Lateral Capsular Fixation : An Implant-Free Technique to Prevent Meniscal Allograft Extrusion

Although several surgical techniques have been described to perform meniscal allograft transplantation with good clinical results and although different methods of capsular stabilization can be found in the literature, there is no standard surgical technique to prevent a common complication in the most of series: the tendency to a radial displacement or extrusion of the transplanted menisci. We present a simple, reproducible, and implant-free technique to perform a lateral capsular fixation (capsulodesis) at the time of only the soft-tissue fixation technique of meniscal allograft transplantation in an effort to reduce or prevent the risk of graft extrusion. Using a minimum of two 2.4-mm tunnels drilled from the contralateral side of the tibia with the help of a regular tibial anterior cruciate ligament guide, a capsular attachment to the lateral tibial plateau is obtained

Open-Wedge Valgus High Tibial Osteotomy Technique With Inverted L-Shaped Configuration

High tibial osteotomy (HTO) is a useful alternative in the treatment of symptomatic varus malalignment. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. On the other hand, patella baja often causes anterior knee pain and, over time, may favor degeneration of the patellofemoral joint. The aim of this study is to describe a technical modification of the standard open-wedge HTO. It consists of a double inverted L-shaped cut, which includes the anterior tibial tuberosity in the proximal fragment, to avoid any alteration of patellar height and control the eventual increase of the posterior tibial slope

Patellar Tendon Lengthening: Rescue Procedure for Patella Baja

Patella baja is a challenging pathologic condition that causes pain and functional restrictions and can even lead to premature osteoarthritis—even more so in cases of patella infera or cases associated with degeneration of the patellar tendon in which simple conservative treatment frequently is not resolutive. Several surgical options have been described for symptomatic patella baja: excision of the lower third of the patella, lengthening of the patellar tendon, reconstruction of the patellar tendon with allograft, and proximalization of the tibial tubercle. A combination of 2 or more of these treatments may be recommended in cases of significant patella baja. We present a simple and reproducible technique to address patella baja that combines a partial transposition of the tibial tubercle and patellar tendon lengthening using a subperiosteal patellar flap in continuity with the patellar tendon

Capsular fixation limits graft extrusion in lateral meniscal allograft transplantation

Purpose: The main purpose of this investigation was to compare the amount of graft extrusion of lateral meniscal allograft transplantation (MAT) performed with a suture-only technique with or without a capsulodesis. Secondarily, the assessment of functional results was also covered. We hypothesized that capsular fixation reduces the post-operative degree of allograft extrusion and it does not affect the functional outcomes during the short-term follow-up period studied. Methods: Prospective series of 29 lateral MAT. Fifteen were fixed with a suture-only technique (group A). The remaining 14 cases (group B) also included arthroscopic lateral capsular fixation (capsulodesis). Functional results were assessed with Lysholm, Tegner, and VAS for pain. Magnetic resonance imaging (MRI) was performed to determine the degree of meniscal extrusion. Millimeters of extrusion and percentage of extruded meniscal tissue were calculated for both groups. The degree of extrusion was considered minor if it was 3 mm. Results: Group A had 11 cases (73.3%) of major extrusion and group B had 4 cases (28.6%) (p = 0.02). The percentage of extruded meniscal tissue was 35% in group A and 24.6% in group B (p = 0.04). At a mean 3.4 years (range 1-4) post-operatively, the Lysholm score had a mean 89.60 ± 6.93 and 91.43 ± 6.19 points in groups A and B, respectively (p < 0.001). The median follow-up Tegner score improved from 4 (range 3-5) to 7 (range 6-9) in group A (p < 0.001) and from 4 (range 3-5) to 7 (range 6-8) in group B (p < 0.001). VAS dropped 5 and 7.3 points in groups A and B, respectively (p < 0.001). There were no complications in this series. Conclusions: In lateral MAT with the suture-only fixation technique, the described capsulodesis minimized meniscal extrusion. In terms of functional results, there were no differences between the groups at a mean 3.4-year follow-up