Knee Arthroscopy : An Up-to-Date Guide

This book provides detailed guidance on knee arthroscopy that reflects the very latest advances in this ever-changing field. Among the techniques covered are reconstruction of the anterior and posterior cruciate ligaments, meniscal repair and transplantation, cartilage repair by means of osteochondral allograft transplantation and autogenous osteochondral transfer, medial patellofemoral ligament reconstruction, and high tibial osteotomy. In each case, clear descriptions of technique are supported by a wealth of high-quality illustrations, with identification of potential pitfalls and how to avoid them. In addition, the latest knowledge is presented on anatomy and biomechanics. The book is written by recognized experts in sports injuries and knee disorders. It will serve as an up-to-date reference for the experienced knee surgeon and an ideal source of information for all who wish to broaden their knowledge of and improve their skills in knee arthroscopy, whether general orthopaedists, orthopaedic trainees, or sports medicine physicians. Preface Contents Biomechanics of the Knee Abstract Alignment Joint Movement Gait Level Walking Stair Climbing ACL Kinematics and Kinetics of the Knee Joint During Knee Motion Biomechanics of ACL Reconstruction Tunnel Position Graft Material Autograft Allograft Rotational Instability, Anterolateral Complex, and ALL Anatomy of Anterolateral Complex Biomechanics of Anterolateral Complex Posterior Cruciate Ligament and Posterolateral Corner Meniscus Load Transmission Shock Absorption Meniscal Motion Joint Stabilization Cartilage References Understanding the Complex Anatomy of the Knee Abstract Introduction Medial Complex Layer 1 Layer 2 Layer 3 Lateral Complex Interval Concept Layered Concept Layer 1 Layer 2 Layer 3 References Subjective and Objective Assessments of Knee Function Abstract Introduction Subjective Assessments Objective Assessments References Evolution of ACL Reconstruction Abstract First Description of ACL Structure and Function Early Treatment of ACL Injury Emergence of ACL Reconstruction Graft Sources Fixation Methods Extra-Articular ACL Reconstruction Emergence of Arthroscopy Changing Paradigms—From Isometric to Anatomic Reconstruction Contemporary ACL Reconstruction—From Anatomic ACLR to Individualized, Anatomic ACLR Future of ACL Repair and Reconstruction Conclusion References ACL—Current Understanding of ACL Insertion Abstract Femoral ACL Insertion Dimensions of the Femoral ACL Insertion Midsubstance of ACL: Ribbon? Bundles? Tibial ACL Attachment Dimensions of the Tibia ACL Attachment Consequences for ACL Reconstruction References High-Grade Pivot Injuries and Quantitative Evaluation of Degree of Instability Abstract Introduction Key Determinant of the High-Grade Pivot-Shift Test Cases Shared by the Author Scenario 1: ACL Injury Combined with Posterolateral Meniscal Root Tear (PLMRT) Scenario 2: Chronic ACL Injury with Posterolateral Meniscal Horn Deficiency Scenario 3: Chronic ACL Injury with Excessively Increased Posterior Tibial Slope Future Direction in Pivot-Shift Quantification Conclusions References Surgical Techniques of ACL Reconstruction, B. Trans-Tibial Technique Abstract Introduction Surgical Techniques Step 1: Harvest QTPB Graft Step 2: Prepare QTPB Graft Step 3: Create Tibial and Femoral Tunnels Step 4: Fix the Graft Rehabilitation Conclusion or Summary References Surgical Techniques of ACL Reconstruction, A. AM Portal Technique Abstract Introduction Re-physical Exam Under Anesthesia and Position Portal Formation Auto-hamstring Tendon Harvest and Graft Preparation Femoral Tunnel Preparation Tibial Tunnel Preparation Graft Passage and Fixation Discussion References Surgical Techniques of Anterior Cruciate Ligament (ACL) Reconstruction, C. Outside-in with Remnant Preservation Technique Abstract Introduction Theoretical Backgrounds of the Remnant Preservation Outside-in Technique for ACL Reconstruction Preparation of the Anatomic Femoral Tunnel Preparation of the Anatomic Tibial Tunnel Graft Passage and Fixation A Remnant of the ACL Preservation Advantages and Disadvantages of Outside-in Technique Clinical Outcomes of the Remnant Preservation Conclusion References The Role of Anterolateral Ligament Reconstruction in Anterior Instability Abstract Introduction History Anatomy and Histology Biomechanics and Function Injury Diagnosis Surgical Indication Surgical Techniques Post-operative Rehabilitation Biomechanics of ALL Reconstructions Clinical Results after ALLR Clinical Outcomes Graft Rupture Protective Effect on Medial Meniscal Repairs Return to Sport Post-operative Complications Conclusion References Revision Anterior Cruciate Ligament Reconstruction Abstract Introduction Cause of Failure Technical Failure Biologic Failure Traumatic Failure Examination and Imaging Preoperative Planning Choice of Graft and Fixation Tunnel Position and Tunnel Widening Limb Alignment Meniscus Status Associated Injuries Patient Positioning Surgical Technique Conclusion References Rehabilitation and Return to Sports After Anterior Cruciate Ligament Reconstruction Abstract Introduction Rehabilitation Range of Motion Weight Bearing Closed Kinetic Chain Exercise and Open Kinetic Chain Exercise Hamstring Exercise Functional Brace Step-by-Step Program Step 1 (0 to 3 Weeks) Step 2 (4 to 6 Weeks) Step 3 (7 to 12 Weeks) Step 4 (13 to 18 Weeks) Step 5 (19 to 24 Weeks) RTS Criteria Patient Reported Outcome Measures Instability Tests Muscle Strength Functional Performance Assessments Psychological Assessments (Fear of Re-Injury and Confidence) Conclusion References Anatomy and Function of the Posterior Cruciate Ligament Abstract Anatomy of the Posterior Cruciate Ligament The Function of the Posterior Cruciate Ligament References Posterior Cruciate Ligament Surgical Techniques Abstract Introduction Non-operative Treatment Operative Treatment Indications Techniques Graft Selection Author’s Preferred Technique Post-operative Care Complications Conclusion References Combined Injury—Posterolateral Rotational Injury Abstract Introduction Anatomy Preoperative Considerations Initial Evaluation Physical Examination Walking Inspection and Palpation Sensory and Circulation Test Anterior and Posterior Translation Test Dial Test Posterolateral External Rotation Test Reverse Pivot Shift Test External Rotation Recurvatum Test Radiographic Evaluation Operative Steps Surgical Indication Anatomical Posteriolateral Corner Reconstruction Anatomical Single Fibular Sling Technique Incision and Approach Tunnel Preparation Fixation of Grafts Rehabilitation Operative Risks and Complications Outcomes and Results References Meniscal Injury and Surgical Treatment: Meniscectomy and Meniscus Repair Abstract Clinical Evaluation Treatment Decision Nonoperative Treatment Operative Treatment Meniscectomy Indication Patient Position and Diagnostic Arthroscopy Arthroscopic Meniscectomy Techniques Outcomes of Meniscectomy Meniscus Repair Indication Arthroscopic Repair Techniques Inside-Out Technique Arthroscopic Inside-Out Technique for a Longitudinal Tear of Midbody and Posterior Horn of the Meniscus Outside-in Technique Arthroscopic Outside-in Technique for a Longitudinal Tear of the Anterior Horn of the Meniscus All Inside Technique Arthroscopic Technique for a Longitudinal Tear at the Posterior Horn of the Medial Meniscus in Red-Red Zone Arthroscopic All-Inside Technique Using the Fast-Fix 360® (Smith & Nephew, Andover, MA, USA) for a Longitudinal Tear of the Posterior Horn of the Lateral Meniscus (Fig. ) Repair for Specific Meniscus Tears Lateral Meniscus Popliteomeniscal Fascicles Tear Radial Tear Horizontal Tear in Young Patients Root Tear Biologic Augmentation for Meniscus Healing References Discoid Lateral Meniscus Abstract Incidence and Bilaterality Classification and Diagnosis Surgical Treatment Diagnostic Arthroscopic Examination Partial Central Meniscectomy Meniscus Suture Repair for Peripheral Tears The Modified Outside-In Technique for Tears from the Anterior Horn to the Posterolateral Corner The Modified All-Inside Technique for Posterior Horn Tears Postoperative Care Outcomes References Ramp Lesions Abstract Introduction Anatomy and Definition Classification Prevalence of Ramp Lesions in ACL Injuries Biomechanical Consequences Associated Factors Injury Mechanism Pre-arthroscopic Diagnosis Arthroscopic Diagnosis Treatment Rehabilitation Outcomes Conclusion References Root Tear: Epidemiology, Pathophysiology, and Prognosis Abstract Epidemiology Anatomy Function of Meniscus Roots Pathophysiology Prognosis References Root Tear: Surgical Treatment and Results Abstract Surgical Procedures of Repair of Medial Meniscus Posterior Root Tear Using Modified Mason-Allen Stitch Postoperative Rehabilitation Clinical Results of Root Repair Conclusions References Meniscus Allograft Transplantation—Basic Principle Abstract Introduction Biomechanics Indication Graft Sizing Graft Selection Surgical Technique Outcomes Rehabilitation Conclusions References Delayed Rehabilitation After Meniscal Allograft Transplantation Abstract Introduction Conventional Rehabilitation Range of Motion (ROM) Weight-Bearing Considerations During Open Kinetic Chain (OKC) Exercise Delayed Rehabilitation First Step (~3 Weeks) Second Step (4 ~ 6 Weeks) Third Step (7 ~ 12 Weeks) Fourth Step (13 Weeks~ ) Returning to Sports Activity References Meniscal Allograft Transplantation: Surgical Technique Abstract Introduction Indications Patient Evaluation Preoperative Planning and Meniscal Sizing Surgical Technique Surgical Team and Patient Positioning Medial MAT Graft Preparation Arthroscopic Portals and Surgical Exposure Meniscus Bed Preparation Socket Preparation Technical Pearl Graft Insertion Graft Fixation Lateral MAT Graft Preparation Arthroscopy and Meniscus Bed Preparation Tibial Trough Preparation Graft Insertion Graft Fixation MAT and Concomitant Procedures Rehabilitation Outcomes References Basic and Current Understanding of Articular Cartilage Abstract Introduction Composition Chondrocytes Extracellular Matrix Structure Biomechanics Articular Cartilage Injury Pure Cartilage Lesions Cartilage Lesions Involving Subchondral Bone Recovery from Impact Repair Cartilage Mechanical Effect on Cartilage Repair Conclusion or Summary References Cartilage Repair with Autogenous Cells Abstract Introduction Autologous Chondrocyte Implantation and Matrix-Assisted Autologous Chondrocyte Implantation Surgical Technique Postoperative Rehabilitation Discussion References Cartilage Repair with Collagen Gel (ACIC®: Autologous Collagen Induced Chondrogenesis) Abstract Introduction Patient Selection Preoperative Imaging Study Ideal Indication for ACIC Exclusion Criteria Atelocollagen and Fibrin Mixture Surgical Technique Arthroscopy Setup and Chondral Preparation Dry Up and CO2 Insufflation Injection of Atelocollagen Mixture Rehabilitation Post-operative Follow-up References General Concepts for Patellofemoral Instability Abstract Introduction Classification of Patellofemoral Instability Related Anatomy and Etiology Clinical History and Physical Examination Imaging Radiographs Computed Tomography (CT) Scans Magnetic Resonance Imaging (MRI) Treatment Nonoperative Treatment Surgical Treatment Summary References Surgical Reconstruction of the Medial Patellofemoral Ligament Abstract Anatomy and Biomechanics General Considerations Before Surgical Treatment Graft Preparation The Method Preferred by the Authors Clinical Outcome Summary References Basic Principles Including Ideal Targeting Point of High Tibial Osteotomy Abstract References Surgical Treatment and Overcoming Complications of High Tibial Osteotomy Abstract Surgical Technique of Open-Wedge HTO Preoperative Planning Diagnostic Arthroscopy Skin Incision Medial Collateral Ligament (MCL) Release Guide Pin Insertion Biplane Osteotomy Gap Opening Check the Mechanical Axis Plate Fixation Bone Graft Closure Rehabilitation Complications Lateral Hinge Fracture Increased Posterior Tibial Slope Angle (PTSA) Correction Error (Overcorrection, Under Correction) Joint Line Obliquity Popliteal Arterial Injury Infection Delayed Union or Nonunion Compartment Syndrome References Minimum Correction of High Tibial Osteotomy with Medial Meniscus Centralization Abstract Introduction Surgical Procedure Indications Preoperative Planning Surgical Technique Postoperative Rehabilitation Clinical Outcomes Discussion Summary References Distraction Arthroplasty for the Advanced OA Abstract Introduction Basic Research on Distraction Arthroplasty for Cartilage Defect of the Knee Surgical Procedures, Postoperative Rehabilitation, and Second-Look Arthroscopy Clinical Outcomes Future Perspective References This Book Provides Detailed Guidance On Knee Arthroscopy That Reflects The Very Latest Advances In This Ever-changing Field. Among The Techniques Covered Are Reconstruction Of The Anterior And Posterior Cruciate Ligaments, Meniscal Repair And Transplantation, Cartilage Repair By Means Of Osteochondral Allograft Transplantation And Autogenous Osteochondral Transfer, Medial Patellofemoral Ligament Reconstruction, And High Tibial Osteotomy. In Each Case, Clear Descriptions Of Technique Are Supported By A Wealth Of High-quality Illustrations, With Identification Of Potential Pitfalls And How To Avoid Them. In Addition, The Latest Knowledge Is Presented On Anatomy And Biomechanics. The Book Is Written By Recognized Experts In Sports Injuries And Knee Disorders. It Serves As An Up-to-date Reference For The Experienced Knee Surgeon And An Ideal Source Of Information For All Who Wish To Broaden Their Knowledge Of And Improve Their Skills In Knee Arthroscopy, Whether General Orthopaedists, Orthopaedic Trainees, Or Sports Medicine Physicians.