Advances in Knee Ligament and Knee Preservation Surgery

Foreword
Preface
Contents
1: Who Needs ACL Surgery?
1.1 Sequelae of Nonoperative Management of Acute ACL Injury
1.1.1 Nonoperative Management Techniques
1.1.2 Biological Perspective
1.1.3 Clinical Perspective
1.2 Return to Sport Following ACL Injury
1.3 Patient Stratification
1.4 Pediatric and Adolescent
1.5 Young Adult (<40 Years)
1.6 Older Adult (>40 Years)
1.7 Summary
References
2: Patient-Specific Graft Choice in Primary ACL Reconstruction
2.1 Introduction
2.2 Outcome with Bone Patella Tendon Bone Autografts
2.3 Outcome with Hamstring Grafts
2.4 Outcome with Quadriceps Autograft
2.5 Outcome with Allograft
2.6 Comparison of Graft Types Regarding Outcome
2.7 ACL Graft Choice and Age
2.8 Graft Consideration in Relation to Gender
2.9 Graft Choice and Sports Activity
2.9.1 Pivoting Sports
2.9.2 Recreational Sports
2.10 Graft Choice and Concomitant Injuries
2.11 Conclusion
References
3: Assessment of Risk Factors for Failure of ACLR: When to Address Concomitant Pathology
3.1 Introduction
3.2 Patient Risk Factors
3.2.1 Sex
3.2.2 Age
3.2.3 Neuromuscular Factors
3.2.4 Anatomical Abnormalities
3.2.5 Body Mass Index
3.2.6 Smoking
3.3 Concomitant Pathologies
3.3.1 Anterolateral Ligament Complex
3.3.2 Posteromedial Ligament Complex
3.3.3 Posterolateral Corner
3.3.4 Posterior Cruciate Ligament
3.3.4.1 Menisci
3.3.4.2 Ramp Lesions
3.3.5 Cartilage
3.4 Conclusions
References
4: Technique Corner: ACLR Optimal Tunnel Placement: How to Get There?
4.1 Introduction
4.2 Key Issues for Anatomical ACL Reconstruction
4.3 Anatomical Bony Landmarks for the Attachment Areas
4.3.1 Femoral Attachment Area
4.3.2 Tibial Attachment Area
4.4 Arthroscopic Delineation of the Attachment Areas Based on the Bony Landmark Strategy
4.4.1 Three Portal Technique
4.4.2 Femoral Attachment Area
4.4.3 Tibial Attachment Area
4.5 Creation of Anatomical Tunnels
4.6 Impingement-Free Grafting
References
5: Evidenced-Based Approach for Anterolateral Surgery for ACL Reconstruction
5.1 Background
5.2 Anatomy
5.3 Biomechanics
5.4 Clinical Evidence: An Historical Perspective
5.5 Clinical Evidence: The Current Concepts
5.6 Indications and Surgical Technique
5.7 Conclusion
References
6: Why Does LET Work?
6.1 Introduction
6.2 Biomechanics
6.3 Clinical Studies
6.4 Conclusions
References
7: The Evidence Regarding ACL Repair
7.1 ACL Repair: Last Millennium and Current Status
7.1.1 Historical Pearls
7.1.2 Shift of Focus: Repair Re-invented?
7.2 What Has Changed?
7.2.1 Techniques: What’s New?
7.3 Did We Miss Something?
7.3.1 Tear Site: What’s the Evidence?
7.3.2 Proximal Tears: Historical Literature (→ 1990)
7.3.3 Proximal Tears: Modern Literature (1991 →)
7.3.3.1 Internal Brace
7.3.3.2 Ligamys
7.3.3.3 BEAR Implant
7.3.3.4 Suture-Anchor Technique
7.4 Possible Advantages with ACL Suture Repair
7.5 Future Studies
7.6 Conclusions
References
8: Laxity Objective Measurement Within MRI of ACL Lesions
8.1 Laxity Versus Instability
8.2 Measurement of Joint Laxity
8.3 Clinical Examination Combined with Laximetry and Imaging
8.4 Joint Laxity After Single ACL or Combined with Other Anterolateral Structures Injury
8.5 Partial ACL Tears: MRI Diagnosis, Instrumented Joint Laxity Discrimination and Assessment of Biomechanical Competence
8.6 Post-operative Knee Joint Laxity
8.7 MRI Instrumented-Assessment of Knee Joint Laxity
8.8 Conclusions
References
9: Return to Sport After Anterior Cruciate Ligament Reconstruction: Criteria-Based Rehabilitation and Return to Sport Testing
9.1 Introduction
9.2 Return to Sport Rates and Factors that Influence Return to Sport
9.3 Return to Sport and Second ACL Injury
9.4 When Should Athletes Return to Sport?
9.5 Criteria-Based Rehabilitation
9.6 Return to Sport Testing
9.6.1 Return to Sport Testing for Making a Safe Return to Play
9.6.2 The Psychological Aspect
9.7 Conclusions
References
10: Revision ACL Reconstruction
10.1 Introduction
10.1.1 Background
10.1.2 Factors Contributing to Failure
10.2 Preoperative Workup
10.2.1 History and Physical Exam
10.2.2 Imaging Studies
10.3 Surgical Planning
10.3.1 Type 1A
10.3.2 Type 1B
10.3.3 Type 2
10.3.4 Graft Choice
10.3.5 Additional Considerations
10.4 Conclusion
References
11: Complications of ACL Reconstruction
11.1 Introduction
11.2 General Complications
11.2.1 Infection
11.2.2 Arthrofibrosis
11.2.3 Thromboembolic Events
11.2.4 Recurrent Postoperative Hemarthrosis
11.3 Complications Related to Autograft Harvest
11.3.1 Bone-Patella Tendon-Bone Autograft-Related Complications
11.3.2 Hamstrings Autograft-Related Complications
11.3.2.1 Sensory Nerve Injury
11.3.2.2 Hamstring Retraction and Persistent Cramps
11.3.2.3 Persistent Hamstrings Weakness
11.3.2.4 Medial Side Laxity
11.3.3 Quadriceps Autograft-Related Complications
11.4 Other Complications
11.4.1 Recurrence of Anterior Laxity
11.4.2 Hardware Failure
11.4.3 Tunnel Widening
11.5 Summary
References
12: Osteotomy: Slope Change Tibial Osteotomy to Address ACL Deficiency
12.1 Introduction
12.2 Biomechanics
12.3 Measurement
12.4 Clinical Application
12.5 Indications and Contraindications
12.6 Preoperative Planning
12.7 Surgical Technique
12.8 Postoperative Rehabilitation
12.9 Conclusions
References
13: Biologics: Post-traumatic Osteoarthritis Following Anterior Cruciate Ligament Reconstruction
13.1 Introduction
13.2 Platelet-Rich Plasma (PRP)
13.2.1 Preparation and Administration
13.2.2 Outcomes
13.3 Hyaluronic Acid (HA)
13.3.1 Preparation and Administration
13.3.2 Outcomes
13.4 Intra-Articular Corticosteroid Injection
13.4.1 Preparation and Administration
13.4.2 Outcomes
13.5 Medicinal Signaling Cells
13.5.1 Preparation and Administration
13.5.2 Outcomes
13.6 Amniotic Suspension Allografts (ASA)
13.6.1 Preparation and Administration
13.6.2 Outcomes
13.7 Monoclonal Antibodies
13.7.1 Preparation and Administration
13.7.2 Outcomes
13.8 Conclusion
Summary Table
References
14: Assessment of the Multiligament Knee
14.1 Physical Examination
14.1.1 Acute Assessment of Multiligament Knee
14.1.1.1 Inspection
14.1.1.2 Palpation
14.1.2 Vascular Assessment
14.1.3 Neurologic Assessment
14.1.4 Clinical Exam and Special Tests
14.1.5 Anterior Cruciate Ligament
14.1.6 Posterior Cruciate Ligament
14.1.7 Collateral Ligaments
14.1.8 Posterolateral and Posteromedial Corner Injuries
14.2 Chronic Presentation of Multiligament Knee
14.3 Imaging of MLKI
14.3.1 Plain Radiographs
14.3.2 Stress Radiographs
14.3.3 Computed Tomography (CT)
14.3.4 Magnetic Resonance Imaging (MRI)
14.4 Controversies in the Treatment of MLKI
14.4.1 Early Versus Late Ligament Reconstruction
14.4.2 Ligament Repair Versus Reconstruction
14.4.3 Rehabilitation After MLKIs
References
15: When Do You Need to Reconstruct the Posterior Cruciate Ligament?
15.1 Introduction
15.2 Clinical and Kinematic Consequences
15.2.1 Clinical Consequences
15.2.2 Kinematic Consequences
15.3 Management
15.3.1 Acute Isolated PCL Tears
15.3.1.1 Surgical Technique
PCL Repair
PCL Reconstruction
15.3.1.2 Results of Surgery
15.3.2 Acute PCL Avulsion Fracture
15.3.3 Acute PCL Injuries in the Context of a Combined Ligament Injury
15.3.3.1 Combined Ligament Injury with No Vascular Injury
15.3.3.2 Combined Ligament Injury with a Vascular Injury
15.3.4 Chronic PCL Injuries
15.4 Conclusion
References
16: Technique Corner: Posterior Cruciate Ligament Injuries
16.1 Introduction
16.2 Anatomy/Biomechanics of the PCL
16.3 Clinical Presentation
16.4 Imaging
16.5 Treatment
16.5.1 Nonoperative Management
16.5.1.1 Nonoperative Treatment Protocol
16.5.2 Operative Management
16.5.2.1 Isometric vs Anatomic PCL-R Techniques
16.5.2.2 Transtibial Tunnel vs Tibial-Inlay PCL-R Techniques
16.5.2.3 Double-Bundle PCL-R
16.5.2.4 Graft Options
16.5.2.5 Complications
16.5.2.6 Surgical Outcomes
16.5.2.7 Author’s Preferred Technique
16.5.2.8 Postoperative Rehabilitation (Table 16.1)
16.6 Summary
References
17: Technique Corner: Posterolateral Corner Reconstruction
17.1 Introduction
17.2 Surgical Indications
17.3 Surgical Technique
17.3.1 Surgical Approach
17.3.2 Graft Preparation
17.3.3 Associated Pathology
17.3.4 Reconstruction Tunnels and Graft Passage
17.4 Rehabilitation Protocol
17.5 Surgical Outcomes
17.6 Complications
17.7 Conclusions
References
18: Technique Corner: MCL
18.1 Anatomy and Function
18.2 Mechanism of Injury and Clinical Presentation
18.3 Diagnosis and Imaging
18.3.1 Conservative Management
18.3.2 Operative Treatment
18.4 Authors’ Preferred Operative Treatment
18.4.1 Anatomic Reconstruction, Double Bundle
18.4.2 Anatomic Augmented Surgical Repair with Semitendinosus Tendon Autograft
18.4.3 Staged Surgical Management
18.5 Other Surgical Options
18.5.1 MCL Repair
18.5.2 Non-anatomic Reconstruction
18.6 Rehabilitation
18.7 Outcomes
18.8 Management in Concomitant Cruciate Injury
18.9 Conclusion
References
19: Fracture Dislocations About the Knee
19.1 Intra-articular Proximal Tibia and Distal Femur Fracture/Dislocations
19.1.1 Background and Mechanism of Injury
19.1.2 Clinical Presentation and Diagnostics
19.1.3 Management Options and Evidence-Based Outcomes
19.1.4 Case Presentation
19.1.4.1 Clinical Decision-Making
19.1.4.2 Intraoperative Findings
19.1.4.3 Outcome
19.1.5 Case Presentation
19.1.5.1 Clinical Decision-Making
19.1.5.2 Intraoperative Findings
19.1.5.3 Outcome
19.2 Acute Proximal Tibiofibular Injuries
19.2.1 Background and Mechanism of Injury
19.2.2 Clinical Presentation and Diagnostics
19.2.3 Management Options and Evidence-Based Outcomes
19.2.3.1 Non-operative Management
19.2.3.2 Operative Management
19.2.4 Case Presentation
19.3 Patellar Dislocation with Associated Osteochondral Fractures
19.3.1 Background and Mechanism of Injury
19.3.2 Clinical Presentation and Diagnostics
19.3.3 Management Options and Evidence-Based Outcomes
19.3.4 Case Presentation
19.3.4.1 Intraoperative Findings
19.3.4.2 Outcome
19.4 Tibia Physeal Fractures of the Knee in the Paediatric Population
19.4.1 Proximal Tibia Physeal Fractures
19.4.1.1 Background and Mechanism of Injury
19.4.1.2 Clinical Presentation and Diagnostics
19.4.1.3 Management Options and Evidence-Based Outcomes
19.4.2 Tibial Tubercle Fractures
19.4.2.1 Background and Mechanism of Injury
19.4.2.2 Clinical Presentation and Diagnostics
19.4.2.3 Management Options and Evidence-Based Outcomes
19.4.2.4 Case Presentation
19.4.2.5 Intraoperative Findings
References
20: Advances in Treating Arthrofibrosis
20.1 Introduction
20.2 Sulfasalazine
20.3 Rosiglitazone
20.4 Celecoxib
20.5 Recombinant Antibodies
20.6 Relaxin-2
20.7 Interleukin-1 Antagonist
20.8 Bevacizumab
20.9 Fosaprepitant
20.10 Artesunate
20.11 Extracorporeal Shock Wave Therapy
References
21: A View of Predisposing Factors by Novel 3D Imaging Techniques for the PF Joint
21.1 Limitation of Conventional Indicators for Predisposing Factors
21.2 Method of Creating a 3D Knee Computer Model and the Coordinate System
21.3 New References for New Indicators in the 3D Space (the Anatomical Coordinate System)
21.3.1 The Mid-Sagittal Plane
21.3.2 The Femoral Condylar Planes (FCPs) or the Femoral Trochlear Planes (FTPs)
21.4 A New View of Predisposing Factors According to the New Indicators in the 3D Space
21.4.1 Patella Alta
21.4.2 Lateral Shift of the Tibial Tubercle
21.4.3 Patellar Shift and Tilt
21.4.4 Classification of Patellar Tracking
21.4.5 Morphology of the Trochlea
21.5 Summary
References
22: MPFL Reconstruction and Patellofemoral Chondral Status
22.1 Medial Patellofemoral Ligament Reconstruction
22.1.1 History
22.1.2 Anatomy
22.1.3 Repair or Reconstruction
22.2 Chondral Damage After Patellar Dislocation
22.2.1 Osteochondral Fracture
22.2.2 Articular Cartilage Damage
22.3 Conventional Surgical Procedure and Prevention of PFOA
22.4 MPFL Reconstruction and PF Chondral Status
22.5 Summary
References
23: Osteotomy: Coronal and Axial Plane Deformity
23.1 Introduction
23.2 Limb Alignment and Preoperative Planning
23.3 Varus Malalignment
23.3.1 Medial Opening High Tibial Osteotomy (HTO)
23.3.1.1 Surgical Technique
23.3.1.2 Postoperative Management
23.3.1.3 Results
23.3.2 Lateral Closing HTO
23.3.2.1 Surgical Technique
23.3.2.2 Postoperative Management
23.3.2.3 Results
23.3.2.4 Complications
23.4 Valgus Malalignment
23.4.1 Medial Closing Distal Femoral Osteotomy (DFO)
23.4.1.1 Surgical Technique
23.4.1.2 Postoperative Management
23.4.1.3 Results
23.4.2 Lateral Opening DFO
23.4.2.1 Surgical Technique
23.4.2.2 Postoperative Management
23.4.2.3 Results
23.4.2.4 Complications
23.5 Torsional Deformities
23.5.1 Femoral Rotational Osteotomy
23.5.1.1 Surgical Technique
23.5.1.2 Postoperative Management
23.5.1.3 Results
23.5.2 Tibial Rotational Osteotomy
23.5.2.1 Surgical Technique
23.5.2.2 Postoperative Management
23.5.2.3 Results
23.5.2.4 Complications
23.6 Take Home Message
References
24: Patient-Specific Instrumentation and 3-D Osteotomy
24.1 Introduction
24.2 Osteotomy Planning
24.3 3-D Printing of PSI: Materials and Equipment
24.4 PSI Techniques and Accuracy
24.5 PSI Technique of the Authors
24.5.1 3-D Planning
24.5.2 Surgical Technique for MOW-HTO
24.5.3 Accuracy Outcome
24.6 General Factors to Consider in 3-D Planning and PSI Osteotomy
24.7 Conclusion
References
25: Save the Meniscus: Advances in Meniscal Repair Techniques
25.1 Introduction
25.2 Anatomical, Physiological and Biomechanical Considerations on Meniscus Regeneration Capacity
25.3 Meniscus Reconstruction Improves the Knee Function in Long-Term
25.4 Prevention of Osteoarthritis by Meniscus Suturing in Long Term
25.5 Higher Revision Rate after Meniscus Suture Compared to Partial Meniscectomy
25.6 Stimulation of the Regenerative Potential of the Meniscus Tissue
25.7 Potential Ways for Meniscus Healing Enhancement by Suture Augmentation
25.7.1 Augmentation of Meniscus Suture with Bioactive Substances/Growth Factors
25.7.2 Augmentation of Meniscus Suture with Mesenchymal Stem Cells
25.8 Conclusion
References
26: Meniscus Root Tears
26.1 Introduction
26.2 Anatomy and Function
26.3 Biomechanical Effects of Meniscal Root Tears
26.4 Diagnosis of Meniscal Root Tears
26.4.1 Clinical Presentation
26.4.2 Imaging
26.5 Clinical Results of Root Repair
26.6 Options of Surgical Procedures of Root Repair
26.6.1 Transtibial Pullout Repair Versus suture Anchor Repair
26.6.2 Anterior Portal Versus Posterior Portal
26.6.3 Non-locking Versus Locking Mechanism Sutures
26.6.4 Non-absorbable Versus Absorbable Sutures
26.7 Senior Authors’ Preferred Approach for Medial Meniscus Posterior Root Tears Repair
26.8 Postoperative Rehabilitation
26.9 Conclusions
References
27: Meniscus Substitution
27.1 Meniscal Allograft
27.2 Meniscal Scaffolds
27.3 Meniscal Implants
References
28: Update on Indications, Techniques, and Outcomes of Meniscal Allograft Transplantation (MAT)
28.1 Introduction
28.2 Indications
28.3 Applied Surgical Anatomy
28.4 Treatment of Concomitant Pathology
28.5 Graft Sizing
28.6 Meniscus Transplant: Surgical Options
28.7 Bone Plug Technique
28.8 Bone-in-Slot Technique
28.9 Suture-Only Technique
28.10 Hybrid Technique
28.11 Considerations in the Adolescent Population
28.12 Updated Outcomes
28.13 Conclusion
References
29: Technique Corner: Cell-Based Cartilage Repair
29.1 Introduction
29.2 Background
29.3 Clinical Evaluation
29.4 Imaging
29.5 Indications
29.6 Surgical Technique
29.6.1 Biopsy Harvest
29.6.2 Implantation
29.7 Post-Operative Protocol
29.8 Surgical Outcomes
29.9 Conclusion
References
30: Technique Corner: Marrow Stimulation and Augmentation
30.1 Microfracture Technique
30.1.1 History/Physical Exam
30.1.2 Indications and Contraindications
30.1.3 Preoperative Imaging and Evaluation
30.1.4 Operative Technique
30.1.4.1 Positioning and Diagnostic Arthroscopy
30.1.4.2 Preparation of Defect
30.1.4.3 Microfracture
Technique Pearl.
30.2 Microfracture Augmentation Techniques
30.2.1 Bone Marrow Aspirate Concentrate (BMAC)
30.2.2 Platelet-Rich Plasma (PRP).
30.2.3 Adipose-Derived Injections.
30.2.4 Autologous Matrix-Induced Chondrogenesis (AMIC).
30.2.5 BioCartilage and Autologous Minced Cartilage
30.3 Post-operative Rehabilitation
30.4 Conclusion
References
31: Technique Corner: Particulate Cartilage
31.1 Particulate Cartilage
31.2 Minced Cartilage
31.3 Rehabilitation
References
32: Osteochondral Allograft Transplantation
32.1 Introduction
32.2 Indications and Contraindications
32.3 Concomitant Procedures
32.4 OCA Transplantation Surgical Technique: Small Defects
32.5 Surgical Technique: Large Condyle Defects
32.6 Surgical Technique: Trochlea
32.7 Surgical Technique: Patella
32.8 Postoperative Rehabilitation
32.9 Potential Complications
32.10 Summary
References
33: Technique Corner: Osteochondral Autograft
33.1 Indications and Contraindications
33.1.1 Indications
33.1.2 Contraindications (Absolute and Relative)
33.2 Clinical Evaluation
33.3 Imaging
33.3.1 X-ray
33.3.2 MRI
33.3.3 CT
33.4 Surgical Technique
33.4.1 Key Principles
33.4.2 Positioning
33.4.3 OAT on Femoral Condyle Lesions
33.4.3.1 Arthroscopic Inspection
33.4.3.2 Exposure of Donor and Recipient Site
33.4.3.3 Recipient Site Preparation
33.4.3.4 Graft Harvesting
33.4.3.5 Graft Implantation
33.4.4 OAT on Retropatellar and Trochlear Lesions
33.4.5 OAT on Tibial Plateau Lesions
33.4.6 OAT for Extensive Defects
33.4.7 Tips and Pearls
33.4.8 Hazards and Pitfalls
33.4.9 Postoperative Care
33.4.10 Outcomes
References
34: Technical Corner: Lateral Extra-Articular Tenodesis
34.1 Introduction
34.2 Anatomy of the Anterolateral Complex
34.3 Patient Setup, Examination Pre-operatively and Intra-articular Procedure
34.3.1 Step 1 and 2: Approach and Harvesting the Iliotibial Band Strip
34.3.2 Step 3: Identification of the Lateral Collateral Ligament
34.3.3 Step 4: Tunnelling the ITB Strip Deep to the LCL
34.3.4 Step 5: Proximal Dissection
34.3.5 Step 6: Cortical Osteotomy
34.3.6 Step 7: Tunnelling the ITB Strip Underneath the Soft Tissues
34.3.7 Step 8: Proximal Fixation of the Free End of the ITB Strip
34.3.8 Step 9: Final Check and Tourniquet Release
34.4 Conclusions
Appendix
References
35: Clinical Application of Scaffold-Free Tissue-Engineered Construct Derived from Synovial Stem Cells
35.1 Introduction
35.2 Scaffold-Free Techniques
35.3 Scaffold-Free 3D TEC
35.4 Cartilage Repair Using TECs in Preclinical Studies
35.5 First-in-Human Clinical Trials Using a TEC for Repair of an Isolated Cartilage Defect
35.6 Future Directions
References
36: Osteotomies Around the Knee for Older Active Patients
36.1 Introduction
36.2 Preoperative Planning
36.2.1 Medial Open Wedge High Tibial Osteotomy (OWHTO)
36.2.1.1 Indication
36.2.1.2 Surgical Technique and Rehabilitation
36.2.2 Open Wedge Distal Tuberosity Tibial Osteotomy (OWDTO)
36.2.2.1 Indication
36.2.2.2 Surgical Technique and Rehabilitation
36.2.3 Hybrid Closed Wedge High Tibial Osteotomy (HCWHTO)
36.2.3.1 Indication
36.2.3.2 Surgical Technique and Rehabilitation
36.2.4 Tibial Condylar Valgus Osteotomy(TCVO)
36.2.4.1 Indication
36.2.4.2 Surgical Technique and Rehabilitation
36.2.5 Medial Closed Wedge Distal Femoral Osteotomy for Valgus Knees with Lateral Compartment Osteoarthritis (MCWDFO)
36.2.5.1 Indication
36.2.5.2 Surgical Technique and Rehabilitation.
36.2.6 Double Level Osteotomy (DLO)
36.2.6.1 Indication
36.2.6.2 Surgical Technique and Rehabilitation.
36.3 Discussion
36.3.1 OWHTO
36.3.2 OWDTO
36.3.3 HCWHTO
36.3.4 TCVO
36.3.5 MCWDFO
36.3.6 DLO
36.4 Conclusions
References
37: Current Introduction of the Biological Agent Derived from Adipose Tissue to the Treatment of Knee Osteoarthritis
37.1 Osteoarthritis
37.2 Biological Agents Derived from Adipose Tissue
37.3 Stromal Vascular Fraction (SVF) Cells
37.4 Fractionated Adipose Tissue (FAT)
37.5 Cultured Adipose-Derived Mesenchymal Stem Cells (ADMSCs)
37.6 Comparisons and Future Directions
References