Anterolateral Procedure Research Articles

False aneurysm following arthroscopic meniscectomy of the knee

Blood vessel injuries during arthroscopic knee surgeries are unusual and rare and comprise less than 1% of all arthroscopic complications. Between 1990 and 2004, at the Department of Orthopedic Surgery and Traumatology, Institute of Surgery, Novi Sad, 2100 arthroscopic knee surgeries were carried out. Only one case of false aneurysm of the geniculate lateral inferior artery was reported. A 35-year-old professional waiter injured his left knee while getting up from a kneeling position. He had a typical clinical rupture with an interior meniscus lesion. Knee arthroscopy with resection of the torn part of interior meniscus was performed. Seven days later, we observed a subcutaneous tumefaction, 2 cm in diameter, which was warm, pulsating and painful on palpation. It was located in the region of anterolateral portal. Angiography confirmed the existence of a false aneurysm of lateral geniculate inferior artery. Revision of the wound was performed on the exterior side of the knee. The hematoma was removed and the artery tied A month later, the patient fully recovered and returned to his professional activities. Only four injuries, that is false aneurysms of the exterior knee artery after knee arthroscopy, have been described so far. The possibility for this injury to occur lies in the fact the artery lies over and is parallel with the lateral knee joint line, at the very entrance of the anterolateral arthroscopic port. Since the latter is the most often used arthroscopic port to access the knee, the above injury is possible, but it does not minifest clinically. This complication is easily diagnosed by a pulsating tumefaction in the area of arthroscopic port and is confirmed by angiography. These rare blood vessel injuries, do not affect the usage of anterolateral arthroscopic procedure. If the injury does exist,, revision of the wound and artery ligature should be carried out, which does not affect the final treatment results.

Extra-articular lateral reconstruction technique

Summary: This article describes an anterolateral reconstruction procedure that, when used in combination with an intra-articular anterior cruciate ligament (ACL) reconstruction, restores rotary and anterior knee stability. We believe that failing to recognize lateral instabilities and to perform an extra-articular reconstruction is an under-recognized cause of failure of ACL reconstruction. We also describe the indications, medical histories, and physical examination tests used to determine when an anterolateral reconstruction is needed. One should suspect a compromise of the lateral structures when presented with a failed ACL reconstruction in which the tunnels, the graft, and the rehabilitation all seem to have been done properly, or when a prior lateral procedure has been attempted and failed. In our experience, if a second ACL reconstruction is undertaken without the benefit of a lateral reconstruction, it may fail as well.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 16, No 5 (July), 2000: pp 553–557

A new technique for the surgical management of unstable thoracolumbar burst fractures: a modification of the anterior approach and an outcome comparison to traditional methods

This study was conducted to determine the safety, efficacy, and complication rate associated with the anterior approach in the use of a new titanium mesh interbody fusion cage for the treatment of unstable thoracolumbar burst fractures. The experience with this technique is compared with the senior authors' (C.S., R.W., and M.S.) previously published results in the management of patients with unstable thoracolumbar burst fractures. Between 1996 and 1999, 21 patients with unstable thoracolumbar (T12-L3) burst fractures underwent an anterolateral decompressive procedure in which a titanium cage and Kaneda device were used. Eleven of the 21 patients had sustained a neurological deficit, and all patients improved at least one Frankel grade (average 1.2 grades). There was improvement in outcome in terms of blood loss, correction of kyphosis, and pain, as measured on the Denis Pain and Work Scale, in our current group of patients treated via an anterior approach when compared with the results in those who underwent a posterior approach. In our current study the anterior approach was demonstrated to be a safe and effective technique for the management of unstable thoracolumbar burst fractures. It offers superior results compared with the posterior approach. The addition of the new titanium mesh interbody cage to our previous anterior technique allows the patient's own bone to be harvested from the corpectomy site and used as a substrate for fusion, thereby obviating the need for iliac crest harvest. The use of the cage in association with the Kaneda device allows for improved correction of kyphosis and restoration of normal sagittal alignment in addition to improved functional outcomes.

Double semitendinosus anterior cruciate ligament reconstruction: 10-year results

In a series of 30 consecutive patients who suffered from chronic instability of the knee joint, reconstruction of the torn anterior cruciate ligament was performed with a looped semitendinosus tendon, reinforced by an extra-articular anterolateral procedure. Of these 30, 27 could be followed up 9-11 years after the operation. The evaluation included the International Knee Documentation Committee (IKDC) questionnaire and was completed by testing with a Kneelax arthrometer at 132 N and by anteroposterior standing X-ray, in order to evaluate the degenerative changes. At the time of the check-up: 96% of the study group considered that they had normal or nearly normal knees, and 81% had recovered to the same sports activity level as before their injury. The degenerative changes noted at the index operation did not progress notably, except in two cases. Laxities of 7 knees were normal, with a side-to-side difference of less than 2 mm; 15 were nearly normal, with a mean difference of 3.45 mm; and 5 were abnormal, with a mean difference of 6.2 mm. The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray.