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- A Rare Cause of Recurrent Pain in Athletes: Synovial Hemangioma
Authors: Marco A. P. de Andrade, Igor G. N. Reis, Luciene Mota de Andrade, Túlio Vinícius de Oliveira Campos, Frederico Silva Pimenta, Guilherme Moreira de Abreu e Silva
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Synovial hemangioma is a rare neoplastic lesion, which can result in recurrent hemarthrosis and pain. It can affect any joint, tendon, or bursa, withal those around the knee. The intra-articular lesion is more prevalent and is more frequently diagnosed in female children or young adults.Indications:Surgery is indicated when patients present with recurrent painful hemarthrosis that affect daily living and functionality.Technique Description:Diagnostic knee arthroscopy, initially without tourniquet inflation, was performed to detect and study the extent of the lesion. Afterwards, the tourniquet was inflated to proceed with the surgical excision. Medial parapatellar approach was performed, and limits of the hemangioma were identified. Wide resection was performed taking care to not damage the medial meniscus and medial condyle cartilage. Neoplastic lesion was sent to pathology analysis. The tourniquet was deflated and hemostasis checked because these lesions can present extensive bleeding.Results:Localized, well-circumscribed, and encapsulated lesions have been reported to usually present low recurrence rate when completely excised.Discussion/Conclusion:It is a rare disease, and around 200 cases have been reported; therefore, conclusions about treatment and outcomes rely mostly on case series and case reports. Early diagnosis and treatment are paramount to prevent degenerative changes secondary to recurrent hemarthrosis.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-20T11:00:01Z
DOI: 10.1177/26350254231201426
Issue No: Vol. 3, No. 6 (2023)
- Anterior Cruciate Ligament Reconstruction With Iliotibial Band Autograft
Authors: Felipe C. Schumacher, Pedro H. S. A. F. Galvão, Enzo S. Mameri, Marcos V. Credidio, Carlos E. Franciozi, Marcelo S. Kubota
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:As there has been an increasing incidence of anterior cruciate ligament (ACL) tears in children and adolescents in the past few decades, nonoperative management is seen to result in less favorable clinical outcomes, resulting in meniscal and cartilage damage, and arthritic changes. Despite the risk of iatrogenic physeal injuries with operative approach, several reconstruction options, such as physeal-sparing techniques for skeletally immature patients, are described to restore joint stability.Indications:We bring a combined extra-articular and intra-articular ACL reconstruction technique using autogenous iliotibial band (ITB), which is indicated for prepubescent patients (Tanner stages 1 or 2) with open physes, significant growth potential (≤11 years for girls and ≤12 years for boys) and smaller knees, where an all-epiphyseal ACL reconstruction would lack epiphyseal spaceTechnique Description:The technique consists of a modified MacIntosh intra-articular and extra-articular ITB reconstruction, described by Micheli and further characterized by Kocher. The central portion of the ITB is harvested proximally (at least 15 cm) and left attached to Gerdy's tubercle distally. The harvested graft is brought from over-the-top posteriorly and passed under the intermeniscal ligament anteriorly through an epiphyseal groove on the tibia.Results:The outcomes shown for the Kocher ITB ACL reconstruction technique are favorable at a mean follow-up of 5.3 years: from 44 patients, 41 returned to sports involving cutting or pivoting, and the revision rate was low at 4.5%.Discussion/Conclusion:The awareness of physeal injury related to the operative treatment of ACL tears in the pediatric population has resulted in several physeal-sparing and physeal-respecting techniques of reconstruction. Some of these have shown to reduce the risk of physeal damage, maintaining stability and providing excellent functional outcomes, with low revision rates in long-term follow-up and minimal risk of growth disturbance.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-16T11:00:01Z
DOI: 10.1177/26350254231200591
Issue No: Vol. 3, No. 6 (2023)
- Weave Technique for Reconstruction of Medial Collateral Ligament and
Posterior Oblique Ligament: A Functional Percutaneous Approach Using
Gracilis Tendon
Authors: Luis Fernando Zukanovich Funchal, Rafael Ortiz, Lucio S. R. Ernlund, Diego Costa Astur, Moisés Cohen
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Injury to the medial collateral ligament (MCL) is common. MCL injuries, with impairment of its superficial portion, associated with the deep portion, lead to valgus instability and extrusion of the medial meniscus, resulting in instability and increased pressure in the medial compartment, with consequent damage to the cartilage. We can synthesize this set of structures as the medial meniscocapsular complex. Treating medial, superficial, and deep capsular meniscal complex together aims to restore the normal anatomy, stability, and function of the medial meniscus.Indications:• Anterior cruciate ligament with MCL grade III or MCL grade II• MCL grade III or grade II with clinical instabilityTechnique Description:An arthroscopic examination was performed to assess the “floating meniscus” sign and to confirm a tear of the MCL. The gracilis tendon is harvested in a usual fashion, leaving its distal insertion pedicle fixed to the tibial bone. An incision over the medial epicondyle is made, and a 6-mm drill is used to create a 2.5-cm bone tunnel. The passage of the medial subfascial graft is made toward the medial epicondyle. At this point, its fixation is performed with an interference screw. After fixing the anterior arm, we will return with the free portion of the graft in the most posterior portion and also percutaneously. This posterior arm is biologically fixed, closing the sartorius fascia over the 2 arms of the reconstruction with periosteal stitches.Results:Reconstruction tests were performed on cadaver models, obtaining a graft tension without compromising the range of motion (ROM) and a good result in their final analysis. We ended up publishing our results in a clinical study, with good functional results in both the Lysholm and Tegner scores, at a follow-up of 2 years.Discussion/Conclusion:We present an arthroscopic-assisted technique for a medial, percutaneous, aesthetic, and extremely functional approach. A technical limitation of our procedure is the absence of a biomechanical test for the gracilis double reconstruction: a strong point is that we performed some reconstruction tests on cadaver models, obtained good visual results and graft tension without compromising the ROM, and performed a positive clinical study with a minimum follow-up of 2 years. In conclusion, a simple and inexpensive technique that uses known anatomic principles of graft placement, without compromising ROM was performed.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-14T11:00:01Z
DOI: 10.1177/26350254231195902
Issue No: Vol. 3, No. 6 (2023)
- Full-Thickness Peroneus Longus Tendon Autograft Harvest
Authors: Carlos E. Franciozi, Enzo S. Mameri, Felipe C. Schumacher, Marcos V. Credidio, Marcelo S. Kubota, Marcus V. Luzo
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Despite extensive evidence of excellent biomechanical and clinical outcomes of ligament reconstructions with bone-patellar tendon-bone, hamstring tendon, and quadriceps tendon autografts, these are not without limitations, including knee-related donor site morbidity, decreased range of motion, and potential for anterior knee pain. Therefore, researchers have explored other options, including the peroneus longus (PL) autograft.Indication:Anterior cruciate ligament (ACL) reconstruction (both primary and revision), as well as multiligament reconstruction, particularly in areas where access to allografts is limited.Surgical Technique:A 3-cm longitudinal skin incision is placed 2 fingerbreadths (or 3 cm) proximal to the tip of the lateral malleolus, and 3 mm posterior to the fibula. The PL and peroneus brevis tendons are identified and isolated, followed by a tenodesis at the distal limit of the incision. The PL is whipstitched proximal to the tenodesis site, and then incised between the tenodesis and whipstitched portion. A closed tendon stripper is inserted and advanced proximally until the PL graft is released.Discussion/Conclusion:PL autograft harvest has been shown to generate thicker and longer grafts relative to the semitendinosus, with demonstrated efficacy in terms of both biomechanical and clinical outcomes. Current literature points largely to a good safety profile, although there is still conflicting evidence in terms of foot and ankle morbidity and no mid- to long-term follow-up data available.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T12:45:12Z
DOI: 10.1177/26350254231195093
Issue No: Vol. 3, No. 6 (2023)
- Tibial-Sling Triangular Medial Collateral Ligament Reconstruction With
Posterior Oblique Ligament Limb
Authors: Carlos E. Franciozi, Enzo S. Mameri, Guilherme C. Gracitelli, Felipe C. Schumacher, Marcos V. Credidio, Sérgio Canuto, Marcelo S. Kubota
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:While most medial-sided knee injuries can be managed conservatively, high-grade injuries of the posteromedial corner have been reported to have less than optimal outcomes with conservative approaches, resulting in residual valgus and rotational instability. Consensus among experts postulates that treatment should be based on reconstructing both the superficial medial collateral ligament (sMCL) and the posterior oblique ligament (POL). We present a modified technique of a tibial-sling anatomic MCL reconstruction with a POL limb.Indications:High-grade injuries of the posteromedial corner, specifically injuries with medial joint gapping in extension or grade 3 medial-sided tears.Technique Description:The MCL is reconstructed with a semitendinosus autograft in a tibial sling, created by converging perpendicular bone tunnels at its anatomic tibial insertion, and fixed to a femoral tunnel in the isometric point just posterior and proximal to the medial epicondyle with the knee at 30° of flexion. That same single femoral tunnel will be shared by the two strands of the semitendinosus graft and a limb of gracilis autograft to reproduce the POL, passed through a tibial tunnel in the posteromedial margin of medial tibial condyle, and fixed in extension.Discussion/Conclusion:As recent evidence suggests that medial reconstruction should be preferred over repair, due to favorable complication and failure rates, we describe a technique that is both anatomic-based, reproducing the 2 main medial knee structures (sMCL, POL), and also cost-saving, with decreased need of fixation devices.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T12:15:00Z
DOI: 10.1177/26350254231195087
Issue No: Vol. 3, No. 6 (2023)
- A Soft Tissue Technique for Treating Knee Hyperextension or Recurvatum:
Posterior Oblique Ligament Advancement
Authors: Carlos E. Franciozi, Enzo S. Mameri, Felipe C. Schumacher, Marcos V. Credidio, Marcelo S. Kubota, Marcus V. Luzo
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Genu recurvatum is a challenging disorder and can negatively affect knee biomechanics, as reflected in its role as a risk factor for knee ligament injury and poor outcomes following ligament reconstruction or arthroplasty.Indication:Pathological recurvatum should be addressed in the presence of a causative correctible structural abnormality, whether due to decreased posterior tibial slope or due to multiligament injury. We described a posterior oblique ligament (POL) advancement technique for the treatment of knee recurvatum.Technique Description:After completion of all concomitant procedures such as ligament reconstructions, the procedure is initiated with a medial approach. The POL is isolated with an inverted L-shaped dissection and mobilized. Mattress sutures are passed through the resulting POL flap, and are re-tensioned and fixed anteriorly and distally, with the knee close to extension, in order for the imbrication to restrain hyperextension.Results:Anecdotal evidence points to satisfactory control of knee recurvatum postoperatively, which can potentially avoid its deleterious effects in surgical outcomes.Discussion/Conclusion:We present a promising option in the treatment of pathological recurvatum, with favorable cost-efficacy, low morbidity relative to slope-altering osteotomy or posterolateral soft tissue procedures, and focused on the biomechanically demonstrated main restrictors to knee hyperextension.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T11:45:01Z
DOI: 10.1177/26350254231195086
Issue No: Vol. 3, No. 6 (2023)
- Hybrid Repair of a Medial Meniscus Mid-Body Radial Tear
Authors: Carlos E. Franciozi, Enzo S. Mameri, Felipe C. Schumacher, Marcos V. Credidio, Marcelo S. Kubota, Marcus V. Luzo
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Meniscal radial tears are associated with altered contact mechanics, as they have the potential to disrupt the meniscal hoop stress mechanism. In prior studies, radial tears are associated with higher grade of cartilage damage, as well as higher rate and severity of meniscal extrusion in knees with a radial tear relative to other types of tears. Improved understanding of the meniscus biological potential together with modern developments in surgical technique has paved the way for the current emphasis on repairing even radial tears.Indication:Large or complete radial tears of the meniscus without prohibitive joint space narrowing or severe cartilage damage.Technique Description:A hybrid technique of meniscal radial repair is described, combining (1) 2 transtibial pullout cinch-loop sutures, (2) 2 inside-out vertical rip-stop sutures and 2 oblique sutures in a “cross-tag” configuration, and (3) 1 horizontal mattress all-inside suture. The repair is biologically augmented with a notch marrow-venting procedure.Results:Recent evidence has demonstrated significant biomechanical benefit in terms of increased load to failure and construct strength when adding transtibial tunnel augmentation to radial repairs. In addition, rip-stop sutures decrease the chance of cut-out relative to nonreinforced repairs. Those biomechanical advancements are reflected in excellent patient-reported outcomes as well as healing rates following radial repair.Discussion/Conclusion:We present a hybrid technique encompassing the most biomechanically effective novel radial repair techniques, backed by excellent clinical outcomes following radial repair in the current literature.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T11:15:00Z
DOI: 10.1177/26350254231195085
Issue No: Vol. 3, No. 6 (2023)
- Combined Trochlear, Patellar, Medial and Lateral Condyle Fresh
Osteochondral Allograft Transplantation: A Case Report
Authors: Bruno Butturi Varone, Daniel Peixoto Leal, Riccardo Gomes Gobbi, Luís Eduardo Passarelli Tirico
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:This is a case report of a 41-year-old man with torsional knee trauma in 2019 and chondral lesions. Previous microfracture had failed, and the patient presented with a dull pain and knee effusion. Imaging revealed multiple focal lesions including trochlea, patella, medial condyle, and lateral condyle. Fresh osteochondral allograft (OCA) transplantation is a versatile treatment for large defects as it is based on mature, living hyaline cartilage attached to a bone interface. A patient with multiple chondral lesions is rare, and this report presents a case with multiple symptomatic large focal lesions in the knee that underwent a fresh OCA in all 3 knee compartments.Indications:Osteochondral allograft is indicated for patients who present with activity-related pain and recurrent knee effusion. Contraindications are patient clinical conditions that may lead to complications, such as tobacco use, inflammatory arthritis, or septic arthritis.Technique Description:After the chondral defect is exposed, an appropriate allograft Mega-OATS sizer (15-30 mm) is chosen. Cartilage and the subchondral bone are drilled until the desired depth. The donor allograft is drilled in the desired diameter, and excess bone is removed according to the previous measurements of the recipient site. The graft is advanced with firm pressure into the created socket. Postoperative rehabilitation includes a limited range of motion and proprioceptive weightbearing in the first 2 weeks but expected total weightbearing and a full range of motion by the sixth week.Results:Range of motion was full by 6 weeks of surgery. The effusion lasted for 2 months after the surgery. Fresh OCA is a good surgical option for patients with multiple large chondral defects.Discussion/Conclusion:Patient satisfaction is high since the mature cartilage leads to a fast rehabilitation compared with the other surgical procedures for large chondral defects. This technique appears to be effective also for multiple focal lesions as presented in this article.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T10:45:01Z
DOI: 10.1177/26350254231193031
Issue No: Vol. 3, No. 6 (2023)
- 40th Anniversary Celebration of the Brazilian Society of Knee
Surgery—Collaboration With VJSM!
Authors: Riccardo Gomes Gobbi, Guilherme Moreira de Abreu e Silva
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T10:00:03Z
DOI: 10.1177/26350254231209948
Issue No: Vol. 3, No. 6 (2023)
- Reconstruction of the Posterior Cruciate Ligament and Medial Collateral
Ligament With a Single Combined Femoral Tunnel
Authors: Andre Giardino Moreira da Silva, Riccardo Gomes Gobbi, Marcelo Batista Bonadio, Fabio Janson Angelini, José Ricardo Pécora, Camilo Partezani Helito
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Lesions of the medial collateral ligament (MCL) are the most common knee ligament injuries and, when they occur in isolation, they often progress with satisfactory outcomes using conservative treatment. However, MCL lesions associated with anterior cruciate ligament or posterior cruciate ligament (PCL) injuries in knee dislocations should be reconstructed to prevent failure of the central pivot. In knees with combined injuries involving the PCL and the MCL, the confluence of tunnels in the medial femoral condyle can be a potential problem during reconstruction surgery.Indications:The indication of this technique is the combined injury of the PCL and the MCL.Technique Description:The technique consists in the reconstruction of the PCL and the MCL with an Achilles tendon allograft. The bone plug of the graft is fixed on the tibial bed with the inlay technique. The graft passes through a single femoral tunnel drilled in the medial femoral condyle, with entrance point on the footprint of the PCL on the inner wall of the condyle and exit on the origin of the native MCL, near to the medial epicondyle. The graft is fixed in the femoral tunnel with an interference screw and continues to the isometric point of the anatomic insertion of the MCL in the tibia, where an interference screw is used to fix it.Results:Results from our group using this technique have shown good clinical outcomes, with complications and failure rates similar to other series in the literature.Discussion/Conclusion:This technique is an excellent option for surgeons, when an Achilles tendon allograft is available, to avoid confluence of tunnels in the medial femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T01:45:08Z
DOI: 10.1177/26350254231195376
Issue No: Vol. 3, No. 6 (2023)
- Reconstruction of the Anterior Cruciate Ligament and the Posterolateral
Corner With a Single Combined Femoral Tunnel
Authors: Andre Giardino Moreira da Silva, Riccardo Gomes Gobbi, Marcelo Batista Bonadio, Fabio Janson Angelini, José Ricardo Pécora, Camilo Partezani Helito
Abstract: Video Journal of Sports Medicine, Volume 3, Issue 6, November 2023.
Background:Posterolateral knee injuries can occur in 16% of patients with acute ligament injuries, and up to 70% have a combined anterior cruciate ligament (ACL) tear. Studies have shown that, in different populations, the distance between the insertion of the popliteus tendon and the lateral collateral ligament (LCL) may be smaller than the 18.5 mm previously reported in the literature. When we have an associated injury of the ACL and the posterolateral corner (PLC), the confluence of tunnels in the lateral femoral condyle can be a potential problem during reconstruction surgery.Indications:The indication of this technique is the combined injury of the ACL and the PLC.Technique Description:The reconstruction is performed with 2 semitendinosus tendons and 1 gracilis tendon. The technique consists of making a tunnel in the lateral wall of the femur, from the outside-in, at the isometric point between the origin of the LCL and insertion of the popliteus tendon, and emerging in the inner wall of the lateral femoral condyle at the anatomic point of the ACL. The graft is passed from the tibia to the femur with the doubled gracilis tendon and the 2 simple semitendinosus tendons for the ACL graft. The remaining portions of the semitendinosus tendons are left for reconstruction of the PLC structures, with one of them going straight to the posterolateral tibial tunnel (reconstructing the popliteus tendon), and the other passing through the fibular head tunnel (reconstructing the LCL) and continuing from the fibular head to the posterolateral tibial tunnel (reconstructing the popliteofibular ligament).Results:Patients undergoing this technique achieved good functional outcomes and a failure rate similar to that reported in the literature for combined ACL and PLC reconstruction.Discussion/Conclusion:This technique is an excellent option for patients with the combined injury of the ACL and the PLC, avoiding the confluence of tunnels in the lateral femoral condyle. It presents good results and acceptable complication rates, compatible with the severity of this lesion.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Citation: Video Journal of Sports Medicine
PubDate: 2023-11-06T01:15:01Z
DOI: 10.1177/26350254231195374
Issue No: Vol. 3, No. 6 (2023)
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