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Posterior cruciate ligament (PCL) ruptures account for nearly 20% of all ligamentous knee injuries. These may be either isolated or in the setting of a more complex knee trauma. Isolated tears with moderate posterior laxity (grades I or II) are commonly treated conservatively; nevertheless, symptomatic grade III injuries frequently require surgical intervention. PCL reconstruction remains a challenging surgery for multiple reasons like the neurovascular structures' proximity, the difficult passage of the graft with the "killer turn" angle, or the risk of poor graft fixation. We describe an all-inside operative technique using hamstrings tendon autografts with tibial and femoral adjustable buttons cortical fixation and the visualization of the posterior transseptal portal.

Despite the numerous techniques described regarding isolated anterior cruciate ligament (ACL) reconstruction, many authors have reported that residual knee rotational instability is not always eliminated. The combination of lateral extra-articular knee tenodesis and ACL reconstruction is an alternative surgical approach with very promising clinical results. The purpose of this article is to describe a reliable and reproducible technique of combined ACL reconstruction and lateral extra-articular knee tenodesis using a continuous looped hamstring tendon autograft. A 4-strand graft inside the joint and a 2-strand graft for the tenodesis are attached to 2 adjustable-loop button suspensory fixation devices.

International audience; Introduction: With increasing life expectancy and ever-improving quality of life in industrialized countries , functional demand and sports levels are increasing in older subjects, who are thus exposed to central pivot lesions almost as much as younger ones. While non-operative treatment provides acceptable results, it entails significant reduction in sports level. The aim of the present study was to analyze medium-term clinical, functional and radiological results of anterior cruciate ligament (ACL) reconstruction in over-50-year-olds, in order to identify factors for failure. Hypothesis: The study hypothesis was that surgical management provides good results if patient selection is rigorous. Patients and methods: A multicenter retrospective study included 398 patients undergoing ACL reconstruction between April 1, 2009 and December 6, 2016. Inclusion criteria comprised: age ≥ 50 years, with proven ACL tear. Preoperatively, clinical work-up was supplemented by measurement of differential anterior laxity and radiologic assessment of cartilage status. Functional level was assessed on the objective IKDC score. Intraoperative data comprised type of graft and meniscal and cartilage status. The same parameters were assessed postoperatively. Functional results were assessed on objective IKDS, KOOS and ACL-RSI scores. Results: The mean follow-up was 42.2 months. The mean improvement in differential anterior laxity was 4.2 mm. Pivot-shift showed improvement, with 97% absent or glide (p < 0.001). Objective IKDC score showed significant improvement (p < 0.0001). 23% of patients had poor clinical results: IKDC C or D. Preoperative explosive pivot-shift (p < 0.0001), medial tibiofemoral osteoarthritis (p < 0.0001) and medial meniscus lesion (p < 0.002) emerged as risk factors for poor functional outcome. Conclusion: ACL reconstruction in over-50-year-olds provided satisfactory clinical and functional results. Rigorous patient selection is mandatory, as radiologic signs of medial tibiofemoral osteoarthritis indicate a risk of poor outcome. Surgery may be proposed in patients with high functional and athletic demand, before medial meniscal lesions can set in. In case of explosive pivot shift, associated anterolateral reconstruction should be considered.

Background: Blood loss during total knee arthroplasty (TKA) remains a concern, as many patients require blood transfusions, which increase risks of allergic reactions, disease transmission, and thromboembolisms. The purpose was to determine factors associated with blood loss and need for transfusion in patients receiving routine TKA. Methods: The authors prospectively analyzed 150 consecutive uncemented TKAs for age, gender, body mass index (BMI), anticoagulant medication, type of anesthesia, tranexamic acid (TXA) administration, tourniquet inflation, drain placement, pre- and post-operative Haemoglobin (Hb) level (g/dL), and whether transfusion was necessary. Univariable and multivariable regression analyses were performed to identify factors associated with Hb loss and need for transfusion with significance level set at P value Results: The cohort comprised 92 women and 58 men, aged 69.5±8.9 years. The mean Hb loss was 3.7±1.3 g/dL. The 20 patients (13%) who had transfusions also had lower preoperative Hb (12.6±1.2 g/dL) compared to the remaining patients (14.3±1.2 g/dL). Hb loss was significantly associated with preoperative Hb, TXA, and gender, but multivariable regression identified gender as a confounder and indicated that TXA reduced Hb loss by 0.92 g/dL. Multivariable regression revealed the need for transfusion was only significantly associated with preoperative Hb and indicated that a decrease of preoperative Hb by 1 g/dL nearly quadrupled the chances of needing transfusion. Conclusions: Hb loss was significantly associated with preoperative Hb levels and use of TXA, while the need for transfusion was only associated with preoperative Hb levels. These findings could help identify patients at risk for blood transfusions. Level of evidence: level III, prospective case series.

Hypertension was induced in rats by constricting the aorta between the origins of the renal arteries. The left kidney, which became ischemic and atrophic ("endocrine kidney"), caused a malignant type of hypertension associated with weight loss, cardiac hypertrophy, hypertension, cardiac necrosis, nephrosclerosis of the right kidney, and arteritis. Amounts of pressor substances were increased in the left kidney and decreased in the right as compared with those in kidneys of normal rats. Aqueous extracts of ischemic kidneys, of kidneys contralateral to ischemic kidneys and of normal kidneys were prepared and the supernatant solutions were injected subcutaneously into test rats which had been uninephrectomized a few hours previously. Extracts of ischemic kidneys caused hypertension, cardiac hypertrophy, weight loss, and renal and vascular lesions mimicking the signs which result from renal ischemia. The extracts from the other kidneys were inactive. Administration of renin in doses roughly equivalent in pressor activity to the extracts of ischemic kidneys caused a rise in pressure, diuresis, and proteinuria but no lesions when given subcutaneously. It is proposed as a working hypothesis that renal hypertensive disease results not only from increased secretion of renin and formation of angiotensin but from simultaneous release from kidneys with reduced perfusion pressure of a substance which augments the enzymatic formation of angiotensin. This substance is presumably absent from normal kidneys and from semipurified renin preparations.