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Meniscal injuries represent one of the main causes of intra-articular knee pain, especially in young patients, athletes or those with a high demand for physical activity; representing a challenge for the arthroscopist surgeon due to the great complexity that some of these injuries can present. Currently, the advances that have been implemented in arthroscopy allow us to repair meniscal injuries that in the past were considered irreparable. Although our priority is to preserve as much of the meniscus as possible, there are cases in which the injury reaches such complexity that this is impossible, with partial or total meniscectomy being the only therapeutic option. In the United States, approximately 690,000 partial meniscectomies are performed each year. This situation makes us consider meniscal transplantation as a great therapeutic option for patients considered young enough for joint replacement. The ideal patient is a relatively young patient (between skeletal maturity and 50 years), who has a well-documented history of partial or total meniscectomy, pain well localized to the affected compartment, with failure to conservative treatment and without high-grade chondral defects. in a generalized way. We present the case of a 35-year-old male patient with a history of total meniscectomy of the right lateral meniscus seven years ago, who currently presents with a postmeniscectomy syndrome of the lateral compartment. Due to the clinical and demographic characteristics of our patient, as well as the findings in the imaging studies, meniscal transplantation with allograft represents an excellent alternative to alleviate the symptoms and slow down as much as possible the need for joint replacement as a definitive treatment.

Discoid meniscus is a congenital morphological variant of the meniscus, which tends to occur more frequently in its lateral form than in the medial form. This anomaly is characterized by central hypertrophy of the meniscus and a larger diameter than the normal meniscus, resulting in an abnormal shape and greater coverage of the tibial plateau. The clinical presentation of this condition varies depending on the stability of the meniscus. In pediatric patients, in particular, it is common to experience progressive and atraumatic symptoms, such as pain and limited mobility. Diagnosis is based on imaging studies, with magnetic resonance imaging being the preferred tool, where the "bowtie sign" is a classic finding. Surgery is recommended for symptomatic patients, with a focus on preserving the peripheral portion of the meniscus. Saucerization is the most commonly used technique, followed by stability assessment to determine if additional procedures are required. In this case, a 9-year-old patient with a medial discoid meniscus presented symptoms following trauma. Despite this atypical presentation, a successful outcome was achieved through arthroscopic surgery, underscoring the importance of accurate diagnosis and proper management of this condition in pediatric patients. Understanding the anatomical and pathophysiological characteristics of the discoid meniscus is essential for an effective therapeutic approach.

Introduction: there is scarce information on meniscal repair in the paediatric population in terms of outcomes of this technique. The aim of this study was to evaluate the clinical outcomes and complications of meniscal repair in paediatric population with isolated lesions, associated with ACL rupture and discoid meniscus with unstable lesions., Material and Methods: data from 78 patients 18 years of age, with arthroscopic diagnosis of isolated meniscal lesion, associated with ACL tear or discoid meniscus, in whom arthroscopic repair was performed, were retrospectively analyzed for demographic characteristics, surgical technique, and perioperative complications. Functional results were assessed with the Lysholm and Pedi-IKDC scales. Time to repair failure was defined as the interval between meniscal repair and revision (re-repair or subtotal meniscectomy)., Results: mean age was 14 years (SD 3.1, range 3-19). The patients in group C were significantly younger (15.4 years in group A vs 14.9 in group B vs 12.1 in group C, p = 0.001). The average follow-up was 33.8 months. The mean Lysholm score and Pedi-IKDC were 96.1 points (range, 76-100) and 93.8 points (range, 59.8-100), respectively. The overall failure rate was 14.1% (11/78). There were 4 (13%) failures in group A, 3 failures (12%) in group B, and 5 failures (17%) in group C (p = 0.429). We found a tendency towards a greater number of failures in bucket handle injuries (p = 0.08) and a significant association when 4 sutures were used (p = 0.041)., Conclusion: in this series, meniscal repair demonstrated a clinical success rate of 85.9%. Patients with discoid meniscus, bucket handle injuries, and those who required a greater number of sutures had a higher risk of failure. Repair should be considered the first surgical treatment option for most meniscal injuries in children and adolescents.

Introduction: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery?, Material and Methods: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student., Results: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001)., Conclusion: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.

Medial discoid meniscus is a rare entity with a reported incidence of 0.12 to 0.3%, although the real incidence may be greater because not all the patients are symptomatic. Like lateral discoid menisci, medial discoid menisci are prone to degeneration that may prompt the presence of mechanical symptoms at early age. We present the case of a 14 year old male patient with bilateral knee symptoms of insidious onset without a traumatic event. Magnetic resonance revealed bilateral medial discoid menisci. Arthroscopic medial meniscus remodelling was performed in the right knee and, three months later, in the left knee, due to limitating mechanical symptoms. At the latest follow up -6 months for the right knee, 3 months for the left knee-, the patient resumed his sports activities., (Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The traditional treatment of unstable symptomatic discoid meniscus has been total or subtotal meniscectomy. However, long-term studies show that the results are poor. The aim of this study was to evaluate the clinical outcomes and survival of arthroscopic saucerization combined with peripheral repair for the treatment of symptomatic discoid meniscus in children., Methods: Patients≤18 years with discoid meniscus and a peripheral lesion treated between January 2012 and January 2018 were analyzed. Clinical results were evaluated using the Ikeuchi, Pedi-IKDC and Lysholm scales. The survival analysis was performed with the Kaplan-Meier method., Results: Eighteen patients (18 knees) were treated in the evaluated period. The average age at the time of surgery was 11.1±3.8 years. The average follow-up was 40.4±21.2 months. An average of 3.4±1 meniscal sutures (range, 2 to 6) was used. Repairs were carried out with a combination of inside-out and outside-inside techniques as dictated by the configuration of the injury. Sixteen patients could be evaluated functionally (2 lost of follow-up). Four patients presented mechanical symptoms. One was treated conservatively with physical therapy and 3 (18.8%) required further surgical treatment (subtotal meniscectomy). According to the Ikeuchi scale 12 (75%) had excellent results, one (6.2%) good and 3 (18.8%) poor (repair failure). The average Pedi-IKDC and Lysholm scores were 98.3±2 and 98.7±2.9 respectively at the last follow-up. The overall Kaplan-Meier survival probabilities after repair were 93.7% at one year, and 85.9% at 2 years., Conclusions: Mid-term outcomes of saucerization in conjunction with meniscal repair are encouraging for children with a symptomatic unstable discoid meniscus., (Copyright © 2019 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: Arthroscopic knee surgery is a minimally invasive technique with moderate pain during the first 24h. Our main objective was to evaluate the efficacy of ultrasound guided saphenous nerve block as a method of pain control intraoperatively and postoperatively for this surgery., Material and Methods: A prospective and observational study. All patients received general anesthesia with laryngeal mask in the saphenous group, nerve block was performed with 10 ml ropivacaine 0.475%. Location of the surgery (external compartment group/internal compartment group), morphine consumption, VAS for pain at 5, 30, 60 and 120 min and 24 h after surgery, need for rescue medication, onset of nausea and vomiting, length of stay in PACU, delayed discharge and satisfaction were evaluated., Results: The study included 73 patients. Of these, 46 received saphenous nerve block and 27 didn't receive it. Consumption of intraoperative, postoperative and total morphine was significantly lower in the saphenous group as well as VAS at 24h. In the subgroup of internal compartment surgery differences in VAS 24 h, morphine consume and lenght of stay in PACU were mantained., Conclusions: The ultrasound-guided block of saphenous nerve, particularly in the internal compartment arthroscopic knee surgery, decreases analgesic requirements, obtaining more effective pain control in the first 24 h postoperatively and without any known side effects., (Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The proximity of the posterior horn of the lateral meniscus to the popliteal artery determines a risk of vascular injury in its suture. The aim of this study is to determine the location of the popliteal artery, and to establish the minimal distance from the posterior wall of the lateral meniscus to the artery, the common peroneal nerve (CPN), and its correlation to other variables., Material and Methods: A total of 102 magnetic resonance studies were retrospectively reviewed from patients undergoing surgery at our institution. The axial section where the lateral meniscus could be clearly defined was selected, and the measurements were performed., Results: The artery lay laterally to the midline in 94% of the cases. The minimal mean distance from the posterior wall of the lateral meniscus to the popliteal artery was 1.01cm. (0.32-1.74, SD: 0.304). The minimal mean distance to the CPN was 1.74cm. (0.75-2.87, SD: 0.374). No association was found between the minimal mean distance from the posterior wall to the popliteal artery with the height, weight, BMI, the lateral meniscus diameter, or the tibial plateau diameter. An association was found between the distance from the posterior wall to the CPN with the weight and the BMI., Conclusions: The proximity of the posterior horn to the popliteal artery should be considered when performing sutures. This distance is within the recommended depth for all-inside meniscus repair devices. This distance is not related to height, weight, BMI, lateral meniscus nor tibial plateau diameters., (Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.)

Purpose: To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy., Methods: Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al., Results: Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p=.001), one year (83.3 points) (p<.001) and final follow-up (84.4 points) (p<.001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p=.001), one year (81.39 points) (p<.001) and final follow-up (83.34 points) (p<.001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p<.001), 1.9 points at one year (p<.001), and 1.9 points at final follow-up (p<.001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus., Conclusion: A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus. The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy., (Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.)

Unlabelled: The practice of sports has experienced a huge boom in societies worldwide. It often involves knee injuries, specifically meniscal tears that warrant surgical treatment which may include: fragment remodeling and resection, meniscal repair or, in extreme cases, the use of a meniscal graft. In this prospective study we performed fragment resection and meniscal remodeling in athletes and we measured their postoperative physical-athletic performance., Methods: Inclusion criteria: Patients of both sexes who practice a sport either as amateurs or at a recreational competitive level, who sustained a meniscal injury. Exclusion criteria: Patients with associated total anterior cruciate ligament tear, patients lost to follow-up, and patients eligible for meniscal repair. 23-patient cohort including 10 females and 13 males who presented at our hospital. A diagnostic protocol to certify the injury was applied. Patients underwent surgery to perform meniscal fragment resection and remodeling. They later underwent rehabilitation at the physiatrics service and finally received approval to return to sports. The Tegner Lysholm Knee Scoring Scale was used to assess postoperative results., Conclusion: All patients were able to return to practice their pre-injury sport, but their performance was 20 to 30% lower than before. Recovery took longer in females.

Knee arthroscopic surgery stands out as one of the most common surgical procedures in orthopedics and traumatology. The incidence of this type of procedures reaches 3.5 million procedures per year worldwide. Thromboprophylaxis is done basically with low molecular weight heparins; however, the dosing, indication and duration of therapy are currently debated. The objective is to prevent both deep venous thrombosis and pulmonary thromboembolism. The purpose is to describe a clinical case reporting the occurrence of DVP and pulmonary thromboembolism after arthroscopic knee surgery and characterize patients in detail.

A patient suffered a complete popliteal artery injury one month after a partial arthroscopic meniscectomy. The patient complained of progressive and severe distal pain. A complete lesion of the popliteal artery was found. Distal vascular flow was barely supported by two geniculate arteries. Vascular repair was performed using open vascular surgery. Although the popliteal neurovascular bundle is close to the posterior capsule of the knee and is obviously potentially vulnerable, injuries in arthroscopy of the knee are very rare. To avoid catastrophic consequences, the possibility of vascular injuries following arthroscopy of the knee, even several weeks after the surgery must not be ruled out., (Copyright © 2011 SECOT. Published by Elsevier Espana. All rights reserved.)

Background: Although the indications for lateral meniscal repair are well established, some aspects are still controversial. The classic recommendation is to avoid going through the popliteal tendon with sutures, even though this is at times difficult to achieve. The purpose of this paper was to assess the feasibility of a meniscal repair that included the popliteal tendon., Methods: To this end, nine human fresh frozen knees were used, in which a bucket handle lesion of the lateral meniscus was inflicted. The knees were divided into three groups: Group A (control): meniscal repair was performed with 5 vertical sutures, 2 posterior and 3 anterior to the popliteal fossa; Group B: one stitch was added between the lateral meniscus and the popliteal tendon, and Group C: the additional stitch included the meniscus, the popliteal tendon and the articular capsule. In all cases a lateral condyle osteotomy was performed to access the lateral compartment of the knee. Once the osteotomy had been fixed, the knees underwent 1000 gait cycles and a rotational test using an experimental gait simulator. Then a macroscopic assessment of the meniscal repair and the popliteal tendon was performed., Results: No differences were seen in the previous situation in any of the groups., Conclusions: In this experimental model the repair of the lateral meniscus including the popliteal tendon did not seem to have any repercussions on suture viability.

Two cases of pituitary apoplexy occurring after spinal anaesthesia are described. Both presented with headache and III par palsy, one of them with additional visual disturbance and hyponatremia. A bibliographical review has been done, looking for early diagnostic keys. We propose the arterial hypotension as a possible pathogenetic mechanism of pituitary adenoma apoplexy.

Introduction: The allogeneic meniscal transplantation (AMT) has received much attention lately for the treatment of young, active patients with painful knees previously subjected to meniscectomy., Objective: Show the current concepts on AMT as well as the methods for meniscal harvesting, processing and preservation that the Tissue Bank must implement., Conclusions: Based on the results of the short- and medium-term studies, the AMT has proven to relieve pain and improve function in patients with symptomatic knees and a history of meniscectomy. To respond to the requests from surgeons, the Tissue Bank should supply grafts that assure the appropriate processing and quality of the meniscus.

Objective: To analyze the subjective and objective outcome of arthroscopic meniscal repair in patients with chronic meniscal lesions., Methods: A group of patients that underwent arthroscopic meniscal repair of chronic tears with a minimum follow-up of six months was retrospectively evaluated. Physical examination oriented at finding persistent meniscal lesions was performed. IKDC, Lysholm and Tegner scores were applied, and a control magnetic resonance imaging (MRI) was performed., Results: Twenty seven menisci in 25 patients were repaired. There were 21 male and 4 female patients with a mean age of 29.6 +/- 8.2 years (20-45). Mean time from lesion to surgery was 25.24 +/- 26 months (6-120). 27. There was significant improvement in all parameters evaluated in 21 patients. Four patients were found to have signs and symptoms of persistent meniscal tears. Abnormal increased signal intensity in the repaired menisci was observed by MRI in all patients, not correlating with clinical findings., Conclusions: Short-term success rate of 85% was obtained with arthroscopic repair of chronic meniscal lesions in this study, which supports the fact that a long period of time before surgery does not necessarily lead to failure. It is valid to perform a meniscal repair in patients with chronic tears as long as the proper surgical technique and an adequate rehabilitation protocol are used.

Objective: Evaluate the results of Pridie chondroplasty as an efficient treatment to recover the complete activity in soccer players and compare this with others chondral repair techniques., Material and Methods: The patients were professional soccer players, all with a knee cartilage injury treated with the Pridie technique in an arthroscopic surgery between March 1999--December 2004. The age of the patients and the presence of a simple meniscal tear wasn't a fact to exclude a patient. Complex meniscal tear and a ACL rupture were an exclusion criteria. We deferred the support by 6 to 8 weeks. We initiated rehabilitation to the 4-5 post operating day. The follow up average was of 30 months., Results: We included 34 patients, age rank 19-31 years (average 24.6), 11 of them with meniscal injury Degree I associated with chondral damage. In 26 patients (76.47%) the outcomes were good allowing them to take up again their high level sport activity. The rest (23.53%) had regular or bad results with decrement in the game level, 4 of which (11%) they retired of the professional practice in relation to the found injuries., Conclusions: The follow up time give us a good validation to establish that the used technique is a treatment of low cost, surgically simple with favorable outcomes and low morbidity comparable to the results obtained with other useful techniques of condral repair in the professional soccer player.

The authors present proofs that a series of rehabilitation exercises put into practice during the hospital stay a patient has favor the rehabilitation and evolution of patients who follow these exercises; furthermore, the authors observed a clear improvement upon hospital release among those patients who performed these exercises compared to a control group which did not perform them. A patient can perform these exercises at home without the need of medical supervision, which reduces medical expenses.

Objective: To assess the clinical usefulness of intradural anesthesia through a 27 gauge Sprotte ("pencil point") needle for arthroscopic knee surgery in outpatients under 40 years of age., Patients and Method: A retrospective study of 116 patients under 40 scheduled for arthroscopic knee surgery, analyzing the incidence of post-dural puncture headache and backache after anesthesia provided with a 27 gauge (0.4 mm) Sprotte needle. Follow-up assessments were performed 24, 48 and 72 hours after surgery. We also studied technical difficulty and failure rate encountered in achieving blockade with this type of needle., Results: We recorded one case of headache (0.86%) that resolved within 48 hours with conservative treatment. Backache was reported by eight patients (6.8%) and was described as slight in all cases. The small caliber and design of the spinal needle caused no technical difficulties and anesthesia was successfully provided for all patients. Time of hospital stay ranged from 330 to 420 minutes (mean 360 +/- 45 minutes). No patient had to stay overnight., Conclusions: The results confirm that intradural anesthesia with 27 gauge Sprotte needles is an acceptable anesthetic technique for outpatient surgery in young patients given that the rate of complications is low.

Hypothesis and Objectives: Trunk blockades in arthroscopic knee surgery are rarely performed because combined blockade of the sciatic and lumbar plexus nerves are required, particularly if ischemia is required. We aimed to assess the efficacy of the "3-in-1 block" combined with intraarticular infiltration of local anesthetic for arthroscopic meniscectomy. The results were compared with our standard technique, subarachnoid anesthesia., Patients and Methods: Forty ASA I-II patients undergoing arthroscopic meniscectomy without ischemia. The patients were randomly assigned to receive "3-in-1 block" with 40 mL of 1.5% mepivacaine (T group, n = 20), or the standard technique of subarachnoid puncture with 3 mL of 2% lidocaine (S group, n = 20). Twenty minutes after puncture patients in both groups received intraarticular injections of 20 ml of bupivacaine 0.25% with 1:200,000 adrenaline in the knee. Surgery began 10 minutes later. We assessed requirements for sedation during surgery, degree of satisfaction during surgery according to the surgeon and the patient, hemodynamic variables at predetermined times, postoperative pain (on a verbal scale and related to consumption of analgesics in the first 48 hours after surgery), and the appearance of side effects attributable to anesthetic technique., Results: Demographic variables were comparable in the two groups and no surgical events were recorded. Eighteen patients in the T group and one in the S group required sedation during surgery (p < 0.05). Blood pressure was significantly lower in the S group than in the T group (p < 0.05). No patient in the T group required atropine and/or ephedrine during surgery, whereas 5 patients in the S group did (p < 0.05). Postoperative evolution was similar in the two groups. No postoperative complications attributable to the techniques were recorded., Conclusions: The "3-in-1 block" combined with joint infiltration of local anesthetics may be an effective alternative when subarachnoid anesthesia is contraindicated in patients undergoing arthroscopic meniscectomy.

As a result of a case report, a bibliographic review was made about false aneurysms on the popliteal arteries accidentally produced following a meniscectomy by arthroscopy. Such type of aneurysms can be defined by its false wall, its sack-shape and extensive haematoma and its clinical presentation as an acute ischemia of an extremity. It should be noted that, in all cases, an important delete in the diagnosis time was registered. It is also remarkable that an early treatment reduced the sequels of this pathology.