Optimizing Posterior Condylar Offset and Joint Line Restoration in Revision Total Knee Arthroplasty Using a Contemporary Implant System
We present a variation of the standard operative technique for the Triathlon total stabilized revision knee system that aims to facilitate recreation of an anatomic joint line, and increase the posterior condylar offset through flexion and posterior translation of the femoral component using short cemented intramedullary stems. We illustrate the technique with a sequential single-surgeon series of 29 patients undergoing total stabilized revision total knee arthroplasty. Joint line ratio is maintained and posterior condylar offset ratio increased from preoperative to postoperatively. Patient reported outcome scores (Oxford ...
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Special Technical Article Source Type: research

Liposomal Bupivacaine: Market Penetration Versus Scientific Evidence: Only the Facts
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Letter to the Editor Source Type: research

Suture Anchor Repair of Quadriceps Tendon and Patellar Tendon Ruptures
Conclusions: Suture anchor repair of QT and PT ruptures results in full active extension and a low failure rate, but IKDC scores indicate continued functional deficits in most patients. Level of Evidence: Level IV—therapeutic. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

The Extensile Medial Parapatellar Approach to the Distal Femur and Knee: Anatomic Landmarks and Surgical Technique
This report describes a novel surgical approach and the relevant anatomy through a series of detailed clinical and fresh cadaveric dissections. A previously undescribed anatomic landmark is demonstrated through photographs and cadaveric variation studies, which may help guide the surgeon in defining crucial planes. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Subspine Impingement: Technique for Arthroscopic Decompression
The anterior inferior iliac spine (AIIS) is a newly recognized etiology of extra-articular hip impingement. The purpose of this article is to describe an arthroscopic technique for AIIS decompression causing extra-articular hip impingement. Arthroscopic decompression of subspine impingement is a novel procedure that can be used to successfully relieve hip pain and improve hip function and range of motion cause by AIIS impingement. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Sterile Adhesive Tape as an Isolation Device in Phalangeal Fracture Fixation
Phalangeal fractures are common injuries in the upper limb. Frequently, fluoroscopy is utilized to assist in the surgical management of these injuries. The use of sterile adhesive tape is a simple and cost-effective technique that minimizes radiation exposure. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

The Modified Anterolateral Approach to the Humerus
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

The Use of a Lacrimal Probe in Closed Catheter Irrigation of Pyogenic Flexor Tenosynovitis
Pyogenic flexor tenosynovitis is a destructive closed space infection of the flexor tendon sheath. Here, we describe an adjunct to its normal surgical treatment by ways of using a lacrimal probe. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

A Simple Technique to Improve the Accuracy of Plaster Molding in Metacarpal Neck Fractures
Metacarpal neck fractures are mostly reduced in A&E or in fracture clinic. Once the cast is applied a simple technique is described to locate the metacarpal head. On the uninjured hand, measurement is taken from the tip of corresponding finger to the metacarpal head. This measurement is transferred on to the cast for further reduction and moulding. This technique provides a reliable outcome. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Unhas Suture, A Novel Tendon Repair Technique: An In Vitro Experimental Study Comparing Unhas Suture and Bunnell Suture in Tensile Strength and Gap Formation
Conclusions: Unhas suture was proven to be able to resist gap forces either in initial gap or 2-mm gap compared with Bunnell suture Clinical Relevance: Unhas suture may be a reliable alternative in tendon repair that provides tensile strength, gapping resistance and also provide easiness which can be performed with conventional suture material and less operating time. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research

Health Care Economics of SI Joint Fusion
Increased interest in the sacroiliac joint (SIJ) as a contributor to chronic low back pain has resulted in an expanding set of surgical and nonsurgical treatment options. Evidence for the effectiveness of nonsurgical treatment is limited, impeding assessment of the overall value of such treatments. For surgical treatment, only triangular titanium implants, used during minimally invasive SIJ fusion, have been the subject of rigorous clinical and economic evaluations. Randomized trials of triangular titanium implants have shown marked immediate and sustained improvements in pain, disability, and quality of life with incremen...
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Navigating the Murk: Ethical and Practical Considerations for the Surgical Treatment of the Sacroiliac Joint Syndrome
The field of spine surgery has many controversies. The surgical treatment of the sacroiliac (SI) joint is, too, fraught with debate. The diagnosis of painful SI joints is currently limited to relief following “diagnostic” injections and pain generated from a suite of clinical maneuvers. Diagnoses of SI joint dysfunction are dependent entirely on patient-reported responses to provocative maneuvers and invasive procedures. There is a glaring lack of objective radiographic and objective physical examination findings for this syndrome. The evidence for treatment, and specifically for the surgical treatment of the S...
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

The Evidence for Sacroiliac Joint Surgery
Sacroiliac joint (SIJ) dysfunction is a condition that has a significant impact on patient’s quality of life. In the past, accurate diagnosis of this condition has proven difficult and even when diagnosed, effective treatments with acceptable morbidity have been lacking. Recently, the use of composites of various physical examination tests in conjunction with joint injections has proven capable of diagnosing the condition with acceptable degrees of sensitivity and specificity. In addition, the advent of minimally invasive techniques for the fusion of the SIJ now offer patients an effective treatment option with morbi...
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Clinical Diagnosis of Sacroiliac Joint Pain
There is a need to establish a standardized clinical examination, based on best available evidence, that identifies those patients with persistent back and buttock pain whose symptoms arise from the sacroiliac joint. This clinical examination is the first step in the selection of patients for controlled and guided diagnostic intra-articular block (the reference standard). This in turn is the prerequisite for selection of patients for minimally invasive therapies such as intra-articular steroid injection or for surgical fusion. The use of pain location and results from pain provocation tests is described within the context ...
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Anatomy and Biomechanics of the Sacroiliac Joint
Sacroiliac (SI) joint pain is a difficult problem that is becoming increasingly recognized for its contribution to low back pain. In certain circumstances it may present independently. However, in many scenarios the SI joint represents one of many factors contributing to axial back pain and its various referral patterns. Low back pain remains a significant burden on the health care system, accounting for ∼12 million physician office visits per year in the United States. It remains among the leading causes of disability, with expenditures in excess of $80 billion dollars every year. Surgical management of low back pain ...
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

The Sacroiliac Joint in 2019
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - May 22, 2019 Category: Orthopaedics Tags: Preface Source Type: research

Clinodactyly
describes an abnormal curvature of the digit in the coronal plane. A familial form of clinodactyly shows autosomal dominant inheritance with an incidence of 1% in healthy newborns. In syndromic populations, the incidence is much higher, especially in Down syndrome. The small finger is the most commonly involved digit and often the clinical finding is present bilaterally. Children are often brought to clinic for evaluation of the cosmetic difference. Most agree, that an angular deformity of (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - March 1, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

A Novel Anterior Approach to Pediatric Dysplastic Hip Surgeries
During surgery for developmental dysplasia of the hip, the anterior approach utilizing the Smith-Peterson interval between tensor fascia lata and sartorius is often used. Exploration of the deep acetabulum is sometimes difficult and cumbersome. We have devised a more direct approach to the hip that improves the exploration of the deep acetabulum by going medial to the sartorius between it and the iliacus. We have found this approach quite useful and easy to master without any added complication. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Early Surgical Treatment of High-grade Multiligamentous Knee Injuries
Conclusions: Open operative treatment within the first 3 weeks of injury with primary repair or reconstruction of all injured structures can yield outcomes similar to those reported in patients treated with delayed or staged reconstruction of ligaments. Early treatment allows definitive management of injuries that are difficult to address on a delayed basis. Complications of infection, revision because of laxity, and stiffness are uncommon with this approach. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Operative Technique: Autologous Impaction Bone Grafting With Uncemented Corail Stem in Primary Total Hip Arthroplasty
We describe a novel surgical technique utilizing the patient’s own femoral head as an autogenic source of cancellous bone graft, impacted into the proximal femoral metaphysis before implanting the stem, in order to improve the quality of bone envelope. This surgical technique is safe and simple to perform and may increase patient’s bone stock. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Cannulated System for Sequential Intramedullary Cement Extraction From Humerus During Revision Shoulder Arthroplasty
Removal of the cement mantle during revision shoulder arthroplasty is often challenging. Previous techniques utilizing a humeral window or split osteotomy have been described. These techniques can be technically challenging, put the patient at risk for nonunion or fracture, and require implants or sutures for fixation. Intramedullary techniques have been described including the use of specialized osteotomes or cement splitters as well as the use of ultrasonic cement extraction devices. However, concerns related to fracture and thermal damage to neurovascular structures remain a concern. Here we describe an intramedullary t...
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Interosseus Wiring of Distal Radius Fractures With Volar Comminution
This study describes the technique of interosseous wiring in a 75-year-old female patient with distal radius and ulnar fractures with subsequent volar locked plate placement. This technique provides an efficient and cost-effective tool to improve anatomic reduction, interfragmentary compression, and proper plate placement in distal radius fractures of this morphology. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Computer-assisted Surgery in Revision Total Knee Replacement: A Description of the Technique
We present a detailed description of our preoperative planning and operative technique, and results of our prospective case series. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Angling Technique for Removal of a Broken Cannulated Intramedullary Nail: A Technical Note
Removal of a broken nail from long bones remains a tricky situation to deal with. We are reporting a new method for retrieval of broken nails, which is technically less demanding than other methods described in the literature. Our method is similar to angling, which is a method of fishing by means of a fishhook. In this method the broken nail is hooked under image guidance and retrieved in a retrograde manner by a nail-hook made from stainless steel wire. It removes the nail noninvasively as no further exposure is required after removal of the proximal part of the nail by traditional methods. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

A Novel Technique for Exeter Stem Extraction
We describe a new technique for extraction of the Exeter V40 stem using the readily available Exeter offset broach handle. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Management of Infected Nonunited Femoral Fracture With Large Bone Defects: A Technique
Conclusions: Our method of treatment presents a new approach for management of one of the most complicated orthopedic problems ever. Our method is economic, and cost and time saving, consuming less time and materials needed for the operation. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research

Improving Value Delivery for Children With Congenital Hand Differences
Value is a measurement of the relative quality and cost of a product or service. High-quality and low-cost increase value. Understanding cost and outcomes in health care can help us understand how to improve value in congenital hand surgery. To do this, we need to better measure and track cost of this pediatric condition as well as quantify outcomes. Delivering care in high-volume centers with pediatric specialists and a multimodal team will improve value in congenital hand differences. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Clinodactyly
describes an abnormal curvature of the digit in the coronal plane. A familial form of clinodactyly shows autosomal dominant inheritance with an incidence of 1% in healthy newborns. In syndromic populations, the incidence is much higher, especially in Down syndrome. The small finger is the most commonly involved digit and often the clinical finding is present bilaterally. Children are often brought to clinic for evaluation of the cosmetic difference. Most agree, that an angular deformity of (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Syndactyly
refers to fusion, or webbing, of the digits. It is one of the more common congenital deformities of the hand. Syndactyly is classified as complete or incomplete, simple or complex. Complete syndactyly extends to the distal tip of the digit. Complex syndactyly refers to bone and/or nail involvement. Release of the fused digits is an option to improve the appearance of the hand and to prevent deformities (eg, clinodactyly and flexion contractures) in the growing hand. Hand function may improve as well, particularly if independent finger motion can be generated. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Symbrachydactyly: Assessing Indications for Operative Treatment
Symbrachydactyly is a congenital hand difference which is sporadic and generally unilateral that presents with shortened or absent central digits. The treatment of symbrachydactyly is multifaceted and optimized when opportunities to enhance innate ability through nonoperative interventions and surgical procedures are applied effectively. There is a significant, meaningful role for hand therapy, normalizing hand differences through hand camps or peer relationships, and, when appropriate, referral to mental health professionals. Surgical management is targeted at the associated features of symbrachydactyly including syndacty...
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Pediatric Forearm Deformity: Use of 3D Modeling to Guide Deformity Correction
Pediatric forearm deformity correction is one of many fundamental skills of practicing pediatric orthopedist. The etiology of forearm deformity can vary from congenital to traumatic. When residual posttraumatic forearm angulation exceeds 20 degrees, and rotational deformity is>30 degrees, an osteotomy may be indicated. Surgeons tasked with preoperative planning are limited by the 2-dimensional (2D) nature of radiographs. It becomes increasingly beneficial to have 3D information when surgical correction is mandated in multiple areas or critical locations such as the distal radioulnar joint or radial head. The purpose of ...
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Symposium Source Type: research

Congenital and Pediatric Upper Extremity Disorders
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - February 21, 2019 Category: Orthopaedics Tags: Preface Source Type: research

An Innovative Technique for Craniocaudal Pedicle Screw Guidance: A Technical Note
In spine surgery, pedicle screw instrumentation is being used very commonly. However, putting pedicle screws in the right place and direction needs the use of image intensifier in 2 orthogonal planes. This consumes valuable time while moving the image intensifier and operating table multiple times during the surgery and also excess radiation exposure. Here, we present a simple technique to apply surgical pearl to angulate the pedicle screws in cephalocaudal direction using simple instrument available on table. This may help in reducing the usage of image intensifier and expedite the procedure. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

The Use of Bladder Syringe for Cement Application in Total Knee Arthroplasty
There are various techniques of cement applications in total knee arthroplasty with a lack of clear consensus on best practice. The use of a bladder syringe as a reservoir and applicator of cement allows for minimal handling of the cement along with greater control and cost savings as compared with the manufacturer cement guns. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Intra-Operative Bone Stability Test
Fractures of the supercondylar humerus are the most common elbow fracture in pediatrics. Management of this injury would be aided if surgeons could reliably test fracture stability intraoperatively after pinning. A transverse supracondylar humerus fracture model was created using 3 adult cadaver upper-extremity specimens with an intact soft tissue envelope. Using the lateral entry technique, three 2.0 mm pins were then drilled using lateral entry technique to create an “A” pinning. Pins were checked in anteroposterior and lateral views with the C-arm to confirm accurate placement in both planes. The pinn...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Rotational Shortening of Collateral Ligament in TKR With Severe Deformity
This study presents a case series study of a new technique for ligament balancing wherein the collateral ligament is detached from its origin and rotated (twisted) around its longitudinal axis to tighten the ligament before the origin is reattached to its original position. The surgical technique for collateral ligament tightening during TKR was performed on 6 patients with a deformed knee caused by osteoarthritis and rheumatoid arthritis. The range of motion, knee society score, and laxity of the patients’ knee joint, after 7 months to 13 years of follow-up, were evaluated. The technique was successful, achieving go...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Biomechanical Comparison of Fifth Carpometacarpal Fusion Methods: Kirschner Wires Versus Plate and Screws
Conclusions: Fifth CMC fusion using either K-wires or plate and screws showed no significant difference in stiffness, peak load, and energy to peak load. These results suggest the 2 methods provide similar biomechanical stability. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Femoral Derotational Osteotomy Using a Modified Intramedullary Nail Technique
We report preliminary results of bilateral derotational osteotomy for excessive femoral anteversion or retroversion using the modified intramedullary nail technique. A retrospective review of 8 patients was performed. Patients were excluded if additional procedures were performed or if the femoral osteotomy included any deformity correction other than rotation. Each patient had simultaneous bilateral femoral osteotomies for a total of 16 limb segments to review. The average age was 12 years, with 4 boys and 4 girls in the group. Seven patients had a preoperative diagnosis of femoral anteversion, and 1 had femoral retrovers...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

“Channel Lines”: A Simple Surgical Technique to Aid in Achieving Patient-specific Ante-version During Implantation of Uncemented Acetabular Cups
Accurate acetabular cup placement is a crucial step for a successful total hip replacement. Transverse acetabular ligament is an important and reliable landmark that helps in determining the version during the placement of acetabular cups. However, the visualization of transverse acetabular ligament may not be easy as the view may be blocked by the implants and the instruments. We have devised a simple technique to aid in achieving patient-specific ante-version during implantation of uncemented acetabular cups by using “channel lines.” (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Hospital-based Patient-specific Templates for Total Knee Arthroplasty: A Proof of Concept Clinical Study
Conclusions: Hospital-based PST was feasible and it was facilitated by the introduction of desktop 3-dimensional printers. This technique was less expensive and more time saving than commercially available PSTs as well as the conventional TKA. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Special Technical Articles Source Type: research

Intraoperative Arthrographic Assessment of Ambiguous Neck of Femur Fractures in Patients With Chronic Kidney Disease
The loss of bone mineral density caused by Chronic Kidney Disease can make the delineation of a patient’s bony anatomy impossible during intra-operative fluoroscopy. This has the potential to increase the failure rate of implants used in the surgical treatment of neck of femur fractures due to sub-optimal placements. Intra-operative arthrograms add to the techniques available to a surgeon to achieve optimal implant placement without compromising the patient’s renal function nor increasing the radiation dose exposure to the surgical team. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Mini-open Repair of Achilles Tendon Rupture With the Patient in the Supine Position
Surgical repair of the Achilles tendon is a common procedure for acute Achilles tendon ruptures. Variations in surgical technique and patient positioning exist, with the ultimate goal of achieving a durable repair while minimizing complications. Recently the use of a mini-open approach has been demonstrated to provide a durable repair that is comparable to using a larger traditional open approach. In this paper we describe a mini-open approach for surgical repair of the Achilles tendon while the patient is in the supine position. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Tips and Pearls Source Type: research

Computer-assisted Patient-specific Prototype Template for Thoracolumbar Cortical Bone Trajectory Screw Placement: A Cadaveric Study
This study aims to evaluate the accuracy of patient-specific computed tomography (CT)-based rapid prototype drill guide templates for the CBT technique. CT scanning was performed in 7 cadaveric thoracolumbar spines, and a 3-dimensional reconstruction model was generated. By using computer software, we constructed drill templates that fit onto the posterior surface of thoracolumbar vertebrae with drill guides to match the CBT. In total, 80 guide templates from T11 to L5 were created from the computer models by using rapid prototyping. The drill templates were used to guide the drilling of CBT screws without any fluoroscopic...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Novel Research Methods and Models Source Type: research

Anterolateral Complex Reconstruction: Another Fad or Method to Improve ACL Outcomes?
Anterolateral rotational laxity of the knee is a persistent problem following anterior cruciate ligament reconstruction (ACLR) that can lead to increased rates of graft failure. Renewed interest in the anterolateral complex of the knee has led to a resurgence in the use of adjunctive techniques such as lateral extra-articular tenodesis and anterolateral ligament reconstruction. Use of these techniques can restore normal knee kinematics and potentially thereby reduce the rate of graft failure. Historically, experience with modified ACLR techniques such as the double-bundle ACLR have shown that improved biomechanics is not a...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Symposium Source Type: research

Clinical Results of Lateral Extra-Articular Tenodesis
In the anterior cruciate ligament (ACL) deficient knee, excellent outcomes are achieved in many patients with an isolated, intra-articular ACL reconstruction. Some patients, however, have ongoing instability or suffer graft rupture. Failure after ACL reconstruction is multifactorial, but residual anterolateral rotatory laxity is 1 potential contributing factor. Lateral extra-articular procedures are a heterogenous group of operations that were initially described as isolated treatments for the ACL deficient knee, and subsequently used in combination with intra-articular reconstructions. Initial observational studies were e...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Symposium Source Type: research

Clinical Outcomes After Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction
Background: Graft rupture rate, return to sport and persistent rotational instability remain a concern postoperatively following anterior cruciate ligament (ACL) reconstruction. The anterolateral ligament (ALL) has recently been shown to act as a lateral knee stabilizer that helps improve rotational stability. To improve functional and clinical outcomes, a combined ACL reconstruction with an associated ALL reconstruction has been proposed. Purpose: The main purpose of this study was to evaluate the clinical outcomes of the combined ACL and ALL reconstruction. Methods: A literature search in PubMed was performed and...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Symposium Source Type: research

The Anterolateral Ligament is Not the Whole Story: Reconsidering the Form and Function of the Anterolateral Knee and its Contribution to Rotatory Knee Instability
The heterogeneity of available cadaveric, histologic, and radiographic results related to the anterolateral ligament (ALL) does not support its existence as a discrete anatomic structure. Moreover, focusing narrowly on the ALL in isolation, what has previously been referred to as “ALL myopia,” obscures a thorough appreciation for the stability contributions of both capsular and extracapsular structures. We consider injury to the soft tissues of the anterolateral knee–the anterolateral complex—just one component of what is frequently found to be a spectrum of pathology observed in the rotationally un...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Symposium Source Type: research

An Overview of Clinically Relevant Biomechanics of the Anterolateral Structures of the Knee
Residual anterolateral rotatory laxity following injury and reconstruction of the anterior cruciate ligament (ACL) has become a popular topic and has generated interest in characterizing the relative contribution from the anterolateral structures of the knee. Studies have reported on the anatomic and biomechanical features of the anterolateral ligament (ALL), revealing a role in restraining internal tibial rotation in both ACL-intact and ACL-deficient knees. The Kaplan fibers of the iliotibial band have also been reported to provide significant restraint to internal tibial rotation. The ACL is the primary restraint to ante...
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Symposium Source Type: research

An Overview of Anatomy and Imaging of the Anterolateral Structures of the Knee
Despite several previous articles in the literature, never before have so many studies with regard to anterolateral knee structures been performed. The anterolateral knee complex consists briefly of the iliotibial band, with its proximal and distal attachments, the joint capsule, and the anterolateral ligament (ALL). The recently introduced ALL has several different descriptions, making it difficult to build a consensus with regard to its anatomy. An extensive description of these structures, particularly the iliotibial band and the ALL, with regard to anatomy and imaging, will be provided in this article. (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Symposium Source Type: research

The Anterolateral Complex: More than Just One Ligament …
No abstract available (Source: Techniques in Orthopaedics)
Source: Techniques in Orthopaedics - November 17, 2018 Category: Orthopaedics Tags: Preface Source Type: research