Arthroscopic Medial Compartment Drive-Through Sign for Knee Medial Collateral Ligament Complex Injuries

Acute injuries of the knee medial collateral ligament complex concomitant with anterior cruciate ligament injuries are common. The exact site of the injury may be difficult to diagnose preoperatively on magnetic resonance imaging. This study describes an arthroscopic sign that helps determine the site of the knee medial collateral ligament complex injury. The "medial compartment drive-through sign," visualized during arthroscopy, is described as an excessive opening of the medial compartment. If this excessive opening is above the meniscus, it corresponds to a femoral-sided injury; conversely, if the excessive opening is below the meniscus, then it is a tibial-sided injury. This allows a precise surgical incision to be made, thereby avoiding extensive approaches and possible wound-related complications.

Outside-In Drilling Allows Avoidance of Two-Stage Surgery in Revision Anterior Cruciate Ligament Reconstruction

The presence of preoperative tunnel widening and/or malposition can pose technical challenges for revision anterior cruciate ligament reconstruction. This Technical Note describes the use of outside-in drilling to avoid the need for 2-stage reconstruction in the presence of tunnel widening or semi-anatomic tunnels.

Multiligament knee injuries treated by one-stage reconstruction using allograft: Postoperative laxity assessment using stress radiography and clinical outcomes

BACKGROUND

Surgical treatment of multiligament knee injuries (MLKIs) leads to better outcomes but there are controversies about optimal surgical strategies. Debates remain about timing of surgery: acute, staged or delayed and about graft choice: autograft, allograft or a combination of both. Therefore, we performed a retrospective study aiming to evaluate postoperative laxity using stress radiographs and clinical outcomes after one-stage reconstructions of injured ligaments using non-irradiated, fresh-frozen allografts.

HYPOTHESIS

MLKIs treated by one-stage reconstructions using non-irradiated, fresh-frozen allograft may lead to satisfactorily postoperative laxity and clinical outcomes.

METHODS

Between November 2013 and July 2015, 23 patients with MLKIs underwent one-stage reconstruction using allograft. Knee injuries were defined according Schenk classification of Knee Dislocation (KD). Patients were evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form at a minimum follow-up of 24 months. Postoperative anterior, posterior, varus, and valgus laxities were assessed using stress radiographs and expressed as side-to-side differences (SSD) in millimeters.

RESULTS

Three of 23 patients were lost to follow-up. There were 6 KD-I, 12 KD-III, and 2 KD-IV lesions, 12 lateral-side and 10 medial-side lesions, and 13 acute and 7 chronic cases. Three patients had associated neurovascular injuries. Mean follow-up was at 29.4±6.1 months. Mean valgus SSD was 0.2mm±1.4mm (range, -2.1-2.2mm), mean varus SSD was 1.4mm±2.5mm (range, -1.7-6.0mm), mean posterior SSD was 7.2mm±3.9mm (range, 1.2-16.0mm), mean anterior SSD was 3.6mm±5.1mm (range, -4.8-16.8mm). Overall IKDC ratings were: 4 grade A, 3B, 7C, and 6D. Three patients complained of postoperative instability, with an IKDC rating of D. The mean subjective IKDC score was 67.2±19.6, the mean Lysholm Knee Scoring Scale was 77.3±16.5, and the mean KOOS results were 78.5±16.6 for pain, 67.7±17.4 for symptoms, 86.5±14.2 for daily activities, 56±25.4 for sports, and 47.2±28.6 for quality of life. Nineteen of 20 patients returned to sport-6 to the same level. One patient underwent an arthroscopic arthrolysis due to postoperative arthrofibrosis.

CONCLUSIONS

Using non-irradiated allografts for one-stage reconstructions of all the injured ligaments in MLKIs is effective and safe. Anteroposterior stability was difficult to restore, but patients returned to their daily activities and sometimes to their sports activity at the same preinjury level.

LEVEL OF EVIDENCE

Level IV, case series.

[Indications and results of meniscal transplantation]

Meniscectomy in a young active patient can lead to poor outcomes with pain, decreased function and long-term osteoarthritis. Meniscal allograft transplantation (MAT) has therefore been developed to address this issue. We now have 30 years of experience with this technique which is no longer considered experimental and new indications have been added. MAT allows restoration of joint biomechanics, pain relief, improvement in knee function and stability, and reduce cartilage degeneration. This is a comprehensive review of the role of menisci, the indications and principles of MAT, as well as these results.

[Do degenerative meniscal tears need surgery ?]

Degenerative meniscal tears (DMT) are common, often asymptomatic, and are associated with early-stage knee osteoarthritis in patients over 35 years of age. Conservative treatment, including exercise, physiotherapy and pain medication, should be offered as a first management approach for patients with symptomatic DMT. The indication for partial arthroscopic meniscectomy should be considered carefully, and based on specific criteria. Recently, several randomized controlled studies comparing partial medial meniscectomy to conservative treatment or to a sham procedure have questioned the effectiveness of surgical treatment of these lesions.The purpose of this article is to provide an update on the diagnosis and treatment of DMT.

Clinical and epidemiological differences between implant-associated and implant-free orthopaedic infections

PURPOSE

Although there have been many publications regarding the risk factors for implant-associated orthopaedic infections, none have investigated how clinical presentations and epidemiology may differ between infections with and without osteosynthetic material.

METHODS

We pooled clinical data from several databases of adult patients with orthopaedic infections hospitalized at Geneva University Hospitals from January 2004 to December 2014.

RESULTS

Among 2740 episodes of orthopaedic infections, 76% were implant-free osteoarticular or soft tissue infections. Among the 665 (24% of the total episodes) infections that involved osteosynthetic material, 319 (49%) were total joint arthroplasties, 143 single plates, and 50 single nails. The remainders were mixed implant infections, pins, wires, screws, cerclages or spondylodeses. The implant-associated, compared to the implant-free, infections were significantly more frequently associated with female sex, older age, bacteraemia and skin commensal infections, e.g. coagulase-negative staphylococci, corynebacteria or propionibacteria. In contrast, implant-associated infections were significantly less frequently associated with immune suppression, abscess formation, infections due to Staphylococcus aureus or streptococci, polymicrobial pathogens and foot infections. The serum CRP levels at admission were similar (median 82 vs. 75 mg/L).

CONCLUSIONS

Compared to implant-free infections, implant-associated orthopaedic infections are more likely monomicrobial, bacteraemic and due to skin commensals. They involve more often female and older patients, but are less often associated with immune suppression, abscess formation and foot infections.

Variables associated with remission in spinal surgical site infections

BACKGROUND

There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.

METHODS

Single-centre case-control study 2007-2014. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.

RESULTS

Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements. The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Especially, the following factors were not significantly related to remission: number of surgical interventions [hazard ratio (HR) 0.9; 95% confidence interval (CI), 0.8-1.1]; infection due to Staphylococcus aureus (HR 0.9; 0.8-1.1), local antibiotic therapy (HR 1.2; 0.6-2.4), and, duration of total (HR 1.0; 0.99-1.01) (or just parenteral) (HR 1.0; 0.99-1.01) antibiotic use.

CONCLUSIONS

In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

[Popliteal cysts: etiologic and therapeutic approach]

In children and adults, a popliteal cyst frequently coexists with an intra-articular disorder of the knee. Its mode of presentation consists of a palpable mass at the level of the popliteal fossa. The cyst is a recess of the synovial cavity of the knee, often associated to a chronic effusion. In children, the etiology may be primary with a development directly from the medial gastrocnemius-semimembranous bursa. In adults, it is usually secondary to degenerative or inflammatory disease of the knee. A communication between the intraarticular space and the cystic cavity can be often found. The aim of this study is to review epidemiology, pathogenesis, symptomatology, diagnosis and treatment options.