mucious cyst acl presenting with pain and limited flexion

Patient presented with one year of pain and restriction of terminal flexion. clinical ex. revealed stable knee with poorly localized pain on terminal flexion. No clear localising signs.. lachman1+ solid end pt. negative pivot shift. ocl and collateral stable.  no clear meniscal signs except pain on terminal flexion

 MRI shows celery stalk appearance with cyst posterior to ACL and between ACL and PCL.

treatment

Arthro scopic cysyt decompression and intraligamentous microfracture inside the femoral attachment of ACL was done

  t

6-week MRI shows a healing ACL with the absent cyst.

 

6 months postop

Is ACLshaving and reconstruction necessary or the trauma of multiple small shaver punctures to decompress and cause bleeding and microfracture to release MSCs into the ligament enough at least in some cases?  The patient feels better and had full range of painless  movement 1-month post-op 

Anatomical large ceramic heads

Q

Ceramtec has finally introduced an anatomic femoral heads (decreased diameter below equator i.e. south) to avoid iliopsoas impingement. Don’t know yet about the wear characteristics to recommend usage.

Anatomic head

1 year post micro fracture for a incidental focal lesion in in 65 year

Is  the regenerative capacity of a microfracture  in above 60 unpredictable? I had a good surprise with the  this patient?

. This was an above 60 lady with ACL and MCL injury after a fall.  the chondral lesion of about 1cm on MFC  was treated with microfracture along with stump ACl reconstruction and scopic MCL repair and orthokine intraarticular injection.  She had a Scopy for a  cyclops when the above video was taken. The defect was well filled with fibrocartilage but on palpation, it appeared stiffer  than the nieghbouring cartilage( no values) rest of her knee was pristine

•25 year male

•RTA on 2/8/2019, Sustained injury to right knee

•O/E:Swelling +

            Multiple abrasion

            Tenderness over joint line

            Posterior sag present

            Lachman with 2 + soft end point

            ?Medio lateral instability

            Mcmurray positive for medial and lateral    meniscus

            Varus stress test positive

            Distal pulses present

•Patella inferior pole communited fracture,

•ACL,PCL,LCL tear

•Flipped lateral meniscus anterior horn &body tear

•Medial meniscus radial tear

• inferior pole fracture was displaced and did not move in flexion x-ray hence left alone.

Right knee ACL,PCL Reconstruction + Lateral and medial meniscus (root,body) repair + LCL reconstruction done  10 days post injury

radial tear repair 

with healed radial tear pic below

He had to have an arthrolysis for a stiff knee.
ROM 20 to 70 at 2 months due to essentially lack of motivation and proper physio. the healed radial tear was visualized at 2 months during arthrolysis.. Had full ROM with a stable knee at 3 months post repair.

The meniscal healing rates are superior I feel in multi- ligament tears. 

Again a reason for early one stage repair in multi-ligament tears

ACL repair

 Over the past 4 years a trend towards repair of ACL  Sherman type 1 has gained interest. The advantages of avoiding donor site morbidity and  better proprioception are talked about. The strength of the repair with fibre wire sutures is less clear. Supplementing the repair with fibre tape augmentation has been discussed. if too tight to protect the repair the stress on the tape will invariably tear it causing IA reaction and a bit loose to avoid stress shielding by experts  defeats its purpose.

 What we clearly do is slower rehab to hopefully avoid repair failure?  Microfracture at the femoral attachment to enhance repair are being touted. 

Time will tell if we are going in the right direction.  one month post repair  mri shows a taut healing graft