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The OATS technique is one of several cartilage repair procedures that exhibits promising short- to intermediate-term results in the surgical management of OLTs. Although the OATS procedure is generally reserved for salvage of failed debridement and drilling, some investigators are suggesting that it may have applications in primary surgical management of OLTs, particularly those that are associated with subchondral cysts. Long-term outcome of the OATS procedure for OLTs is not yet available.

Purpose: The use of blunt-threaded titanium interference screws for arthroscopic-assisted fixation of a quadruple-strand hamstring anterior cruciate ligament (ACL) reconstruction has recently been reported. However, the pitfalls of the low medial portal technique, rehabilitation protocol, and long-term results have not. The purpose of this multicenter study was to prospectively evaluate this technique's application to ACL instability in symptomatic patients as well as to develop a standardized rehabilitation protocol. Type of Study: Observation cohort study. Methods: One hundred-twenty patients had quadruple hamstring ACL reconstructions, followed the study protocol, and were seen at 2 years follow-up. They were evaluated using Lysholm score, Lachman test, anterior drawer test, pivot-shift test, KT-1000, effusion assessment, and the Tegner Sports Activity Scale. Results: The average Lysholm score improved 42 points; Lachman test, effusion assessment, anterior drawer test, KT-1000, and Tegner Sports Activity Scale scores all improved. Of 120 ACL reconstructions, 5 failed. Of these, 3 failed from new late injury, 1 from technical error, and 1 from patient nonadherence to rehabilitation protocol. Some anterior knee pain was present in 30% of patients, and 22% had at some time experienced hamstring pain that did not interfere with athletic activity. Conclusions: This multicenter study reports success with quadruple hamstring ACL reconstruction using the low medial portal technique. Specific pitfalls and a rehabilitation protocol are also discussed. Low medial portal position is critical in successful surgery. Variations in screw size to accommodate the variation in graft construct size are also recommended. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 7 (September), 2002: pp 715–724

The orthopaedic department at Providence Medical Center, Seattle, Washington, instituted a streamlined care pathway and product standardization for total knee arthroplasty (TKA) in July 1995. The goal was to reduce operating room time and to streamline the care pathway for a safe, expedited hospitalization of patients. The hospital staffs standardized nursing orders, cut the instrument systems from 13 to 4 sets, and coordinated the expedited care pathway. Fifty-two consecutive primary TKAs were compared prepathway to 77 consecutive primary TKAs postpathway. The average length of stay declined 1.9 days from 5.1 to 3.2. The tourniquet time declined from 61 minutes to 56 minutes. The average dollar charges were $1,063 less. There were no infections in either group. The manipulation rate for adhesions declined 37%.

A new technique is presented for an endoscopic, quadruple, hamstring, anterior cruciate ligament reconstruction technique. The technique involves the use of a quadrupled hamstring construct, blunt-threaded titanium screws, and a low medial portal. This simple technique, on the average, is performed in less than an hour. To date, more than 100 outpatient cases have been performed with good results. The results are measured by the self-assessment International Knee Documentation Committee (IKDC) and K-T 1000 (Medmetric Corp, San Diego, CA) measurements.