Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review

The purposes of this paper are to summarize the concepts relating to the use of a combined intra-articular and extra-articular reconstructive procedure in the arthroscopic treatment of a torn ACL and to review several operative techniques utilizing gracilis and semitendinosus tendons that are currently in use to treat this instability. The highly satisfactory results obtained over the time show that a combination of intra- and extra-articular procedures for ACL reconstruction is a valid surgical option

The local iron age pottery from selected strata at Tel Yin'am, eastern lower Galilee, Israel

Tel Yin’am and nearby Khirbet Beit Gan are the only excavated sites in the Yavne’el Valley, which constituted part of an ancient international highway that connected the hinterland of the Hauran (modern-day Syria) with the Mediterranean coast. As one of the few multi-occupational, small rural sites excavated in the Eastern Lower Galilee, Tel Yin’am, which was occupied intermittently from the Neolithic period to the Roman period (6500 BCE-325 CE), provides a critical link in the occupation history and material culture of northern (modern-day) Israel. Concentrating on critical selected Iron Age strata (1200-732 BC), this study focuses on the mostly unpublished domestic pottery assemblages, subjecting the various ceramic forms to classification and development analysis, and comparing them to contemporary pottery assemblages from proximate and distant, rural and urban sites in Cisjordan and Transjordan. Through diachronic and synchronic analyses, I succeeded in: 1) developing a picture of the ceramic history of domestic types at Tel Yin’am during the Iron Age; 2) providing both relative and absolute dates for this ceramic assemblage; 3) placing the assemblage into the broader ceramic context of the Iron Age in northern Cisjordan and Transjordan; 4) highlighting the important role of roads and ancient highways and how they impacted on the history of Tel Yin’am and its material culture in the Iron Age, thereby closing a gap in the knowledge of the history of rural life and culture in the Yavne’el Valley in the Iron Age; and 5) gaining an understanding of the approximately 500-year history of consistent and changing points of contact between Tel Yin’am and other sites that lay along the highways traversing the northern Lower Galilee.Middle Eastern Studie

Diagnosis and treatment of rotatory knee instability

BACKGROUND Rotatory knee instability is an abnormal, complex three-dimensional motion that can involve pathology of the anteromedial, anterolateral, posteromedial, and posterolateral ligaments, bony alignment, and menisci. To understand the abnormal joint kinematics in rotatory knee instability, a review of the anatomical structures and their graded role in maintaining rotational stability, the importance of concomitant pathologies, as well as the different components of the knee rotation motion will be presented. MAIN BODY The most common instability pattern, anterolateral rotatory knee instability in an anterior cruciate ligament (ACL)-deficient patient, will be discussed in detail. Although intra-articular ACL reconstruction is the gold standard treatment for ACL injury in physically active patients, in some cases current techniques may fail to restore native knee rotatory stability. The wide range of diagnostic options for rotatory knee instability including manual testing, different imaging modalities, static and dynamic measurement, and navigation is outlined. As numerous techniques of extra-articular tenodesis procedures have been described, performed in conjunction with ACL reconstruction, to restore anterolateral knee rotatory stability, a few of these techniques will be described in detail, and discuss the literature concerning their outcome. CONCLUSION In summary, the essence of reducing anterolateral rotatory knee instability begins and ends with a well-done, anatomic ACL reconstruction, which may be performed with consideration of extra-articular tenodesis in a select group of patients

ACL Reconstruction with Extra-articular Plasty

This practical and instructional guidebook, written by international experts in anterior cruciate ligament (ACL) reconstruction, covers all challenging aspects of ACL rupture in the acute and chronic setting. It covers the latest, spectacular anatomical findings, treatment of partial ACL tears, various techniques for single- and double-bundle ACL reconstruction, and complex ACL revision surgery. Important surgical steps are clearly described with the help of instructive, high-quality photographs. Important tips, tricks, and pitfalls are highlighted and intra- and postoperative complications, rehabilitation, and prevention of re-rupture are discussed. All authors are prominent and experienced ACL surgeons