Knee Arthroscopy: An Up-to-Date Guide

Preface
Contents
Biomechanics of the Knee
Abstract
Alignment
Joint Movement
Gait
Level Walking
Stair Climbing
ACL
Kinematics and Kinetics of the Knee Joint During Knee Motion
Biomechanics of ACL Reconstruction
Tunnel Position
Graft Material
Autograft
Allograft
Rotational Instability, Anterolateral Complex, and ALL
Anatomy of Anterolateral Complex
Biomechanics of Anterolateral Complex
Posterior Cruciate Ligament and Posterolateral Corner
Meniscus
Load Transmission
Shock Absorption
Meniscal Motion
Joint Stabilization
Cartilage
References
Understanding the Complex Anatomy of the Knee
Abstract
Introduction
Medial Complex
Layer 1
Layer 2
Layer 3
Lateral Complex
Interval Concept
Layered Concept
Layer 1
Layer 2
Layer 3
References
Subjective and Objective Assessments of Knee Function
Abstract
Introduction
Subjective Assessments
Objective Assessments
References
Evolution of ACL Reconstruction
Abstract
First Description of ACL Structure and Function
Early Treatment of ACL Injury
Emergence of ACL Reconstruction
Graft Sources
Fixation Methods
Extra-Articular ACL Reconstruction
Emergence of Arthroscopy
Changing Paradigms—From Isometric to Anatomic Reconstruction
Contemporary ACL Reconstruction—From Anatomic ACLR to Individualized, Anatomic ACLR
Future of ACL Repair and Reconstruction
Conclusion
References
ACL—Current Understanding of ACL Insertion
Abstract
Femoral ACL Insertion
Dimensions of the Femoral ACL Insertion
Midsubstance of ACL: Ribbon? Bundles?
Tibial ACL Attachment
Dimensions of the Tibia ACL Attachment
Consequences for ACL Reconstruction
References
High-Grade Pivot Injuries and Quantitative Evaluation of Degree of Instability
Abstract
Introduction
Key Determinant of the High-Grade Pivot-Shift Test
Cases Shared by the Author
Scenario 1: ACL Injury Combined with Posterolateral Meniscal Root Tear (PLMRT)
Scenario 2: Chronic ACL Injury with Posterolateral Meniscal Horn Deficiency
Scenario 3: Chronic ACL Injury with Excessively Increased Posterior Tibial Slope
Future Direction in Pivot-Shift Quantification
Conclusions
References
Surgical Techniques of ACL Reconstruction, B. Trans-Tibial Technique
Abstract
Introduction
Surgical Techniques
Step 1: Harvest QTPB Graft
Step 2: Prepare QTPB Graft
Step 3: Create Tibial and Femoral Tunnels
Step 4: Fix the Graft
Rehabilitation
Conclusion or Summary
References
Surgical Techniques of ACL Reconstruction, A. AM Portal Technique
Abstract
Introduction
Re-physical Exam Under Anesthesia and Position
Portal Formation
Auto-hamstring Tendon Harvest and Graft Preparation
Femoral Tunnel Preparation
Tibial Tunnel Preparation
Graft Passage and Fixation
Discussion
References
Surgical Techniques of Anterior Cruciate Ligament (ACL) Reconstruction, C. Outside-in with Remnant Preservation Technique
Abstract
Introduction
Theoretical Backgrounds of the Remnant Preservation
Outside-in Technique for ACL Reconstruction
Preparation of the Anatomic Femoral Tunnel
Preparation of the Anatomic Tibial Tunnel
Graft Passage and Fixation
A Remnant of the ACL Preservation
Advantages and Disadvantages of Outside-in Technique
Clinical Outcomes of the Remnant Preservation
Conclusion
References
The Role of Anterolateral Ligament Reconstruction in Anterior Instability
Abstract
Introduction
History
Anatomy and Histology
Biomechanics and Function
Injury
Diagnosis
Surgical Indication
Surgical Techniques
Post-operative Rehabilitation
Biomechanics of ALL Reconstructions
Clinical Results after ALLR
Clinical Outcomes
Graft Rupture
Protective Effect on Medial Meniscal Repairs
Return to Sport
Post-operative Complications
Conclusion
References
Revision Anterior Cruciate Ligament Reconstruction
Abstract
Introduction
Cause of Failure
Technical Failure
Biologic Failure
Traumatic Failure
Examination and Imaging
Preoperative Planning
Choice of Graft and Fixation
Tunnel Position and Tunnel Widening
Limb Alignment
Meniscus Status
Associated Injuries
Patient Positioning
Surgical Technique
Conclusion
References
Rehabilitation and Return to Sports After Anterior Cruciate Ligament Reconstruction
Abstract
Introduction
Rehabilitation
Range of Motion
Weight Bearing
Closed Kinetic Chain Exercise and Open Kinetic Chain Exercise
Hamstring Exercise
Functional Brace
Step-by-Step Program
Step 1 (0 to 3 Weeks)
Step 2 (4 to 6 Weeks)
Step 3 (7 to 12 Weeks)
Step 4 (13 to 18 Weeks)
Step 5 (19 to 24 Weeks)
RTS Criteria
Patient Reported Outcome Measures
Instability Tests
Muscle Strength
Functional Performance Assessments
Psychological Assessments (Fear of Re-Injury and Confidence)
Conclusion
References
Anatomy and Function of the Posterior Cruciate Ligament
Abstract
Anatomy of the Posterior Cruciate Ligament
The Function of the Posterior Cruciate Ligament
References
Posterior Cruciate Ligament Surgical Techniques
Abstract
Introduction
Non-operative Treatment
Operative Treatment
Indications
Techniques
Graft Selection
Author’s Preferred Technique
Post-operative Care
Complications
Conclusion
References
Combined Injury—Posterolateral Rotational Injury
Abstract
Introduction
Anatomy
Preoperative Considerations
Initial Evaluation
Physical Examination
Walking
Inspection and Palpation
Sensory and Circulation Test
Anterior and Posterior Translation Test
Dial Test
Posterolateral External Rotation Test
Reverse Pivot Shift Test
External Rotation Recurvatum Test
Radiographic Evaluation
Operative Steps
Surgical Indication
Anatomical Posteriolateral Corner Reconstruction
Anatomical Single Fibular Sling Technique
Incision and Approach
Tunnel Preparation
Fixation of Grafts
Rehabilitation
Operative Risks and Complications
Outcomes and Results
References
Meniscal Injury and Surgical Treatment: Meniscectomy and Meniscus Repair
Abstract
Clinical Evaluation
Treatment Decision
Nonoperative Treatment
Operative Treatment
Meniscectomy
Indication
Patient Position and Diagnostic Arthroscopy
Arthroscopic Meniscectomy Techniques
Outcomes of Meniscectomy
Meniscus Repair
Indication
Arthroscopic Repair Techniques
Inside-Out Technique
Arthroscopic Inside-Out Technique for a Longitudinal Tear of Midbody and Posterior Horn of the Meniscus
Outside-in Technique
Arthroscopic Outside-in Technique for a Longitudinal Tear of the Anterior Horn of the Meniscus
All Inside Technique
Arthroscopic Technique for a Longitudinal Tear at the Posterior Horn of the Medial Meniscus in Red-Red Zone
Arthroscopic All-Inside Technique Using the Fast-Fix 360® (Smith & Nephew, Andover, MA, USA) for a Longitudinal Tear of the Posterior Horn of the Lateral Meniscus (Fig. )
Repair for Specific Meniscus Tears
Lateral Meniscus Popliteomeniscal Fascicles Tear
Radial Tear
Horizontal Tear in Young Patients
Root Tear
Biologic Augmentation for Meniscus Healing
References
Discoid Lateral Meniscus
Abstract
Incidence and Bilaterality
Classification and Diagnosis
Surgical Treatment
Diagnostic Arthroscopic Examination
Partial Central Meniscectomy
Meniscus Suture Repair for Peripheral Tears
The Modified Outside-In Technique for Tears from the Anterior Horn to the Posterolateral Corner
The Modified All-Inside Technique for Posterior Horn Tears
Postoperative Care
Outcomes
References
Ramp Lesions
Abstract
Introduction
Anatomy and Definition
Classification
Prevalence of Ramp Lesions in ACL Injuries
Biomechanical Consequences
Associated Factors
Injury Mechanism
Pre-arthroscopic Diagnosis
Arthroscopic Diagnosis
Treatment
Rehabilitation
Outcomes
Conclusion
References
Root Tear: Epidemiology, Pathophysiology, and Prognosis
Abstract
Epidemiology
Anatomy
Function of Meniscus Roots
Pathophysiology
Prognosis
References
Root Tear: Surgical Treatment and Results
Abstract
Surgical Procedures of Repair of Medial Meniscus Posterior Root Tear Using Modified Mason-Allen Stitch
Postoperative Rehabilitation
Clinical Results of Root Repair
Conclusions
References
Meniscus Allograft Transplantation—Basic Principle
Abstract
Introduction
Biomechanics
Indication
Graft Sizing
Graft Selection
Surgical Technique
Outcomes
Rehabilitation
Conclusions
References
Delayed Rehabilitation After Meniscal Allograft Transplantation
Abstract
Introduction
Conventional Rehabilitation
Range of Motion (ROM)
Weight-Bearing
Considerations During Open Kinetic Chain (OKC) Exercise
Delayed Rehabilitation
First Step (~3 Weeks)
Second Step (4 ~ 6 Weeks)
Third Step (7 ~ 12 Weeks)
Fourth Step (13 Weeks~ )
Returning to Sports Activity
References
Meniscal Allograft Transplantation: Surgical Technique
Abstract
Introduction
Indications
Patient Evaluation
Preoperative Planning and Meniscal Sizing
Surgical Technique
Surgical Team and Patient Positioning
Medial MAT
Graft Preparation
Arthroscopic Portals and Surgical Exposure
Meniscus Bed Preparation
Socket Preparation
Technical Pearl
Graft Insertion
Graft Fixation
Lateral MAT
Graft Preparation
Arthroscopy and Meniscus Bed Preparation
Tibial Trough Preparation
Graft Insertion
Graft Fixation
MAT and Concomitant Procedures
Rehabilitation
Outcomes
References
Basic and Current Understanding of Articular Cartilage
Abstract
Introduction
Composition
Chondrocytes
Extracellular Matrix
Structure
Biomechanics
Articular Cartilage Injury
Pure Cartilage Lesions
Cartilage Lesions Involving Subchondral Bone
Recovery from Impact
Repair Cartilage
Mechanical Effect on Cartilage Repair
Conclusion or Summary
References
Cartilage Repair with Autogenous Cells
Abstract
Introduction
Autologous Chondrocyte Implantation and Matrix-Assisted Autologous Chondrocyte Implantation
Surgical Technique
Postoperative Rehabilitation
Discussion
References
Cartilage Repair with Collagen Gel (ACIC®: Autologous Collagen Induced Chondrogenesis)
Abstract
Introduction
Patient Selection
Preoperative Imaging Study
Ideal Indication for ACIC
Exclusion Criteria
Atelocollagen and Fibrin Mixture
Surgical Technique
Arthroscopy Setup and Chondral Preparation
Dry Up and CO2 Insufflation
Injection of Atelocollagen Mixture
Rehabilitation
Post-operative Follow-up
References
General Concepts for Patellofemoral Instability
Abstract
Introduction
Classification of Patellofemoral Instability
Related Anatomy and Etiology
Clinical History and Physical Examination
Imaging
Radiographs
Computed Tomography (CT) Scans
Magnetic Resonance Imaging (MRI)
Treatment
Nonoperative Treatment
Surgical Treatment
Summary
References
Surgical Reconstruction of the Medial Patellofemoral Ligament
Abstract
Anatomy and Biomechanics
General Considerations Before Surgical Treatment
Graft Preparation
The Method Preferred by the Authors
Clinical Outcome
Summary
References
Basic Principles Including Ideal Targeting Point of High Tibial Osteotomy
Abstract
References
Surgical Treatment and Overcoming Complications of High Tibial Osteotomy
Abstract
Surgical Technique of Open-Wedge HTO
Preoperative Planning
Diagnostic Arthroscopy
Skin Incision
Medial Collateral Ligament (MCL) Release
Guide Pin Insertion
Biplane Osteotomy
Gap Opening
Check the Mechanical Axis
Plate Fixation
Bone Graft
Closure
Rehabilitation
Complications
Lateral Hinge Fracture
Increased Posterior Tibial Slope Angle (PTSA)
Correction Error (Overcorrection, Under Correction)
Joint Line Obliquity
Popliteal Arterial Injury
Infection
Delayed Union or Nonunion
Compartment Syndrome
References
Minimum Correction of High Tibial Osteotomy with Medial Meniscus Centralization
Abstract
Introduction
Surgical Procedure
Indications
Preoperative Planning
Surgical Technique
Postoperative Rehabilitation
Clinical Outcomes
Discussion
Summary
References
Distraction Arthroplasty for the Advanced OA
Abstract
Introduction
Basic Research on Distraction Arthroplasty for Cartilage Defect of the Knee
Surgical Procedures, Postoperative Rehabilitation, and Second-Look Arthroscopy
Clinical Outcomes
Future Perspective
References