Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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The purpose of this study was to prospectively determine the outcome of meniscal repairs for tears that extended into the central one-third zone of the meniscus, or had a rim width of 4 mm or greater, in a case series of patients 40 years of age and older. ⋯ In athletically active patients, we recommend the preservation of meniscal tissue wherever possible regardless of age, basing indications for the procedure on current and future activity levels.
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The purpose of this study was to determine if an optimal knee flexion angle existed that would minimize the risk of neurovascular injury from the passage of transtibial hardware during posterior cruciate ligament (PCL) reconstruction. ⋯ The results of this study suggest that increasing knee flexion reduces, but does not completely eliminate, the risk of arterial injury during arthroscopic PCL reconstruction.
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Our goal was to analyze the results of 194 consecutive arthroscopic Bankart repairs (performed by 2 surgeons with an identical suture anchor technique) in order to identify specific factors related to recurrence of instability. ⋯ (1) Arthroscopic Bankart repairs give results equal to open Bankart repairs if there are no significant structural bone deficits (engaging Hill-Sachs or inverted-pear Bankart lesions). (2) Patients with significant bone deficits as defined in this study are not candidates for arthroscopic Bankart repair. (3) Contact athletes without structural bone deficits may be treated by arthroscopic Bankart repair. However, contact athletes with bone deficiency require open surgery aimed at their specific anatomic deficiencies. (4) For patients with significant glenoid bone loss, the surgeon should consider reconstruction by means of the Latarjet procedure, using a large coracoid bone graft.
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Case Reports
Massive intraosseous ganglion of the talus: reconstruction of the articular surface of the ankle joint.
We report on the outcome after autologous chondrocyte and spongiosal bone transplantation in a case of a massive intraosseous ganglion of the talus in a young patient. A 24-year-old man suffered from decreased ankle joint motion, recurrent swelling, and pain. Diagnostic evaluation by plain radiographs, computed tomography, and magnetic resonance imaging revealed cystic lesions in the head and the body of the talus with additional involvement of the cartilage surface. ⋯ The postoperative evaluation score of Finsen (modified Weber score) of 2/6 = 0.3 showed an improvement comparison with the preoperative value of of 21/6 = 3.5 (0 = normal, 4 = pathologic). We encountered no complications postoperatively. Clinical success was achieved by this method of treatment on a patient too young to be treated through arthrodesis.
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Although it is well known that the anterior cruciate ligament (ACL) is a primary restraint of the knee under anterior tibial load, the role of the ACL in resisting internal tibial torque and the pivot shift test is controversial. The objective of this study was to determine the effect of these 2 external loading conditions on the kinematics of the intact and ACL-deficient knee and the in situ force in the ACL. ⋯ Our data indicate that the ACL plays an important role in restraining coupled anterior tibial translation in response to the simulated pivot shift test as well as under an isolated internal tibial torque, especially when the knee is near extension. These findings are also consistent with the clinical observation of anterior tibial subluxation during the pivot shift test with the knee near extension.