Urszula Zdanowicz

Medial meniscus anatomy—from basic science to treatment

Abstract This paper focuses on the anatomical attachment of the medial meniscus. Detailed anatomical dissections have been performed and illustrated. Five zones can be distinguished in regard to the meniscus attachments anatomy: zone 1 (of the anterior root), zone 2 (anteromedial zone), zone 3 (the medial zone), zone 4 (the posterior zone) and the zone 5 (of the posterior root). The understanding of the meniscal anatomy is especially crucial for meniscus repair but also for correct fixation of the anterior and posterior horn of the medial meniscus.

Value of ultrasonography in assessment of recent injury of anterior talofibular ligament in children

Introduction Sprained ankle is a very common injury in children. Proper treatment of ligament injuries enables full recovery. X-ray and US examinations are commonly available diagnostic methods. Material and methods Two hundred and six children (113 girls and 93 boys, mean age 10.6) with recent ankle joint sprain (up to 7 days of injury) were subject to a retrospective analysis. All patients underwent an X-ray and US examination of the ankle joint within 7 days of injury. In 19 patients, anterior talofibular ligament reconstruction was conducted. Results X-ray failed to visualize a pathology in 129 children (63%); in 24 patients (12%), avulsion fracture of the lateral malleolus was found, and in 36 cases (17%), effusion in the talocrural joint was detected. Ultrasonography failed to visualize a pathology in 19 children (9%); in 60 patients (29%), it showed avulsion fracture of the lateral malleolus involving the attachment of the anterior talofibular ligament (ATFL); in 34 cases (17%), complete ATFL tear was detected, and in 51 patients (25%), partial ATFL injury was found. Other injuries constituted 19%. The surgeries conducted to repair the anterior talofibular ligament (19) confirmed the US/X-ray diagnoses in 100% of cases. Avulsion ATFL injury, i.e. the one that involves the ligament attachment site, is usually found in younger children (median: 8 years of age). Complete ATFL tears (not involving the attachment site) concern older children (median: 14 years of age). Conclusions Since X-ray is of limited value in diagnosing ankle joint pathologies in recent sprain injuries in children, soft tissue imaging, i.e. ultrasonography, is the basic examination to assess the ligament complex. Avulsion fractures, which involve the ATFL attachment site and are usually found in younger children, are a consequence of the incomplete ossification and require urgent diagnosis and orthopedic consultation.

Ribbonlike Anatomy of the Anterior Cruciate Ligament from Its Femoral Insertion to the Midsubstance

Recently the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to the midsubstance was found to be flat. This might have an important impact on anatomical ACL reconstruction.

Variations of the Tibial Insertion of the Anterior Cruciate Ligament: An Anatomical Study

An anatomical cadaveric study was performed in 111 knees to evaluate the macroscopic appearance of the tibial midsubstance of the ACL and its tibial insertion. The ACL was flat like a ribbon with a “C”-shaped tibial insertion along the medial tibial spine to the anterior aspect of the anterior horn of the lateral meniscus. Three variations of the tibial insertion were found. The bony insertion of the anterior horn of the lateral meniscus is in the center of the “C”-shaped tibial ACL insertion. Fibers of the anterior and posterior horn of the lateral meniscus blend with the tibial ACL insertion.

Adipose-Derived Cells (Stromal Vascular Fraction) Transplanted for Orthopedical or Neurological Purposes: Are They Safe Enough?

Although mesenchymal stem cells are used in numerous clinical trials, the safety of their application is still a matter of concern. We have analysed the clinical results of the autologous adipose-derived stem cell treatment (stromal vascular fraction (SVF) containing adipose-derived stem cells, endothelial progenitors, and blood mononuclear cells) for orthopedic (cartilage, bone, tendon, or combined joint injuries) and neurologic (multiple sclerosis) diseases. Methods of adipose tissue collection, cell isolation and purification, and resulting cell numbers, viability, and morphology were considered, and patients age, sex, disease type, and method of cell administration (cell numbers per single application, treatment numbers and frequency, and methods of cell implantation) were analysed and searched for the unwanted clinical effects. Results of cellular therapy were compared retrospectively to those obtained with conventional medication without SVF application. SVF transplantation was always the accessory treatment of patients receiving “standard routine” therapies of their diseases. Clinical experiments were approved by the Bioethical Medical Committees supervising the centers where patients were hospitalised. The conclusion of the study is that none of the treated patients developed any serious adverse event, and autologous mesenchymal stem (stromal) cell clinical application is a safe procedure resulting in some beneficial clinical effects (not analysed in this study).

Suture Manipulation in Arthroscopic Surgery

Suture manipulation is a key point in arthroscopic surgery. Sutures are mainly used in shoulder surgeries. However, during meniscal repairs, some ankle and elbow arthroscopic procedure surgeons need ability of suture manipulation. In this chapter, we will focus on suture manipulations during shoulder arthroscopies such as basic suture handling and configurations. All these maneuvers can be adapted to other procedures in different joints.

Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review

Revision anterior cruciate ligament reconstruction remains a challenge, especially optimising outcome for patients with a compromised knee where previous autogenous tissue has been used for reconstruction. Allograft tissue has become a recognized choice of graft for revision surgery but questions remain over the risks and benefits of such an option. Allograft tendons are a safe and effective option for revision ACL reconstruction with no higher risk of infection and equivalent failure rates compared to autografts provided that the tissue is not irradiated, or any irradiation is minimal. Best scenarios for use of allografts include revision surgery where further use of autografts could lead to high donor site morbidity, complex instability situations where additional structures may need reconstruction, and in those with clinical and radiologic signs of autologous tendon degeneration. A surgeon needs to be able to select the best option for the challenging knee facing revision ACL reconstruction, and in the light of current data, allograft tissue can be considered a suitable option to this purpose.Level of evidence IV.

Anatomy of ACL Insertion: Ribbon

“Ribbon” concept of anterior cruciate ligament (ACL) anatomy has become one of the hottest topics in orthopedic world recently. In this chapter, we are going to present key points of this concept including direct and indirect insertion at the femoral side; flat, twisting nature of midsubstance of the ACL; and “C”-shaped appearance, with different anatomical variations on the tibial side. The chapter is accompanied by detailed anatomical dissection pictures.

Achilles Tendon Pathology

There is no consensus on the best method for management of the Achilles tendon pathologies. Individual preferences, drawn from experience and study, determine whether treatment is operative or nonoperative. In this chapter there is a description of Achilles tendon pathologies including disorders of Achilles tendon insertion, tendinopathy, partial rupture and complete rupture. We are focusing on identifying underlying pathology, as this would determine the choice of treatment. And although there are many different approaches, the key would be to name exactly what kind of pathology we are dealing with. One should not rely only on clinical symptoms (pain).

Anatomy and Vascularisation

The idiom ‘A picture is worth a thousand words’ refers to the notion that a complex idea can be conveyed with a single image more effectively then a description does. This chapter will focus on the astonishing meniscus anatomy. A number of highly detailed pictures are provided, highlighting the fact that an in-depth anatomical knowledge has a direct impact on meniscal reconstruction techniques (including any meniscal surgery: meniscectomy, suturing or meniscus replacement), thus determining their final clinical outcome.