The femoral intercondylar notch has been an anatomic site of interest as it houses the anterior cruciate ligament (ACL). The objective of this study was to arthroscopically evaluate the femoral notch in patients with known ACL injury. This evaluation included establishing a classification for notch shapes, identifying the shape frequency, measuring notch dimensions, and determining correlation between notch shape, notch dimensions, and demographic patient data. In this clinical cohort study, 102 consecutive patients underwent diagnostic arthroscopic evaluation of the notch. Several intra-operative photos, videos, and measurements were taken of the notch. Demographic data for each patient were recorded including age, gender, height, weight, and BMI. Three categories of notch shape were established: 1. A-shaped; 2. U-shaped; and 3. W-shaped. Two blinded independent orthopedic surgeons were asked to categorize the recorded notches. Notch shape, dimensions, and demographic factors were correlated. Of the 102 notches evaluated, 55 notches were found to be ''A-shaped,'' 42 ''U-shaped,'' and 5 ''W-shaped.'' ''A-shaped'' notches were narrower in all width dimensions than ''U-shaped'' notches. Only patient height was found to influence notch shape with a positive association between taller patients and ''U-shaped'' and ''W-shaped'' notches (P = 0.011). Women had a smaller notch width at the base and middle of the notch. With this data, surgeons who enter the knee and appreciate an ''A-shaped'' notch should consider placing the arthroscope in the anteromedial portal and drill the femoral tunnel through an accessory medial portal to improve visualization and accuracy in anatomic femoral tunnel creation.

Over-the-top reconstruction provides comparable result to anatomic SB reconstruction in terms of controlling the dynamic rotational stability. Over-the-top reconstruction might be one of the options for revision cases and in skeletally immature patients.

PurposeTo assess the ability of a transtibial aimer with a 7-mm off-set in a standardized position to reach the center of the ACL footprint on the femur through the AM portal.MethodsNineteen cadaveric knees were dissected, and the perimeter of the femoral ACL footprint was marked. The aimer was placed just superior to the medial joint line close to the medial condyle through the AM portal. The guide was rested upon the posterior cortex and placed in three different positions: (A) at zero degrees in frontal plane and 60° in axial plane, (B) at 45° in frontal and 45° in axial, and (C) at the center of the ACL insertion site under direct visualization. A digital camera was used to take pictures on the axial plane, and Image J software was used for angle measurement. Aluminum beads were used to mark the three positions indicated by the aimer, and CT scans were performed. The distances from the true center of the ACL to each point were determined.ResultsPosition A resulted in femoral tunnel placement furthest from the center of the ACL footprint (8.6 mm). Position B was at a distance of 3.2 mm, and position C was the most accurate, with an average distance of 2.0 mm. The angles required by Position C varied with an average of 54° ± 11° in the frontal plane and an average of 44° ± 6° in the axial plane.ConclusionThe 7-mm transtibial aimer was unable to reach the center of ACL footprint at a fixed orientation.

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Despite good clinical outcomes, unicompartmental knee arthroplasty (UKA) still rises concerns as treatment for isolated medial knee arthritis, to the point that total knee arthroplasty (TKA) is still largely perceived as the best solution. The purpose of this study is to compare clinical results and survivorship rates of two different options for isolated medial arthritis in the same patient, UKA versus TKA, at a mid-term follow-up. Materials and methods. We retrospectively reviewed 22 patients with isolated medial arthritis treated with UKA in the period between 2004 and 2013, who had previously undergone TKA on the other knee. The mean follow-up was 9.2 years for UKA. The inclusion criteria were that preoperative KSS and KOOS scores were similar or presumed similar for both knees, and that the same degree of osteoarthritis affected both knees. Results. Clinical evaluation was carried on according to KSS and KOOS scores. At the final follow-up at 9.2 years, clinical outcomes between UKA and TKA were very similar. Significantly better results were, however, seen in range of motion (ROM) for UKA implants. Among patients invited to choose between the two procedures, 10 expressed no preference, 8 indicated a preference for UKA, and 4 for TKA. Final survivorship at 9.2 years follow-up was 95% for UKA and 100% for TKA. Conclusions. No differences were reported between TKA and UKA in terms of KSS and KOOS scores at a mid term follow-up, while significantly better results were detected for UKA considering ROM.