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Purpose To evaluate the radiographic and clinical follow-up results of iatrogenic medial collateral ligament (MCL) injuries caused by valgus stress during arthroscopic surgery of the knee. Methods This study retrospectively evaluated 15 knees in 15 patients (8 female and 7 male patients), with a mean age of 58 years (range, 45-66 years), with iatrogenic MCL injuries caused by valgus stress during arthroscopic surgery of the knee. All patients were treated conservatively without an immobilizer or brace. The mean follow-up period was 24 months (range, 18-51 months). Evaluations included magnetic resonance imaging immediately postoperatively, as well as physical examinations and valgus stress radiographs (at 0° and 30° of knee flexion) 6 weeks after surgery and at final follow-up. Results Postoperative magnetic resonance imaging in all patients showed increased signal intensity, swelling, and partial loss of continuity at the meniscofemoral portion of the MCL. Physical examination showed mild tenderness in only 1 patient after 6 weeks and none at final follow-up. Valgus stress tests and valgus stress radiographs showed no significant differences between the injured and uninjured knees at 6 weeks postoperatively and at final follow-up (P > .05). Conclusions Iatrogenic MCL injuries during arthroscopic knee surgery could be treated successfully without a splint or brace. Level of Evidence Level IV, prognostic case series.

Background We evaluated the effectiveness of postoperative pain management using intraoperative periarticular injection (PAI) and/or electromyography-guided preoperative femoral nerve block (FNB) in knees undergoing total knee arthroplasty (TKA). Methods This study included 90 patients (90 knees) who underwent primary TKA. Thirty patients received a single injection of electromyography-guided FNB, 30 received intraoperative PAI, and 30 received both. Pain at rest and while moving was evaluated by a visual analog scale (VAS) at 0, 4, 8, 24, and 48 hours. Postoperative range of motion, time to walking, amount of opioid consumption, and complications were analyzed. Results VAS immediately after surgery was significantly higher in the FNB group than in the PAI and combined groups, but did not differ significantly in the latter 2 groups. VAS after 4 and 8 hours showed similar results. VAS after 24 hours was significantly higher in the PAI than in the FNB and combined groups. After 48 hours, there were no differences among the 3 groups. Total opioid consumption was lower in the combined than in the FNB and PAI groups. Postoperative range of motion and time to walking were similar in the 3 groups. Conclusion PAI was more effective than FNB during the early (0-8 hours) postoperative period after TKA. Patients treated with PAI, however, experienced rebound pain at 24 hours. The combination of PAI and FNB may provide greater postoperative pain management than either alone for the first 24 hours after TKA.

Introduction We analyzed the location of femoral and tibial tunnels by three-dimensional (3D) CT reconstruction images after modified transtibial single bundle (SB) anterior cruciate ligament (ACL) reconstruction, creating a femoral tunnel with varus and internal rotation of the tibia. Material and methods Data from 50 patients (50 knees) analyzed by 3D CT after modified transtibial SB ACL reconstructions were evaluated. 3D CT images were analyzed according to the quadrant method by Bernard at the femur and the technique of Forsythe at the tibia. Results The mean distance of the femoral tunnel center locations parallel to the Blumensaat's line was 29.6% ± 1.9% along line t measured from the posterior condylar surface. The mean distances perpendicular to the Blumensaat's line were 37.9% ± 2.5% along line h measured from the Blumensaat's line. At the tibia, the mean anterior-to-posterior distance for the tunnel center location was 37.8% ± 1.2% and the mean medial-to-lateral distance was 50.4% ± 0.9%. Discussion The femoral and tibial tunnels after modified transtibial SB ACL reconstruction creating a femoral tunnel with varus and internal rotation of the tibia (figure-of-4 position) were located between the anatomical anteromedial and posterolateral footprints.

The purpose of this study is to evaluate results after total knee arthroplasty using a medial pivot prosthesis with the posterior cruciate ligament (PCL)-retaining and PCL-sacrificing techniques. The PCL was retained in 67 knees and sacrificed in 70 knees. The mean Knee Society knee score increased from 59.6 before surgery to 91.5 at the last follow-up, and the mean function score increased from 53.6 to 85.4. The mean preoperative femorotibial angle was varus 4.1°, which corrected to valgus 5.8° after surgery. The increased knee and function score did not vary significantly between the cruciate-retaining and cruciate-sacrificing groups (P > .108), nor did the mean preoperative and postoperative femorotibial angle (P > .140). The clinical results of total knee arthroplasty with a medial pivot prosthesis were satisfactory, whether the PCL was retained or sacrificed.