Quadriceps Tendon Attachment Technique for Medial Quadriceps Tendon-Femoral Ligament (MQTFL) Reconstruction in the Surgical Treatment of Recurrent Patella Dislocation

Medial quadriceps tendon-femoral ligament (MQTFL) reconstruction for prevention of recurrent patella dislocation is an alternative to medial patellofemoral ligament (MPFL) reconstruction. Because the reconstruction graft attaches to the quadriceps tendon, no patella drill hole is required, thereby eliminating iatrogenic fracture risk. The procedure remains anatomically accurate and early results are comparable to MPFL reconstruction for preventing patella dislocation. The MQTFL reconstruction graft is brought up under the vastus medialis obliquus distal to the patella apex, such that its orientation is directed toward the medial patellofemoral complex (MPFC) midpoint, also known as Tanaka's point. The graft is then secured by looping it around the vastus medialis and rectus femoris tendons, after which optimal graft length is easily established by cycling the knee, after which it is sutured securely into the deep quadriceps tendon precisely at the anatomic midpoint of the MPFC. Anatomic reconstruction of the MQTFL-in which graft orientation is crucial-confers reliable patellofemoral joint stability in the surgical treatment of patients with recurrent patella dislocations.

Coronal Malalignment-When and How to Perform a Tibial Tubercle Osteotomy

Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.

An Imaging Overview of the Posterior Septum of the Knee and Trans-Septal Portal Procedure: Normal Anatomy, Indications, and Unique Imaging Considerations

The posterior trans-septal portal technique is an arthroscopic surgery of the knee providing surgeons with the ability to fully visualize the posterior compartment. With this procedure, portals are placed at the posteromedial and posterolateral aspect of the knee. Visualization of the medial and lateral posterior compartments then allows working space for the creation of the intra-articular portal that is made by dividing the posterior septum. We provide an imaging overview of the posterior septum, the trans-septal portal technique, possible indications, and introduce how surrounding anatomy may warrant unique imaging considerations.

Retroperitoneal Approach for Excision of Wear-Debris Pseudotumor: A Case Report

CASE

Pelvic pseudotumors may occur as a reaction to wear-debris after hip arthroplasty and are rarely treated with surgery. We describe an instance in which a pelvic pseudotumor along the iliopsoas muscle tendon sheath was debulked using a retroperitoneal approach in a patient presenting for treatment of a prosthetic hip infection. The patient recovered uneventfully and was ambulatory with a new hip prosthesis at 3 months after procedure.

CONCLUSIONS

Retroperitoneal exposure provided safe, excellent exposure to a wear-debris pelvic pseudotumor in this case.

Parental understanding of intoeing gait - A preliminary study

OBJECTIVE

Evaluation of a child's intoeing gait is one of the most common referrals made to a pediatric orthopedist. Families may have difficulty understanding the often transient and usually benign nature of intoeing. The purpose of this study was to investigate parental perceptions of an intoeing gait both before and after consultation with an orthopedic practitioner.

METHODS

48 parents of children referred to pediatric orthopedic surgeons for evaluation of intoeing gait completed a 22-item questionnaire that assessed demographics, anxiety, and parental perceptions of intoeing. Questionnaires were administered before and after visits. Statistical analysis was performed using Wilcoxon signed-rank tests and Fisher exact tests.

RESULTS

Before their visits, parents reported similar levels of anxiety and understanding regarding intoeing, independent of their age or education. After the visits, anxiety decreased (P < 0.001), and understanding increased (P < 0.001) although younger parents (18-25 years) reported higher post-visit anxiety compared to parents older than 25 (P = 0.014). Similarly, parents with a high school degree or less reported higher post-visit anxiety compared to parents who attended college (P = 0.009). Post-visit understanding was inversely correlated with post-visit anxiety (r = -0.717; P < 0.001). Additionally, parents who reported high anxiety post-visit stated they were more likely to seek additional care (P < 0.001).

CONCLUSIONS

Younger parents with lower education levels were more likely to leave visits with high anxiety and poor understanding. These parents were more likely to consider seeking further treatment for their child's intoeing, placing additional stress on their child, themselves and an overburdened healthcare system.

The Grapefruit: An Alternative Arthroscopic Tool Skill Platform

PURPOSE

To establish the construct validity of an arthroscopic training model that teaches arthroscopic tool skills including triangulation, grasping, precision biting, implant delivery and ambidexterity and uses a whole grapefruit for its training platform.

METHODS

For the grapefruit training model (GTM), an arthroscope and arthroscopic instruments were introduced through portals cut in the grapefruit skin of a whole prepared grapefruit. After institutional review board approval, participants performed a set of tasks inside the grapefruit. Performance for each component was assessed by recording errors, achievement of criteria, and time to completion. A total of 19 medical students, orthopaedic surgery residents, and fellowship-trained orthopaedic surgeons were included in the analysis and were divided into 3 groups based on arthroscopic experience. One-way analysis of variance (ANOVA) and the post hoc Tukey test were used for statistical analysis.

RESULTS

One-way ANOVA showed significant differences in both time to completion and errors between groups, F(2, 16) = 16.10, P < .001; F(2, 16) = 17.43, P < .001. Group A had a longer time to completion and more errors than group B (P = .025, P = .019), and group B had a longer time to completion and more errors than group C (P = .023, P = .018).

CONCLUSIONS

The GTM is an easily assembled and an alternative arthroscopic training model that bridges the gap between box trainers, cadavers, and virtual reality simulators. Our findings suggest construct validity when evaluating its use for teaching the basic arthroscopic tool skills. As such, it is a useful addition to the arthroscopic training toolbox.

CLINICAL RELEVANCE

There is a need for validated low-cost arthroscopic training models that are easily accessible.