Anterior cruciate ligament (ACL) insufficiency in combination with patellar instability are rare occurrences and are difficult to treat. Failure to address patellar instability in such cases may place excessive strain on ACL graft leading to graft rupture. We present three such cases treated by concurrent ACL and medial patellofemoral ligament (MPFL) reconstruction with hamstring tendon autografts. Two patients had MRI evidence of MPFL injury and one patient had intact MPFL on MRI. All patients had good outcome without any residual instability at final followup.
PurposeTraditionally, MRI has not been used to predict meniscus tear reparability. An attempt has been made in this study to predict meniscal reparability using MRI, and a new scoring system to help with the same has been developed and tested.
MethodsThirty repaired menisci were compared with equal number of meniscectomy cases retrospectively. Various clinical and radiological (radiographs and MRI) characteristics like chronicity of tear, pattern of tear, etc, were tabulated. Based on their association with the outcome of repair or meniscectomy, odds ratio of each attribute were calculated. A scoring system—Ortho One PROMT Score (Prediction of Reparability of Meniscal Tears)—to predict meniscal repair was formulated. Using this score, meniscus surgery outcomes were prospectively predicted in 120 cases and results tabulated.
ResultsThe newly devised Ortho One PROMT score predicted medial meniscus repair with a sensitivity of 90.9% and a specificity of 93.2% and medial meniscectomy with a sensitivity of 93.2% and a specificity of 90.9%. It predicts lateral meniscus repair with a sensitivity of 69.2% of patients and lateral meniscectomy with a sensitivity of 78.8% of patients.
ConclusionOrtho One PROMT score is a useful scoring system to predict the outcomes of meniscus surgery preoperatively. It uses a combination of clinical and radiological (MRI and plain radiograph) characteristics. With this scoring system, both the surgeon and the patient are better prepared preoperatively regarding the outcome of a particular meniscus surgery. The scoring shall make day‐to‐day arthroscopic meniscus surgery less stressful.
Level of evidenceIII.
Background: Posterolateral corner injuries can result in persistent varus and rotary instability. Many open/ arthroscopic procedures of reconstruction/ repair have been reported, but there is a paucity of literature on clinical outcomes. We follow an all arthroscopic reconstruction technique of the popliteus sling with the use of the ‘popliteus portal’ in cases of isolated popliteus injuries (intact fibular collateral ligament). Methodds: Prospective case study of 12 patients undergoing Arthroscopic Popliteus sling reconstruction with or without associated cruciate ligament reconstruction was peformed. We report our surgical technique and clinical outcomes. Results: All our patients had good to excellent knee function at final follow up (IKDC and Tegner Scores). We did not encounter any major complications intra or post – operatively. Conclusions: In cases of Popliteus tendon injury without fibular collateral ligament injury, an ‘all – arthroscopic’ Popliteus sling reconstruction is an effective and reproducible technique of restoring posterolateral stability of the knee. The advantages of our procedure are – an ‘all – arthroscopic Technique’, avoiding damage to the meniscotibial ligaments and a more ‘anatomic’ reconstruction of the popliteus sling. Keywords: Knee, Posterolateral corner injury, popliteus, Arthroscopy, Reconstruction
Arthroscopic surgeries can be made cost effective by avoiding the use of implants whenever possible. Usage of confluent tunnels, suture bridges, bone bridges, and modifications in standard arthroscopic procedures will help us in achieving comparable mechanical as well as the functional outcome at the same time have technical advantages and cause less financial burden to the patient. On this technical note, we propose the use of various implant free techniques in arthroscopic and other sports related surgeries of the knee.
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