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Doan H, Holy T, Richter DL, Campos T, Held M, Del Castillo J, Schenck RC. Supine Lobenhoffer Approach Optimizes PCL Reconstruction with Tibial Inlay in Knee Dislocations: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00068. [PMID: 37616422 DOI: 10.2106/jbjs.cc.23.00071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
CASE A 47-year-old man suffered a knee dislocation while skiing with associated damage to the anterior cruciate, posterior cruciate, medial collateral, and medial patellofemoral ligaments. The patient underwent a multiple-ligament knee reconstruction using the supine Lobenhoffer approach, which resulted in remarkable outcomes that persisted throughout the 56-month follow-up period. CONCLUSION The utilization of this approach can prevent inappropriate graft tension and iatrogenic damage, reduce surgical time, and minimize airway complications by eliminating the need for the prone position. Optimizing these factors enhances the patient's chances for long-term outcomes; thus, surgeons should consider this approach in managing multiple-ligament knee injuries.
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Affiliation(s)
- Hoi Doan
- University of New Mexico School of Medicine, Albuquerque, NM
| | - Tomas Holy
- Department of Orthopaedics, University of New Mexico School of Medicine, MSC 10 5600, Albuquerque, NM
| | - Dustin L Richter
- Department of Orthopaedics, University of New Mexico School of Medicine, MSC 10 5600, Albuquerque, NM
| | - Tulio Campos
- Departamento de Aparelho Locomotor Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Michael Held
- Department of Orthopaedics,University of Cape Town
| | - Juan Del Castillo
- Clínica de Traumatología y Ortopedia, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Robert C Schenck
- Department of Orthopaedics, University of New Mexico School of Medicine, MSC 10 5600, Albuquerque, NM
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Campos T, Perucci M, Gomes P, Giordano V. Combined reconstruction of medial collateral ligament and posterior cruciate ligament using one femoral tunnel: a technical note and case report applicable to limited-resource settings. BMJ Case Rep 2023; 16:e252877. [PMID: 36882260 PMCID: PMC10008166 DOI: 10.1136/bcr-2022-252877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Knee dislocations are severe injuries difficult to treat. Specially in low-resources scenarios, reconstruction of multiple ligaments can be challenging. We describe a technical note that can be reconstruct multi ligaments using ipsilateral hamstrings autograft. A posteromedial knee incision is made to visualise the medial corner of the knee and to reconstruct medial collateral ligament (MCL) and posterior cruciate ligament (PCL) with semitendinosus and gracilis tendon graft, using one femoral tunnel from the anatomic femoral insertion of the MCL to the anatomic femoral insertion of the PCL. After 1-year follow-up, the patient returned to his previous function with a Lysholm score of 86. This technique can reconstruct more than one ligament anatomically with limited graft resource.
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Affiliation(s)
- Túlio Campos
- Orthopaedic Surgery, Universidade Federal de Minas Gerais Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Marcelo Perucci
- Orthopaedic Surgery, Universidade Federal de Minas Gerais Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Paulo Gomes
- Orthopaedic Surgery, Universidade Federal de Minas Gerais Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
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Schenck RC. CORR Insights®: Does the Nice Knot Offer Less Elongation Than the Modified Prusik Knot? An In Vitro Study in Cadaver Quadriceps Tendons. Clin Orthop Relat Res 2022; 480:1411-1413. [PMID: 35426863 PMCID: PMC9191299 DOI: 10.1097/corr.0000000000002210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Robert C Schenck
- Professor and Chair, Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Schenck RB, Swiontkowski M. JBJS Arts & Humanities. J Bone Joint Surg Am 2022; 104:1-3. [PMID: 34985448 DOI: 10.2106/jbjs.21.01103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Scheepers W, Khanduja V, Held M. Current concepts in the assessment and management of multiligament injuries of the knee. SICOT J 2021; 7:62. [PMID: 34870591 PMCID: PMC8647687 DOI: 10.1051/sicotj/2021058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Multiligament knee injuries (MLKIs), though rare, pose significant challenges to the patient and surgeon. They often occur in the setting of high-velocity trauma and are frequently associated with concomitant intra- and extra-articular injuries, the most immediately devastating of which is vascular compromise. A detailed evaluation is required when acute or chronic MLKIs are suspected, and stress radiography, MRI and angiography are valuable adjuncts to a thorough clinical examination. Surgical treatment is widely regarded as superior to non-surgical management and has been demonstrated to improve functional outcome scores, return to work, and return to sport rates, though the incidence of post-traumatic osteoarthritis remains high in affected knees. However, acceptable results have been obtained with conservative management in populations where surgical intervention is not feasible. Early arthroscopic single-stage reconstruction is currently the mainstay of treatment for these injuries, but some recent comparative studies have found no significant differences in outcomes. Recent trends in the literature on MLKIs seem to favour early surgery over delayed surgery, though both methods have distinct advantages and disadvantages. Due to the heterogeneity of the injury and the diversity of patient factors, treatment needs to be individualised, and a single best approach with regards to the timing of surgery, repair versus reconstruction, surgical technique and surgical principles cannot be advocated. There is much controversy in the literature surrounding these topics. Early post-operative rehabilitation remains one of the most important positive prognostic factors in surgical management and requires a dedicated team-based approach. Though outcomes of MLKIs are generally favourable, complications are abundant and precautionary measures should be implemented where possible. Low resource settings are faced with unique challenges, necessitating adaptability and pragmatism in tailoring a management strategy capable of achieving comparable outcomes.
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Affiliation(s)
- Waldo Scheepers
- Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, 7925 Cape Town, South Africa
| | - Vikas Khanduja
- Consultant Orthopedic Surgeon, Addenbrooke's - Cambridge University Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Michael Held
- Department of Orthopedic Surgery, Groote Schuur Hospital, Orthopedic Research Unit, University of Cape Town, 7925 Cape Town, South Africa
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Chuaychoosakoon C, Parinyakhup W, Wiwatboworn A, Purngpiputtrakul P, Wanasitchaiwat P, Boonriong T. Comparing the Efficacy of Postoperative Pain Control Between Intravenous Parecoxib and Oral Diclofenac in ACL Reconstruction. Orthop J Sports Med 2021; 9:23259671211041660. [PMID: 34692879 PMCID: PMC8532231 DOI: 10.1177/23259671211041660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background: A nonsteroidal anti-inflammatory drug such as oral diclofenac is normally used to relieve postoperative pain after anterior cruciate ligament reconstruction (ACLR), but most patients continue to have moderate-to-severe pain that disturbs their rehabilitation. Some orthopaedists prefer to use intravenous (IV) parecoxib for postoperative pain control. Purpose: To compare the efficacy of IV parecoxib and oral diclofenac for postoperative pain control in ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively collected and analyzed postoperative pain in patients who underwent both single- and double-bundle ACLR; pain was reported on a 10-point visual analog scale (VAS; 10 = worst pain). After the operation, each patient was given either IV parecoxib twice a day or oral diclofenac 3 times a day, and all patients received paracetamol 6 times per day for 24 hours postoperatively. If the patient complained of moderate or severe pain (VAS >3) after surgery, 3 mg of morphine would be given intravenously every 3 hours and 1 mg of morphine as a rescue analgesic every 1 hour for 24 hours postoperatively. Postoperative VAS and morphine consumption were recorded every 4 hours for 24 hours. Data were analyzed using paired t test, analysis of variance, and chi-square test. Results: Overall, 161 patients were included in this study, of whom 47 received IV parecoxib and 114 received oral diclofenac. The mean VAS scores at 4 and 8 hours postoperatively were 3.5 and 3.4, respectively, in the parecoxib group, and 4.4 and 4.7, respectively, in the diclofenac group. The parecoxib group had significantly lower mean VAS than the diclofenac group at 4 hours (P = .047) and 8 hours (P = .005), and the mean cumulative morphine consumption in the parecoxib group was significantly lower than in the diclofenac group at all time points (P < .05) except 4 hours postoperatively. Conclusion: This study found that IV parecoxib was more effective than oral diclofenac in controlling postoperative pain and resulted in lower postoperative morphine consumption within the first 24 hours after ACLR.
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Affiliation(s)
- Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wachiraphan Parinyakhup
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnan Wiwatboworn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Pawin Wanasitchaiwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Tanarat Boonriong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Schenck RC. CORR Insights®: Is There a Disadvantage to Early Physical Therapy After Multiligament Surgery for Knee Dislocation? A Pilot Randomized Clinical Trial. Clin Orthop Relat Res 2021; 479:1737-1739. [PMID: 33944810 PMCID: PMC8277294 DOI: 10.1097/corr.0000000000001785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Robert C Schenck
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Imada AO, O'Hara JJ, Proumen IL, Molinari PS, Wascher DC, Richter DL, Schenck RC. Bucket handle meniscus tears in low-resource settings can be successfully treated with a cost-effective technique. INTERNATIONAL ORTHOPAEDICS 2021; 46:43-49. [PMID: 34050384 DOI: 10.1007/s00264-021-05090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In regions of the world where resources can limit medical care (limited-resource settings, LRS), most meniscal tears are often treated with meniscectomy. A simple, low-cost option for meniscal repair has been developed. We sought to evaluate patient reported outcomes (PROMs) and clinical failure rates of bucket handle meniscus tears (BHTs) treated with meniscal repair in a LRS. METHODS We prospectively enrolled patients over 18 who were treated for BHT with meniscal repair in a LRS. Meniscal repair was primarily accomplished using an outside-in technique. Pre-injury and final follow-up PROMs were recorded. Clinical failure was defined as the need for re-operation or symptoms that prevented the patient from returning to recreational activities or work responsibilities. RESULTS Nineteen patients with a mean age of 25.4 years were eligible. Two patients sustained a clinical failure (10.5%). At mean follow-up of 40.6 months, there was significant improvement in all PROMs from baseline. Subgroup analysis revealed no significant difference in the failure group compared to the success group in number of knots used, pre-injury Tegner score, number of devices used, suture type, or technique. CONCLUSION Bucket-handle meniscal tears can be repaired using a low-cost technique resulting in satisfactory healing rates and excellent outcomes.
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Affiliation(s)
- Allicia Ostoposides Imada
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA.
| | - James J O'Hara
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
| | - Ignacio L Proumen
- Department of Orthopedic Surgery, Instituto Medico De Alta Complejidad (IMAC), Salta, Argentina
| | - Pablo S Molinari
- Department of Orthopedic Surgery, Instituto Medico De Alta Complejidad (IMAC), Salta, Argentina
| | - Daniel C Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
| | - Dustin L Richter
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
| | - Robert C Schenck
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, Albuquerque, NM, 87131-0001, USA
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Held M, Laubscher M, von Bormann R, Richter DL, Wascher DC, Schenck RC. Open approaches for cruciate ligament reconstruction in knee dislocations: A technical note and case series. SICOT J 2021; 7:17. [PMID: 33749587 PMCID: PMC7984149 DOI: 10.1051/sicotj/2021016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/28/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Arthroscopic surgery is the gold standard for cruciate ligament reconstruction in multi-ligament knee injuries. However, hospitals in limited-resource settings often lack arthroscopic-trained surgeons or equipment. Open approaches for treating knee dislocations can overcome many of these limitations. METHODOLOGY This study aims to describe techniques for open approaches in a supine patient to address the cruciate ligaments in multi-ligament knee injuries and to review associated complications and clinical outcomes in a retrospective case series. RESULTS Ten patients with multi-ligament knee injuries who had undergone open cruciate ligament reconstruction between July 2016 and November 2018 were retrospectively identified. Open approaches were performed owing to the extravasation of arthroscopy fluid into the posterior compartment (3) or a large traumatic arthrotomy (7). Complications and patient-reported outcomes were analysed. Eight of the 10 patients were followed up at 10 months postoperatively (range, 5-23 months). None had iatrogenic neurovascular damage. Median outcomes scores were: visual analogue scale, 45 (range, 0-100); Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form, 81.4 (range, 75-100); Lysholm, 85 (range, 67-92). DISCUSSION Open approaches were safe and useful in treating cruciate ligaments and should be considered in arthroscopy fluid extraversion and large traumatic arthrotomies.
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Affiliation(s)
- Michael Held
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Orthopaedic Research Unit, University of Cape Town, 7925 Cape Town, South Africa
| | - Martiz Laubscher
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Orthopaedic Research Unit, University of Cape Town, 7925 Cape Town, South Africa
| | - Richard von Bormann
- Knee Unit, Groote Schuur Hospital and Christiaan Barnard Memorial Hospital, University of Cape Town, 7700 Cape Town, South Africa
| | - Dustin L Richter
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, 87131-0001 NM, USA
| | - Daniel C Wascher
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, 87131-0001 NM, USA
| | - Robert C Schenck
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, 87131-0001 NM, USA
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Held M, Schenck RC, Khanduja V, Campos TVDO, Tapasvi S, Williams A, Yau WP, Harner C. Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study. J ISAKOS 2021; 6:193-198. [PMID: 34272294 DOI: 10.1136/jisakos-2020-000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD. METHODS A modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori. RESULTS Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management. CONCLUSION This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Michael Held
- Orthopaedic Surgery, University of Cape Town, Rondebosch, South Africa
| | - Robert C Schenck
- Orthopaedic Surgery, University of New Mexico - Albuquerque, Albuquerque, New Mexico, USA
| | - Vikas Khanduja
- Orthopaedic Department, Addenbrooke's Hospital, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Sachin Tapasvi
- Orthopaedics, The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | | | - Wai Pan Yau
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
| | - Christopher Harner
- University of Texas McGovern Medical School, Pittsburgh, Pennsylvania, USA
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