Project description:The medial collateral ligament (MCL) is a major contributor to knee joint stability and is the most common ligament involved in knee injuries. When conservative management for high-grade MCL injuries fails, operative treatment is indicated. Various reconstruction techniques are described in the literature. The following report describes a reconstruction technique based on the modified Bosworth. We present a step-by-step technique for using autograft semitendinosus tendon as a double limb to reconstruct the MCL and if necessary, the posterior oblique ligament. The technique is versatile with respect to a spectrum of MCL injury patterns, isometric, incorporates techniques that are common to other knee reconstructions, and uses readily available autograft. It has been used extensively by the senior authors as an adjunct/augmentation to the repair of acute MCL injuries as well as in the reconstruction of chronic MCL laxity. The technique restores stability to rotation and valgus stress while maintaining the distal insertion of the semitendinosus intact. Technique Video Video 1 Video demonstrates the described technique in a right knee.
Project description:A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury.
Project description:We introduce our technique for posterolateral corner reconstruction, which is based on the principle described in Arciero's technique for anatomic reconstruction of lateral collateral ligament (LCL) and popliteofibular ligament (PFL) to gain static stability in varus strain and external rotation. This technique uses a doubled gracilis autograft to reconstruct the PFL and a split biceps tendon transfer to reconstruct the LCL. Using this technique an anatomical LCL and PFL reconstruction can be performed in combination with anterior cruciate ligament or posterior cruciate ligament reconstruction without contralateral graft harvest or allograft. The technique also enables an isolated reconstruction of LCL or PFL when required and can be performed to augment an acute repair.
Project description:IntroductionSnapping biceps femoris tendon over the fibular head is an uncommon cause of snapping knee. We report a rare case of knee pain secondary to subluxation of the long head of the biceps femoris over the fibular head in an athlete with no history of trauma. This case was treated surgically by a modification of Kennedy procedure.Case reportA 21-year-old Lebanese athletic male presented for a nauseating feeling of something snapping over his lateral knee since the age of 12 when performing self-defense sports with no history of trauma. Snapping begins when the patient flexes above 80° during squatting, cycling, gym exercises, and climbing stairs.ConclusionA symptomatic snapping biceps femoris tendon is a rare phenomenon with limited reports in the literature. When conservative treatment fails, surgery may be the only successful treatment. A modification of the Kennedy procedure was used. Rerouting of the subluxating superior aspect of the tendon without further dissection and release appears to be an effective treatment that can result in symptom resolution as long as no anatomic variants are present.
Project description:A snapping biceps tendon is an infrequently seen and commonly misdiagnosed pathology, leaving patients with persistent symptoms that can be debilitating. Patients will present with a visible, audible, and/or painful snap over the lateral aspect of their knee when performing squats, sitting in low seats, or participating in activities with deep knee flexion. A thorough knowledge of the anatomy is essential for surgical treatment of this pathology, which is caused by a detachment of the direct arms of the long and short heads of the biceps femoris off the fibular styloid. This Technical Note provides a diagnostic approach, postoperative management, and details of a surgical technique to treat a snapping biceps tendon with an anatomic repair of the long and short head attachments of the biceps femoris to the posterolateral fibular styloid.
Project description:Key clinical messageWe present a case of lateral knee pain from snapping of an accessory tendinous insertion of the biceps femoris. After failure of conservative treatment options, tenodesis of the accessory band to the direct arm insertion at the posterolateral edge of the fibular head effectively resolved symptoms.AbstractThere are several distinct causes of lateral knee pain including IT band syndrome, meniscus tears, or other soft tissue pathologies; however, a few case reports have shown the biceps femoris as a cause of lateral knee pain and snapping. Conservative treatment is of modest benefit to the patient in these scenarios, and an MRI is not always able to identify the accessory band, as in our case. Intraoperatively, we discovered an accessory band of the biceps femoris attaching to the anterolateral tibia, causing pain and snapping during knee flexion as the band passed over the fibular head. There have been various surgical attempts to address this pathology; however, we report a successful outcome after tenodesis of the accessory band to the direct insertion at the posterolateral fibular head.
Project description:The proportion of postoperative retears after arthroscopic rotator cuff reconstruction remains constant despite advancement of suture techniques and improved anchor implants. The commonly degenerative nature of rotator cuff tears can carry the risk of compromised tissue. Several techniques have been developed to biologically enhance rotator cuff repair, and a considerable number of autologous, allogeneic, and xenogenous augmentation methods have been described. This article introduces the biceps smash technique, an arthroscopic augmentation procedure for posterosuperior rotator cuff reconstruction using an autograft patch of the long head of the biceps tendon.
Project description:The integrity of the medial ulnar collateral ligament (UCL) of the elbow is vital for the throwing athlete. Although newer techniques exist, reconstruction remains the gold standard for full-thickness UCL tears. An increase in throwing velocity, inadequate recovery, and early sports specialization have contributed to increased rates of UCL injury. As increasing numbers of athletes undergo UCL reconstruction, we continue to search for the optimal technique to return athletes to the same level of competition. We present a UCL reconstruction utilizing a 3-stranded palmaris longus tendon autograft with an inlay linear construct.
Project description:Snapping biceps femoris is a rare phenomenon in which the biceps femoris tendon subluxates over the fibular head when the leg is brought into deep flexion. Two primary pathologies have been identified: biceps insertion tears/anatomic variants and/or an enlarged fibular head. Often, it can be treated nonoperatively; however, if symptoms are severe enough and refractory to conservative treatments, the underlying pathology can be corrected surgically to alleviate symptoms. The diagnosis is made clinically; the subluxation should be reproducible with deep flexion and should abate with manual compression of the biceps muscle and internal rotation of the tibia. Radiographs can help to discern the size and shape of the fibular head, and magnetic resonance imaging can often help to determine any abnormal tendon insertions. The surgeon should be comfortable with the anatomy of the lateral knee. It is critical to protect the common peroneal nerve. With the appropriate correction, the subluxation can be eliminated and symptoms dramatically improved.