The Finochietto Sign as a Pathognomonic Finding of Ramp Lesion of the Medial Meniscus

Ramp lesions are considered hidden injuries of the medial meniscus and are very difficult to diagnose. The Finochietto jump sign is a very specific finding that could be considered pathognomonic regarding ramp lesions. This sign consists of a sudden jerk that appears when the free edge of the posterior horn of the medial meniscus is dislocated anteriorly due to the medial condyle interposition when an anterior drawer test is performed on a knee with a ramp lesion, especially when it is associated with an anterior cruciate ligament tear. In this technical note, the Finochietto sign is described clinically, is correlated with its exploration under anesthesia, and is described for the first time under arthroscopic examination in the case of a ramp lesion, in which this finding can help to the diagnosis when present, especially when associated with anterior cruciate ligament tears

Anterior Cruciate Ligament Reconstruction Using Combined Graft of Hamstring and Fascia Lata With Extra-articular Tenodesis. A Technique in Case of Insufficient Hamstrings

A technique for augmentation of the anterior cruciate ligament (ACL) with hamstring graft and lateral extra-articular tenodesis is presented. The patient is positioned supine with the knee flexed 90°. First, intra-articular injuries are addressed arthroscopically, and then autologous hamstring tendons are harvested and measured; the present technique is a resource for cases with a very small graft diameter (less than 8 mm), due to thin tendons or to tendon breakage, even after tripling the hamstring graft, which is prepared using a facia lata strip long enough to fit the lengths of the femoral tunnel, the anterior cruciate ligament graft, and the tibial tunnel. A single femoral tunnel is performed and only 2 interference screws are needed for fixation

Physeal Sparing Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients Bridging the Tibial Physis With Two Divergent Tunnels

A technique for anterior cruciate ligament (ACL) reconstruction in patients with open physis is presented. The patient is positioned supine with the knee flexed 90°. After intraarticular injuries are addressed, an autologous hamstring graft is harvested and prepared using a suspension device attached in its expansion device. All-epiphyseal femoral and tibial tunnels of the same diameter of the graft are created; both of them are drilled in an outside-in direction, sparing the physis under radioscopic control. A second divergent tibial tunnel of the same diameter of the graft, distal to the physis, is created in an outside-in, mediolateral, and craniocaudal direction, leaving a 1-cm bone bridge between the 2 tibial tunnels. The graft is passed through the all-epiphyseal tunnels, from femoral to tibial, and pulled until the suspension device leans on the lateral femoral cortex. The graft is passed through the second divergent tibial tunnel and fixed in it with an interference screw to move the pressure away from the physis

“Over the Top” Augmentation for Partial Anterior Cruciate Ligament Tears Using Suspension Device for Tibial Fixation

A technique for augmentation of the partial anterior cruciate ligament is presented. The patient is positioned supine with the knee flexed 90°. After addressing intra-articular injuries, the autologous semitendinosus tendon is harvested and measured in a doubled manner; after that, the tibial tunnel is performed in the outside-in direction, of the same diameter of the doubled graft. Both ends of the graft are sutured together, after inserting it through the loop of a suspension device, which is attached in its augmentation piece. A lateral femoral incision is made, to approach the joint through the “over the top” position. A looped thread is introduced inside the joint with the aid of a hook. This thread pulls the graft's sutures through the “over the top” position. A femoral tunnel is then drilled in the lateromedial and caudocranial direction. The suspension device is attached to the anterior tibial cortex and the graft is pulled in the caudocranial direction to the femoral tunnel, where an interference screw is used for fixation