Abstract: PURPOSE: The purpose of this study was to determine the relation between the position of the transverse ligament, the anterior edge of the anterior cruciate ligament (ACL) tibial footprint, and the center of the ACL tibial insertion. We used arthroscopy for localization of the anatomic landmarks, followed by insertions of guide pins under direct visualization, and then the position of these guide pins was checked on plain lateral radiographs. METHODS: The transverse ligament and the anterior aspect of the ACL tibial footprint were identified by arthroscopy in 20 unpaired cadaveric knees (10 left and 10 right). Guide pins were inserted with tibial ACL adapter drill guides under direct observation at the transverse ligament, the anterior aspect of the tibial footprint, and the center of tibial insertion of the ACL. Then, plain lateral radiographs of specimens were taken. The Amis and Jakob line was used to define the attachment of the ACL tibial insertion and the transverse ligament. A sagittal percentage of the location of the insertion point was determined and calculated from the anterior margin of the tibia in the anteroposterior direction. RESULTS: The transverse ligament averaged 21.20% ± 4.1%, the anterior edge of the ACL tibial insertion averaged 21.60% ± 4.0%, and the center of the ACL tibial insertion averaged 40.30% ± 4.8%. There were similar percent variations between the transverse ligament and the anterior edge of the ACL tibial insertion, with no significant difference between them (P = .38). Intraobserver and interobserver reliability was high, with small standard errors of measurement. CONCLUSIONS: This study shows that the transverse ligament coincides with the anterior edge of the ACL tibial footprint in the sagittal plane. CLINICAL RELEVANCE: The transverse ligament can be considered as a new landmark for tibial tunnel positioning during anatomic ACL reconstruction.
Abstract: PURPOSE: The objective of this study was to determine the safe penetration depth of the FasT-Fix meniscal suture repair system during all-inside repair of the posterior part of the lateral meniscus. METHODS: Thirty-one knees from 17 embalmed and formalin-fixed cadavers (11 women, 6 men) were used. In each case, the circumference of the cadaver knee was measured before dissection. After dissection, 41 Fast-Fix meniscal repair devices were used in different predetermined penetration depths ranging from 8 to 16Â mm. In this study, non-involvement of the popliteal neurovascular bundle, common peroneal nerve or the inferior lateral genicular vessels by either needle penetration or affixment by the suture bar anchors was considered to be a safe trial. RESULTS: Out of the 41 FasT-Fix devices used in this study, only one device bent during introduction and was excluded from the study. For the remaining 40 trials, 27 of them were considered safe, while 13 trials were considered unsafe. The ratio of the average penetration depth to the average circumference of the cadaver knee was found to be >0.05 for the unsafe penetrations, and this was statistically significant PÂ <Â 0.05. Additionally, for the first point, which is more central, there was a trend for the straight needles through the direct lateral approach to be less safe, and this was found to be statistically significant PÂ <Â 0.05. CONCLUSIONS: Correlating the needle-penetration depth to the measured circumference of the cadaver knee may be an important clinical predictor of safety whereby a ratio of less than 0.05 might be useful as a guide to determine the safe penetration depth of the FasT-Fix suture repair needle during repair of the posterior horn lateral meniscus. Also, it is better to avoid using straight needles through the direct lateral approach during repair of the more central portion of the posterior horn lateral meniscus.
Abstract: Double Bundle Arthroscopic Anterior Cruciate Ligament
Reconstruction with Remnant Preserving Technique Using a
Hamstring Autograft
Abstract
Background: Preservation of the Anterior Cruciate Ligament (ACL) remnant is important
from the biological point of view as it enhances revascularization, and preserves the
proprioceptive function of the graft construct. Additionally, it may have a useful
biomechanical function. Double bundle ACL reconstruction has been shown to better
replicate the native ACL anatomy and results in better restoration of the rotational stability
than single bundle reconstruction.
Methods: We used the far anteromedial (FAM) portal for creation of the femoral tunnels,
with a special technique for its preoperative localization using three dimensional (3D) CT.
The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL
remnant to allow visualization of the tips of the guide pins during anatomical creation of
the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow
retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal
slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft
against the ACL remnant as well as the roof of the intercondylar notch.
Conclusion: Our technique allows for anatomical double bundle reconstruction of the ACL
while maximally preserving the ACL remnant without the use of intra-operative image
intensifier.
Abstract: The biological reconstruction of a large osteochondral defect in the weight-bearing area of the knee joint has long been a challenge to orthopedic surgeons. We present a case of a large posttraumatic defect in the weight-bearing area of knee joint treated with a novel distraction arthroplasty device after reconstruction of the joint surface using combined autologous and artificial bone graft.
Abstract: miRNAs, which are non-coding RNAs, play a role in the pathogenesis of disease including OA. miRNA (miR)-34a is induced by p53, subsequently leading to cell apoptosis, which is one of the major factors in the pathogenesis of OA. The purpose of this study is to investigate the effect of silencing miR-34a on IL-1β-induced chondrocyte apoptosis in a rat OA model in vitro.
Abstract: The objective of this study was to investigate the effect of microRNA-21 (miR-21) on the proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel. Articular cartilage was harvested aseptically from the knee and hip joints of rats. In the experimental group, double-stranded miR-21 was transfected into the chondrocytes, and in the control group, scrambled siRNA was used. After that, chondrocytes were cultured in atelocollagen gel for 3 weeks. At 1, 2, and 3 weeks after transfection, the cell numbers were counted, and the expression levels of Col2a1 and aggrecan were measured by real-time PCR. Histological analysis by toluidine blue staining was performed at 3 weeks. The cell number in the experimental group rapidly increased compared to the control group. The expression levels of Col2a1 and aggrecan in the experimental group were higher than in the control. Histological analysis revealed that many more cells with a metachromatic stain were present in the experimental group than in the control. This study demonstrated that miR-21 promotes high proliferation and matrix synthesis of chondrocytes embedded in atelocollagen gel.
Abstract: We report one case of mid-substance injury of the posterior cruciate ligament and two cases of mid-substance injuries of the anterior cruciate ligament in children. Surgical repair with augmentation using the iliotibial band was performed on these patients without the use of transphyseal drill holes. A small strip of the iliotibial band was sutured onto the end of the cruciate ligament stump to augment the remnant. At the most recent follow-up examinations, conducted 5-11 years after surgery, no restriction or discomfort in daily and sport activities was reported, and acceptable levels of function in the injured knees were noted in all patients.
