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Arthroscopy Techniques
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    • Cover Image - Arthroscopy Techniques, Volume 12, Issue 2
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  • Technical Note
    Open Access

    Intrameniscal Cyst—Arthroscopic Open- and Closed-Door Repair Technique

    Arthroscopy Techniques
    Vol. 12Issue 2e141–e145Published online: January 18, 2023
    • Mukesh S. Laddha
    • Darshan Shingane
    Cited in Scopus: 0
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    Meniscal cyst is rare and usually is associated with degenerative horizontal meniscus tears. These cysts are parameniscal in nature, as synovial fluid collects due to a check-valve mechanism. Most often, they are located on at the posteromedial aspect of the knee. Various repair techniques had been established in the literature to decompress and repair them. We describe an isolated intrameniscal cyst with an intact meniscus managed by arthroscopic open- and closed-door repair technique.
    Intrameniscal Cyst—Arthroscopic Open- and Closed-Door Repair Technique
  • Technical Note
    Open Access

    Anatomic Combined Anterior Cruciate Ligament and Antero-Lateral Ligament Reconstruction Using Autologous Gracilis and Semitendinosus Graft With Single Tibial and Femoral Tunnel

    Arthroscopy Techniques
    Vol. 12Issue 2e255–e259Published online: January 18, 2023
    • Daniele Screpis
    • Marco Baldini
    • Stefano Magnanelli
    • Andrea Amarossi
    • Gianluca Piovan
    • Simone Natali
    • and others
    Cited in Scopus: 0
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    Anterior cruciate ligament (ACL) injuries are among the most common lesions in orthopaedics practice, but still today, rates up to 24% of unsatisfactory results are reported. Unaddressed anterolateral complex (ALC) injuries have been claimed to be responsible for residual anterolateral rotatory instability (ALRI) after isolate ACL reconstruction and have demonstrated to increase graft failure. In this article, we present our technique for reconstruction of the ACL and anterolateral (ALL) ligament combining the advantages of the anatomical position and the intraosseous femoral fixation to ensure anteroposterior and anterolateral rotational stability.
    Anatomic Combined Anterior Cruciate Ligament and Antero-Lateral Ligament Reconstruction Using Autologous Gracilis and Semitendinosus Graft With Single Tibial and Femoral Tunnel
  • Technical Note
    Open Access

    Endoscopic Technique to Remove Endobutton After Anterior Cruciate Ligament Reconstruction.

    Arthroscopy Techniques
    Vol. 12Issue 2e291–e296Published online: January 18, 2023
    • Soshi Uchida
    • Tomoya Arashi
    • Dean K. Matsuda
    Cited in Scopus: 0
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    Suture button-based femoral cortical suspension constructs of anterior cruciate ligament grafts may facilitate fast and secure fixation. The necessity of Endobutton removal is controversial. Many current surgical techniques do not allow direct visualization of the Endobutton(s), making it challenging to remove; the buttons are fully flipped without soft tissue interposition between the Endobutton and femur. This Technical Note demonstrates endoscopic removal of Endobuttons through the lateral femoral portal.
    Endoscopic Technique to Remove Endobutton After Anterior Cruciate Ligament Reconstruction.
  • Technical Note
    Open Access

    Reefing of the Posteromedial Capsule in Anteromedial Rotatory Instability

    Arthroscopy Techniques
    Vol. 7Issue 5e547–e551Published online: April 30, 2018
    • Christoph Offerhaus
    • Maurice Balke
    • Justin W. Arner
    • Volker Musahl
    • Jürgen Höher
    Cited in Scopus: 4
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    • Video
    The posterior oblique ligament (POL) is the main component of the posteromedial corner (PMC) of the knee and plays a crucial role in acting as a secondary restraint against translation, rotation, and valgus forces. Injuries to the PMC often occur in association with acute or chronic deficiency of the anterior cruciate ligament and may result in anteromedial rotatory instability. A surgical technique for treatment of acute and chronic injuries of the posteromedial structures was first established by Hughston in 1973.
    Reefing of the Posteromedial Capsule in Anteromedial Rotatory Instability
  • Technical Note
    Open Access

    Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation

    Arthroscopy Techniques
    Vol. 7Issue 5e557–e567Published online: April 30, 2018
    • Naser M. Selim
    Cited in Scopus: 2
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    An untreated posterolateral corner (PLC) injury in patients with a torn anterior cruciate ligament (ACL) may be a leading cause of ACL reconstruction failure. Combined ACL and PLC reconstruction is discussed in few studies in the literature. Femoral tunnel intersection in combined reconstruction has been reported to be high. Short grafts may render combined reconstruction undoable. This Technical Note describes a technique that allows a combined ACL and PLC reconstruction. The ACL graft is a 4-stranded hamstring tendon graft from 1 limb.
    Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction by Hamstring Tendon Autografts Through a Single Femoral Tunnel by Graft-to-Graft Suspension and Fixation
  • Technical Note
    Open Access

    The Adjustable Locking Suspension Sling Technique for Fixation of the Tibial Eminence Fracture in Adolescents

    Arthroscopy Techniques
    Vol. 7Issue 5e491–e497Published online: April 16, 2018
    • Mohamed Aboalata
    • Ahmed Almohandes
    • Osama Abunar
    • Moheib S. Ahmed
    • Andreas B. Imhoff
    • Yehia Bassiouny
    Cited in Scopus: 3
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    Avulsion fractures of the tibial eminence, although generally a rare injury pattern, are more common in children and adolescents than in adults. Many open and arthroscopic techniques are available with variable degrees of satisfying results and incidence of complications and adverse effects. Arthroscopic fixation appeared to improve the functional outcomes with fewer complications than the open fixation. New techniques were reported using commercially available suspension sling devices for the acromioclavicular joint that offers an easy and rapid method of fixation.
    The Adjustable Locking Suspension Sling Technique for Fixation of the Tibial Eminence Fracture in Adolescents
  • Technical Note
    Open Access

    Suture Pullout Technique of Acute Anterior Cruciate Ligament Femoral Avulsion Repair

    Arthroscopy Techniques
    Vol. 7Issue 5e499–e503Published online: April 16, 2018
    • Nishith Shah
    • Reetadyuti Mukhopadhyay
    • Rohan Vakta
    • Jaymin Bhatt
    Cited in Scopus: 2
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    It was in the early 1900s that anterior cruciate ligament (ACL) repair was first described with its resurgence in the mid-1900s. It however failed to gain popularity because of unsatisfactory early outcomes as a result of poorly selected patients. We describe a suture pullout technique of acute ACL repair in a carefully selected cohort of patients. Healing capabilities similar to that of the proximal medial collateral ligament have been shown in the proximal ACL avulsions. Adding microfracture of the lateral wall of the notch further enhances the healing environment by countering the synovial fluid environment.
    Suture Pullout Technique of Acute Anterior Cruciate Ligament Femoral Avulsion Repair
  • Technical Note
    Open Access

    Radiofrequency Ablation for Mucoid Degeneration of the Anterior Cruciate Ligament

    Arthroscopy Techniques
    Vol. 7Issue 5e459–e463Published online: April 9, 2018
    • Andrew J. Hotchen
    • Joel T.K. Melton
    Cited in Scopus: 4
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    Mucoid degeneration of the anterior cruciate ligament (MD-ACL) is an underdiagnosed ACL pathology. When recognized, one potential management strategy involves arthroscopic debridement to “debulk” the ACL. Here, with the addition of video footage, we describe our arthroscopic technique for MD-ACL debridement using radiofrequency ablation. We show the engorged, stranded MD-ACL during arthroscopy and how this engorgement causes impingement in the femoral notch, resulting in the symptoms described by the patient.
    Radiofrequency Ablation for Mucoid Degeneration of the Anterior Cruciate Ligament
  • Technical Note
    Open Access

    All-Inside Anterior Cruciate Ligament Reconstruction as a Salvage for Small or Attenuated Hamstring Grafts

    Arthroscopy Techniques
    Vol. 7Issue 5e453–e457Published online: April 9, 2018
    • Patrick E. Jones
    • Dustin J. Schuett
    Cited in Scopus: 10
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    Anterior cruciate ligament (ACL) tears represent one of the most common sports-related injuries in the young population. There are multiple studies showing higher failure rates in the younger population with an allograft supporting the routine use of an autograft. In addition, higher failure rates have been shown with grafts narrower than 8 mm in diameter. This places the surgeon in an operative dilemma determining what to do with a narrow graft or an attenuated hamstring during harvest. All-inside ACL reconstruction is a promising technique for reliably creating sufficiently wide grafts without the need for allograft augmentation.
    All-Inside Anterior Cruciate Ligament Reconstruction as a Salvage for Small or Attenuated Hamstring Grafts
  • Technical Note
    Open Access

    Arthroscopic Single-Tunnel Pullout Suture Fixation for Tibial Eminence Avulsion Fracture

    Arthroscopy Techniques
    Vol. 7Issue 5e443–e452Published online: April 2, 2018
    • Ahmed Nady Saleh Elsaid
    • Assem Mohamed Noureldin Zein
    • Mohamed ElShafie
    • Nady Saleh El Said
    • Alaa Zenhom Mahmoud
    Cited in Scopus: 9
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    Various arthroscopic techniques have been devised for fixation of tibial eminence avulsions, namely percutaneous K-wires, arthroscopy-guided screw fixation, staples, TightRope (Arthrex)–suture button fixation, and transosseous suture fixation. Such techniques provide well-pronounced advantages including less postoperative pain, a reduced hospital stay, and minimal scar with resultant earlier and more compliant rehabilitation. As for transosseous suture fixation, the standard technique comprises the creation of 2 tibial tunnels exiting on both sides of the footprint of the avulsion fracture using an anterior cruciate ligament tibial guide with the angle set at 45°.
    Arthroscopic Single-Tunnel Pullout Suture Fixation for Tibial Eminence Avulsion Fracture
  • Technical Note
    Open Access

    Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation

    Arthroscopy Techniques
    Vol. 7Issue 4e385–e389Published online: March 26, 2018
    • Matt Daggett
    • Andrea Redler
    • Kevin Witte
    Cited in Scopus: 18
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    The advent of suture tape augmentation has led to increased use in knee, elbow, and ankle ligament repairs and reconstructions. Recent biomechanical analysis of the use of suture tape augmentation have shown superior strength characteristics compared with repair or reconstruction alone. Despite its increased use in extra-articular ligament procedures, its use as an augment to anterior cruciate ligament reconstruction has not been widely described. This article details a simple technique to incorporate the use of suture tape augmentation during concurrent anterior cruciate ligament reconstruction using hamstring autograft.
    Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation
  • Technical Note
    Open Access

    Anterior Cruciate Ligament Reconstruction With Amnion Biological Augmentation

    Arthroscopy Techniques
    Vol. 7Issue 4e355–e360Published online: March 19, 2018
    • Brittany M. Woodall
    • Nicholas Elena
    • Joseph T. Gamboa
    • Edward C. Shin
    • Neil Pathare
    • Patrick J. McGahan
    • and others
    Cited in Scopus: 7
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    • Video
    Anterior cruciate ligament (ACL) ruptures are common and unfortunate injuries for many athletes. The standard therapy for ACL rupture is ACL reconstruction with either autograft, harvested from hamstring or patellar tendon, or allograft tendon from a tissue donor. Advances in tissue engineering have produced interventions to augment the healing process and may have applications when it comes to ACL reconstruction. In this Technical Note and accompanying video, we describe a simple technique to implant an amnion matrix graft with a tendon graft during ACL reconstruction.
    Anterior Cruciate Ligament Reconstruction With Amnion Biological Augmentation
  • Technical Note
    Open Access

    Primary Anterior Cruciate Ligament Single-Bundle Repair With Augmentation for a Partial Anterior Cruciate Ligament Tear

    Arthroscopy Techniques
    Vol. 7Issue 4e367–e372Published online: March 19, 2018
    • Aaron Michael Gipsman
    • Nicholas Trasolini
    • George F. “Rick” Hatch III
    Cited in Scopus: 1
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    Although anterior cruciate ligament (ACL) reconstruction remains the gold standard for the treatment of ACL tears, repair is regaining popularity as a treatment option for proximal or distal ACL avulsions. Historically, ACL repairs had poor outcomes. To remedy this, techniques were developed using graft-based augmentation but never gained widespread popularity. Recently, there has been a renewed interest in primary ligament repairs, with newer techniques incorporating modern synthetic materials to augment the repair site.
    Primary Anterior Cruciate Ligament Single-Bundle Repair With Augmentation for a Partial Anterior Cruciate Ligament Tear
  • Technical Note
    Open Access

    Inside-out Tibial Tunnel Drilling Technique for All-inside Anterior Cruciate Ligament Reconstruction

    Arthroscopy Techniques
    Vol. 7Issue 4e373–e377Published online: March 19, 2018
    • José Carlos Noronha
    • João Pedro Oliveira
    Cited in Scopus: 2
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    All-inside anterior cruciate ligament reconstruction passed through a series of modifications over the past 2 decades, maintaining 2 common factors: half tunnels in both the femur and tibia and introduction of the graft into the knee through an arthroscopic portal. One of the disadvantages noted with this technique is the excessive cost of the instrumentation needed to perform it and its economic impact on the health care system. We describe a modification of the original technique, both maintaining the cortical bone in an intact state and avoiding the retrograde drill aiming device.
    Inside-out Tibial Tunnel Drilling Technique for All-inside Anterior Cruciate Ligament Reconstruction
  • Technical Note
    Open Access

    Graft Retensioning Technique Using an Adjustable-Loop Fixation Device in Arthroscopic Anterior Cruciate Ligament Reconstruction

    Arthroscopy Techniques
    Vol. 7Issue 2e185–e191Published online: February 4, 2018
    • Joseph T. Gamboa
    • Edward C. Shin
    • Neil P. Pathare
    • Patrick J. McGahan
    • James L. Chen
    Cited in Scopus: 8
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    Anterior cruciate ligament (ACL) tears are an unfortunate and devastating injury in the athletic patient. Surgical reconstruction of the ACL with a taut graft construct is necessary to restore knee stability and help expedite the patient's return to an active lifestyle. Arthroscopy-assisted ACL reconstruction can be a technically involved procedure, where strong fixation limits graft motion to allow sufficient healing within the tibial and femoral tunnels at the bone-tendon interfaces. Loss of tension in a graft can cause symptomatic anterior or rotatory instability and potential retear of the ACL graft.
    Graft Retensioning Technique Using an Adjustable-Loop Fixation Device in Arthroscopic Anterior Cruciate Ligament Reconstruction
  • Technical Note
    Open Access

    Arthroscopic Delivery of Injectable Bone Graft for Staged Revision Anterior Cruciate Ligament Reconstruction

    Arthroscopy Techniques
    Vol. 6Issue 6e2223–e2227Published online: November 20, 2017
    • Kent T. Yamaguchi Jr.
    • Gina M. Mosich
    • Kristofer J. Jones
    Cited in Scopus: 5
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    Bone defects caused by femoral and tibial tunnel enlargement can pose a significant technical challenge when planning to perform revision anterior cruciate ligament reconstruction. A number of options have been described for managing osseous deficiencies, including the use of large autograft or allograft bone dowels to provide sufficient tunnel fill and subsequent structural support for revision surgery. These techniques can be time-consuming and technically demanding to ensure proper tunnel fill and press-fit stability of the bone graft.
    Arthroscopic Delivery of Injectable Bone Graft for Staged Revision Anterior Cruciate Ligament Reconstruction
  • Technical Note
    Open Access

    Graft Preparation Technique to Optimize Hamstring Graft Diameter for Anterior Cruciate Ligament Reconstruction

    Arthroscopy Techniques
    Vol. 6Issue 6e2169–e2175Published online: November 13, 2017
    • Brett Fritsch
    • Francisco Figueroa
    • Bertrand Semay
    Cited in Scopus: 20
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    Hamstring autografts are frequently used for anterior cruciate ligament reconstruction. The inherent variability in graft diameter has been stated as a disadvantage in its use because the presence of smaller graft diameters has been correlated with increased risk of re-rupture. Several techniques have been described to address this concern. Modifications of the basic Graftlink technique allows for increased control over final graft diameter using a standard harvest of the semitendinosus tendon with or without the gracilis tendon, and results in a graft of adequate length and diameter in all patients with rigid cortical fixation on the femur and tibia.
    Graft Preparation Technique to Optimize Hamstring Graft Diameter for Anterior Cruciate Ligament Reconstruction
  • Technical Note
    Open Access

    Hamstring Graft Preparation Techniques for Anterior Cruciate Ligament Reconstruction

    Arthroscopy Techniques
    Vol. 6Issue 6e2079–e2084Published online: November 6, 2017
    • Gustavo Vinagre
    • Nicholas I. Kennedy
    • Jorge Chahla
    • Mark E. Cinque
    • Zaamin B. Hussain
    • Morten L. Olesen
    • and others
    Cited in Scopus: 28
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    Anterior cruciate ligament reconstruction is one of the most commonly performed procedures in orthopaedics, with more than 125,000 performed in the United States per year. There are several reconstruction graft choices that can be used to reconstruct the native anterior cruciate ligament, with autograft hamstring tendons being one of the most commonly used. Preparation of a hamstring autograft varies depending on patient characteristics and physician preference. The purpose of this Technical Note is to describe in detail different variants of hamstring graft preparation techniques that are commonly used in practice.
    Hamstring Graft Preparation Techniques for Anterior Cruciate Ligament Reconstruction
  • Technical Note
    Open Access

    Anterior Cruciate Ligament Primary Repair With Independent Tensioning of the Anteromedial and Posterolateral Bundles

    Arthroscopy Techniques
    Vol. 6Issue 6e2123–e2128Published online: November 5, 2017
    • Patrick A. Smith
    • Jordan A. Bley
    Cited in Scopus: 4
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    This procedure represents an update on traditional primary repair methods by taking advantage of technological advancements to optimize soft tissue fixation and allow for an anatomic double-bundle primary repair with independent bundle tensioning and an internal brace construct to restore normal anterior cruciate ligament biomechanics.
    Anterior Cruciate Ligament Primary Repair With Independent Tensioning of the Anteromedial and Posterolateral Bundles
  • Technical Note
    Open Access

    Opening Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction or Revision

    Arthroscopy Techniques
    Vol. 6Issue 5e1735–e1741Published online: October 2, 2017
    • Davide Edoardo Bonasia
    • Federico Dettoni
    • Anna Palazzolo
    • Roberto Rossi
    Cited in Scopus: 10
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    • Video
    High tibial osteotomy (HTO) is a valid treatment option for young active patients with medial tibiofemoral osteoarthrosis (OA) and varus deformity. Sometimes medial OA is combined with symptomatic anterior cruciate ligament (ACL) deficiency. Although isolated HTO (with possible delayed ACL reconstruction) might be indicated in the older population, young active patients may require combined HTO and ACL reconstruction. In addition, an abnormally increased tibial slope may predispose to ACL reconstruction failure and should be addressed for a successful ACL revision.
    Opening Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction or Revision
  • Technical Note
    Open Access

    Biologic and Mechanical Augmentation in Anterior Cruciate Ligament Reconstruction: Fibrin Clot Augmentation of 5-Strand Hamstring Autograft

    Arthroscopy Techniques
    Vol. 6Issue 5e1851–e1855Published online: October 9, 2017
    • Michael H. Amini
    • Juan F. Prieto
    Cited in Scopus: 0
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    Hamstring autografts in anterior cruciate ligament reconstruction have an excellent clinical track record, but some patients have hamstring tendons that yield grafts of smaller diameter, which has been shown to be a significant risk factor for worse outcomes and graft failure. Some authors have advocated augmentation with allograft in these patients. Tripling the semitendinosus yields a completely autogenous 5-strand graft with a larger diameter but still of sufficient length. In addition, imaging studies still show signal heterogeneity within grafts, even autografts, after the healing process, which correlates with worse biomechanical properties.
    Biologic and Mechanical Augmentation in Anterior Cruciate Ligament Reconstruction: Fibrin Clot Augmentation of 5-Strand Hamstring Autograft
  • Technical Note
    Open Access

    Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique

    Arthroscopy Techniques
    Vol. 6Issue 5e1937–e1943Published online: October 23, 2017
    • Bancha Chernchujit
    • Renaldi Prasetia
    Cited in Scopus: 5
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    The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner.
    Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique
  • Technical Note
    Open Access

    Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft

    Arthroscopy Techniques
    Vol. 6Issue 5e2039–e2046Published online: October 30, 2017
    • Alejandro Espejo-Baena
    • Alejandro Espejo-Reina
    • Abel Gómez-Cáceres
    • Maria Josefa Espejo-Reina
    • Jaime Dalla Rosa-Nogales
    Cited in Scopus: 7
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    The anterior cruciate ligament (ACL) rupture is a common disease that accounts for 250,000 cases/year in the United States. The anterolateral ligament (ALL) has been suggested to be an important restraint for rotational instability, and its reconstruction provides a reinforcement to the ACL reconstruction in this aspect, especially in high-demand athletes and in knees with high-grade pivot shift. Different techniques for associated ACL and ALL reconstruction have been described, but the ideal technique remains unclear.
    Associated Reconstruction of Anterior Cruciate and Anterolateral Ligaments With Single Asymmetric Hamstring Tendons Graft
  • Technical Note
    Open Access

    Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation

    Arthroscopy Techniques
    Vol. 6Issue 5e1529–e1534Published online: September 11, 2017
    • Jelle P. van der List
    • Gregory S. DiFelice
    Cited in Scopus: 33
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    Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. In hindsight, however, appropriate patient selection (i.e. proximal tears and good tissue quality) was not performed, because it has recently been recognized that good outcomes of primary ACL repair are possible when selectively performed in patients with proximal tears and good tissue quality. Moreover, with modern-day advances, arthroscopic primary repair can be an excellent treatment option for patients with proximal tears.
    Arthroscopic Primary Anterior Cruciate Ligament Repair With Suture Augmentation
  • Technical Note
    Open Access

    Combined Anatomic Anterior Cruciate Ligament and Double Bundle Anterolateral Ligament Reconstruction

    Arthroscopy Techniques
    Vol. 6Issue 4e1229–e1238Published online: August 7, 2017
    • Assem Mohamed Noureldin Zein
    • Mohamed Elshafie
    • Ahmed Nady Saleh Elsaid
    • Mohamed Ahmed Elsaid Elrefai
    Cited in Scopus: 9
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    The results of arthroscopic anterior cruciate ligament (ACL) reconstruction are so far satisfactory and improving over time as a result of the improved understanding of the anatomy and biomechanics of the ACL. Rotational instability confirmed by a positive pivot shift is present in more than 15% of cases who underwent successful ACL reconstruction. Persistent rotational instability interferes with performing pivoting sports, and also may lead to meniscal and chondral injuries, or re-rupture of the reconstructed ACL.
    Combined Anatomic Anterior Cruciate Ligament and Double Bundle Anterolateral Ligament Reconstruction
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