An Overview of Pediatric Knee Arthroscopy With Use of the NeedleScope

As sports-related injuries are becoming more common among children, there has been an increased need for knee arthroscopies in the pediatric population. Nevertheless, pediatric knee arthroscopy exposure is varied among orthopaedic surgeons, especially during residency training. There is a considerable difference in knee arthroscopy case volume between the adult and the pediatric population among orthopaedic residents. Although the fundamentals of adult knee arthroscopy have been well delineated, there is a paucity of literature surrounding basic pediatric knee arthroscopy. Our goal is to further explain the fundamentals needed to perform successful arthroscopic surgery in the pediatric knee. Through discussing proper patient positioning, instrumentation, including the utility of the 1.9-mm small-bore needle arthroscope (NanoScope; Arthrex, Naples, FL), subtle tips and tricks, as well as advantages and disadvantages of arthroscopy in children, this Technical Note along with the corresponding video are designed to help elucidate the intricacies of the pediatric knee. It will serve as educational material targeted to the resident trainee or any orthopaedic practitioner interested in gaining an introductory foundation to pediatric knee arthroscopy

Suture Tape Augmentation Repair of the Medial Patellofemoral Ligament

Adolescents with osteochondral loose bodies after a first-time patellar dislocation are most commonly treated with surgical intervention. However, the ideal method of managing a concurrent medial patellofemoral ligament (MPFL) disruption is still unknown. Recent evidence suggests high failure rates are associated with primary MPFL repair. The purpose of this Technical Note is to describe an alternative surgical technique for managing acute first-time patellar dislocations by using high-strength suture augmentation of the MPFL

Relaxation of the Medial Collateral Ligament to Facilitate Pediatric Meniscal Surgery

Meniscal injuries are becoming increasingly common in the pediatric population. During arthroscopic evaluation, pediatric patients typically have pristine articular cartilage and tight medial joint spaces. Therefore, when an arthroscope enters the medial compartment, iatrogenic damage to the articular cartilage may occur. Additionally, proper visualization of the medial meniscus (posterior horn or meniscocapsular junction) can prove to be difficult, and potential pathology may be missed. Proposed methods of increasing medial compartment visualization include the use of a 70° arthroscope placed through the intercondylar notch (Gillquist maneuver), creation of a posteromedial portal, or relaxation of the deep medial collateral ligament (MCL). Similar techniques have been described for use in adults for partial meniscectomy, but not in the pediatric population. The purpose of this Technical Note is to describe the steps to successfully perform the relaxation technique for meniscal repairs in pediatric patients, using an extra-articular outside-in percutaneous method

Comprehensive Arthroscopic Characterization of Discoid Meniscus Tears and Instability Using the PRiSM Discoid Meniscus Classification

The discoid meniscus is a congenital abnormality, with the vast majority occurring in the lateral meniscus. More commonly seen in pediatric populations, patients present with acute or chronic knee symptoms such as joint line pain, audible or palpable mechanical symptoms, and the inability to achieve terminal extension. The classic discoid classification system by Watanabe excludes anterior and horizontal instability and tearing that commonly occur with this pathology. A comprehensive classification, the Pediatric Research in Sports Medicine (PRiSM) Discoid Meniscus Classification, was developed to include these characteristics. To complement this classification system, we describe a complete arthroscopic examination of the discoid meniscus, assessing meniscal width, height, instability, and tearing. For thorough anterior assessment, the importance of medial portal viewing with lateral portal probing is highlighted. Assessment of the meniscus for tearing and instability should be performed before and after saucerization. Consistent use of a comprehensive classification system and a diagnostic arthroscopic exam will improve the understanding, treatment, and quality of research in the discoid meniscus

Detrimental Effects of Chlorhexidine on Articular Cartilage Viability, Matrix, and Mechanics.

BACKGROUND: Chlorhexidine gluconate (CHG) solution is commonly used as an antiseptic irrigation for bacterial decontamination during orthopaedic surgery. Although the chondrotoxicity of CHG on articular cartilage has been reported, the full extent of CHG-related chondrotoxicity and its effects on the extracellular matrix and mechanical properties are unknown. PURPOSE: To investigate the in vitro effects of a single 1-minute CHG exposure on the viability, biochemical content, and mechanics of native articular cartilage explants. STUDY DESIGN: Controlled laboratory study. METHODS: Articular cartilage explants (6 per group) were harvested from femoral condyles of the porcine stifle and sectioned at tidemark. Explants were bathed in CHG solution (0.05% CHG in sterile water) at varying concentrations (0% control, 0.01% CHG, and 0.05% CHG) for 1 minute, followed by complete phosphate-buffered saline wash and culture in chondrogenic medium. At 7 days after CHG exposure, cell viability, matrix content (collagen and glycosaminoglycan [GAG]), and compressive mechanical properties (creep indentation testing) were assessed. RESULTS: One-minute CHG exposure was chondrotoxic to explants, with both 0.05% CHG (2.6% ± 4.1%) and 0.01% CHG (76.3% ± 8.6%) causing a decrease in chondrocyte viability compared with controls (97.5% ± 0.6%; P < .001 for both). CHG exposure at either concentration had no significant effect on collagen content, while 0.05% CHG exposure led to a significant decrease in mean GAG per wet weight compared with the control group (2.6% ± 1.7% vs 5.2% ± 1.9%; P = .029). There was a corresponding weakening of mechanical properties in explants treated with 0.05% CHG compared with controls, with decreases in mean aggregate modulus (177.8 ± 90.1 kPa vs 280.8 ± 19.8 kPa; P < .029) and shear modulus (102.6 ± 56.5 kPa vs 167.9 ± 16.2 kPa; P < .020). CONCLUSION: One-minute exposure to CHG for articular cartilage explants led to dose-dependent decreases in chondrocyte viability, GAG content, and compressive mechanical properties. This raises concern for the risk of mechanical failure of the cartilage tissue after CHG exposure. CLINICAL RELEVANCE: Clinicians should be judicious regarding the use of CHG irrigation at these concentrations in the presence of native articular cartilage