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to investigate the association between the lateral femoral condylar ratio (LFCR), the posterior tibial slope (PTS), and injury of the anterolateral ligament (ALL).Inclusion criteria were patients with acute anterior cruciate ligament (ACL) tear after noncontact injury during sports from October 1997 to May 2021. The LFCR and PTS were measured, and injury of the ALL was evaluated. Patients were divided into 2 groups: isolated ACL tear (isolated group) and combined ACL with ALL tear (combined group). The LFCR and PTS were compared between the isolated and combined groups. For each risk factor, the receiver operating characteristic curve, the area under the curve (AUC), and its 95% confidence interval (CI) were calculated to determine the cutoff for detecting increased risk of ALL injury.There were 83 patients in the isolated group and 176 patients in the combined group. Demographics of the 2 groups did not differ significantly. The LFCR was significantly larger in the combined group than in the isolated group (P = .000). The PTS did not differ between the two groups (P = .405). The LFCR (odds ratio [OR] = 1.58; P = .000) was a significant factor. Age, body mass index, and PTS were not associated with an ALL injury. The AUC (0.79; 95% CI, 0.74-0.85) for the LFCR had a sensitivity of 73% and specificity of 76% to predict an ALL rupture. The calculated cutoff of 64.5 was associated with an increased risk for ALL rupture (OR = 8.65; 95% CI, 4.73-15.81) when compared with the isolated group.An increased LFCR was associated with the ALL injury. However, increased PTS was not associated with ALL injury. These findings need to be considered for clinicians in treating ACL tear patients at risk for an ALL injury.III, retrospective comparative prognostic trial.

Purpose To investigate the relationship between the lateral femoral condyle ratio (LFCR) among osseous morphologic characteristics of the knee and anterior cruciate ligament (ACL) injury in female patients. Methods Inclusion criteria were female patients (ACL group, n = 59) undergoing primary ACL reconstruction from 2012 to 2018. Control female patients (control group, n = 58) were matched by age, height, and body mass index to ACL group. They had no meniscal or ligament tear, and no trochlear dysplasia on magnetic resonance imaging. The LFCR, notch width index (NWI), and posterior tibial slope (PTS) were measured and compared between the ACL and control groups. For each risk factor, the receiver operating characteristic curve and the area under the curve and its 95% confidence interval (CI) was calculated to determine the cutoff for detecting increased risk of ACL injury. Results The LFCR was significantly larger in the knees in the ACL group than in the control group (P = .001). The NWI was significantly smaller and the PTS was significantly larger in the knees in the ACL group than in the control group (P = .000, P = .000, respectively). The NWI (odds ratio [OR] 1.41; P = .000) was the most significant factor, followed by the PTS (OR 1.29; P = .003) and the LFCR (OR 1.26; P = .001). The area under the curve (0.67, 95% CI 0.58-0.77) for the LFCR had a sensitivity of 66% and specificity of 66% to predict an ACL injury. The cutoff of 63.9 was associated with an increased risk for ACL injury (OR 3.71; 95% CI 1.73-7.95). Conclusions An increased LFCR was associated with female ACL injury. The LFCR, NWI, and PTS are predictive risk factors for an ACL injury. These findings need to be considered for clinician in identifying female patients at risk for an ACL injury. Level of Evidence III, retrospective comparative prognostic trial.

Purpose To evaluate the effect of the location of the femoral tunnel on 3-dimensional (3D) computed tomography (CT) upon the postoperative tunnel widening after anterior cruciate ligament (ACL) reconstructions. Methods Inclusion criteria were patients who underwent hamstring ACL reconstructions using an adjustable-loop cortical suspension device, underwent 3D CT at the day after surgery, and were followed for a minimum of 2 years after surgery. Exclusion criteria were patients with combined ligament injury and reinjury after reconstruction. Using 3D CT, the center of the femoral tunnel aperture was located on a standardized grid system. The center of the ACL footprint was defined from the literature. The femoral tunnel location was classified as anatomic if it located within 2 standard deviations of the center position. If it was outside the 2 standard deviations, the tunnel was classified as nonanatomic. The patients were divided into either anatomic or nonanatomic groups. Femoral tunnel angles on both sagittal and coronal planes were measured. Both femoral and tibial tunnels measured on anteroposterior and lateral radiographs at immediate postoperative day and at 2 years after surgery. Postoperative knee stability and patient-reported outcomes were evaluated. Results There were 37 patients in anatomical group and 52 patients in nonanatomical group among enrolled 87 patients. There were no differences in demographics between the 2 groups. There were no differences in the femoral tunnel angles and postoperative tunnel widening between the 2 groups. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. Postoperative knee stability and patient-reported outcomes showed no statistically significant differences between the 2 groups. Conclusions There was no significant difference in postoperative tunnel widening or clinical outcomes between anatomic and nonanatomic femoral tunnel location after hamstring ACL reconstructions. A higher position correlated to the femoral tunnel widening at 2 years postoperatively. Level of Evidence Level III, Retrospective comparative study.

Background: There is a paucity of literature reporting clinical and magnetic resonance imaging (MRI) outcomes after allogeneic umbilical cord blood–derived mesenchymal stem cell (UCB-MSC) implantation for chondral defects of the knee. Purpose: To report clinical and MRI outcomes after UCB-MSC implantation for chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: Inclusion criteria were patients aged between 40 and 70 years with focal chondral lesions of grade 3 or 4 on the medial femoral condyle, defect sizes >4 cm2, and intact ligaments. Exclusion criteria were patients who required realignment osteotomy or who had a meniscal deficiency, ligamentous instability, or a concomitant full-thickness chondral defect in the lateral or patellofemoral compartment. A mixture of human UCB-MSCs and sodium hyaluronate was implanted into the chondral defect through mini-arthrotomy. MRI at 1-year follow-up was performed to evaluate repaired cartilage hypertrophy. Repaired cartilage thickness was measured, and hypertrophy was classified as grade 1 (Results: Enrolled were 85 patients with a mean age of 56.8 ± 6.1 years and a mean chondral defect size of 6.7 ± 2.0 cm2. At follow-up, a significant improvement in all PRO scores was seen compared with preoperatively ( P < .001 for all). MRI at 1-year follow-up demonstrated that 28 patients had grade 1 repaired cartilage hypertrophy, 41 patients had grade 2, and 16 patients had grade 3. MRI performed in 11 patients at 2 years after surgery indicated no difference in repaired cartilage hypertrophy between the 1- and 2-year time points. The grade of repaired cartilage hypertrophy did not correlate with PRO scores. Conclusion: Clinical outcomes improved significantly at short-term follow-up after UCB-MSC implantation. Although all patients showed repaired cartilage hypertrophy, it did not correlate with clinical outcomes.

The long-term results of high tibial osteotomy (HTO) depend mainly on postoperative alignment. However, under- or overcorrection can occur during and after surgery. Biomechanically, excessive overcorrection after HTO can potentially lead to unfavorable knee kinematics and increased shear stress at the joint surface. Fine tuning of the medial soft tissue during open wedge HTO is necessary for a satisfactory limb alignment.

Purpose To report magnetic resonance imaging (MRI) findings and clinical outcomes after anterior cruciate ligament reconstruction using an adjustable-loop device (ALD) with retensioning and knot tying. Methods The inclusion criteria were patients who underwent hamstring anterior cruciate ligament reconstruction using an ALD with retensioning and knot tying between May and December 2015 and were followed up for a minimum of 2 years. The exclusion criteria were patients with combined ligament injury, revision surgery, or reinjury after reconstruction. After initial tightening of the adjustable loop, retensioning and knot tying were performed and the graft was fixed at the tibia. Multiplanar reformatted images of 3-T MRI scans were obtained on the immediate postoperative day and at 6 months after surgery to measure the gap between the top of the graft and the top of the femoral tunnel (i.e., tunnel-graft gap). Differences in the tunnel-graft gap between the immediate postoperative day and 6 months after surgery (i.e., gap difference) were calculated and correlated with knee stability and functional outcomes. Results Thirty-six patients were enrolled in this study. The mean tunnel-graft gap was 2.1 ± 2.8 mm on the immediate postoperative day and 4.6 ± 3.5 mm at 6 months after surgery (P Conclusions Although the ALD was secured by retensioning and knot tying, MRI showed that the graft was not fully inserted in some patients and the tunnel-graft gap increased at 6 months’ follow-up. The increase in the tunnel-graft gap did not correlate with knee stability or the Tegner activity scale score but correlated negatively with the Lysholm score. Level of Evidence Level IV, therapeutic case series.

Background: Determining the rotational axis of the bony trough during lateral meniscal allograft transplant (MAT) is difficult. The use of anatomic landmarks may help a surgeon determine the rotational alignment of the graft during the procedure. Purpose: To investigate the association between the knee's anatomic landmarks and the position of the bony trough to prevent extrusion after lateral MAT. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled were 44 patients who underwent lateral MAT between July 2000 and February 2011. The patients’ mean age at the time of surgery was 30.8 years. Extrusion was measured on magnetic resonance imaging (MRI) scans at a mean of 3.6 months postoperatively, and patients were divided into an extrusion group (n = 15) and a no-extrusion group (n = 29). Three coronal MRI scans from each patient were selected, each from the region at the level of the tibial tuberosity (TT), the anterior bony trough, and the posterior bony trough. We measured the distance between the center of the anterior bony trough and the center of the TT (the TT distance) and the distance between the center of the posterior bony trough and the medial border of the lateral femoral condyle (LFC) (the LFC distance). Results: The mean center of the anterior bony trough was in a more medial position relative to the center of the TT in the no-extrusion group (–2.9 ± 4.8 mm) compared with the extrusion group (1.3 ± 4.9 mm; P = .010). The mean center of the posterior bony trough was in a more medial position relative to the medial border of the LFC in the no-extrusion group (–1.7 ± 3.9 mm) compared with the extrusion group (1.0 ± 3.2 mm; P = .027). Both TT distance and LFC distance were significantly correlated with extrusion ( P = .005 and .025, respectively). The cutoff value was –0.24 mm for the anterior bony trough and –0.58 mm for the posterior bony trough (negative values indicate that the trough was medial to the respective landmarks). Conclusion: To prevent extrusion of the allograft, the center of the anterior bony trough needs to be aligned with the center of the TT, and the center of the posterior bony trough needs to be aligned with the medial border of the LFC.

Background: Anatomic placement of the meniscal allograft is imperative to achieve satisfactory outcomes after meniscal allograft transplantation (MAT). Few studies have reported on the accuracy of the provisional location of the center of the anterior horn of the lateral meniscus (AHLM). Hypothesis: The authors hypothesized that the provisional center would not coincide with the anatomic center of the AHLM. Study Design: Descriptive laboratory study. Methods: Tibial plateaus were retrieved from 93 consecutive patients who underwent total knee arthroplasty. A complete radial cut was made 2 cm lateral to the insertion of the AHLM on the retrieved tibial plateau. While moving the stump of the anterior horn with forceps, the center of the insertion was determined, and a Kirschner wire (provisional wire) was drilled into the location. The insertion area of the AHLM was dissected carefully, and the periphery of the insertion area of the anterior horn was marked. Another Kirschner wire (anatomic wire) was drilled into the center of the dissected anterior horn. The resected tibial plateau was positioned so that the longitudinal line of the tibial plateau was aligned on a plastic ruler. The distance between the provisional and anatomic wires was measured by a digital caliper along the longitudinal and vertical axes. Results: The mean distance between the provisional and anatomic wires was 2.5 ± 1.2 mm. The provisional wire in 14 patients (15%) was placed at the anatomic center. In 36 patients (39%), the provisional wire was drilled anterolateral to the anatomic center, and in 18 patients (19%), the wire was drilled anteromedial to the anatomic center. In 21 patients (23%), the provisional wire was located within 2 mm of the anatomic center, and in 62 patients (67%), the wire was located within 3 mm of the anatomic center. Conclusion: The provisional wire was located a mean of 2.5 mm from the anatomic center, and only 23% of patients had wires that were located within 2 mm of the anatomic center. In 39% of patients, the provisional wire was drilled anterolateral to the anatomic center. This finding needs to be considered during lateral MAT. Clinical Relevance: Without dissection of the AHLM, the determination of the anatomic center of the anterior horn is not accurate during lateral MAT.

Purpose To evaluate the feasibility of anatomic tunnel placement by a transclavicular-transcoracoid drilling technique and with reference to the coracoclavicular ligaments' insertional anatomy and their orientations. Methods We used 12 fresh-frozen human cadaveric shoulders (6 matched pairs; mean age, 70 years; age range, 51-82 years) to simulate intraoperative tunnel placement with the transclavicular-transcoracoid drilling technique. After both the conoid and trapezoid ligaments were identified, two 2.5-mm guide pins were inserted from the clavicle to the coracoid, passing the centers of the clavicular and coracoid insertions of the conoid and the trapezoid ligaments, in a collinear fashion to the orientation of both ligaments. The entry point of the drill at the clavicle and the exit point at the coracoid undersurface, as well as the tunnel orientations, were measured. Complications due to the procedure, including a breach of the bone cortex of the clavicle and/or coracoid process, were recorded. Results The transclavicular-transcoracoid drilling technique for anatomic conoid ligament tunnel placement resulted in a medial cortical breach at the coracoid process in 6 of 12 shoulders. In the remaining 6 shoulders without a breach, the distance of the exit point from the medial cortex of the inferior coracoid process was only 3.6 ± 4.3 mm. For anatomic trapezoid ligament tunnel placement, no medial cortex breaching at the coracoid process occurred. However, the distance of the exit point was 3.1 ± 4.2 mm, indicating an eccentric location to the medial cortex of the coracoid process, similar to the conoid ligament. Conclusions This cadaveric study showed that anatomic tunnel placement by the transclavicular-transcoracoid drilling technique would not be feasible without breaching or almost breaching the medial cortex of the coracoid process. Clinical Relevance The transclavicular-transcoracoid drilling technique for CC ligament reconstruction may not reproduce the anatomy of the CC ligaments but may place the coracoid process at high risk of fracture during tunnel placement.

The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group.This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score.The mean follow-up period was 17.5 months (range, 11-38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (allClavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.

This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations.This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications.There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P .001), and 10.6 ± 3.3 mm (24% ± 39%) at the final assessment (P .001), showing an increase of the CC distance during the follow-up. Loss of reduction (defined as25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P .001]).In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes.

This study aimed to investigate the clinical outcomes after human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) implantation for medial compartment (MC) osteoarthritis of the knee. Inclusion criteria were patients older than 60 years, with a kissing lesion of the MC, a full-thickness chondral defect ≥ 4 cm2 of the medial femoral condyle (MFC), and a varus deformity ≥ 3° on a long cassette scanogram. The mean age was 64.9 ± 4.4 years and the mean chondral defect of the MFC was 7.2 ± 1.9 cm2. A mixture of sodium hyaluronate and hUCB-MSC was implanted into the chondral defect and a high tibial osteotomy was performed in all patients. International Knee Documentation Committee (IKDC), visual analog scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and 1 year and 2 years postoperatively. Cartilage regeneration was evaluated in 14 (56%) patients by second-look arthroscopy at 1 year postoperatively. Twenty-five patients underwent hUBC-MSC implantation. IKDC, VAS, and WOMAC scores at 1 year and 2 years improved significantly compared to preoperative scores. These scores at 1 year and 2 years were not significantly different between the body mass index (BMI)

Background: Few studies have compared clinical and radiological outcomes after hamstring anterior cruciate ligament (ACL) reconstruction with fixed-loop and adjustable-loop cortical suspension devices. Purpose/Hypothesis: The purpose of this retrospective study was to compare clinical outcomes and tunnel widening after hamstring ACL reconstructions with fixed- and adjustable-loop cortical suspension devices. The hypothesis was that compared with femoral graft fixation with the fixed-loop device, fixation with the adjustable-loop device would show similar clinical outcomes and would result in less tunnel widening after hamstring ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 117 consecutive patients underwent hamstring ACL reconstruction at a single institution. The fixed-loop cortical suspension device was used in 67 patients, and the adjustable-loop cortical suspension device was used in 50 patients. All patients were observed for a minimum of 2 years. Postoperative knee laxity was evaluated with the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed by use of the Lysholm score and the Tegner activity scale. On anteroposterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 1 year after surgery were compared with the diameter of the reamer used at surgery. The measured diameters of the tibial tunnel at 1 year after surgery were compared with those taken immediately after surgery. Results: The mean KT-1000 arthrometer laxity measurement was 1.5 ± 1.8 mm in the fixed-loop group and 1.2 ± 2.3 mm in the adjustable-loop group ( P = .530). Results of postoperative knee laxity evaluations and functional outcomes from both groups showed no statistically significant differences. However, the fixed-loop group showed significantly better stability in the pivot-shift test than did the adjustable-loop group ( P = .018). On AP radiographs, the mean diameter of the femoral and tibial tunnels increased by 42.2% ± 15.9% and 37.0% ± 17.8%, respectively, in the fixed-loop group and by 43.0% ± 15.4% and 36.8% ± 18.2% in the adjustable-loop group. On lateral radiographs, the mean diameter of the femoral and tibial tunnels increased by 38.1% ± 14.8% and 39.9% ± 13.8%, respectively, in the fixed-loop group and by 35.8% ± 12.2% and 38.1% ± 21.0% in the adjustable-loop group. No significant differences were found between the 2 groups in postoperative femoral and tibial tunnel widening on AP radiographs ( P = .801 and .951, respectively) or lateral radiographs ( P = .422 and .621, respectively). Conclusion: Compared with femoral fixation by use of the fixed-loop device, femoral fixation by use of the adjustable-loop device showed similar clinical outcomes but did not reduce tunnel widening after hamstring ACL reconstructions.

Purpose To determine a relationship between the direction of the guide pin for the keyhole in the lateral meniscus (LM) transplantation and the line connecting the centers of both horns of the LM. Methods Forty-four resected tibial plateaus during total knee arthroplasty were used for anatomical and radiological evaluations. The inclusion criterion was medial compartment osteoarthritis. Exclusion criteria were osteoarthritic changes, meniscal tear, and previous fracture in the lateral compartment. Resected tibial plateaus were positioned so that the anterior and posterior parts of the lateral tibial spine (LTS) were overlapped accurately on fluoroscopic anteroposterior view. A wire (Pin-F) was drilled along the peak of the LTS. The insertion area of anterior and posterior horns of the LM was dissected carefully. The periphery and the center of the insertion area of both horns were marked. Another wire (Pin-A) was drilled along a line connecting the centers of both horns. An axial radiograph was taken for each prepared tibial plateau. A longitudinal line was drawn along each wire, and the angle between the 2 wires was measured using the imaging software. If the Pin-F was externally rotated relative to the Pin-A, the angle was designated as positive, and if the Pin-F was internally rotated, the angle was designated as negative. Results The mean angle between Pin-F and Pin-A was −7.4° ± 9.6°. Thirty-three (75%) Pin-Fs were fixed in an internally rotated position, and 11 (25%) were fixed in an externally rotated position. Conclusions The direction of most guide pins drilled along the LTS was not coincident with the line connecting the centers of both horns of the LM. Clinical Relevance The axis of the LTS is not a reliable marker for the trough in the LM allograft transplantation.

Background: Accurate positioning of the bony bridge is crucial to prevent extrusion of meniscal allografts after transplant. However, oblique or lateralized placement of the bony bridge of the lateral meniscal allograft may occur due to technical error or a limited visual field. The patellar tendon may be an obstacle to approaching the anterior horn of the lateral meniscus, resulting in a laterally placed allograft. Therefore, lateral meniscal transplant through a medial arthrotomy would be an alternative approach. However, no report exists regarding allograft extrusion when comparing medial and lateral arthrotomy techniques in lateral meniscal transplants. Hypothesis: Extrusion of the midbody of the allograft is less severe and the rotation of the bony bridge is less oblique in lateral meniscal allograft transplants through the medial parapatellar approach than those through the lateral approach. Study Design: Cohort study; Level of evidence, 3. Methods: A bony bridge was used to perform 55 lateral meniscal transplants through either a medial or a lateral arthrotomy. Thirty-two allografts were transplanted through a medial arthrotomy and 23 were transplanted through a lateral arthrotomy, not randomly. Because correct positioning of the bony trough through the medial arthrotomy was easier than that through the lateral arthrotomy, the method of the arthrotomy was changed for the latter. The procedure for both groups was identical except for the arthrotomy technique, and rehabilitation was identical for both groups. Follow-up magnetic resonance imaging was conducted for all patients to measure the postoperative extrusion and obliquity of the bony bridge of the allograft. On the coronal view, extrusion was measured as the distance between the outer edge of the articular cartilage of the lateral tibial plateau and the outer edge of the meniscal allograft. On the axial view, a line (line B) was drawn along the longitudinal axis of the bony bridge. The posterior tibial condylar tangential line was drawn between the medial and lateral posterior tibial condylar cortices. A line (line T) was drawn perpendicular to the posterior tibial condylar tangential line. The angle (trough angle) between lines B and T was measured. Postoperative extrusion and the trough angle were compared between the medial and lateral arthrotomy groups. Results: The median extrusion of the midbody of the allograft was 2.2 mm (interquartile range [IQR], 2.4 mm; range, 0-4.6 mm) in the medial arthrotomy group and 3.1 mm (IQR, 1.5 mm; range, 0-5.3 mm) in the lateral arthrotomy group ( P = .001). Seven (21.9%) patients demonstrated extrusion in the medial arthrotomy group, and 15 (65.2%) patients had extrusion in the lateral group ( P = .002). The median trough angle was 0.9° (IQR, 9.3°; range, -8.8-15.8°) in the medial arthrotomy group and 11.6° (IQR, 2.8°; range, 3-19.8°) in the lateral arthrotomy group ( P < .001). Conclusion: Based on this experience, lateral meniscal allograft transplant through a medial arthrotomy is preferred to decrease postoperative extrusion of the allograft.

A ring-shaped meniscus is a very rare anatomical variant among all meniscal abnormalities. Additionally, an accessory meniscus is extremely rare, and only a few cases have been reported. We herein report a case involving the combination of these two features in a single lateral meniscus. These abnormalities were found during arthroscopic surgery for removal of an osteochondral fragment that had detached from the patellar bone and plication of the medial patellofemoral ligament in a patient with acute patellar dislocation. To our knowledge, each variant is extremely rare and the combination of the two variants has not been reported.

Background: Previous reports have shown that graft fixation with the Endobutton is associated with tunnel widening because it provides distant fixation rather than aperture fixation. Hypothesis: A longer loop of the Endobutton results in greater tunnel widening than a shorter loop. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 171 consecutive patients underwent hamstring anterior cruciate ligament (ACL) reconstruction fixed with the Endobutton. They were followed for a minimum of 2 years postoperatively. A 15-mm loop was used in 20 patients, a 20-mm loop in 53, a 25-mm loop in 58, and a >30-mm loop in 40. On anterior-posterior (AP) and lateral radiographs, the measured diameters of the femoral tunnel at 2 years after surgery were compared with the diameter of the reamer used at surgery. The measured diameter of the tibial tunnel at 2 years after surgery was compared with measurements taken on the immediate postoperative day. The center of the tibial tunnel and direction of the ACL graft were also measured. Postoperative knee stability was evaluated using the Lachman test, pivot-shift test, and KT-1000 arthrometer. Functional evaluations were performed using the Lysholm score and Tegner activity scale. All measurements were compared among the 4 groups according to the length of the Endobutton loop. Results: The mean ± standard deviation (SD) diameter of the femoral tunnel increased by 50.7% ± 23.3% and 37.0% ± 18.8% on AP and lateral radiographs at 2 years after surgery, respectively. The mean ± SD diameter of the tibial tunnel increased by 40.8% ± 19.3% and 46.4% ± 22.6% on AP and lateral radiographs, respectively. No significant difference in tunnel widening was present according to the length of the Endobutton loop. There were no significant differences in the average center of the tibial tunnel or the average angle of the direction of the ACL graft among the 4 groups. There was no significant difference in Lachman test results, postoperative KT-1000 arthrometer side-to-side differences, Lysholm score, and Tegner activity scale score among the 4 groups. The group with a >30-mm loop showed a significant difference in the pivot-shift test than the other 3 groups ( P = .023). Conclusion: A longer Endobutton loop did not result in greater tunnel widening than a shorter loop. Long fixation distance may not be associated with tunnel widening after hamstring ACL reconstructions.

Background: There are no published articles reporting clinical outcomes after all-inside meniscal repair using a suture anchor for a medial meniscal root tear. Purpose: To evaluate the subjective and objective outcomes after repair of medial meniscal root tears. Study Design: Case series; Level of evidence, 4. Methods: Thirteen patients with a root tear of the medial meniscus underwent all-inside repair using a suture anchor. Postoperative evaluation of meniscal status was performed using physical examination criteria, specifically joint line tenderness, McMurray test, and follow-up magnetic resonance imaging (MRI). Functional evaluations were performed using Tegner activity level and Lysholm knee score. Follow-up MRI scans were obtained 6 months postoperatively to evaluate healing of the root tear and measure extrusion of the midbody of the medial meniscus. Results: The average follow-up was 30.8 months (range, 24-40 months). No patients had joint line tenderness or effusion. No patients demonstrated a positive McMurray test result postoperatively. The preoperative mean Tegner activity level was 1.9 (range, 1-6), and the mean Lysholm score was 69.1 (range, 53-91). At last follow-up, the mean Tegner activity level was 3.9 (range, 2-6), and the mean Lysholm score was 90.3 (range, 75-100). Improvements in both the Tegner activity level and Lysholm score were statistically significant ( P = .001 and P = .000, respectively). Follow-up MRI was performed in 10 patients. Five (50%) patients showed complete healing; 2 of these 5 patients showed complete healing with isointense signal of a normal meniscus, and 3 showed intermediate signal tissue at the previous tear site without any high signal cleft or ghost sign. Four (40%) patients showed partial healing, and 1 (10%) showed no healing. Mean extrusion of the midbody of the medial meniscus was 3.9 mm (range, 2.2-7.1 mm) preoperatively and 3.5 mm (range, 1.2-6.1 mm) postoperatively. Extrusion was not significantly decreased. Conclusion: This study demonstrated symptomatic improvement after meniscal root repair using a suture anchor. However, follow-up MRI scans did not show complete healing of all repaired root tears.

Background Radial meniscal tears historically have been treated by partial meniscectomy, although they are more biomechanically detrimental than longitudinal tears. Clinical results after meniscal repair for radial tears of the midbody of the lateral meniscus have been reported rarely. Study Design Case series: Level of evidence, 4. Methods Fourteen consecutive patients who had radial tears of the midbody of the lateral meniscus underwent arthroscopic repair. Inclusion criteria were radial tears involving the red-red or red-white zone. All patients underwent all-inside meniscal repair using absorbable sutures. Postoperative evaluation was performed using joint-line tenderness, McMurray test, range of motion, and follow-up magnetic resonance imaging (MRI) scan at 6 months postoperatively. Lysholm knee score and Tegner activity level were evaluated at last follow-up. In 4 patients, second-look arthroscopies were performed. Results The average follow-up was 36.3 months. No patient had joint-line tenderness. Three patients complained of pain or a click on McMurray test. The mean follow-up range of motion was 138.6°. Follow-up MRI scans demonstrated that 5 (35.7%) menisci were healed, 8 (57.1%) were partially healed, and 1 (7.1%) was not healed. The follow-up Lysholm score was 94.7 (range, 81-100; standard deviation [SD] = 6.4) and Tegner score was 5.7 (range, 3-7; SD = 1.4). Second-look arthroscopies in 4 patients showed partial healing of meniscal tears. Conclusion Meniscal repair for radial tears of the midbody of the lateral meniscus may be an effective, alternative treatment to partial meniscectomy.

Background There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. Hypothesis No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Study Design Cohort study; Level of evidence, 2. Methods Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Results Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in pivot-shift test between groups ( P = .023). There were 2 complications associated with surgery. In the inside-out group, 1 patient required manipulation, and 2 patients had limited motion at final follow-up. Two patients in the inside-out group experienced transient saphenous nerve injury. Conclusion There was no significant difference in meniscal healing between inside-out and all-inside repair techniques in combination with anterior cruciate ligament reconstructions.

In this study we designed and evaluated a home-made thermo-denuder (TD) both experimentally and numerically. Sodium chloride (NaCl) particles, toluene gas, and carbon black particles were used for the performance evaluation of the TD. The TD was evaluated for various set-point air temperatures and particle sizes using the following three parameters: the temperature profile, penetration efficiency, and gas adsorption efficiency. At 0.6 l min - 1 , the temperature was nearly uniform, remaining within ± 15 ∘ C of the set-point temperature, in the heating section and decreased to the temperature of ambient air in the cooling section. The particle penetration efficiencies were 93–96% at 20 ∘ C and 58–67% at 300 ∘ C for particle sizes of 20–60 nm. The gas adsorption efficiency was nearly unity until the breakthrough time of 65 h, and the total amount of toluene adsorbed by activated carbon particles was 72 mg-toluene/g-activated carbon particles. From size distribution measurements of dry carbon black and toluene enriched carbon black particles, the mode diameter measured at the set-point temperature of 300 ∘ C was found to be 48.6 nm, which agreed with the one obtained from the dry particle measurements. The overall number concentration obtained after particle losses were compensated was lower than that measured without using the TD by 35.6%, which was caused by gas adsorption in the TD.

a h p a t a t w s c i c r m c F s one tunnel enlargement after anterior cruciate ligaent (ACL) reconstruction was first reported in the arly and mid 1990s. Various graft sources, reservation techniques, methods of fixation, and reabilitation protocols have been considered as possile factors leading to the enlargement phenomenon, ut the etiology still remains unknown. However, hamtring tendon autografts seem to cause more tunnel idening compared with patella tendon autografts. ince 1999, we have been performing coracoclaviclar (CC) ligament reconstruction with a semitendious autograft tendon, making a 4.5-mm-diameter unnel to the distal clavicle to pass the tendon for cromioclavicular (AC) joint separation patients. We resent a case in which distal clavicle tunnel widening as observed after CC ligament reconstruction with a emitendinous tendon autograft.

The attachment of the posterior cruciate ligament to the posterior intercondylar fossa of the tibia is in a location that is difficult to access for arthroscopic surgical procedures. This report presents a variety of arthroscopically assisted reduction and fixation methods for managing avulsion fractures of the posterior cruciate ligament from the tibia.Thirteen patients (fourteen knees) who had an avulsion fracture of the posterior cruciate ligament were treated with an arthroscopic procedure. Eleven patients underwent the operation in the acute phase (four to ten days after the injury), and two patients had delayed surgery (at nineteen and twenty months after the injury) because of nonunion. The choice of fixation method was based on the size of the avulsed fragment. Six knees that had a small bone fragment (10 mm) with comminution were fixed with use of multiple sutures. Two knees that had a small bone fragment without comminution were fixed with 23-gauge wires. Two knees that had a medium-sized fragment (10 to 20 mm) were fixed with Kirschner wires. Four knees that had a large single fragment of bone (20 mm) that involved the condyles were fixed with one or two cannulated screws.All patients had osseous union as determined on radiographs. Three injured knees in two patients showed limitation of motion after the operation. These patients had been immobilized for two or three months after the surgery because of concomitant fractures. The eleven patients who had undergone the operation in the acute phase, including two in whom postoperative arthrofibrosis had developed, showed no or trace posterior instability following the procedure. However, the two patients in whom the surgery had been delayed had residual grade-I posterior instability. The postoperative side-to-side differences, when measured with use of the KT-2000 arthrometer and posterior stress radiographs, showed better results in the patients in whom the surgery had been performed in the acute phase than in the patients in whom the operation had been delayed.Arthroscopic procedures can be used to treat tibial avulsion fractures of the posterior cruciate ligament.

To our knowledge, only 1 case of medial and lateral discoid meniscus in the same knee has been reported. We report on 2 cases of medial and lateral discoid meniscus in the same knee. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp E9–E9

Avulsion fractures of the tibial tuberosity are uncommon injuries. They usually occur during athletic activities in adolescents. The classification of these injuries has been divided into three types. Only two cases of avulsion fractures of tibial tuberosity have previously been reported with associated damages to menisci. We report a type III fracture of the tibial tuberosity associated with tear of the medial meniscus.

Twenty patients underwent operative arthroscopic procedures of the hip joint. All procedures were performed with the patient in the supine position on a standard fracture table using fluoroscopy through three arthroscopic portals (anterolateral, anterior paratrochanteric, and posterior paratrochanteric). The initial indications were therapeutic in 16 patients: loose bodies in four, synovial chondromatosis in three, rheumatoid arthritis in five, ankylosing spondylitis in one, septic arthritis in one, avascular necrosis of femoral head in one, and primary osteoarthritis in one. In four patients who had unexplained hip pain, the initial indications were diagnostic: minimal synovial change was seen in two patients, a synovial chondromatosis was present in another, and a tear of the acetabular labrum and hypertrophy of ligament teres were present in a fourth patient. In one patient who had primary osteoarthritis, the insertion of the arthroscopic instrument into the hip joint failed because of profuse osteophytes along the acetabular rim. Twelve of the 19 patients showed significant improvement of the symptoms after the arthroscopic procedure, but seven patients had no benefit from the procedure. One patient had a postoperative reflex sympathetic dystrophy.

Bony avulsion fractures of the posterior cruciate ligament of the tibia have commonly been treated by open reduction and internal fixation using the posterior approach. However, this approach, using the prone position, makes it difficult to investigate and treat other combined injuries of the knee joint. We report a case of posterior cruciate ligament avulsion of the tibia that was arthroscopically reduced and firmly fixed with two cannulated screws. The posterior sag was absent after the operation and the result was excellent. By arthroscopy, we got rigid fixation of the avulsed fragment for early rehabilitation, and detection of a concomitant injury was also possible.

Purpose To compare meniscal healing and functional outcomes after all-inside meniscal repair between sutures and meniscal fixation devices. Methods Sixty patients with a tear within the red-red or red-white zones of the posterior horn of the medial or lateral meniscus in conjunction with an anterior cruciate ligament (ACL) tear were included in this study. Meniscal repairs were performed with sutures in 35 patients and the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) in 25 patients concomitantly with hamstring ACL reconstruction. Postoperative evaluations included Lysholm knee score, Tegner activity scale, Lachman and pivot-shift tests, and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Follow-up magnetic resonance imaging (MRI) scans were obtained postoperatively for all patients to evaluate meniscal healing. Results The mean follow-up period was 47.2 months. In the suture group, 31 patients (86.1%) were asymptomatic and 4 (13.9%) were symptomatic. In the FasT-Fix group, 20 patients (80%) were asymptomatic and 5 (20%) were symptomatic. Postoperative functional evaluation and knee stability showed no statistically significant difference between the 2 groups. Follow-up MRI showed that 26 menisci (74.3%) were healed, 3 menisci (8.6%) were partially healed, and 6 menisci (17.1%) were not healed in the suture group. In the FasT-Fix group, 15 menisci (64%) were healed, 7 menisci (24%) were partially healed, and 3 menisci (12%) were not healed. Follow-up MRI showed no statistically significant difference between the 2 groups. In the FasT-Fix group, follow-up MRI showed a newly developed cyst posterior to the medial meniscus in 2 patients. A new tear anterior to the previous tear was found in 1 patient. In the suture group, follow-up MRI showed no cysts or new tears. Conclusions All-inside meniscal repairs using either sutures or the FasT-Fix device showed satisfactory results in patients with concomitant hamstring ACL reconstruction. There was no statistically significant difference in meniscal healing evaluated by MRI and functional outcomes between the 2 techniques. Level of Evidence Level III, retrospective comparative study.

Complications after meniscal repair have been associated with inside-out and outside-in techniques. After the introduction of devices for meniscal repair, reports of chondral damage have been increasing. However, meniscal cyst formation after use of suture materials for meniscal repair is a very rare complication. We report a case of meniscal cyst formation after use of nonabsorbable sutures for meniscal repair.

Background: Previous reports have shown that bio-Transfix implants (Arthrex, Naples, Florida) have the possibility of fracture during the early postoperative period. However, to date, there exists no study reporting the radiological and clinical significance of broken bio-Transfix implants. Hypothesis: A broken bio-Transfix results in adverse effects, both radiologically and clinically. Study Design: Cohort study; Level of evidence, 3. Methods: Hamstring anterior cruciate ligament (ACL) reconstructions using bio-Transfix in 50 patients with a minimum of 2 years’ postoperative follow-up were reviewed. On the anteroposterior (AP) and lateral radiographs, the diameter of the femoral tunnel was measured at the widest diameter and compared with the diameter of the reamer used at surgery. Magnetic resonance imaging (MRI) scans were obtained 6 months postoperatively for all patients to evaluate the condition of bio-Transfix implants. The patients were divided into intact and broken bio-Transfix groups. Postoperative stability evaluations were performed using the Lachman and pivot-shift tests and instrumented laxity testing using the KT-1000 arthrometer. Functional evaluations were performed using the Lysholm score and Tegner activity scale. Results: Follow-up MRI scans revealed that the bio-Transfix was broken in 11 and intact in 39 patients. Five implants were broken within the femoral tunnel and 6 were broken outside the femoral tunnel. Two bio-Transfix in the intact group were bent. On the AP and lateral radiographs at 24 months postoperatively, the average diameter of the femoral tunnel in the intact group increased by 13.1% and 17.1%, respectively. In the broken group at 24 months postoperatively, the average diameter of the femoral tunnel increased by 33.6% and 26.5%, respectively. There were significant differences between the 2 groups in the average diameters of the femoral tunnel on the AP radiographs at 24 months postoperatively ( P = .000). However, on the lateral radiographs, there were no significant differences between the 2 groups. Postoperative knee stability tests and functional evaluations showed no significant differences between the 2 groups. Conclusion: Broken bio-Transfix implants resulted in significant femoral tunnel widening in the coronal plane, although clinical results were not affected. Surgeons should be aware of this phenomenon when selecting a fixation device for hamstring grafts.

Background There is no study comparing tibial tunnel widening after hamstring anterior cruciate ligament (ACL) reconstructions between RigidFix(r) and Bio-TransFix(r). Methods Hamstring ACL reconstructions using RigidFix(r) in 56 patients and Bio-TransFix(r) in 41 with a minimum of 2years postoperative evaluation were reviewed. Tibial fixation was performed using Intrafix in both groups. On the anterior–posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal, middle, and distal positions. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and instrumented laxity testing using the KT-1000 arthrometer. Results On the AP and lateral radiographs, the average diameter of the tibial tunnel in the Bio-TransFix(r) group significantly increased after 6months compared to the immediate postoperative measurement ( p =0.002 and p =0.002, respectively). However, the average diameter of the tibial tunnel in the RigidFix(r) group did not increase after 6months compared to the immediate postoperative measurement. Tunnel widening at 12months postoperatively in the Bio-TransFix(r) group was significantly more than that of the RigidFix(r) group on AP and lateral radiographs ( p =0.012 and 0.016, respectively). Tunnel widening at 24months postoperatively showed a significant difference between the two groups ( p =0.000 and 0.000, respectively). Fifteen patients (36.6%) in the Bio-TransFix(r) group and 15 patients (26.8%) in the RigidFix(r) group showed tunnel widening. There were no significant differences in results of the Lachman and pivot-shift tests, and mean KT-1000 measurement between the two groups. Conclusion The Bio-TransFix(r) group showed progressive tibial tunnel widening after 6months postoperatively but no clinical signs of instability. Level of evidence Level III.

Background: There are several reported causes of midbody extrusion after lateral meniscal allograft transplantation. However, there are no reports studying the correlation between the position of the bony bridge and extrusion of the midbody after meniscal allograft transplantation. Hypothesis: The position of the bony bridge of lateral meniscal allografts can affect meniscal extrusion. Study Design: Case series; Level of evidence, 4. Methods: Twenty-three consecutive patients underwent a lateral meniscal allograft transplantation using a fresh-frozen graft. The lateral meniscal allograft was prepared with a bony bridge. Postoperative evaluations of the meniscal allografts were performed using follow-up magnetic resonance imaging 6 months postoperatively. On the coronal view, extrusion was measured as the distance between the outer edge of the articular cartilage of the lateral tibial plateau and the outer edge of the meniscal allograft. On the axial view, the length of the entire tibial plateau (PL) and distance between the lateral edge of the lateral tibial plateau and center of the bony bridge (CB) were measured. Measurements of CB were divided by measurements of PL. The correlation test between CB/PL and extrusion was performed to determine whether the position of the bony bridge can affect extrusion of the midbody of meniscal allograft. Results: The mean center of the bony bridge of the meniscal allograft (CB/PL) was positioned at 42.3% (range, 36.1%-49%; standard deviation [SD] = 3.6%) from the outer edge of the lateral tibial plateau. The mean extrusion of meniscal allografts was 3.2 mm (range, 0-6.5 mm; SD = 2.3). The amount of extrusion was correlated with the position of the bony bridge of the graft and the Pearson correlation coefficient was –.567 ( P = .003). The cut-off percentage above which extrusion did not occur was 42.05%. Conclusion: The more closely the center of the bony bridge approached 50% of the entire tibial plateau, the less extrusion of the midbody occurred. Anatomic placement of the bony bridge of lateral meniscal allograft is imperative to prevent extrusion after lateral meniscal allograft transplantation.

Extrusion of the meniscus has been reported as a complication after meniscus transplantation. Previous reports showed extrusion after meniscal allograft transplantation was associated with development of the osteoarthritis. In this study, a surgical technique is described to tentatively prevent extrusion of the meniscus.

The purpose of this study was to evaluate tibial tunnel widening prospectively after anterior cruciate ligament (ACL) reconstruction with hamstring tendon grafts using Rigidfix (DePuy Mitek, Raynham, MA) femoral fixation and Intrafix (DePuy Mitek) tibial fixation. Fifty-six consecutive patients who underwent ACL reconstruction with a minimum of 2 years' postoperative evaluation were reviewed. On the anterior-posterior (AP) and lateral radiographs, the diameter of the tibial tunnel was measured at proximal, middle, and distal positions, and the shape of the tibial tunnels were classified. Tunnel widening was defined as widening of greater than 2 mm. Group I was defined as cases with no tunnel widening, and group II was defined as cases with tunnel widening. Postoperative laxity evaluations were performed using Lachman test, pivot-shift test, and instrumented laxity testing using the KT-1000 arthrometer. On the AP radiographs, the average diameter of the tibial tunnel increased 8.8% at 6 months and 8.5% at 12 months postoperatively compared to the immediate postoperative day. On the lateral radiographs, the average diameter of the tibial tunnel increased 7.2% at 6 months and 8.1% at 12 months year postoperatively compared to the immediate postoperative day. The tunnel shape evaluation revealed predominantly linear type in 53 patients (95%). Group I was 42 patients (75%), and group II was 14 (25%). The average KT-1000 measurement was 1.0 +/- 1.8 mm in group I and 2.1 +/- 2.8 mm in group II (n.s.). The Lachman and pivot-shift tests showed no significant differences between the two groups. In conclusion, hamstring ACL reconstruction using Rigidfix and Intrafix fixation showed less widening of the tibial tunnels than observed in previously published studies.

This technical note describes a new arthroscopic technique to repair a tear of posterior root of the medial meniscus. Cartilage at the insertion area of the posterior horn of the medial meniscus (PHMM) was removed using a curved curette inserted through an anteromedial portal. A metal anchor loaded with two FiberWires (Arthrex, Naples, FL) was placed at the insertion area of the PHMM through a high posteromedial portal. A PDS suture was passed the PHMM by curved suture hook through the anteromedial portal. Two limbs of the PDS were then used to pass two limbs of the FiberWire through the meniscus. The same procedure was repeated for the second FiberWire suture. The sutures were tied, achieving secure fixation of the posterior meniscal root at the anatomic insertion.

Recently, studies have emphasized the importance of anatomical placement of the lateral meniscal allograft to decrease postoperative extrusion. However, it is infeasible to identify the exact rotation of the allograft during transplantation. We present a patient who underwent a lateral meniscal transplantation using a wire for correct positioning of the allograft. The use of a wire intraoperatively shaped to resemble the contour of the lateral meniscal allograft will aid in more accurate and anatomical graft placement.

While attempting femoral fixation during anterior cruciate ligament (ACL) reconstruction using Bio-TransFix (Arthrex, Naples, FL), we experienced failure of complete insertion of a hamstring graft into the femoral tunnel. A passing wire was twisted in the femoral tunnel during insertion of the ACL graft. The cause and methods of prevention of this complication are discussed.

There are many methods for fixation of the posterior cruciate ligament grafts. We introduce a new surgical technique that provides more secure femoral and tibial fixation of a tibialis posterior allograft. The tendon was prepared as a four-stranded graft. The tibial tunnel was made using a standard trans-tibial technique. A femoral tunnel was prepared through a low anterolateral portal. The graft was inserted into the femoral tunnel through the anterolateral portal and TransFix (Arthrex, Naples, FL) was fixed at the femur. Four stands of the graft were passed through the tibial tunnel and IntraFix (DePuy Mitek, Raynham, MA) was fixed at the tibia.

Radial displacement or extrusion of the meniscus has been reported as a complication after meniscal transplantation and is sometimes observed in knees with advanced osteoarthritis. In this report, the case of a patient with radial displacement of the lateral meniscus after partial meniscectomy is presented. He had an incomplete discoid lateral meniscus with an anterior horn tear. The inner portion of the lateral meniscus was excised to leave a width of 8 to 10 mm. However, follow-up magnetic resonance imaging showed radial displacement of the mid-body of the lateral meniscus and a compatible finding of chondromalacia of the lateral compartment of the knee.

This technical note describes all-inside meniscal repair for anterior horn tears of the lateral meniscus. A modified anteromedial portal is created for use in visualizing the anterior horn of the lateral meniscus. A crescent-shaped suture hook loaded with a polydioxanone suture (PDS) is inserted through an anterolateral portal. The hook tip penetrates the meniscal peripheral rim and advances across the tear. The suture hook penetrates the mobile central fragment. A leading limb of the PDS is advanced into the knee joint. Then, the leading limb of the suture is retrieved back to the anterolateral portal. With 2 limbs of PDS, endoscopic knot tying is done. With this simple technique, vertically oriented all-inside meniscal repair of an anterior horn tear of the lateral meniscus with the use of absorbable suture materials is easily performed.

Snyder et al. coined the term superior labral anterior and posterior (SLAP) lesion and classified SLAP lesion into 4 types. Morgan et al. developed a secondary classification of Snyder type II lesions based on the anatomic location. Maffet et al. found that some lesions could not be classified according to classification of Snyder et al.; types V to VII were added to the 4-part classification. In this study, we present the case of a patient with a superior labral tear that could not be classified to any of the reported classification. The superior labrum was detached with cartilage exposing the underlying bone of the glenoid.

We report the case of a tenosynovial giant-cell tumor causing limitation of extension of the knee. The tumor was treated successfully by arthroscopic removal.

Arthroscopic debridement and drainage was done in 10 patients with septic arthritis of the hip. Staphylococcus aureus was the most commonly identified organism. All patients were placed in the supine position on a fracture table and three arthroscopic portals were used during the procedure. No major complication related to the arthroscopy of the hip resulted. The average followup was 4 years 11 months. All patients had excellent results.