Medial and Lateral Meniscus Tear Patterns and Newer Ways of Repair, Including Root Repair

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Medial and Lateral Meniscus Tear Patterns and Newer Ways of Repair, Including Root Repair

By Mary Ireland 48 Videos FEATURING Mary Ireland

1,815 views

May 28, 2020

ACL & Meniscal Tear Cases: Panel
Fellows Course 8/25/19
Moderator Mary Lloyd Ireland, MD Professor ...
read more ↘
Dept. of Orthopaedic Surgery & Sports Medicine
University of Kentucky Lexington, Kentucky www.MaryLloydIreland.com
Disclaimer
The presenter is a paid consultant of Smith & Nephew.
1:53
ACL & Meniscal Tear Cases Panelists
Dr. Walt Shelton Dr. Geoffrey Van Thiel
Dr. Freddie Fu Dr. Volker Musahl
Meniscus Root Tears
Medial
Lateral
2:38
Right Knee
Medial Lateral
3:29
Posterior View
Medial PCL Lateral
3:50 Isolated Medial Meniscal Tear Diagnose Root Tears Early Coronal Oblique MRI
4:16 Coronal Oblique T1 Root Tears
4:32 Coronal Oblique T1 Root Tears
4:52 15-year-old soccer player
Noncontact pivoting right knee injury
Prior tibial spine avulsion repair 9 months ago
5:17 MRI - Hemarthrosis
6:14 Lateral View
6:56 Arthroscopic View
7:17 Root Tear Repair
7:29 17 YO
Wrestler Hyperflexion Left Knee Injury
Medial Meniscus Posterior Capsular Root Tear
ACL Tear
9:21 Medial Meniscus Vertical Tear Posterior Half
9:52 Medial Meniscus Repair Vertical Tibial
11:01 Questions
11:52 90% of the patients with Grade III pivot shift had 2 or more of the below risk factors:
LM root tears
Bucket handle tears of the LM
Increased lateral tibial slope
Injury to the ALC
12:31
LM radial tears
LM root tears
Bucket handle tears of the LM
13:30 Repair of LM radial tears
14:10 Root repair instruments
14:51 Low profile curved tibial aimers
Courtesy of Charlie Brown
15:06 The Hidden Reality: LM Root Tears
You may not have seen IT, but IT has seen YOU many times!
Incidence: 7 – 14% in patients undergoing ACLR
Normal LM root attachment
LM root tear
16:13 Grade Three Pivot Shift Repair, Ultra Tape
16:50 - Fast Fix - Inside Fixation
Courtesy of Charlie Brown
18:42 Inside-Out Meniscal Repair Technique
Still the “Gold Standard” for Meniscus Repair
20:13 Fibrin Clot
20:46 Save the whale!
Save the meniscus if at all possible . . . Always, no exceptions!
22:15 Part 2
22:53 16YO football player contact left knee injury C/O Knee and Calf Pain
23:55 X-ray ACL MCL injury
24:08 Knee Instabilities AMRI
25:55 Surgery: Arthroscopy
28:43 Surgery: MCL Repair
30:07 Know your Anatomy Posteromedial corner:
Medial collateral ligament
Superficial and deep layers
Meniscotibial and meniscofemoral ligaments
Posterior Oblique ligament
Runs posterior to superficial MCL
Multiple bands attaching to posteromedial capsule, semimembranosus, and proximal tibia
OKU 10: “Soft Tissue Injuries About the Knee,” Kaar et. al., p. 455. Fig. 1A.
31:58 The ACL does not work alone!
“I get by with a little help from my friends.”
The Beatles
32:56 Questions
34:03 Part 03
35:02 17 YO UK Freshman Pick Up Basketball 3 months Prior to ACLR
-B PT B Autograft
-Medial Meniscus Repair
Retore ACL and Medial Meniscus: How and When?
-Slipped on Ice
-Playing Basketball?
-Did not Return to see me Until 5 months PO
36:17 Post Op
ACL Autograft B-PT-B
37:21 Revision ACL Allograft B-PT-B
38:08 Allograft Patellar Tendon
41:03 Revision ACL Reconstruction Femoral Hardware Removal
42:07 The surgeon who performs the ACL reconstruction should drive the “Return to Play” train
43:28 Questions
45:09 Part 4 Anterolateral Complex of the Knee
47:19 Modified Lemaire tenodesis with an iliotibial band graft and Biosure Regenesorb interference screw fixation
48:29 Clinical evidence is currently lacking to support clear indications for lateral extra-articular procedures as an augmentation to ACL reconstruction. Appropriate indications may include:
-Revision ACLR
-Patient’s with a high-grade pivot shift
-Generalized ligamentous laxity/genu recurvatum
-Young patients returning to pivoting activities
49:08 Extra-Articular Technique - Charlie Brown
49:39 Fixation
50:03 IT Band Tenodesis - Past History
Andrews, Lemair, Ellison, Macintosh
51:54 -Your Indications for Extra Articular Tenodesis? -Preferred Procedure?
During my fellowship we did two open ACL reconstructions and too numerous to count Andrews Mini ReconstructionsFellows be ready for change in surgical techniques
What does not change?
-How to take care of patients
-History and physical exam skills
53:12 Questions
53:42 Beware of new drugs, implants and devices which seem to be too good to be true. - Charles Dickens
“Take nothing on its looks. Take everything on evidence. There is no better rule.”
54:02 X-ray - zimmer screws - Martha Murray's Barre technique
56:02 Experience
“Experience is the name everyone gives to their mistakes.”
— Oscar Wilde
“Good judgement comes from experience, and experience comes from bad judgement.” — Anonymous
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