Medial Patellofemoral Ligament Repair With Suture Tape Augmentation

The medial patellofemoral ligament (MPFL) is the main restraining force in the first 20° of flexion against lateral patellar displacement and is disrupted after patellar subluxation or dislocation. MPFL reconstruction is frequently performed when conservative management fails and the patient has recurrent patellar dislocations. However, a variety of complications have been reported in the literature with this procedure. Internal bracing with suture tape augmentation encourages healing and allows early mobilization. This article describes, with video illustration, MPFL repair with suture tape augmentation

Anterior Cruciate Ligament Repair Using Independent Suture Tape Reinforcement

Recently there has been renewed interest in primary repair of the anterior cruciate ligament (ACL). Repair of the acute proximal ruptured ACL can be achieved with the independent suture tape reinforcement ACL repair technique. The independent suture tape reinforcement technique reinforces the ligament as a secondary stabilizer, encouraging natural healing of the ligament by protecting it during the healing phase and supporting early mobilization. The purpose of this article is to describe, with video illustration, this ACL repair technique

Anterolateral Ligament Repair With Suture Tape Augmentation

Recent insights into the structure and function of the anterolateral ligament (ALL) of the knee has resulted in a recognition of its contribution in rotational control of the knee. Several ALL reconstruction techniques have been described in the literature. This article describes, with video illustration, a percutaneous repair technique using suture tape augmentation. A tendon graft is not needed. This technique allows early mobilization and encourages natural healing of the ligament by protecting the ligament during the healing phase as a secondary stabilizer

Posterolateral Corner Repair With Suture Tape Augmentation

The posterolateral corner (PLC) of the knee is the main restraint to varus forces of the knee as well as posterolateral rotation of the tibia relative to the femur. Primary PLC repairs have been associated with a high failure rate in past literature. However, with modern improved arthroscopic instrumentation and devices, there has been a renewed interest in repair of the ligaments around the knee. Internal bracing with suture tape augmentation encourages healing and allows early mobilization. This article describes, with video illustration, PLC repair with suture tape augmentation

ACL Repair: A Game Changer or Will History Repeat Itself? A Critical Appraisal

Until the past decade the common thought was that the anterior cruciate ligament (ACL) was not able to heal and restore knee stability. In this manuscript a brief review of studies of the developers and the early adaptors of four different modern ACL repair techniques are presented. The present status and considerations for the future of ACL repair and its research are shared. After promising short- to midterm ACL healing results by the developers, the results of the early adaptors show more variety in terms of rerupture and reintervention for other reasons. Risk factors for failure are a young age, high preinjury sports activity level, midsubstance ruptures and impaired integrity of the ACL bundles and the synovial sheath. There is a call for more clinical data and randomized clinical trials. Conclusion: an important finding of the past decade is that the ACL is able to heal and subsequently restabilize the knee. Patient selection is emphasized: the ideal patient is a non-high athlete older than 25 and has an acute proximal one bundle ACL rupture. Further research will have to show if ACL repair could be a game changer or if history will repeat itself

Posterior cruciate ligament repair seems safe with low failure rates but more high level evidence is needed: a systematic review

Abstract Purpose To discuss recent literature on posterior cruciate ligament (PCL) repair and report on the clinical and radiological outcomes. Methods A systematic review was conducted according to the PRISMA guidelines. In August 2022, three databases (PubMed, Scopus, and Cochrane Library) were searched for studies on PCL repair by two independent reviewers. Articles published between January 2000 and August 2022 focussing on the clinical and/or radiological outcomes, following PCL repair, were included. Patient demographic data, clinical evaluations, patient‑reported outcome measures, post‐operative complications and radiological outcomes were extracted. Results Nine studies met the inclusion criteria, covering 226 patients with a mean age ranging from 22.4 to 38.8 years and mean follow‐up periods ranging from 14 to 78.6 months. Seven studies (77.8%) were level IV and two studies (22.2%) were level III. Arthroscopic PCL repair was performed in four studies (44.4%) while the remaining five studies (55.6%) described open PCL repair. In four studies (44.4%) additional suture augmentation was applied. Arthrofibrosis affected a combined total of 24 patients (11.7%; range 0–21.0%) making it the most common complication and the overall failure rate was 5.6%, ranging from 0 to 15.8%. Two studies (22.2%) performed post‐operative MRI and confirmed PCL healing. Conclusion This systematic review indicates that PCL repair can be a safe procedure with an overall failure rate of 5.6%, ranging from 0% to 15.8%. However, more high quality research is necessary before widespread clinical implementation is warranted. Level of Evidence IV

Additional file 1 of Posterior cruciate ligament repair seems safe with low failure rates but more high level evidence is needed: a systematic review

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Joint distraction using a purpose-built device for knee osteoarthritis: a prospective 2-year follow-up

Objective Knee distraction treatment for end-stage osteoarthritis successfully postpones arthroplasty for years. Studies performed thus far used general intended use, patient-personalised or custom-made devices. In this study, for the first time, a device specifically designed for knee distraction is evaluated.Design 65 patients (≤65 years) with end-stage knee osteoarthritis indicated for arthroplasty received knee distraction. Before, 1-year and 2-year post-treatment, questionnaires were filled out and knee radiographs made. Adverse events and self-reported pain medication were registered.Results Forty-nine patients completed 2-year follow-up: one patient did not complete treatment, three patients received arthroplasty in the first and four patients in the second year follow-up. Eight patients were lost to follow-up in the second year. The total Western Ontario and McMaster Universities Osteoarthritis Index score showed a clinically relevant improvement at 1 and 2 years (+26 and +24 points), as did all subscales (all p<0.001). The minimum radiographic joint space width improved over 1 (+0.5 mm; p<0.001) and 2 (+0.4 mm; p=0.015) years, as did the physical Short-Form 36 (+10 points; p<0.001). The most common adverse event was pin tract infection, experienced by 66% of patients, in 88% successfully treated with oral antibiotics. In two cases, hospitalisation and/or intravenous antibiotics were needed. Eight patients experienced device-related complications. None of the complications influenced 2-year outcomes. Before treatment, 42% of patients used pain medication, which had nearly been halved 1 (23%; p=0.02) and 2 years (29%; p=0.27) post-treatment.Conclusions Patients treated with a general applicable, for knee distraction purpose-built device showed, despite adverse events, significant clinical and structural improvement over 2 years.Trial registration number NL7986