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The menisci have a poor intrinsic healing capability. Biological augmentation is used to promote meniscal healing in conjunction with suture techniques as the result of their poor healing rate. A fibrin clot (FC) is a well-known treatment option for meniscal injuries that are difficult to heal. Several methods for delivering FCs to target sites have been reported; however, all available methods have drawbacks such as unstable delivery, low maneuverability, and/or clot sizes that are too large. We use a dedicated device to efficiently deliver FCs of a suitable size for the tear. In this method, an FC formed to a size of 5 mm is stored and delivered in a thin syringe with a built-in plunger. This method enables an accurate delivery of a suitably sized FC to the desired location and fixes FCs to the tear site when used in combination with conventional suture methods. In this report, we will succinctly describe how to make and deliver an FC using the aforementioned device with a step-by-step instructional technique and an illustrative video.

A large posterior tibial slope (PTS) has been widely recognized as a potential risk factor in loosening and retear after anterior cruciate ligament reconstruction. Anterior closed-wedge osteotomy is an effective surgical approach to mitigate this risk factor but presents several disadvantages. We describe in this Technical Note an original PTS correction technique called the posterior open-wedge osteotomy. The posterior surface of the proximal tibia is exposed, and 2 K-wires are inserted anteroposteriorly as osteotomy guides, and one wire is inserted mediolaterally as a hinge blocker. The osteotomy is performed from the posterior side and advanced to the anterior side using a single-bladed reciprocating saw. The slope is corrected by opening the osteotomy plane posteriorly with a spreader. The correction is maintained by inserting the harvested fibula fragments into the open space, and the fixation is completed with a locking plate to ensure firm fixation and allow early rehabilitation. This procedure can be an effective solution for patients with various risk factors for retear of the anterior cruciate ligament graft, including abnormal PTS.

Recent studies on the detailed anatomy of the medial patellar stabilizer have revealed that the medial patellofemoral ligament (MPFL) not only attaches to the patella but also has fibers that attach to the quadriceps muscle, known as the medial quadriceps tendon femoral ligament (MQTFL). Reconstruction of the medial stabilizer for patellar dislocation that includes both the MPFL and MQTFL may achieve better anatomical and physiological correction. In this Technical Note, we will describe a simultaneous reconstruction technique of the MPFL and MQTFL for patellar dislocation using an artificial ligament.