Minimally Invasive Functional Reconstruction of the Knee

Contents
Part I: Knee Basics
1: Arthroscopic Knee Examination
The Diagnostic Value of Arthroscopic Knee Examination
Procedures of Arthroscopic Knee Examination
Patient Position
Portal Establishment
The Suprapatellar Pouch
The Lateral Gutter
The Patellofemoral Joint Viewed from the Lateral Side
The Medial Synovial Plica and the Medial Gutter
Anterior Compartment
The Patellofemoral Joint Viewed from the Distal Side
The Femoral Notch
Medial Compartment
Posteromedial Compartment
Lateral Compartment
The Posterolateral Compartment
Comments on Current Procedures
References
2: Treatment Strategies of Meniscus Injuries
Anatomy of the Menisci
Symptoms and Sources of Pain of Meniscus Injury
Types, Functions, and Treatment Strategies of Meniscus Injury
Longitudinal Vertical Tear of the Meniscus
Ramp Lesion of the Meniscus
Horizontal Tear of the Meniscus
Radial Tear of the Meniscus
Root Tear of the Meniscus
Flap and Mixed Tear of the Meniscus
Discoid Meniscus and Injury
Surgical Technique for Meniscus Injuries
Resection of the Posterior Horn of the Medial Meniscus
Technique
Repair of the Bucket-Handle Tear and Ramp Tear of the Medial Meniscus
Repair of Root Tear of the Posterior Horn of the Medial Meniscus
Lateral Meniscus Plasty and Repair
Repair of the Root Tear of the Posterior Horn of the Lateral Meniscus
References
3: Arthroscopic Meniscus Repair with Autograft Tendon Fibers
Introduction
Technique
Preparation of Autograft Tendon Fibers Suture
Suture Passing Tools
Meniscal Lesion Management
Suture Techniques
Introducing the Guiding Suture
Introducing the Autograft Tendon Strips and Fixation
Checking the Tendon Suture
Combined Injuries Treatment
Comments on Current Technique
References
4: Outside-In Transfer All-Inside Meniscus Repair
Introduction
Technique
Comments on Current Technique
Conclusions
References
5: Lateral Meniscus Posterior Root Repair
Introduction
Technique
Side-to-Side Repair
Pullout Repair
Outcomes
References
6: Combined Pullout Repair and Centralization for Medial Meniscus Posterior Root Tear
Introduction
Surgical Techniques
Surgical Indications for MMPRT
Trans-Tibial Pullout Repair Technique and Meniscus Centralization
Surgical Approach
Evaluation of MMPRT
Suture of Medial Meniscus Posterior Root
Establish the Tibial Tunnel
Fixation at the Tibial Side
Meniscus Centralization
Open Wedge HTO
References
7: Arthroscopic Synovectomy
Introduction
Surgical Indications
Rheumatoid Arthritis/Synovitis
Sero-Negative Arthritis/Reactive Arthritis
Rheumatic Arthritis
Gout Arthritis/Synovitis
Synovial Chondromatosis
Villonodular Synovitis
Tuberculous Synovitis
Suppurative Arthritis
Hemorrhagic Synovitis
Traumatic Synovitis
Preoperative Preparation
Surgical Techniques
Patient Position and Portals
Debridement in the Anterior, Medial, and Lateral Compartment
Debridement in the Posterior Compartments
Debridement in the Suprapatellar Pouch and the Medial and Lateral Gutters
Postoperative Treatment
Complications
References
8: Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Knee
Principles of Treatment of Villonodular Synovitis
Preoperative Preparation
Surgical Procedures of Arthroscopic Synovectomy for Diffused PVNS of the Knee
Clearing the Anterior Compartment and the Medial and Lateral Joint Space
Preliminary Debridement in Posteromedial Compartment
Preliminary Debridement of the Posterolateral Compartment
Removal of the Posterior Septum
Complete Debridement in the Posterior Compartments
Debridement of the Posterior Outlet of the Femoral Notch
Debridement of the Medial and Lateral Gutter and Suprapatellar Pouch
Postoperative Rehabilitation
References
9: Hamstring Tendon Harvesting
Harvesting the Semitendinosus Tendon
Surgical Methods
Simultaneous Harvesting of the Semitendinosus Tendon and Gracilis Tendon
Surgical Methods
References
10: Harvesting the Anterior Half of the Peroneus Longus Tendon
Surgical Methods
Harvesting the AHPLT Through One Incision
Harvesting the AHPLT Through Two Incisions
References
11: Preparation of Autogenous Tendon
Tendon Braiding
Tendon Folding
The Folding Method to Make a Four-Stranded Graft
The Folding Method to Make a Three-Stranded Graft
Measurement of the Graft
Pretension of the Graft
Calculating the Required Length of the Loop at the Proximal End of the Graft Complex
Proximal Marking of the Graft
Internal Bracing
Reference
12: Graft Length in the Tunnel in Cruciate Ligaments Reconstruction
Introduction
The Length and Zero-Time Biomechanics of the Graft in the Tunnel
The Length of the Graft in the Tunnel and the Tendon–Bone Healing
Internal Fixation Method and Length of Tendon Graft in Tunnel
Clinical Procedures Regarding the Length of the Graft in Tunnel
References
Part II: Anterior Cruciate Ligament
13: Principles of Anterior Cruciate Ligament Reconstruction
Indications of Operation
Symptoms After ACL Injury
Treatment Strategies
Surgical Indications
The Timing of Surgery
Preoperative Examination
Medical History
Physical Examinations
Imaging Examinations
Instrumental Measurement
Functional Evaluation
Ultra-Strong ACL Reconstruction
The Rationale for Ultra-Strong ACL Reconstruction
The Methods and Feasibility of Ultra-Strong ACL Reconstruction
References
14: Isometric Single-Bundle Trans-Tibial Anterior Cruciate Ligament Reconstruction
Introduction
Basic Concepts in Isometric ACL Reconstruction
Where to Locate the Femoral Tunnel During Isometric Single-Bundle ACL Reconstruction?
Where Is the Over-the-Top Position?
Is Clock Face Reference Reliable?
What Is the Difference Between the Intercondylar Ridge and the Residence Ridge?
Surgical Techniques
Graft Preparation
Locating the Tibial Tunnel
Locating the Femoral Tunnel
Creating the Tibial Tunnel
Creating the Femoral Tunnel
Adjusting the Adjustable Loop
Graft Placement and Proximal Fixation
Graft Fixation on the Tibial Side
Technical Comments
References
15: Single-Bundle Isometric ACL Reconstruction with Remnant Preservation
Introduction
Surgical Technique
Graft Preparation
Locating the Femoral Tunnel
Locating the Tibial Tunnel
Creating the Femoral Tunnel
Creating the Tibial Tunnel
Graft Placement and Proximal Fixation
Graft Fixation on the Tibial Side
Comments on Current Technique
References
16: Anatomical Transtibial Single-Bundle Anterior Cruciate Ligament Reconstruction
Basic Concepts
How to Locate the Tibial Tunnel During Anatomical Single-Bundle ACL Reconstruction?
How to Locate the Femoral Tunnel During Anatomical Single-Bundle ACL Reconstruction?
Surgical Techniques of Anatomical Transtibial Single-Bundle Anterior Cruciate Ligament Reconstruction
Graft Preparation
Locating the Tibial Tunnel
Locating the Femoral Tunnel
Creating the Tibial Tunnel
Creating the Femoral Tunnel
Graft Placement and Proximal Fixation
Graft Fixation on the Tibial Side
Comments on Current Technique
References
17: Treatment Strategies of a Partial ACL Injury
The Concept of Partial ACL Injury
The Diagnosis of Partial ACL Injury
The Principle of Treatment of Partial ACL Injury
The Strategies of Surgical Treatment of Partial ACL Injury
Isolated Anteromedial Bundle Reconstruction of the ACL
Arthroscopic Examination
Graft Preparation
Creating the Tibia Tunnel
Creating the Femoral Tunnel
Treatment of the Femoral Notch
Graft Implantation and Fixation
Isolated Posterolateral Bundle Reconstruction of the ACL
Arthroscopic Examination
Graft Preparation
Creating the Tibial Tunnel
Creating the Femoral Tunnel
Graft Implantation and Fixation
References
18: Single-Bundle Anatomical Hardware-Free ACL Reconstruction
Surgical Techniques
Grafting Harvesting and Preparation
Locating the Tibial and the Femoral Tunnels
Creating the Tibial Tunnel
Creating a Y-Shaped Femoral Tunnel
Graft Implantation
Proximal Fixation
Distal Fixation
Discussions
References
19: Anterior Cruciate Ligament Reconstruction with Internal Bracing
Surgical Technique
Internal Tension-Relieving Brace Augmentation and Graft Preparation
Graft Passage and Fixation
The Rehabilitation Protocol After ACL Reconstruction
Comments on Current Technique
References
20: Anatomical Double-Bundle Transtibial Anterior Cruciate Ligament Reconstruction
Surgical Technique
Graft Preparation
Locating the Femoral Tunnels
Creating the Tibial Tunnels
Creating Femoral Tunnels
Graft Placement and Proximal Fixation
Graft Fixation on the Tibial Side
Comments on the Current Technique
Basic Concepts Regarding Anatomical Double Bundle ACL Reconstruction
The Purpose of Anatomical ACL Reconstruction
The Methods of Tunnel Creation
The Optimal Number of Strands of the Grafts
The Optimal Length of the Grafts in the Tunnel
Graft Fixation Methods
Femoral Notch Plasty
References
21: Double-Bundle Anterior Cruciate Ligament Reconstruction with Remnant Preservation
Surgical Procedure
Tendon Harvesting and Graft Preparation
Ligating the Remnant
Femoral Notch Plasty
Locating the Femoral and the Tibial Tunnels
Creating the Tibial Tunnels
Creating the Femoral Tunnels
Debridement in the Posterior Compartments of the Knee
Pulling the Remnant to the Femoral Tunnel
Graft Implantation and Proximal Fixation
Graft Fixation on the Tibial Side
Technical Considerations
Basic Concepts Regarding Remnant Preservation in ACL Reconstruction
The Definition of Remnant in ACL Injury
The Significance of Remnant Preservation
The Disadvantage of Remnant Preservation
Surgical Indication and Remnant Preservation Methods
References
22: Combined ACL-Mimicking Anterolateral Structure Reconstruction and Single-Bundle Anterior Cruciate Ligament Reconstruction
Surgical Techniques
Graft Preparation
Locating the Femoral Tunnel
Creating the Tibial Tunnel for ALS Reconstruction
Creating a Common Femoral Tunnel
Creating the Tibial Tunnel for ACL Reconstruction
Graft Placement
Graft Fixation on the Tibial Side
Comments on the Current Technique
References
23: Combined ACL-Mimicking Anterolateral Structure Reconstruction and Double-Bundle Anterior Cruciate Ligament Reconstruction
Surgical Techniques
Graft Preparation
Locating the Femoral Tunnel
Creating Tibial Tunnel for the ALS
Creating the Common Femoral Tunnel for the ALS and the PL Bundle of the ACL
Creating Two Tibial Tunnels for ACL Bundles
Creating Femoral Tunnel for AM Bundle
Placement of the Combined Graft
Placement of the AM Bundle Graft
Graft Fixation on the Tibial Side
Comments on the Current Technique
References
24: Slope-Reducing High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction
Introduction
Technique
Graft Preparation
Arthroscopic Evaluation and Tibial Tunnel Drilling
Slope-Reducing High Tibial Osteotomy
Graft Passage and Fixation
Postoperative Rehabilitation Protocols
Comments on the Current Technique
References
25: Basic Concepts in Revision Anterior Cruciate Ligament Reconstruction
The Causes of Failure After ACL Reconstruction
Trauma
Surgical Technique Error
Overlooking Combined Structural Deficiency
Failed Graft–Tunnel Healing
Failed Graft Ligamentization
Strategies and Indications of Revision Operation
Preoperative Planning and Preparation
Review of Medical Histories
Physical Examination
Imaging Examination
Selection of Grafts
Revision Methods
References
26: Three-in-One Procedure for Revision ACL Reconstruction
Free Tendon Graft Preparation
Locating the Femoral Tunnel
Creating the Tibial Tunnel for the ALS
Iliotibial Band Preparation
Creating the Common Femoral Tunnel
Creating the Tibial Tunnel for ACL Reconstruction
Graft Placement
Graft Fixation on the Tibial Side
Postoperative Rehabilitation
Discussion
References
27: Basic Concepts in the Treatment of Tibial Avulsion Fracture of the Anterior Cruciate Ligament
Anatomy
Epidemiology
Mechanism of Injury
Diagnosis
Imaging Examination
Arthroscopic Examination
Classification of ACL Tibial Avulsion Fracture
Treatment Strategies for Acute ACL Tibial Avulsion Fracture
Treatment Strategies for Malunion of ACL Tibial Avulsion Fracture
Treatment Strategies for Nonunion of ACL Tibial Avulsion Fracture
Fracture Fixation Methods
References
28: Arthroscopic Suture-to-Adjustable Loop Fixation of Adult ACL Tibial Avulsion Fracture
Surgical Technique
Creating Portals
Preparation of the Bone Bed
Ligating the ACL and the Bone Fragment
Creating Tibial Tunnels
Fracture Reduction
Fracture Fixation
Postoperative Management
Comments on the Current Technique
References
29: Arthroscopic Epiphyseal Plate-Sparing Fixation of ACL Tibial Avulsion Fracture in Skeletally Immature Patients
Surgical Procedures
Creating Portals
Exposing the Bone Fragment
Preparation of the Bone Bed
Ligating the ACL and the Bone Fragment
Fracture Reduction
Fracture Fixation
Rehabilitation
Comments on the Current Technique
References
30: Suture Bridge Fixation for Adolescent ACL Tibial Avulsion Fracture
Surgical Technique
Preoperative Planning
Patient Position and Anesthesia
Treatment of Concomitant Injuries
Exposing the Avulsed Bone Fragment and the Bone Bed
Drilling in the Guide Wires for Anchor Placement
Placement of the Posterior Anchor
Creating the Tibial Tunnels
Passing the Sutures Through the ACL
Pulling the Sutures Through the Tibial Tunnels
Fixation of the Bone Fragment
Postoperative Rehabilitation
Core Technology
References
Part III: Posterior Cruciate Ligament
31: Ultra-strong Posterior Cruciate Ligament Reconstruction
Rationale of Ultra-strong Posterior Cruciate Ligament Reconstruction
Suitable Graft Type and Volume for Ultra-strong PCL Reconstruction
How to Make Use of the Autogenous Tendons to Realize Ultra-strong PCL Reconstruction
Double-Bundle PCL Reconstruction
Remnant Preservation
PCL Reconstruction with Internal Bracing
References
32: Single Bundle Posterior Cruciate Ligament Reconstruction Without Remnant Preservation
Basic Concept of Single Bundle Posterior Cruciate Ligament Reconstruction
Isometric Posterior Cruciate Ligament Reconstruction
Anatomical PCL Reconstruction
Single Bundle PCL Reconstruction Without Remnant Preservation
Surgical Procedures
Tendon Harvesting and Preparation
Creating Arthroscopic Portals and Performing Debridement
Placing Guide Wire to Create the Tibial Tunnel
Creating the Femoral Tunnel
Creating the Tibial Tunnel
Graft Implantation and Fixation
Postoperative Rehabilitation
Comments on the Current Technique
References
33: Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction with Remnant Preservation
Surgical Techniques
Tendon Harvesting and Preparation
Establishing of Surgical Portals
Exposing the Tibial Insertion of the PCL
Placing the Guide Wire for the Creation of the Tibial Tunnel
Creating the Femoral Tunnel
Creating the Tibial Tunnel
Placing the Guide Suture
Graft Implantation
Graft Fixation
Comment on the Current Technique
References
34: Lower Tibial Tunnel Placement in Transtibial PCL Reconstruction
Introduction
Surgical Technique
Graft Preparation
Locating and Creating the Tibial Tunnel
Locating and Creating the Femoral Tunnel
Graft Placement and Fixation
Postoperative Rehabilitation
Comments on the Current Technique
References
35: Four-Tunnel Double-Bundle Anatomical Posterior Cruciate Ligament Reconstruction Without Remnant Preservation
Surgical Technique
Preparation of the Grafts
Debriding the Femoral Attachment
Debriding the Tibial Attachment of the PCL
Placing the Guide Wires to Create the Tibial Tunnels
Creating the Femoral Tunnels
Creating the Tibial Tunnels
Placing Guide Suture Loop for Graft Implantation
Implantation and Proximal Fixation of the Grafts
Distal Fixation of the Grafts
Postoperative Treatment and Rehabilitation
Comments on the Current Technique
References
36: Sandwich-Style Posterior Cruciate Ligament Reconstruction: Four-Tunnel Double-Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation
Surgical Technique
Graft Preparation
Creation of Posteromedial and Posterolateral Portals
Exposing PCL Tibial Insertion Site
Placing Guide Wires for the Tibial Tunnels
Creating Femoral Tunnels
Creating the Tibial Tunnels
Placing Guide Suture Loop for Graft Implantation
Implantation and Proximal Fixation of the Grafts
Distal Fixation of the Grafts
Postoperative Treatment and Rehabilitation
Comments on the Current Technique
References
Untitled
37: Basic Concepts in the Treatment of Tibial Avulsion Fracture of the Posterior Cruciate Ligament
Anatomy
Epidemiology
Mechanism of Injury
Symptoms and Signs
Imaging Examination
Classification
Treatment Principle
The Acute PCL Tibial Avulsion Fracture
Chronic Injuries
Judgment of Fracture Displacement Degree
Surgical Choices for PCL Tibial Avulsion Fracture
References
38: Arthroscopic Suture to Loop Fixation of PCL Tibial Avulsion Fracture
Surgical Procedures
Creating Anterolateral and Anteromedial Portals
Creating the Posteromedial Portals
Debridement of the Bone Bed
Creating the Posterolateral Portal
Exposing the Bone Ridge Between the Tibial Recess and the Proximal Posterior Tibia
Ligating the PCL
Creating Tibial Tunnels
Out-Pulling of the Fixing Sutures
Fixing the Bone Fragment
Postoperative Treatment and Rehabilitation
Comments on the Current Technique
References
Part IV: Collateral and Multi Ligaments
39: The Basic Concept in Treatment of Injuries of the Posteromedial Corner of the Knee
Functional Anatomy of the Posteromedial Side of the Knee
Injury Mechanism
Diagnosis
Symptoms and Signs
Auxiliary Examination
Principles of Treatment
Treatment of Isolated MCL Injury
Treatment of MCL Injury Combined with ACL Injury
Treatment of the PMC Injury
Surgical Techniques
References
40: Structural Augmentation of the Posteromedial Corner of the Knee
Introduction
Indications of Operation
PMC Augmentation
Anatomic PMC Augmentation of Knee
Graft Preparation
Creating the Femoral Tunnels
Creating the Femoral Tunnels
Tendon Implantation and Fixation
Reverse V-Shaped Augmentation of Knee PMC
Tendon Preparation
Creating Femoral Tunnel
Creating Tibial Tunnel
Tendon Implantation and Fixation
Span Augmentation of Knee PMC
Tendon Preparation
Tunnel Creation
Graft Implantation and Fixation
Postoperative Rehabilitation
References
41: Basic Concept in the Treatment of Knee Posterolateral Corner Injury
Applied Anatomy of the Posterolateral Corner of the Knee
Biomechanics of the Posterolateral Knee
Evaluation of Posterolateral Knee Instability
Classification of Posterolateral Knee Instability
Treatment Principle of Acute PLC Injury
Femoral Attachment Avulsion
Avulsion of the Fibular Head Attachment
Avulsion Fracture of the Fibular Head or the Styloid Process of the Fibular Head
Ligament Ruptures
Avulsion Fracture of the Lateral Edge of the Tibial Plateau
Treatment Principle of Chronic PLC Injury
Surgical Methods for Chronic PLC Injury
Posterolateral Functional Tissue Adjustment
Posterolateral Augmentation
Posterolateral Reconstruction
References
42: Knee Posterolateral Corner Reconstruction with a Single Tendon
Surgical Techniques
Graft Preparation
Surgical Approaches
Creating Bone Tunnels
Tendon Implantation and Fixation
Comments on the Current Technique
References
43: Arthroscopic Popliteal Tendon Reconstruction for Type A PLC Injury
Introduction
Methods
Pre- and Postoperative Assessments
Surgical Technique
Graft Preparation
Femoral Tunnel
Tibial Tunnel
Passage of Graft
Fixation of Graft
Results
Conclusions
References
44: The Lateral Gutter Drive-Thru Sign and Drive-Thru Test
Part I: The “Lateral Gutter Drive-Thru” Sign: An Arthroscopic Indicator of Acute Femoral Avulsion of the Popliteus Tendon in Knee Joints
Technique
Arthroscopic Evaluation of the Lateral Compartment
Arthroscopic Findings of the Lateral Gutter
Repair Procedures
Discussion
Part II: Validity of a Novel Arthroscopic Test to Diagnose Posterolateral Rotational Instability of the Knee Joint: The Lateral Gutter Drive-Through Test
Methods
Study Design
Inclusion and Exclusion Criteria
Patient Characteristics
Evaluation Methods
Results
Validity of LGDT Test
Discussion
Conclusions
References
45: Basic Concepts in the Treatment of Knee Dislocation
Knee Dislocation/Multiple Ligament Injuries/Multidirectional Instability
Anatomical and Histological Changes Related to Knee Dislocation
Blood Vessel Injury
Nerve Damage
Deep Venous Embolism
Fracture
Knee Extension Device Injury
Ligament Injury
Internal Environment Disorder
Classification of Knee Dislocation
Treatment Protocols of Acute Knee Dislocation
Evaluation of the General Situation
Holistic Assessment, Treating Life-Threatening Injuries First
Assessing and Monitoring Blood Supply to Limbs
Examination of Knee Dislocation and Nerve Function of Lower Limbs
Imaging Examination
Trying to Reduce the Knee
Knee Stability Examination
Principles of Treatment of Acute Knee Dislocation
Indications for Emergency Surgery
Treatment of Reduced Acute Closed Knee Dislocation
Treatment of Non-reduced Acute Closed Knee Dislocation
Surgical Reduction in Acute Stage
Release and Reduction Under Arthroscopy
Indications
Surgical Technique
Mini-Open Reduction
Indications
Surgical Techniques
Extensive Open Surgery for Reduction
Indications
Surgical Techniques
Ligament Repair and Reconstruction in Acute Stage
References
46: Treatment Strategies for Multi Ligament Injuries of the Knee
Introduction
Etiology and Mechanism of the Injury
History and Physical Examination
History of Injury
Symptoms
Physical Signs
Preoperative Imaging
Diagnosis
Treatment
Timing of Treatment for Multiple Ligament Injuries of the Knee Joint
Repair or Reconstruction of Ligaments
Repair of Joint Capsule
Rehabilitation
References
47: Simultaneous Anterior Cruciate Ligament, Posterior Cruciate Ligament, Posteromedial Corner, and Posterolateral Corner Reconstruction of the Knee
Surgical Techniques
Graft Harvesting and Preparation
Creating Bone Tunnels
Graft Placement and Proximal Fixation
Distal Fixation of the Grafts
Postoperative Management
Comments on the Current Technique
References
Part V: Patellofemoral Joint
48: Basic Concepts in the Diagnosis and Treatment of Patella Instability and Dislocation
The Causes of Patella Dislocation
Skeletal Abnormalities
Abnormal Bone Alignment
Soft Tissue Abnormality
Diagnosis and Treatment of Primary Patella Dislocation in Acute Stage
Clinical Manifestations in Acute Stage
Imaging Findings
Treatment of Primary Patella Dislocation in Acute Stage
Diagnosis and Treatment of Primary Patella Dislocation in Chronic Stage
Clinical Manifestations
Imaging Examination
Physical Examination
Treatment of Primary Patella Dislocation in Chronic Stage
Diagnosis and Treatment of Recurrent Patella Dislocation
Clinical Manifestations
Treatment Strategies for Recurrent Patella Dislocation
Diagnosis and Treatment of Fixed Patella Dislocation
Classifications
Etiology
Clinical Manifestations
Imaging Examinations
Treatment Strategies for Fixed Patella Dislocation
Surgical Procedures for Patella Dislocations
References
49: Wide-Patellar Insertion Medial Patellofemoral Ligament Reconstruction with Internal Bracing
Surgical Procedures
Tendon Harvesting
Debridement of the Knee
Lateral Retinaculum Release
Creating the Patella Tunnels
Tendon Implantation Through the Patella Tunnels
Creating the Femoral Tunnel
Tendon Connection to a Cortical Fixation Device
Tendon Implantation into the Femoral Tunnel
Comments on the Current Technique
References
50: Polyethylene Suture Augmentation of the Medial Patellofemoral Ligament in Skeletally Immature Patients with Recurrent Patella Dislocation
Surgical Procedures
Debridement of the Knee
Lateral Retinaculum Release and Quadriceps Rebalance
Creating the Patellar Tunnels
Placing Augmenting Sutures Through the Patellar Tunnels
Creating the Femoral Tunnels
Placing Sutures Through the Femoral Tunnels
Retrieving Sutures Through the Space Resulted from Lateral Retinaculum Release
Fixing the Augmentation Sutures
Postoperative Rehabilitation
Comments on the Current Technique
References
51: Arthroscopic Release of the Lateral Retinaculum of the Patella
Indications/Contraindications for Lateral Retinaculum Release
Preoperative Planning and Preparation
Surgical Procedures
The Route of the Standard Release of the Lateral Retinaculum
The Route of Short Medial Branch Y-Shaped Release of the Lateral Retinaculum
Arthroscopic Standard Release of the Lateral Retinaculum of the Patella
Postoperative Management and Rehabilitation
References
52: Tibial Tubercle Transfer: Indications and Modified Fulkerson Osteotomy
Indications for Tibial Tubercle Transfer
Indications for Medial Transfer of the Tibial Tubercle
Indications of Lateral Tibial Tubercle Transfer
Indication for Distal Transfer of the Tibial Tubercle
Indications for Proximal Tibial Tubercle Transfer
Modified Fulkerson Osteotomy
Indications/Contraindications for Modified Fulkerson Osteotomy
Preoperative Planning and Preparation
Surgical Procedures
Comments on the Current Technique
References
53: Surgical Treatment of Habitual Patellar Dislocation with Patella Baja: Tibial Tubercle Proximalization
Radiological Imaging
Surgical Techniques
“Step-by-Step” Extensive Lateral Release
Tibial Tubercle Proximalization and Medialization
Postoperative Rehabilitation
Results
Conclusion
References
54: Derotational Distal Femoral Osteotomy for Recurrent Patellar Dislocation
Introduction
Indication for DDFO
Surgical Technique
Comments on Current Techniques
References
55: Biplanar Knee Derotation Osteotomy in the Treatment of Patella Instability
Basic Concepts of Knee Derotation Osteotomy
Surgical Indications and Preoperative Preparation
Surgical Technique
Reconstruction of the Medial Patellofemoral Ligament
Placing the Guide Pins for Rotation and Alignment Control
Derotation of the Distal Femur
Derotation at the Proximal Tibia
Comments on the Current Technique
References
56: Rebalance of the Quadriceps Femoris
Classification and Diagnosis
Preoperative Preparation
Surgical Techniques
Skin Incision
Detachment and Preparation of the Vastus Medialis
Lateral Retinaculum Release
Detachment and Preparation of the Vastus Lateralis
Release the Lateral Parts of the Rectus Femoris and Vastus Intermedius
Transfer of the Lateral Quadriceps Structure
Transfer of the Vastus Medialis
Subsequent Operations
Comments on the Current Technique
References
57: Arthroscopic Patellofemoral Arthroplasty for Isolated Patellofemoral Osteoarthritis
Preoperative Planning
Surgical Technique
Femoral Trochlea Denervation
Patella Denervation
Femoral Trochlea Plasty
Patella Plasty
Removal of the Infrapatellar Pad
Lateral Retinaculum Release
Comments on the Current Technique
References
Part VI: Knee Osteoarthritis and Stiffness
58: Arthroscopic Arthroplasty for Knee Osteoarthritis
Surgical Procedures
Debridement of the Medial and Lateral Compartment of the Knee
Releasing the Medial Collateral Ligament
Femoral Notch Plasty
Debridement in the Posterior Compartments
Plasty and Denervation of the Posterior Femoral Condyles
Release of Posterior Capsule and Muscles
Distal Femur Denervation from the Anterior, Medial, and Lateral Sides
Denervation at the Anterior Side of the Proximal Tibia
Denervation of Anteromedial Side of the Tibia
Patella Plasty and Denervation
Comments on the Current Technique
References
59: Anterior Proximal-to-Posterior Distal Oblique Proximal Tibial Osteotomy
Surgical Procedures
Preoperative Planning and Preparation
Patient Position
Arthroscopic Surgery
Placement of Reference K Wires
Marking the Osteotomy Line
Tibial Osteotomy
Tibial Deformity Correction and Fixation
Postoperative Management
Comments on the Current Technique
References
60: Basic Concepts in the Treatment of Knee Stiffness
Treatment Strategies for Flexion-Impeding Knee Stiffness
Etiology and Pathological Anatomy of Flexion-Impeding Knee Stiffness
Principles of Surgical Treatment for Flexion-Impeding Knee Stiffness
Contraindications for Surgery for Flexion-Impeding Knee Stiffness
Treatment Methods for Flexion-Impeding Knee Stiffness
Principles of Surgical Treatment of Extension-Impeding Knee Stiffness
Etiology and Pathological Anatomy of Extension-Impeding Knee Stiffness
Diagnosis of Extension-Impeding Knee Stiffness
Treatment of Extension-Impeding Knee Stiffness
References
61: Arthroscopic Release of Severe Flexion- and Extension-Impeding Knee Stiffness with Inaccessible Joint
Indications and Contraindications
Preoperative Planning
Surgical Techniques
Creating Working Space in the Infrapatellar Fat Pad
Medial Retinaculum Release
Lateral Retinaculum Release
Detachment of the Lateral Extensor from the Femoral Condyle
Detach the Infrapatellar Fat Pad from the Patella
Reestablishing the Suprapatellar Pouch
Reestablishing the Medial Gutter
Reestablishing the Lateral Gutter
Quadriceps Plasty in Case of Extensor Contracture
Eliminating Anterior Impingement
Creating the PM and PL Portals
Reestablishing the Posterior Compartments
Posterior Capsule Release
Postoperative Management
Comments on the Current Technique
References
62: Zhao Quadriceps Plasty
Indications and Contraindications
Surgical Technique
Incision
Step 1: Release of the Vastus Lateralis and the Lateral Retinaculum
Step 2: Release of the Distal Quadriceps and Femur and Recreation of the Suprapatellar Pouch
Step 3: Release of the Patellofemoral Joint, the Patella Tendon, and the Infrapatellar Fat Pad
Step 4: Release of the Medial Retinaculum
Step 5: Release of the Adhesion Between the Retinaculum and the Femoral Condyles and Recreation of the Medial and Lateral Gutters
Step 6: Distal Dissociation of the Rectus Femoris Tendon
Step 7: Proximal Dissociation of the Vastus Intermedius
Step 8: Transection of the Anterolateral and Anteromedial Capsule-Ligament
Step 9: Overlapping Z-Plasty of the Rectus Femoris and Vastus Intermedius
Step 10: Transfer of the Vastus Lateralis
Postoperative Management and Rehabilitation
Comments on the Current Technique
References