Marc Tey

Meniscal Allograft Transplantation Without Bone Blocks: A 5- to 8-Year Follow-Up of 33 Patients

PURPOSE The purpose of this study was to evaluate the functional and radiographic results on a midterm basis, as well as complications, in an initial series of meniscal allograft transplantations performed with suture fixation without any bone block. METHODS A series of 33 meniscal allograft transplantations were performed at our institution from January 2001 to October 2003. Inclusion criteria were patients with compartmental joint line pain due to a previous meniscectomy. There were 24 men and 9 women with a mean age of 38.8 years (range, 21 to 54 years). The functional outcomes were evaluated by use of Lysholm and Tegner scores at a mean and minimum follow-up of 6.5 years and 5 years, respectively. A visual analog scale for pain was also used. Radiographic assessment included joint space narrowing on the Rosenberg view and magnetic resonance imaging evaluation. RESULTS The Lysholm and Tegner scores significantly improved from 65.4 to 88.6 (P < .001) and from 3.1 to 5.5 (P < .001), respectively, after surgery. The visual analog scale score significantly dropped from 6.4 to 1.5 (P < .001). The radiographic evaluation did not show any joint space narrowing (P = .38). Meniscal extrusion was a constant finding, averaging 36.3% of total meniscal size. According to the Van Arkel criteria, the survival rate was 87.8% at 6.5 years. The rate of complications was 33%. CONCLUSIONS This study suggests that this procedure provides significant pain relief and functional improvement in selected symptomatic individuals on a midterm basis. However, there was a high rate of complications (33%) and revision surgery. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction From the Anteromedial Portal: Evaluation of Transverse Femoral Fixation in a Cadaveric Model

PURPOSE The purpose of this study was to assess the risk of injury to the posterolateral structures of the knee when performing anterior cruciate ligament reconstruction from the anteromedial portal while fixing the graft with a femoral cross-pin system. METHODS The anterior cruciate ligament was reconstructed arthroscopically with hamstring graft in 10 fresh cadaveric knees. Femoral fixation was performed with a cross-pin system. This was originally developed for a transtibial drilling technique. A femoral tunnel measuring 30 mm in length was drilled through the anteromedial portal in each knee. The knee flexion angle was set at 110 degrees . Lateral dissection was then performed to measure the distances from the cross-pin system to the lateral collateral ligament, the popliteus tendon, the lateral gastrocnemius tendon, and the peroneal nerve. RESULTS The lateral collateral ligament was partially torn by the pin in 1 case. In 8 cases the distance to the lateral collateral ligament was shorter than 3 mm (range, 0 to 2.43 mm). In 7 specimens, the cross-pin system was within 4.5 mm of the popliteus tendon. The lateral gastrocnemius tendon was pierced by the cross-pin device in 2 cases. The minimal distance to the peroneal nerve was 23.89 mm. CONCLUSIONS Fixation of a hamstring graft with a cross-pin system initially developed for an upper femoral tunnel, following the aforementioned technique, presents the possibility of a high risk of injury to the lateral collateral ligament. The popliteus tendon and the lateral gastrocnemius tendon may also be injured. CLINICAL RELEVANCE The risk of injury to the lateral stabilizers of the knee suggests discarding the technique used in this study.

Hip Labral Cyst Caused by Psoas Impingement

Hip labral impingement can cause labral tears and secondary paralabral cyst formation. Femoroacetabular impingement is the main cause of labral impingement, but other conditions such as iliopsoas tendon impingement are described. There is no description of labral cyst resulting from psoas impingement treated arthroscopically in the literature. We present the case of a young sportsman with groin pain caused by psoas impingement with a labral tear and secondary paralabral cyst who was treated arthroscopically by cyst debridement, psoas tenotomy, and labral repair.

Arthroscopic Treatment of Hip Chondral Defects With Bone Marrow Stimulation and BST-CarGel

Microfracture, the current standard of care for the treatment of non-degenerative chondral lesions in the hip joint, is limited by the poor quality of the filling fibrocartilaginous tissue. BST-CarGel (Piramal Life Sciences, Laval, Quebec, Canada) is a chitosan-based biopolymer that, when mixed with fresh, autologous whole blood and placed over the previously microfractured area, stabilizes the blood clot and enhances marrow-triggered wound-healing repair processes. BST-CarGel has been previously applied in the knee, with statistically significant greater lesion filling and superior repair tissue quality compared with microfracture treatment alone. In this report we describe the application of BST-CarGel for the arthroscopic treatment of hip chondral lesions. Our preliminary data suggest that our BST-CarGel procedure provides high-quality repair tissue and therefore may be considered a safe, cost-efficient therapeutic choice for the treatment of hip chondral defects.

Collagen Meniscus Implant: Technique and Results

The Collagen Meniscus Implant is a first-generation tissue-engineered scaffold to reconstruct partial defects of the meniscus. After 20 years of both experimental and clinical experience, the device has proven to be safe and seems to reconstruct the deficient meniscus in a significant number of cases. Over the years, the surgical technique has evolved in order to make the procedure easier and faster. However, careful patient selection and a refined surgical technique still appear to be the most important factors in achieving a successful outcome. In this chapter, the authors review, step by step, the details and tricks relative to the procedure, as well as the mid-term results achieved in their series of patients.

A Novel Association between Femoroacetabular Impingement and Anterior Knee Pain

Background. For a long time it has been accepted that the main problem in the anterior knee pain (AKP) patient is in the patella. Currently, literature supports the link between abnormal hip function and AKP. Objective. Our objective is to investigate if Cam femoroacetabular impingement (FAI) resolution is related to the outcome in pain and disability in patients with chronic AKP recalcitrant to conservative treatment associated with Cam FAI. Material and Methods. A retrospective study on 7 patients with chronic AKP associated with FAI type Cam was performed. Knee and hip pain were measured with the visual analogue scale (VAS), knee disability with the Kujala scale, and hip disability with the Nonarthritic Hip Score (NAHS). Results. The VAS knee pain score and VAS hip pain score had a significant improvement postoperatively. At final follow-up, there was significant improvement in all functional scores (Kujala score and NAHS). Conclusion. Our finding supports the link between Cam FAI and AKP in some young patients. Assessment of Cam FAI should be considered as a part of the physical examination of patients with AKP, mainly in cases with pain recalcitrant to conservative treatment.

Good Outcome After Meniscal Repair Using an All-Inside Suturing System in Combination with High-Frequency Biostimulation

The reported hypercellular response in meniscal tissues seen within a few weeks after radiofrequency meniscectomy suggests that the meniscal tissue may repair itself when exposed to this technology.

There is no relation between mild malalignment and meniscal extrusion in trauma emergency patients.

OBJECTIVE To evaluate whether an alteration of the lower limb axis is associated with meniscal extrusion. MATERIALS AND METHODS Ninety-four patients who had complained of knee pain with good knee function and had a knee magnetic resonance image (MRI) and a full-length X-ray taken of the lower limb were included in the study. Meniscal extrusion was measured in the coronal MRI. Subluxation of the meniscus was considered minor or physiological if ≤ 3 mm, and major if >3 mm. The extrusion as a percentage of meniscus size was also calculated. Knee alignment (varus, negative value; valgus, positive value) was correlated with the presence of minor and major extrusion. RESULTS There were varus knees in 61 cases (58.7%), with a mean measured deviation of -2.63°. Valgus knees were observed in 27 knees (26%) and had a mean deviation of 2.22°. The medial meniscus showed major extrusion in 18 cases (17.3%). It corresponded to 44.7% of the meniscus size. The lateral menisci showed no subluxation in most cases. There was no correlation between alignment and meniscal extrusion in this series, either for the medial meniscus (p = 0.760) or for the lateral meniscus (p = 0.381). CONCLUSIONS In patients complaining of knee pain with good knee function, there is no relationship between mild malalignment and the degree of meniscus extrusion.

Combined Tibial Tubercle Realignment and MPFL Reconstruction

The etiology of the patellar instability involves multiple factors and it can often be successfully managed with conservative treatment. This is particularly so in cases of primary dislocation. If there is no clinical improvement with nonoperative management, surgery may be considered especially in cases of recurrent patellar dislocation. In these patients, a complete physical examination and some imaging studies are mandatory.

Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP.