anchors can result in material cost savings with no significantly increased risk for fracture as well as an overall reduction in complication rates.
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