Thomas Engel

Arthroscopic reduction and subchondral support of reverse Hill–Sachs lesions with a bioabsorbable interference screw

Traumatic posterior dislocation of the shoulder is frequently associated with an osteochondral defect on the anterior articular surface of the humeral head (so-called reverse Hill–Sachs lesion). Possible treatment options are either filling or elevation of the osseous defect. Previously, an open technique has been described using a bioabsorbable interference screw. On the basis of a 64-year-old patient presenting with a reverse Hill–Sachs lesion after epileptic seizure, we describe an arthroscopic technique in which the defect is reconstructed under arthroscopic and fluoroscopic control and supported by a bioabsorbable interference screw.

Knotless anatomic double-layer double-row rotator cuff repair: a novel technique re-establishing footprint and shape of full-thickness tears

The standard technique for restoring footprint after full-thickness tears of the rotator cuff includes double-row or transosseous-equivalent techniques. However, the anatomically typical bird’s beak shape and profile of tendon insertion may not be originally restored and biomechanics may be altered. In this report, the authors describe a technique that involves creating two intratendinous stitches at different levels of the torn tendon. The first passes through the bursal-side layer, the second stitch through the joint-side layer. Both stitches may be performed in mattress suture configuration. The anchorage is performed by knotless anchors in order to avoid knots lying within the insertion area. The footprint is restored first medially then laterally by the use of double-row principles. The joint-side suture is anchored within the medially placed anchor. The bursal-side suture is anchored by a laterally placed anchor. The anatomic insertion and restoration of the shape and profile may be enabled by the described double-layer suture technique. Using a double-layer double-row repair may potentially improve functional results of rotator cuff repair constructs.

Biomechanical Evaluation of Knotless Anatomical Double-Layer Double-Row Rotator Cuff Repair: A Comparative Ex Vivo Study

Background The layered configuration of the rotator cuff tendon is not taken into account in classic rotator cuff tendon repair techniques. Hypothesis The mechanical properties of (1) the classic double-row technique, (2) a double-layer double-row (DLDR) technique in simple suture configuration, and (3) a DLDR technique in mattress suture configuration are significantly different. Study Design Controlled laboratory study. Methods Twenty-four sheep shoulders were assigned to 3 repair groups of full-thickness infraspinatus tears: group 1, traditional double-row repair; group 2, DLDR anchor repair with simple suture configuration; and group 3, DLDR knotless repair with mattress suture configuration. After ultrasound evaluation of the repair, each specimen was cyclically loaded with 10 to 100 N for 50 cycles. Each specimen was then loaded to failure at a rate of 1 mm/s. Results There were no statistically significant differences among the 3 testing groups for the mean footprint area. The cyclic loading test revealed no significant difference among the 3 groups with regard to elongation. For the load-to-failure test, groups 2 and 3 showed no differences in ultimate tensile load when compared with group 1. However, when compared to group 2, group 3 was found to have significantly higher values regarding ultimate load, ultimate elongation, and energy absorbed. Conclusion The DLDR fixation techniques may provide strength of initial repair comparable with that of commonly used double-row techniques. When compared with the knotless technique with mattress sutures, simple suture configuration of DLDR repair may be too weak. Knotless DLDR rotator cuff repair may (1) restore the footprint by the use of double-row principles and (2) enable restoration of the shape and profile. Clinical Relevance Double-layer double-row fixation in mattress suture configuration has initial fixation strength comparable with that of the classic double-row fixation and so may potentially improve functional results of rotator cuff repair.

Infiltration of the pes anserinus complex by an extraarticular diffuse-type giant cell tumor (D-TGCT)

This report describes the case of a 26-year-old woman with a recurrent extraarticular diffuse-type tenosynovial giant cell tumor (D-TGCT) of the medial region of the knee affecting the pes anserinus and hamstring tendons. Presurgical MRI did not exclude infiltrative properties of the tumor. In the histological evaluation, the tumor showed an aggressive dispersion by infiltrating the collagenous tissue of the hamstring tendons. The treatment included a resection of the pes anserinus complex with distal semitendinosus and gracilis tendons. Regarding extraarticular D-TGCT a review of the literature showed a predominant affection of the medial region of the knee and thigh.

Fresh meniscal allograft transplantation and autologous ACL/PCL reconstruction in a patient with complex knee trauma following knee dislocation – a case report

Instability of the knee joint, particularly in combination with the loss of one meniscus, regularly leads to the early development of arthritis. This paper describes the case of a 19‐year‐old male with ruptures of the anterior (ACL) and posterior cruciate ligament (PCL) along with the loss of the medial meniscus due to knee dislocation. Combined, time‐delayed reconstruction of both the ACL and PCL and the allogenic fresh meniscal transplantation of the medial meniscus without bone plugs were performed. The control arthroscopy performed 6 months post‐transplantation revealed good vitality and integration of the grafts as assessed both macroscopically and histologically. A small portion of the posterior horn had to be refixated, and the anterior horn was atrophic. At 24 months after trauma and 13 months following meniscal transplantation, the patient achieved a Lysholm score of 88 points and clinical examination indicated a stable knee. Fresh meniscal allograft transplantation, in combination with autologous ACL and PCL reconstruction, constitutes – in specialized centers – an alternative treatment option for complex trauma of the knee joint with loss of a meniscus.