Knee Arthroscopy (eBook)

Foreword 6
Preface 7
Contents 8
Contributors 9
Knee Arthroscopy: Technique and Normal Anatomy 11
Introduction 11
Anatomy 11
External Anatomy 11
Intraarticular Anatomy 11
Preoperative Preparation 12
Techniques 12
Operating Room Setup 12
Anesthesia 12
Patient Setup 13
Portals (Fig. 6) 14
Anterolateral Portal 14
Anteromedial Portal 14
Superomedial Portal 16
Posteromedial Portal 17
Posterolateral Portal 17
Accessory Anterior Medial and Lateral Portals 17
Rehabilitation 17
Complications 18
Deep Venous Thrombosis 18
Clinical Pearls/Summary 18
Case Report 19
Case 1 19
Partial Meniscectomy 21
Introduction 21
Anatomy 21
Gross Anatomy 21
Vascular Anatomy 22
Neuroanatomy 23
Biomechanics 23
Tear Anatomy 23
Indications 24
History 24
Physical Exam 24
Diagnostic Studies 24
Surgical Decision Making 25
Surgery 25
Technique 25
Outcome Studies 27
Rehabilitation 28
Complications 28
Clinical Pearls 29
Summary 29
Case Reports 29
Case 1 29
Case 2 30
Meniscus Repair and Future Directions 34
Introduction 34
Anatomy 35
Pathology 36
Indications and Techniques 36
Nonoperative Treatment 36
Surgical Treatment 37
Surgical Technique 37
Inside-Out Technique 38
Outside-In Technique 40
All-Inside Fixator Technique 40
All-Inside Suture Fixation Technique 41
Repair Augmentation and Future Directions 42
Rehabilitation 43
Complications 43
Results 44
Clinical Pearls/Summary 44
Case Reports 45
Case 1 45
Case 2 46
Case 3 46
Case 4 47
Case 5 48
Meniscal Allograft Transplantation 50
Introduction 50
History 50
Anatomy 50
Function 52
Surgical Indications 53
Patient Evaluation 53
Graft Preservation 53
Sizing 54
Surgical Technique 54
Bone Bridge or Slot Technique for Lateral Meniscal Reconstruction 56
Allograft Preparation 56
Allograft Insertion 56
Bone Plug Technique for Medial Meniscal Reconstruction 57
Allograft Preparation 57
Tunnel Preparation 58
Allograft Insertion 59
Advanced Techniques 60
Corrective Osteotomy 61
Ligament Reconstruction 61
Cartilage Restoration 62
Rehabilitation 63
Complications 64
Clinical Pearls 64
Summary 65
Case Reports 65
Case 1 65
Case 2 68
Arthroscopic Treatment of the Osteoarthritic Knee 75
Introduction 75
History 75
Indications 76
Authors Preferred Surgical Technique 76
Rehabilitation 80
Complications 80
Results 81
Clinical Pearls/Summary 82
Case Report 82
Case 1 82
Current Concepts in Articular Cartilage 86
Introduction 86
Basic Science 86
Matrix Composition 86
AC Structure 87
Biomechanics 87
Incidence/Natural History 87
Classification of AC Lesions 88
Imaging 88
Patient Evaluation with Symptomatic AC Defect 89
Cartilage Restoration Treatment Options 92
Arthroscopic Lavage and Debridement 92
Surgical Technique 92
Postoperative Care/Rehabilitation 92
Case Report 93
Marrow Stimulation 94
Surgical Technique 94
Postoperative Care/Rehabilitation 94
Case Report 96
Osteoarticular Grafting 98
Autograft 99
Allograft 101
Case Report 103
Autologous Chondrocyte Transplantation 105
Surgical Technique 105
Postoperative Care/Rehabilitation 106
Case Report 107
Associated Bone Deficit/Uncontained Lesions 109
Osteochondritis Dissecans 110
Juvenile Osteochondritis Dissecans 110
Adult Osteochondritis Dissecans 111
Case Report 112
Future of Cartilage Repair 114
Summary 114
Patellofemoral Disorders 119
Introduction 119
Anatomy 119
Patient History 120
Physical Examination 121
Imaging 122
Operative Techniques 122
Lateral Release 122
Indications 122
Contraindications 123
Technique 123
Rehabilitation 125
Complications 125
Cartilage Procedures 125
Indications for Chondroplasty 125
Technique for Chondroplasty 126
Rehabilitation for Chondroplasty 127
Indications for Microfracture 127
Technique for Microfracture 127
Rehabilitation for Microfracture 127
Complications for Chondroplasty and Microfracture 128
Medial Retinacular Imbrication 128
Indications 128
Technique 128
Rehabilitation 129
Complications 129
Clinical Pearls 129
Evaluating Patients with Prior Surgical History 129
Limiting Bleeding After Lateral Release 130
Evaluating the Medial Knee Capsule when Considering Medial Imbrication 130
Summary 130
Case Report 130
Case 1: Chondroplasty 130
Surgical Management of Anterior Cruciate Ligament Injuries 134
Introduction 134
Anatomy 134
Biomechanics 136
Diagnosis and Imaging 137
Meniscal and Chondral Injuries 138
Indications for Reconstruction 138
Timing of Surgery 139
Graft Options 140
Reconstruction Technique 141
Rehabilitation 145
Complications 145
Clinical Pearls 147
Summary 147
Case Reports 147
Case 1 147
Case 2 148
Case 3 150
Case 4 150
Case 5 151
Posterior Cruciate Ligament and Posterolateral Corner Reconstruction 157
Introduction 157
PCL Anatomy and Biomechanics 157
Posterolateral Corner Anatomy and Biomechanics 158
Incidence of PCL and Posterolateral Corner Injuries 158
Clinical Presentation 158
Treatment 159
Surgical Indications 159
Surgical Timing 159
Surgical Technique 159
Graft Selection 160
PCL Reconstruction Surgical Technique 160
Posterolateral Reconstruction Surgical Technique 162
Rehabilitation 164
Complications 165
Results: Single-Bundle PCL Reconstruction 165
Double-Bundle Compared with Single-Bundle PCL Reconstruction Results and Single-Bundle Versus Double-Bundle Arthroscopic Transtibial PCL Reconstruction Results 166
Clinical Pearls/Summary 167
Arthrofibrosis and Synovial Lesions of the Knee 169
Arthrofibrosis 169
Introduction 169
Anatomy 169
Pathophysiology 170
Indications and Techniques 170
Complications 174
Clinical Pearls and Summary 174
Case Report 174
Case 1 174
Synovial Lesions 175
Introduction 175
Anatomy 175
Indications and Techniques 176
Rheumatoid Arthritis 176
Seronegative Arthritis 176
Pigmented Villonodular Synovitis 176
Synovial Chondromatosis 176
Nonspecific Synovitis 177
Hemophilic Arthropathy 177
Lyme Arthritis 177
Surgical Technique and Planning 178
Postoperative Management 179
Localized Pathology of the Synovium 179
Symptomatic Plica 180
Hoffa's Disease: Fibrosis of the Infrapatella Fad Pad 180
Ganglions 180
Localized PVNS 180
Synovitis and Osteoarthritis of the Knee 180
Complications 181
Clinical Pearls and Summary 182
Case Report 182
Case 2 182
Arthroscopic Treatment of Knee Fractures 184
Introduction 184
Anatomy 184
Mechanism of Injury 184
Tibial Plateau Fractures 184
Tibial Eminence Fractures 184
Indications 185
Tibial Plateau Fractures 185
Tibial Eminence Fractures 187
Treatment 187
Tibial Plateau Fractures 187
Tibial Eminence Fractures 188
Technique 189
Tibial Plateau Fractures 189
Tibial Eminence Fractures 192
Rehabilitation 193
Tibial Plateau Fractures 194
Tibial Eminence Fractures 194
Complications 194
Tibial Plateau Fractures 194
Tibial Eminence Fractures 195
Clinical Pearls and Summary 195
Tibial Plateau Fractures 195
Tibial Eminence Fractures 195
Case Reports 195
Case 1 195
Case 2 196
Index 199