Maximiliano Ibañez

Lateral Capsular Fixation: An Implant-Free Technique to Prevent Meniscal Allograft Extrusion

Although several surgical techniques have been described to perform meniscal allograft transplantation with good clinical results and although different methods of capsular stabilization can be found in the literature, there is no standard surgical technique to prevent a common complication in the most of series: the tendency to a radial displacement or extrusion of the transplanted menisci. We present a simple, reproducible, and implant-free technique to perform a lateral capsular fixation (capsulodesis) at the time of only the soft-tissue fixation technique of meniscal allograft transplantation in an effort to reduce or prevent the risk of graft extrusion. Using a minimum of two 2.4-mm tunnels drilled from the contralateral side of the tibia with the help of a regular tibial anterior cruciate ligament guide, a capsular attachment to the lateral tibial plateau is obtained.

Reconstruction of the Medial Patellofemoral Ligament

Patellar instability has been shown to be associated with different major factors. However, studies have demonstrated that soft tissue reconstructions are adequate enough to reestablish patellar constraint. In recent years, the medial patellofemoral ligament has been recognized as the primary passive restraint for lateral translation of the patella. Their reconstruction has gain popularity as the procedure is quite simple and fast. Although several surgical techniques have been described for their reconstruction, no clear consensus has been reached as to which is best. We present an implant-free, medial patellofemoral ligament reconstruction technique that uses a gracilis tendon autograft, 2 bone convergent tunnels at the original patellar attachment, and looping the graft around the adductor magnus tendon that is used as a pulley for femoral fixation.

Open-Wedge Valgus High Tibial Osteotomy Technique With Inverted L-Shaped Configuration

High tibial osteotomy (HTO) is a useful alternative in the treatment of symptomatic varus malalignment. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. On the other hand, patella baja often causes anterior knee pain and, over time, may favor degeneration of the patellofemoral joint. The aim of this study is to describe a technical modification of the standard open-wedge HTO. It consists of a double inverted L-shaped cut, which includes the anterior tibial tuberosity in the proximal fragment, to avoid any alteration of patellar height and control the eventual increase of the posterior tibial slope.

Fresh Osteochondral Patellar Allograft Resurfacing

The treatment of articular cartilage lesions in young patients is certainly a complex matter and subject of continuous research, particularly for those located at the patellofemoral joint, given its peculiar biomechanical characteristics. Osteochondral grafts can be of relatively small size when the defect is focal and in an area that allows good stability and consequently the grafts integration. In case of large or multifocal lesions, it is possible to consider an osteochondral transplantation of the entire articular surface of the patella. We present a simple and reproducible technique to perform a patellar fresh osteochondral allograft resurfacing attempting to reduce the symptoms and delay a prosthetic implant in young patients with advanced patellar chondral injuries.

What is the most reproducible classification system to assess tibial plateau fractures

PurposeTraditional classification systems for tibial plateau fractures (TPF) are based on simple radiographs, and intra- and inter-observer variability is low. The aim was to assess intra- and inter-observer variability using traditional systems and some recently described classification systems of TPF in the interpretation of standard radiographs and bidimensional (2D) and tridimensional (3D) computed tomography (CT).MethodsWe studied all patients at two centres who underwent TPF surgery over a three-year period. Demographic data (age, sex, BMI) and mechanism of injury were recorded. Four observers classified each TPF according to the Schatzker, AO, Luo, modified Duparc and Khan classification systems. We calculated intra- and inter-observer variability using the Kappa test.ResultsA total of 112 (71 males) patients were included. Mean age was 47.1 years (range 21–86) and mean BMI was 25.2 ± 3.6. Intra- and inter-observer variability was 0.95 and 0.62 for AO, 0.87 and 0.65 for Schaztker, 0.86 and 0.73 for Luo, 0.56 and 0.37 for the modified Duparc, and 0.43 and 0.25 for Khan classifications.ConclusionsAlthough previous training could be needed, AO, Schatzker and Luo classifications showed a good reproducibility of TPF assessment from a combination of standard radiographs and 2D and 3D CT images. The results using the Modified Duparc and Khan classifications were less favourable and their use is not therefore recommended.

Biceps tendinopathy Tenodesis All Arthroscopic vs Open Subpectoral Tenodesis

Introduction: Tenodesis is the preferred technique in the treatment of the long head of the biceps tendon pathology in younger people, athletes, workers, and those wishing to avoid any cosmetic deformity. The aim of our study was to compare a group of patients who underwent all arthroscopic biceps tenodesis with a group of patients who underwent an open subpectoral procedure. A clinical assessment was performed and we also registered the occurrence of complications. Materials and Methods: We retrospectively reviewed 90 patients with lesions in the long head of the biceps tendon treated at our institution between January 2009 and January 2012. Group A underwent an arthroscopic technique while Group B was treated in an open fashion. Clinical assessment included appropriate scores (ASES, Rowe, Simple Shoulder Test, Constant Murley), and we also evaluated pain with Visual Analogue Scale (VAS), and personal satisfaction in terms of aesthetics and local pain at the scar. Results: Group A: Rowe 86 points, ASES 81 points, SST 9 points, Constant and Murley 87 points. VAS 2/10. Regarding scars of the portals patients were satisfied. Group B: Rowe 85 points, ASES 82 points, SST 8.5 points, Constant and Murley 85 points. VAS 3/10 (greater at the site of subpectoral approach). Aesthetic concerns about the scar was observed in 4 cases (4 women). Arm deformity (sign of Popeye) was not observed at the latest follow-up. Discussion: No statistical significant differences were found in clinical assessment between both procedures. Arthroscopic tenodesis is technically more challenging and requires an initial longer learning curve in order to perform a successful procedure. Open subpectoral tenodesis despite being a faster and simpler procedure reports discomfort regarding the scar site.

Osteochondral lesions of the talus: clinical and functional assessment of conservative vs scope treatment

Introduction: Osteochondral injuries involving the ankle joint are unusual (incidence of 0.09% according to Berndt and Harty), third in frequency after knee and elbow location. They are described as a cause of chronic pain after ankle sprains in the active population (thought to occur in 2-6% of sprains). MRI is the gold standard diagnostic method. Therapeutic strategies include both conservative and surgical treatment. The aim of our study was to evaluate the clinical and functional outcome of patients with osteochondral lesions of the talus. Materials and Methods: We retrospectively reviewed 20 patients with osteochondral lesions of the talus treated in our department between January 2007 and December 2012. Sixty per cent were male with an average age of 42 years. Eleven patients were treated conservatively, one of them had clear surgical indication (LOC G III, as classified by Ferkel and Sgaglione) but refused to perform the procedure. Nine patients underwent arthroscopic surgery (debridement and microfracture), one of the procedures was a review of an arthroscopy performed in another service. No open surgery was performed. Clinical and functional evaluation was performed using the AOFAS score, Freiburg and VAS Score System. Results: Non-surgical treatment group had a pretreatment average AOFAS score of 58, which improved to 74.8 points; a Freiburg Score System that ranged from 65 to 79.3 points and a VAS average of 5,4. AOFAS surgical treatment group improved from 54.3 to 84.8 points, Freiburg Score System ranged from 60.6 to 81.4 points and VAS average was of 5,8. Discussion: It is difficult to compare our results with other series of patients, because we made a comparison between conservative versus artrhoscopic treatment, while other authors show results obtained when performing certain surgical technique Although surgical treatment has better results, we agree with the literature that conservative treatment presents acceptable results and should always be considered as the first option.

Long head of the biceps tendon pathology: Arthroscopic biotenodesis vs tenotomy.

Introduction: Disorders of the long head of the biceps tendon can exist in conjunction with other shoulder pathologies. It was proposed as a cause of pain in patients with rotator cuff injury. A detailed history, thorough physical examination and radiographical evaluation are necessary for a correct diagnosis. The aim of our study was to describe the surgical technique and analyze the results obtained in patients based on the same. Materials and Methods: Were included in this retrospective study 70 patients who had lesions in the long head of the biceps tendon, diagnosed with MRI treated at our institution with arthroscopic biotenodesis technique of the tendon with interference screw in the lower portion of the bicipital groove since January 2009 to January 2012. Functional clinical evaluation was performed with the appropriate scores for the disease (ASES, Rowe, Simple Shoulder Test, Constant Murley). Pain was evaluated using Visual Analog Scale. Results: The Rowe score was 86 points, 81 points ASES, SST 9 points, Constant and Murley 87 points. The VAS showed poor post surgical pain. At the time, no associated deformity similar to a Popeye sign was observed. Discussion: The decision to perform a surgical management of the long head of the biceps pathology depends on the clinical presentation, thorough physical examination with specific test, the presence of associated pathologies and failure of nonsurgical treatment.