Arthroscopic Portals Research Articles

Arthroscopic Fixation Technique for Avulsion Fracture of the Posterior Cruciate Ligament From the Tibia

This study describes an arthroscopic pullout fixation technique for small and comminuted avulsion fractures of the posterior cruciate ligament from the tibia. Intra-articular surgery required 3 arthroscopic portals, the anterolateral, anteromedial, and posteromedial portals. To simplify surgery, the posterolateral portal was omitted. A 2.4-mm K-wire was inserted through the anterior incision to the center of the bone fragment. This central guidewire was subsequently overdrilled with a 4.0-mm cannulated drill. The fixation material consisted of Pass Telos artificial ligaments inserted through the fiber loop of a fixed suspensory device such as RIGIDLOOP. The leading end of the thread of the RIGIDLOOP was pulled out through the anteromedial portal. The button of RIGIDLOOP was gradually advanced through the bone tunnel. The button was pulled out and flipped over the bony fragment. The artificial ligament was pulled distally to reduce the bony fragment, and fixed onto the tibia using a ligament button while applying anterior drawer force to the proximal tibia with the knee flexed at 90°. This minimally invasive procedure was successful in treating small and comminuted avulsion fracture of the tibial attachment of the posterior cruciate ligament.

Variabilidad en la ubicación de los túneles femoral y tibial en reconstrucción del ligamento cruzado anterior. Revisión narrativa

BackgroundAlthough several studies have detailed the origin, shape, and insertion of the anterior cruciate ligament (ACL), there is still no consensus on the location of the appropriate point for the positioning of the femoral and tibial tunnels for its grafting. The purpose of this study is to review the literature on the variability in the positioning of femoral and tibial tunnels when a graft reconstruction of the ACL has to be performed. MethodsA systematic search was carried out on the literature published in the Medline, Embase, Central, Cochrane, and Lilacs databases, using MesH and free terms. A selection was made by title and summary and a review of complete texts. The publications were classified by topic, and a narrative presentation of the findings was made. ResultsA total of 25 studies were included. Variability was found in the selection of areas of origin and insertion of the ACL in both cadaveric models and patients. Among the anatomical repairs for the positioning of the femoral tunnel are the intercondylar crest, bifurcated crest, the resident's crest, clockwise or counter-clockwise direction, remnant of the ACL, and for the tibial tunnel, the anterior horn of the lateral meniscus. There was also variability in the intra-surgical methods and imaging aids, such as the use of the antero-medial arthroscopic portal, Bernard's quadrants, fluoroscope, and navigated fluoroscope. Only one study evaluated the variability in positioning between and within each surgeon, showing relative consistency between them. DiscussionThe positioning site of tunnels for the reconstruction is determined by the experience of the surgeon, since there are no objectively standardised guides to perform the reconstruction. Evidence LevelIV

Minimally invasive surgery versus an arthroscopic procedure for the first metatarsophalangeal arthrodesis: A comparative study of the effectiveness and safety profile.

First metatarsophalangeal (MTP) arthrodesis is a common procedure for treating degeneration in the MTP joint. Open arthrodesis is a conventional procedure that provides acceptable results but is more invasive than minimally invasive or arthroscopic arthrodesis. However, little is known about the different outcomes between minimally invasive surgery (MIS) and arthroscopic surgery (AS) for MTP arthrodesis. This study was performed to compare the outcomes of the first MTP joint preparation for arthrodesis regarding the effectiveness of articular surface preparation and safety between MIS and the arthroscopic procedure in cadaveric specimens. Sixteen cadaveric feet were collected in this study from eight cadavers. The potential exclusion criteria were significantly decomposed or deformed joint. All feet were randomly allocated into two groups, eight feet for the MIS (under fluoroscopic control) group and eight feet for the arthroscopic group. One foot in the AS group was excluded because the position of an arthroscopic portal was incorrect. All feet were operated on by four fellowship-trained foot and ankle orthopedic surgeons who also had prior clinical experience with the arthroscopic and minimal invasive procedure. Following a complete procedure in each specimen, all feet were dissected and the areas of joint preparation on the metatarsal and phalangeal sides were recorded via photography and the ImageJ program. Injury to the adjacent structure was noted in each specimen. All data were analyzed via the IBM SPSS program version 22 and GraphPad to compare the outcomes between the two groups. The average age of the cadavers was 68.6 ± 12.3years. The average areas of joint preparation on the metatarsal and phalangeal sides were 136.97 and 99.08mm2, respectively. The average areas of joint preparation on the metatarsal sides were 154.26 and 117.21mm2 in the MIS and arthroscopic groups, respectively (p value = 0.353). The average areas of joint preparation on the phalangeal sides were 82.46 and 118.08mm2 in the MIS and arthroscopic groups, respectively (p value = 0.151). Regarding the ratio of prepared area/mean estimated fusion contact area, there was no significant difference of a ratio on metatarsal side with p value as 0.285. However, a higher level of ratio on phalangeal side was found in the arthroscopic group with p value as 0.085. For the safety profiles, the rate of adjacent injury was insignificantly higher in the MIS group (37.5%) than the arthroscopic group (0%) (p value = 0.20). All injuries were found at the extensor hallucis longus tendon. There were no significant differences of the effectiveness of articular surface preparation between the MIS and arthroscopic groups. However, the arthroscopic procedure seemed to provide higher rate of prepared surface area on phalangeal side and be safer to the adjacent structures than MIS for this arthrodesis.

Modified Surgical Technique of Making Posteromedial Portal in Knee Arthroscopy Using a Radiofrequency Device

In knee arthroscopy, a posteromedial portal is used for various indications including arthroscopic posterior cruciate ligament reconstruction, posterior cruciate ligament avulsion fracture fixation, posterior medial meniscal repair, medial ramp lesion repair, and synovectomy. Making the posteromedial portal is challenging for young and even experienced surgeons. Creating the posteromedial portal in knee arthroscopy is challenging and technically demanding for surgeons because of the thick muscular cover, proximity of the neurovascular bundle, tenacious tough capsule, and excessive fat deposition in the posteromedial knee and thigh region. Access for viewing the posteromedial compartment during different procedures is made simple, safe, and replicable with this technique of creating the posteromedial portal. This article describes a simple way to create the posteromedial portal using a radiofrequency device by a modified outside-in surgical technique.

Arthroscopic Reduction and Stable Fixation of an Anterior Glenoid Fracture With 4 Buttons

An arthroscopic technique for the reduction and stable fixation of an articular glenoid fracture with a 2-button compression system, originally designed for the treatment of shoulder instability with bone deficiency in the anterior glenoid, is presented. This technique allows direct visualization of the joint, reduction of the fracture, precise placement of the buttons according to the fracture line, and stable fixation. It is a safe and reproducible technique, using the standard shoulder arthroscopy portals.

Incisionless Knee Synovectomy and Biopsy With Needle Arthroscope and Autologous Tissue Collector

Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures, and the NanoScope (Arthrex, Naples, FL) has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and using the GraftNet (Arthrex), we can harvest tissue with a standard shaver for further evaluation. This technique provides an option to perform a synovectomy and biopsy without the use of standard arthroscopy portals through an incisionless approach.

The distribution pattern of the dorsal cutaneous nerves of the foot and its clinical implications.

Iatrogenic injury to subcutaneous nerves on the dorsum of the foot is an established risk factor during the surgical procedures resulting in postoperative pain, sensation loss and painful neuroma. Previous studies have reported on the distribution pattern of the superficial peroneal, deep peroneal and sural nerves (SNs) and their branches with various classifications about specific populations. The purpose of the present study was to evaluate the distribution pattern and classification of the nerves on the dorsum of the foot and analyze the location of these nerves into five zones with clinical implications. Fifty-four lower limbs of fresh frozen cadavers were used in the present study. The anatomical patterns of the superficial peroneal, deep peroneal, SN and their branches were classified into eight, two and five patterns respectively. Type VI pattern, a classic distribution pattern of the superficial peroneal nerve was the most frequent type with a prevalence of 13 limbs (25.00%). In Zone 5, where the arthroscopic portal placements for the first metatarsophalangeal joint arthrodesis, 29 limbs (55.77%) showed three nerve branches located in this zone. The results of the present study provide anatomical knowledge that may help the surgeon to choose the appropriate treatment for their patients and reducing the rate of complications in surgery.

Partial Patellar Lateral Facetectomy: Arthroscopic Technique

Lateral patellofemoral osteoarthritis is a relatively common condition in young, active patients. Partial lateral patellar facetectomy is a relatively minimally invasive option to restore knee function and return to sport when conservative treatments are insufficient. We describe the arthroscopic technique of partial lateral patellar facetectomy , which has been historically performed as an open procedure. We describe preoperative planning, arthroscopic portals, landmarks, intra-articular evaluation of bone resection, and surgical difficulties. The goal of the preoperative planning was a target bone resection of 10 to 15 mm including osteophytes and the lateral facet of the patella. Arthroscopic anterolateral and anterior superolateral portals were used to achieve the desired resection. An arthroscopic technique allows a direct view of the osteoarthritic bone for removal and permits intraoperative dynamic evaluation, which allows the surgeon to finetune the bone resection and obtain optimal patellar tracking. Avoiding arthrotomy could reduce morbidity and allows a rapid postoperative rehabilitation.

Arthroscopic Hip Capsular Plication With Augmentation Using a Bioinductive Collagen Implant

With advancements in arthroscopic techniques and instrumentation, hip arthroscopy has become an increasingly used technique to treat soft-tissue and osseous pathologies about the hip. Patient predisposition to labral and capsular injuries can present as femoroacetabular impingement or hip dysplasia, sometimes in combination. Capsular management continues to be a topic of debate, with capsular repair becoming the standard of care in most cases. Furthermore, in cases of borderline dysplasia and microinstability, considerations for not only capsular repair but with plication has shown significant clinical success. Although plication in this setting has shown promise, given a 20% failure rate, we suggest capsular augmentation to bolster the repair. We present a technique of capsular augmentation using a bioinductive collagen implant (Smith & Nephew) to improve the capsular integrity following repair and plication. The benefits of this implant are easy delivery through standard arthroscopic portals and secure fixation to the capsular tissue. These implants have a proven track record in the shoulder and serve as a scaffold for improved tissue quality, and their application in hip arthroscopy has potential by increasing the integrity of the capsular repair. Future studies are needed to address the clinical outcomes of this technique.

Anterocentral Portal in Ankle Arthroscopy.

Background:The anterocentral portal is not a standard portal in anterior ankle arthroscopy due to its proximity to the anterior neurovascular bundle. However, it provides certain advantages, including a wide field of vision, and portal changes become redundant. The purpose of this study was to evaluate the neurovascular complications after anterior ankle arthroscopy using the anterocentral portal.Methods:We retrospectively identified patients who had undergone anterior ankle arthroscopy with an anterocentral portal at our institution from 2013 to 2018. Medical record data were reviewed and patients were invited for clinical follow-up, where a clinical examination, quantitative sensory testing for the deep peroneal nerve, and ultrasonography of the structures at risk were performed. A total of 101 patients (105 arthroscopies) were identified and evaluated at a mean follow-up of 31.5 ± 17.7 months.Results:Leading indications to surgery were heterogeneous and included anterior impingement (48.6%), osteochondral lesions of the talus (24.8%), chronic ankle instability (14.3%), and fractures (8.6%). The overall complication rate was 7.6%, and no major complications were observed. In 1.9% (2/105) of the cases, the complications were associated with the anterocentral portal and included injury to the medial branch of the superficial nerve (1/105) and to the deep peroneal nerve (1/105). Injury to the deep peroneal nerve was associated with a loss of detection and nociception. There were no injuries to the anterior tibial artery. In 41.9% (44/105) of the cases, only 1 working portal was used in addition to the anterocentral portal, and in 19% (20/105) the anterolateral portal could be avoided. Ultrasonography confirmed the integrity of the deep peroneal nerve, the medial branch of the superficial peroneal nerve, and the anterior tibial artery in all patients. Patients with nerve injuries associated with the anterocentral portal showed no signs of neuroma or pseudoaneurysm.Conclusion:Using a standardized technique, the anterocentral portal in ankle arthroscopy is safe with a low number of neurovascular injuries and can be recommended as a standard portal. The anterolateral portal remains associated with a high number of injuries to the superficial peroneal nerve.Level of Evidence:Level III, retrospective cohort study.

Meniscal Root Injuries.

Meniscal root tears are an increasingly recognized injury leading to notable functional limitations, potential rapid cartilage deterioration of the affected compartment, and subsequent risk of total knee arthroplasty if left untreated. Repair of these tears is advised when articular cartilage remains intact because both medial and lateral meniscus root repairs have demonstrated favorable results. Recent literature demonstrates decreased rates of osteoarthritis and arthroplasty after medial meniscus root repair compared with partial meniscectomy and nonsurgical management. The transtibial pull-out repair technique is most commonly used and provides a biomechanically strong suture construct with standard and familiar knee arthroscopy portals. Furthermore, repair has recently been shown to be economically effective by decreasing overall societal healthcare costs when compared with more conservative management strategies. This review outlines the evaluation, treatment, and documented outcomes of meniscal root repair, which is imperative to the preservation of knee function and maintaining quality of life.

Arthroscopic Tenovaginotomy and Ganglion Excision of the Flexor Carpi Radialis Fibro-Osseous Tendon Sheath.

The treatment of flexor carpi radialis (FCR) tendon stenosing tenosynovitis recalcitrant to nonsurgical intervention has been open or blind tenovaginotomy of the volar trapezial fibro-osseous sheath of the FCR tendon. The surgical literature has not reported arthroscopic tenovaginotomy of the FCR fibro-osseous tendon sheath with or without associated ganglia. This report describes a technique of arthroscopic tenovaginotomy for stenosing tenosynovitis of the FCR tendon at the trapezial fibro-osseous sheath with or without excision of any associated ganglion through a not previously described new volar radial trapezial arthroscopic portal.

An alternative arthroscopic approach to the caudal pouches of the equine lateral femorotibial joint

Current arthroscopic approaches to the caudal pouches of the lateral femorotibial joint are challenging and risk iatrogenic nerve and cartilage injury. Describe an alternative arthroscopic approach to the caudal pouches of the lateral femorotibial joint in the horse and report intra-articular abnormalities observed during diagnostic stifle arthroscopy of these pouches. Descriptive cadaver anatomical and clinical study. An approach to the caudal pouches of the lateral femorotibial joint was developed during clinical surgery using an arthroscopic portal in the popliteal tunnel of the femorotibial joint. Relevant anatomy of the lateral femorotibial joint was reviewed and the arthroscopic landmarks validated on 19 cadaver limbs. The procedure was then incorporated as part of routine inspection of 38 joints in 33 horses. Entry and examination of both pouches of the caudal lateral femorotibial joint was consistently achieved using an arthroscopic portal immediately cranial to the lateral collateral ligament in both cadaver and clinical limbs, with no adverse effects noted in the latter. Contrary to published descriptions, the division of the pouches was principally formed by a meniscopopliteal septum derived from the joint capsule in all cases, rather than the popliteus muscle and tendon as previously described. Abnormalities were detected in five cases. The finding of bilateral tearing within the popliteus muscle may represent a previously unrecognised arthroscopic condition. Limited case numbers. An arthroscopic portal immediately cranial to the lateral collateral ligament permitted consistent entry into the popliteal tunnel and both pouches of the caudal lateral femorotibial joint.

Needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses.

To develop a technique for standing diagnostic needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses. Experimental study. Six cadaveric forelimbs (phase 1) and six healthy horses (phase 2). In phase 1, six cadaveric forelimbs were used to assess needle arthroscopic evaluation of both joints. Six healthy horses were subsequently enrolled in phase 2 to validate the procedure in live animals. The joint was maintained in flexion with a custom-made splint and base. In phase 1, needle arthroscopy allowed thorough evaluation of the dorsal and palmar recesses of both joints with traditional arthroscopic portals. In phase 2, joint evaluation was also thorough but only dorsal approaches were performed. All horses underwent radiocarpal joint arthroscopy, whereas the middle carpal joint was evaluated in only three of six horses because of limb movement. The technique was quickly performed and well tolerated by all horses. Complications included moderate movement, mild iatrogenic cartilage damage, and mild hemarthrosis. Standing needle arthroscopy allowed thorough evaluation of the dorsal aspect of both joints, although only three of six middle carpal joints were assessed because of movement limitations. The proposed technique offers an alternative diagnostic tool for radiographically silent intra-articular lesions of the carpus while initially avoiding the cost and risks associated with general anesthesia. Arthroscopy of a single joint is recommended to minimize risks associated with movement during the procedure.

Minimally invasive treatment of portal pseudoaneurysm in a haemophiliac after knee arthroscopy

The formation of a pseudoaneurysm or ‘false’ aneurysm is a rare vascular complication of arthroscopic surgery. Its occurrence is even more uncommon in the background of a clotting disorder. We present a case of a recreational athlete with a history of haemophilia, who developed a pseudoaneurysm over an arthroscopic portal site following arthroscopic-assisted anterior cruciate ligament reconstruction. The lesion was treated successfully with image-guided thrombin injection. We discuss the association between haemophilia and pseudoaneurym formation as well as prevention methods and treatment options.

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

When femoral head chondropaties are located medially or parafoveal, they pose a challenge to arthroscopically reach the affected area through commonly used portals. Though surgical hip dislocation remains as the gold standard for treatment of such lesions, many patients reject surgery for its potential complications and postoperative demanding rehabilitation protocol. We aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to describe the outcome of this procedure. We describe 9 transtrochanteric drillings throughout an otherwise uneventful arthroscopic treatment of femoroacetabular impingement pathology. All of them had a parafoveal osteochondral lesion unapproachable with curved awls through routinely used portals. After debriding the cartilage flap with a chondrotome, the surgical technique consisted of a minimally invasive 3.2-mm drilling through the femoral lateral cortex fluoroscopically guided. Mean follow-up was 55.8 months (range, 43 to 113 mo). Outcome was evaluated with the modified Harris Hip Score (mHHS) and healing was assessed through magnetic resonance imaging findings. Overall, all patients showed better results when comparing preoperative and postoperative mHHS (43.8 vs. 79.5; P=0.0008). No complications were reported due to the surgical technique. Complete healing of the osteochondral lesion was confirmed in 7 of 9 cases, and partially in one. One patient with Tönnis 2 preoperative changes required conversion to total hip arthroplasty at 80-month follow-up. Retrograde drilling was a valid option for treating small-sized medially located osteochondral lesions of the femoral head which are difficult to treat through standard arthroscopic portals.

Incidence and location of heterotopic ossification following hip arthroscopy

BackgroundWe investigated the incidence and location of heterotopic ossification (HO) following hip arthroscopy.MethodsThis retrospective study enrolled 327 patients who underwent hip arthroscopy from January 2010 to December 2015. From this cohort, we extracted an HO group with simple radiographs or three-dimensional computed tomography (3D CT). Findings consistent with HO were classified according to the Brooker classification aided with 3D CT for the location of HO. The indication for revision arthroscopic excision of HO was painful, functional impairment of the hip. Patient clinical outcomes were assessed pre- and postoperatively, with modified Harris Hip Scores (mHHS), a visual analogue scale (VAS) for pain, and the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport Specific Subscales (HOS-SSS).ResultsIn all, 14 (4.28%) of the 327 patients had confirmed HO radiographically. The mean follow-up was 39 months. In 13 patients, HO formed in the central area of the arthroscopic portals or capsulotomy. Ten patients had Brooker Grade 1 and four had Grade 2. At the last follow-up, 12 asymptomatic patients had significant (P < 0.001) improvements in all clinical outcome scores (mHHS, pain VAS, HOS-ADL, and HOS-SSS). Two patients developed symptoms sufficient to require revision hip arthroscopy for HO excision. After revision hip arthroscopy, both symptomatic patients had improved significantly in all clinical outcomes at the final follow-up.ConclusionsHO is a minor complication of hip arthroscopy, but sometimes induces severe pain and functional impairment. Usually, HO forms in the arthroscopic portal or capsulotomy area.

Intra-articular echo-endoscopy during shoulder arthroscopy: an anatomical feasibility study

Background:The development of an ultrasound probe that can be used through an arthroscopic portal would provide direct access to the deep tissues of the shoulder. These structures are sometimes barely seen with an external ultrasound system and are also difficult to analyze under arthroscopy. Therefore, this intraoperative imaging technique could refine the diagnosis and surgical procedure and as a result provide more adequate therapy. The main objective of the study was to evaluate the feasibility of using an echo-endoscope to produce images during shoulder arthroscopy without causing secondary lesions. The secondary objective was to detect rotator cuff tears, calcific tendonitis, chondropathies, acromioclavicular arthropathy and labral tears.Methods:We used 6 shoulders of 3 anatomic subjects. The endo-ultrasound system used was the M15 probe developed by the society Cartimage Medical SAS® . The eleven structure of interest included in the principal objective of the study were: the tendon of the long head of the biceps, the glenoid and humeral cartilage surface, the gleno humeral ligament, the labrum, the rotator cuff tendon on their acromial and articular surfaces and the acromioclavicular joint. We noticed all lesions induced by the probe and we measured the acquisition time for the ultrasound images. The validation of the principles and secondary objectives were assessed by independent observer during the manipulations which were realized by one unique shoulder surgeon specialized in arthroscopic surgery.Results:We were able to produce ultrasound images of 68% of all the structures of interest.The inability to acquire certain images was partially due to the fact that the subjects were elderly (average age 90 years) and therefore, the structures of interest were no longer present.The secondary objective was partially fulfilled with the detection of complete tears of the supraspinatus tendon in 3 shoulders. We were also able to produce images of partial tears in the intra-tendinous cleavage. Intra-tendinous calcifications were explored in 1 shoulder. Humeral or glenoid chondropathy was identified in all the shoulders examined.Finally, no ultrasound-induced injuries were noted in any of the 6 shoulders in the study. The image acquisition time with the echo-endoscope was no more than 20 minutes for each shoulder, with an average time of 10 min 15 sec for shoulders with complete tissue evaluation.Conclusion:The echo-endoscope was easy and safe to use to acquire ultrasound images of the different glenohumeral or subacromial structures during shoulder arthroscopy. These results open the way for further explorations with the echo-endoscope.

There is poor accuracy in documenting the location of labral and chondral lesions observed during hip arthroscopy

PurposeTo determine and compare the accuracy and interobserver reliability of the different methods for localizing acetabular labral, acetabular chondral, and femoral head chondral lesions with hip arthroscopy .MethodsThree cadaver hips were placed in the supine position. Three labral, three femoral chondral, and six acetabular chondral lesions were made in each cadaver using electrocautery. Six surgeons classified the lesions according to different classification systems (clock-face, geographic, Method-G) using hip arthroscopy and standardized portals. Identification of each lesion was performed after conclusion of the study through open dissection and surgical hip dislocation to be used as the “gold-standard.” Accuracy was calculated as the number of correct answers divided by total number of responses for a given system. The interobserver reliability was calculated using the kappa coefficient. The different classification methods were compared. All P values were reported with significance set at P < 0.05.ResultsThe clock-face method had an accuracy of 74% (95% CI, 60%–85%) and interobserver reliability of 0.19 (95% CI, 0.11–0.26) while the geographic method had an accuracy of 50% (95% CI, 36%–64%) and interobserver reliability of 0.21 (95% CI, 0.05–0.31) for acetabular labral lesion identification (P > 0.05). The acetabular chondral lesion identification accuracy was 56% (95% CI, 46%–65%) for Method G, 66% (95% CI, 56%–75%) for Method G-simp, and 63% (95% CI, 53%–72%) for the geographic system (P > 0.05) with an interobserver reliability of 0.31 (95% CI, 0.27–0.35), 0.34 (95% CI, 0.28–0.40), and 0.40 (95% CI, 0.34–0.45), respectively (P > 0.05). Femoral chondral lesion identification accuracy was 74% (95% CI, 60%–85%) for Method G, 43% (95% CI, 29%–57%) for the geographic method, and 59% (95% CI, 45%–72%) for the geographic-simp system with interobserver reliability of 0.37 (95% CI, 0.27–0.47), 0.34 (95% CI, 0.28–0.40), and 0.40 (95% CI, 0.29–0.51), respectively (P > 0.05). Method G was significantly more accurate than the geographic system (P = 0.001).ConclusionsThere was poor to fair accuracy and interobserver reliability of the reporting systems for localization of labral, acetabular chondral, and femoral chondral lesions encountered during hip arthroscopy. The study suggests there is a need for a new method that is easy to use, reliable, reproducible and accurate.

MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation

Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging.