Mario Carneiro

Arthroscopic anterior cruciate ligament double-bundle reconstruction using hamstring tendon grafts-fixation with two interference screws: technical note

In this article, an original double-bundle anterior cruciate ligament reconstruction technique is described. The procedure is developed using hamstring tendon grafts while maintaining tibial osseous insertion. Two tibial tunnels are drilled and a simplified and precise outside-in double tunnel femoral drilling technique is utilized. The graft fixation is made using only two interference screws.

Is it safe the empirical distal femoral resection angle of 5 to 6 of valgus in the Brazilian geriatric population

Objective The purpose of this study is to determine if there is a safe distal femoral resection angle to restore the normal axial alignment of the limb in total knee arthroplasty (TKA) in the Brazilian geriatric population with knee arthrosis. Method This study analyzed 99 pre-operative hip-knee-ankle radiographs of osteoarthritic knees of 66 patients (54 women, 12 men) with knee osteoarthritis. The distal femoral cut angle was determined based on the femoral mechanical-anatomical angle (FMA). Mean, median and standard deviation measurements of the distal femoral cut angle were calculated, differentiated by gender and side. The mean result of the distal femoral resection angle was compared to 5.7°, the mean average angle of previous and similar study based on European population of patients with knee arthrosis. Results The mean average of the distal femoral resection angle of the study was 6.05 (range 3–9°). The distribution of this angle between genders showed a slight superior average of the male population (6.17°) compared to the female (6.02°), but with no statistically significant difference (p = 0.726). There was no statistically significant difference (p = 0.052) between the mean average of this study (6.05°) compared to the mean average of the literature (5.7°). However, considering 3° as the limit of acceptable error in the coronal plane, this empirical femoral resection angle would not be appropriated for 19.7% of the population. Conclusion The distal femoral resection angle of 5–6° is not completely safe for the Brazilian geriatric population.

MPFL Reconstruction Combined with Anteromedialization Tibial Tubercle Osteotomy Versus Isolated MPFL Reconstruction in Patients with Recurrent Patellar Instability: A Quasi-Randomized Controlled Trial

PURPOSE: Compare the clinical outcomes of the anteromedialization tibial tubercle osteotomy (TTO) combined with medial patellofemoral ligament reconstruction (MPFLR) versus MPFLR alone for the treatment of recurrent patellar instability (RPI) in patients with TT-TG 17 to 20 mm presenting its mid-term outcomes. METHODS: From January 2008 to August 2013, skeletally mature patients with RPI and TT-TG 17-20mm were quasirandomized into two groups: TTO combined with MPFLR (TTO+MPFLR) or MPFLR alone (MPFLRa). Quasirandomization: both interventions were explained to the patients and they chose which one to be submitted. Subjects were evaluated for patellar tracking lateralization, patellar glide, apprehension test, increased femoral anteversion, Caton index, trochlea dysplasia by Dejour classification, TT-TG, Kujala, IKDC, Lysholm and Tegner. RESULTS: Forty-two patients composed the study. TTO+MPFLR group was comprised of 18 patients and MPFLRa group was comprised of 24 patients. Demographics between groups were not significantly different related to age, gender, side, and cartilage lesion. Results are presented comparing TTO+MPFLR and MPFLa, respectively, as follows. Follow-up: 41.33±10.26, 40.5±11.63 months, p=0.81. Patellar tracking lateralization preoperatively: 3.33±0.84, 3.25 ±0.67, p=0.182. Patellar tracking lateralization postoperatively: 1±0, 1.33±0.48, p=0.006. Patellar glide and apprehension test preoperatively: All patients had a positive apprehension test or a patellar luxation at the patellar glide test rated as grade 4 before surgery. Patellar glide postoperatively: 1.17±0.38, 1.21±0.41, p=0.734. Apprehension test postoperatively: none. Increased femoral anteversion: 6%, 25%, p=0.9. Caton index preoperatively: 1.12±0.14, 1.12±0.11, p=0.97. Caton index postoperatively: 1±0.08, 1.12±0.11 (the same preoperatively), p=0.0012. TTO+MPFLR patients submitted to concurrent tibial tubercle distalization: 44%. Trochlea dysplasia: no significant difference between groups, p=0.67. TT-TG preoperatively: 18.5±1.24, 18.04±1.12, p=0.16. TT-TG postoperatively: 10.55±0.83, 18.04±1.12 (the same preoperatively), p<.001. No significant difference was seen International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine 11 th Biennial ISAKOS Congress • June 4-8, 2017 • Shanghai, China ISAKOS

DARTHROSCOPIC DOUBLE- BUNDLE RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT USING HAMSTRING TENDON GRAFTS - FIXATION WITH TWO INTERFERENCE SCREWS

Surgical procedures for double-bundle reconstruction of anterior cruciate ligament, which currently use semitendinous and gracilis tendon grafts, have been described in the last decade. Most of the techniques utilize twice the hardware used in single-bundle reconstructions. We report an original anterior cruciate ligament double-bundle reconstruction technique using semitendinous and gracilis tendon grafts, maintaining their tibial bone insertions with two tibial and two femoral tunnels. A simplified and precise outside-in femoral drilling technique is utilized, and the graft fixation is made utilizing only two interference screws.