Contraindications to Harvest of the Patellar Tendon Preexisting Patellofemoral Pain

Is preexisting patellofemoral pain a contraindication to harvesting the patellar tendon The conventional wisdom is yes it would not be a wise procedure in this situation. Rather, it is like hitting a sore thumb with a hammer In the past, when chondromalacia was seen at the time of arthroscopy, the graft choice would be changed to hamstrings. The harvesting of the central third of the patellar tendon in a small tendon is more theoretical than practical. The advice in a small patient with a...

Pivot Shift Test

This test is more difficult to perform, but is more consistent in reproducing the athlete's symptoms. Holding the heel in one hand and applying a valgus stress in the other hand, the knee is slowly flexed. The tibia, when in internal rotation, slides anterior when the valgus stress is applied. The tibia, as well as the valgus, subluxes easily if anterior force is applied. After the anterior subluxation of the tibia is noticed, the knee is slowly flexed, and the tibia will reduce with a snap at...

Patellar Autograft Disadvantages Harvest Site Morbidity

The main disadvantage of the patellar tendon graft is the harvest site morbidity. The problems produced by the harvest are patellar ten-donitis, quadriceps weakness, persistent tendon defect, patellar fracture, patellar tendon rupture, patellofemoral pain syndrome, patellar entrap ment, and arthrofibrosis. The common long-term problem is kneeling pain. The most common complaint after patellar tendon harvest is kneeling pain. This can be reduced by harvesting through two transverse incisions....

Nonoperative Management Protocol

The nonoperative treatment of the acute injury consists of the following Extension splint and crutches. The length of time on crutches will depend on the degree of associated meniscal capsular injury. Cryotherapy with the Cryo-Cuff helps to reduce the swelling and pain. Physiotherapy to regain range of motion and strength. Nautilus or gym program to strengthen the muscles with machines and to improve the cardiovascular fitness with steppers and bikes. Functional brace to stabilize the knee in...

Intrinsic Joint Laxity

There are contradictory studies on the role of ligamentous laxities. Daniel's study with the KT-1000 arthrometer showed no gender differences in the measurable laxity of the ACL. It has been documented that exercise produces laxity of the ACL, but there are no significant differences in gender. Yu et al. have shown that the ACL has both estrogen and progesterone receptors. The cyclic variation of estrogen may affect the ligament metabolism and make females more prone to injury during the...

Loss of Flexion or Extension Problem

The loss of flexion is due to suprapatellar pouch adhesions, or the tight patellofemoral joint. The loss of extension is the result of anterior notch scarring. The solution for extension loss is to mobilize early with passive extension. If this fails, then arthroscopic excision of the scar and cyclops lesion. The solution to loss of flexion is to manually mobilize patella longitudinally. If this fails, then arthroscopic medial lateral retinacular release should be done. The patella is mobilized...

Stripping of the Tendon

The tendon stripper is pushed up along the tendon to remove it from its muscular attachment Fig. 6.35 and Fig. 6.36 . The tendon must be cut free from the bands that attach to the gastrocnemius. If there is even Figure 6.36. The stripping of the tendons with the closed-loop tendon stripper. Figure 6.36. The stripping of the tendons with the closed-loop tendon stripper. a small band, it causes the tendon to kink, and the stripper may cut it off short Fig. 6.37 . The full length of the harvested...

KT1000 Measurements Joint Injection and Femoral Nerve Block

1000 Measurements

First confirm which is the correct side. The physician's initials Fig. 6.3 should be visible on the correct knee. The low profile leg holder is high on the thigh to allow the graft passing wire to penetrate the anterolat-eral thigh. The tourniquet is placed proximal under the leg holder. Figure 6.2. The KT-1000 arthrometer measurement of the anterior-to-posterior motion of the knee. Figure 6.2. The KT-1000 arthrometer measurement of the anterior-to-posterior motion of the knee. Figure 6.3. The...

Diagnostic Arthroscopy and Meniscal Repair Meniscectomy

Accessory Anteromedial Portal

The portals must be accurately placed to visualize all aspects of the knee Fig. 6.5 . The high lateral portal, at the corner of the patellar tendon and the patella, is the first portal to establish. The medial portal may be identified with an 18-guage needle before it is cut with the knife Fig. 6.6 . The W maneuver initially scans the entire knee Fig. 6.7 . The order of the examination is as follows 1. Suprapatellar pouch. Examine the synovium and look for loose bodies. Figure 6.5. The...

The Technique of the Bio Stinger Insertion

The appropriate length of BioStinger Linvatec, Largo, FL selected, is usually 13 mm, and loaded on the cannulated wire of the delivery unit Fig. 6.20 . The cannula is placed against the meniscus and 2 mm of cannulated wire is delivered into the torn fragment Fig. 6.21 . The fragment is then reduced to the peripheral rim. When the torn fragment is reduced, the cannulated wire is advanced into the rim using the slider bar on the side of the device Fig. 6.22 . The BioStinger is inserted into the...

Tunnel Malposition Tibial Tunnel Anterior Problem

The tibial tunnel is drilled anterior Fig 9.10 . The result is failure of the graft by anterior notch impingement. If the tunnel is just slightly anterior, chamfer back of tunnel to move it more posterior. The usual situation is similar to Figure 9.10. The coring reamer can be used to position the tunnel in the correct position. The bone plug is used to graft the old anterior tunnel. Before drilling the tunnel, use a K-wire and if necessary reposition the wire to the correct position before...

Notchplasty and ACL Stump Debridement

Notchplasty

The ACL stump is removed with a combination of the shaver and the electrocautery. In most cases no bone is removed, only the soft tissue from the wall of the notch. There is still considerable controversy over the extent of the notchplasty. Some surgeons do a notchplasty in only 10 of their cases. Others always do one. The author thinks that the answer lies somewhere in between. Each physician should do what needs to be done to accommodate an 8 to 10 mm graft. In cases with a very narrow...