Semitendinosus Allograft Research Articles

Operative management of chronic isolated rectus femoris rupture with semitendinosus graft and biofiber: A case report

Rectus femoris tear is rare and often overlooked in emergencies. The majority of quadriceps muscle belly injuries can be successfully treated conservatively and for less active, older populations Non-operative management is reasonable. A case report of a 19-year-old male Kabbaddi player who sustained an injury to his rectus femoris muscle belly while playing 5 months back. This young patient did not recover the functional outcome required to get back to running and participating in kabaddi despite 5 months of physiotherapy and non-operative management and had complaints of Pain over midthigh and weakness in quadriceps during hip flexion and knee extension. This leads to Hindrances in Jumping, running, and kicking movements. Tenderness over the midthigh and palpable defect with Pain upon resisted hip flexion or extension was seen.3/5 quadriceps power was noted. Ultrasound and MRI were done to confirm the clinical diagnosis. Operative treatment using the semitendinosus allograft with bio fiber reconstruction system to augment rectus femoris repair allowed immediate full passive flexion of the knee and an early graduated physiotherapy program leading to a return to running and his previous level of sport without any restrictions. Surgical treatment of rectus femoris tear seems to be a good option for Chronic tears.

Fixation failure and early loss of reduction with the use of suture anchors for surgical repair of acromioclavicular joint dislocation: a case series

IntroductionSuture anchors have been used in surgical repair of acromioclavicular joint (ACJ) dislocation. While some reports indicate favorable results, others emphasize less promising outcomes. This case series reports our experience with suture anchors for surgical treatment of ACJ dislocation. MethodsClinical and radiographic outcomes in three patients treated operatively for ACJ dislocations were reviewed. In all patients, two suture anchors were inserted in the coracoid (unicortical) and #5 non- absorbable suture from the suture anchor was shuttled through drill holes in the clavicle and tied over two button devices. The coracoclavicular (CC) ligaments were reconstructed using a figure of eight semitendinosus allograft around the coracoid and clavicle. Postoperatively, sling immobilization was used for 6 weeks, and physical therapy was initiated at 6 weeks with contact activity allowed at 6 months. ResultsThree male patients underwent treatment for Rockwood type 3 (chronic; n=1) and type 5 (n=2) ACJ dislocations. Loss of reduction was noted within 6 weeks postoperatively. Two patients exhibited failure due to complete suture anchor pullout and the third patient had partial pull out of one of the anchors. Additionally, the third patient also suffered a coracoid fracture adjacent to the anchor’s placement after sustaining direct trauma to his shoulder, one-year postoperatively. ConclusionIn our case series, we found a high rate of fixation failure and early loss of reduction with the use of suture anchors for the treatment of ACJ dislocation. These findings should be taken into consideration when selecting an appropriate implant for fixation of ACJ dislocation.

Poster 289: Impact of Graft Selection on Clinical Outcomes following Isolated MPFL Reconstruction in Adolescent and Young Adult Athletes

Objectives: Patellofemoral instability (PFI) commonly requires surgical intervention in adolescent and young adult athletes. However, the clinical impact of graft selection, which may vary amongst surgeons, has not been well studied. The purpose of this study was therefore to compare clinical outcomes, including recurrent instability reoperations and complications, of medial patellofemoral ligament reconstruction (MPFLR), based on graft type. Methods: Electronic medical records of patients who underwent primary MPFLR surgery for PFI over a 10-year period between 2010 and 2019 at a single center were retrospectively reviewed. Collected data included demographic, clinical, and radiologic parameters of instability and post-operative clinical outcomes. Exclusion criteria included concomitant extensor realignment procedures (tibial tubercle osteotomy, patellar tendon transfer procedures) and factors that would alter routine surgical indications or technical approaches, such as fixed or syndromic PFI, osteochondral shear fractures undergoing fixation or >1 cm in diameter, and prior ipsilateral knee surgery. Results: One-hundred and one patients (average age 15.2 years, 63% female), underwent primary isolated MPFLR with an average follow up time of 2.87 years. There were no significant differences in demographic and radiographic parameters between autograft and allograft, other than more semitendinosus grafts, increased number of pre-op dislocation events, and higher sulcus angle in autograft (Table 1). The autograft group had a higher rate of recurrent instability (41% vs 14%, p = 0.01) but no significant difference in return to sport, complications, and reoperations (Table 2). Reoperations for recurrent instability were performed in 9% of all patients (Table 3). Subgroup analysis of allograft tendon type demonstrated more dislocations and recurrent instability in gracilis than semitendinosus, though these differences were not statistically significant, and there was no difference in recurrent instability surgery or complications (Table 4). Conclusions: In adolescent and young adult athletes undergoing isolated primary MPFLR for PFI, allograft may be associated with decreased rates of recurrent instability compared to autograft. While trends towards higher recurrent instability were detected with gracilis allograft, compared to semitendinosus allograft, the precise role of allograft tendon type would benefit from future studies with larger sample size to better elucidate its impact on clinical outcomes.

Open Acromioclavicular Joint Reconstruction via Cerclage With Semitendinosus Allograft

Background: Acromioclavicular (AC) joint separations occur most often in young male patients, commonly in athletes. Initially described by Jones et al. in 2001, reconstruction with semitendinosus allograft via cerclage has been increasingly adopted in recent times, though this not been as well described in video journals. Indications: Operative management of AC joint separation is classically indicated in Rockwood grade IV or higher AC joint injuries and controversial for grade III separations. One such treatment is AC joint reconstruction with semitendinosus allograft as described in this 37-year-old male patient, with a grade IIIB AC joint separation. Technique Description: A 6-cm incision was created overlying the clavicle. No distal clavicle excision was performed, but coracoclavicular (CC) scar tissue was elevated with medial and lateral windows about the coracoid. A passing suture was placed around the coracoid, and holes were drilled in the clavicle at 17% and 31% of the total clavicle length, consistent with ratios described by Rios et al; 5-mm tunnels were created corresponding to the trapezial and conoid limbs of the CC ligaments and tapped to 5.5 mm. A semitendinosus allograft was passed and fixed with two 5.5 × 15 mm polyetheretherketone (PEEK) screws after primary fixation with a FiberTape cerclage looped around the coracoid and clavicle independently with use of a tensiometer for maximal tightening. A FiberTak was used to fix the additional graft limb at the acromion to stabilize the AC joint and reinforced on itself with 0 vicryl. The patient was placed in a sling and assigned physical therapy (PT) focusing on limiting shoulder abduction and forward flexion for the first 6 weeks. Results: At 6 months postoperation, the patient continues to progress from PT, with low pain and near full range of motion. Although PT protocols vary widely, a full recovery is expected by 6 months, with the patient able to return to work, lifting no greater than 50 pounds. Discussion/Conclusion: This study describes the treatment of an acute grade IV AC joint separation in a 37-year-old male patient. Further adoption of AC joint reconstruction utilizing a semitendinosus allograft via cerclage continues to be a viable option for patients requiring operative management. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Anterior Cruciate Ligament Reconstruction: 3-Incision Technique With Allograft Quad Tendon ACL Reconstruction

Background: Anterior cruciate ligament (ACL) ruptures are becoming more common in younger and older athletes. Approximately 250,000 ACL injuries occur each year, requiring the need for an effective and reproducible surgical technique. Indications: The 3-incision outside-in technique utilizes the donor quadriceps tendon, an extraordinarily strong graft, without damage from autogenous harvesting of patellar tendon or hamstrings. While some data suggest higher re-rupture risk with donor tissue, this is counterbalanced by avoiding secondary surgical site damage. Technique Description: The ruptured ACL is removed and the intercondylar notch is cleaned to visualize the anatomical ACL insertion site. Using the 3-tunnel technique a gaff is passed through the intercondylar notch, through a puncture hole (incision 1) and a rear entry guide hooked to its tip. The guide point is pulled into the knee and placed in posterior aspect of the anatomic footprint of the native ACL. Through incision 2, a guide pin is drilled to this point and overdrilled with a 10-mm drill. The edges of the hole in the intercodylar notch are smoothed with a currette. The tibial footprint is cleared, a tibial aiming guide placed. Through incision 3, a guide pin is placed and over drilled with a 10-mm drill followed by a Gore-Tex reamer to ensure no impingement would inhibit graft passage. The proximal bone of a quadriceps tendon graft is sized through a 10-mm sizer and compacted. Two holes are drilled to hold sutures for the proximal aspect of the femoral graft. The quadriceps tendon graft is sized to fit through a 9-mm tunnel and the free end whipped with a stitch before being passed from outside-in through the smoothed tunnels. The femoral bone block is tapped to have a press fit initially and then is fixed with a Milagro screw. The knee is cycled ten times to remove slack and the interference fit guide pin is placed on the anterior aspect of the graft, and fixed with the knee at 15° to 30° of flexion. Stability is tested with confirmation of no impingement, and then an extra-articular reconstruction with a semitendinosus allograft is performed. The extra articular reconstruction is placed at the point between Gerdy's tubercle and the fibular head, passed under the skin and the iliotibial band, and then inserted just anterior and superior to the ACL femoral drill hole. Results: Patient outcomes in our initial experience are comparable to our autogenous bone-tendon-bone (BTB) procedures without anterior knee pain. Return to sport is similar with autogenous procedures, with a delay of 6 to 12 months. In addition, there is a possibility for acceleration of healing with the addition of platelet-rich plasma and hyaluronic acid between 1 and 3 months postsurgery. We have insufficient data so far to determine if the re-rupture rate will decline compared with reported outcomes. Conclusion: The 3-incision technique with allograft quadriceps tendon for ACL reconstruction is a reproducible surgical technique that avoids harvest from the patient's own body. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Triple Varus Knee: A Case Presentation

Background: Knee instability due to posterior cruciate ligament (PCL) and posterolateral corner (PLC) deficiency is a devastating condition that negatively affects patient quality of life. This video presents the surgical management of a triple varus knee, including combined high tibial osteotomy (HTO), revision PCL and PLC reconstruction, and meniscus root repair. Indications: Combined HTO and revision PCL and PLC reconstruction is indicated for patients with previously failed PCL and PLC reconstruction in the setting of varus malalignment. Technique Description: The procedure begins with a medial opening-wedge biplanar HTO, which is fixed with a patient-specific locking plate. The PCL femoral tunnel is drilled via a low anterolateral portal, and the tibial insertion is debrided via a posteromedial portal. The medial meniscus is carefully freed from the posterior capsule, and 2 luggage tag sutures are placed through the posterior root. The PCL tibial tunnel and meniscus root tunnels are drilled via their respective guides. The meniscal sutures are passed through the tunnel but not fixed. An Achilles bone-block allograft is passed through the PCL tibial tunnel and fixed with suspensory fixation and an interference screw on the femoral side, while the tibial side is left free. A peroneal nerve neurolysis is performed. A fibular tunnel is drilled, and a semitendinosus allograft is whip-stitched on both sides and passed through the tunnel. A Beath pin is inserted into the femur, and the tunnel is over drilled. Both limbs of the graft are passed deep to the iliotibial band and into the tunnel. The tibial side of the PCL is fixed with an interference screw at 90° of knee flexion. The PLC grafts are fixed with an interference screw at 30° of knee flexion with slight valgus. The medial meniscus root sutures are tied over a button, with 60° of knee flexion. Screws from osteotomy fixation are replaced as needed. Results: Although outcomes following the combined procedure are lacking, good to excellent clinical outcomes have been reported in isolation following each procedure. Conclusion: A combination of HTO and revision PCL and PLC reconstruction should be considered for patients with persistent instability and/or pain in the setting of triple varus knee. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement

Background: The posterolateral corner (PLC) is an important knee stabilizer that resists varus stress, external tibial rotation, and posterior tibial translation. Untreated PLC injuries have been shown to increase failure rates of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions and lead to degenerative changes. Our modified Arciero technique reconstructs the femoral insertion site and functionality of the lateral collateral ligament (LCL) and popliteal fibular ligament, components of the PLC, with an internal brace and tensionable loops. Indications: The primary indication for PLC reconstruction is identified PLC injury. Patients often have a feeling of knee instability and a varus thrust gait. PLC injury should be confirmed with imaging. Technique Description: We employed a modified Arciero technique via LCL reconstruction with tensionable loops and internal brace. We used a semitendinosus allograft truncated at 240-millimeters to avoid the graft bottoming out. A suture augment was incorporated into the graft to reinforce the LCL reconstruction construct during graft tensioning and early rehabilitation. The graft construct was then passed through the transfibular tunnel to femoral sockets at the LCL and popliteus insertions. The graft construct is then affixed to the opposite femoral cortex. The graft was then tensioned with the knee in approximately 30° of flexion, neutral to 10° of internal rotation, and a valgus force applied. This restored excellent valgus stability. Results: Fibular and tibiofibular-based constructs are common procedures for PLC reconstruction. Our LCL reconstruction with tensionable loops technique and the Arciero technique are fibular-based constructs. The fibular-based construct and the tibiofibular-based construct have been found to be biomechanically equivalent at restoring knee stability. However, fibular-based constructs, such as our LCL reconstruction with tensionable loops, were found to be less technically demanding than tibiofibular-based constructs, used fewer grafts, and required a smaller surgical approach. Conclusion: Given similar clinical outcomes, it was concluded that fibular-based constructs, such as our modified Arciero technique, may be more advantageous because of the ability to avoid some of the pitfalls of tibiofibular-based constructs. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft

A Novel Patellar Tendon Reconstruction Technique Using Semitendinosus Allograft

Low-Volume Surgeons Use Allograft in Younger Patients and Show Greater Rates of Revision Following Primary Allograft Anterior Cruciate Ligament Reconstruction Compared With High-Volume Surgeons

To determine whether surgeon volume affects revision rate following primary anterior cruciate ligament reconstruction (ACLR) with allograft and to determine whether surgeon volume impacts allograft tissue type used. All patients aged 14 years or older who underwent primary allograft ACLR at a large hospital system between January 2015 to December 2019 with minimum 2-year follow-up were included. Patients with double-bundle ACLR, multiligament reconstruction, and absent allograft type data were excluded. Surgeon volume was categorized as 35 or more ACLR/year for high-volume surgeons and less than 35 ACLR/year for low-volume surgeons. Revision was defined as subsequent ipsilateral ACLR. Patient characteristics, operative details, allograft type, and revision ACLR rates were retrospectively collected. Revision rate and allograft type were analyzed based on surgeon volume. A total of 457 primary allograft ACLR cases (mean age: 38.8 ± 12.3 years) were included. Low-volume surgeons experienced greater revision rates (10% vs 5%, P= .04) and used allograft in a younger population (37.6 vs 40.0 years old, P= .03) than high-volume surgeons. Subgroup analysis of the total cohort identified a significantly increased failure rate in patients <25 years old compared with ≥25 years old (30% vs 4%, P < .001). Allograft type selection varied significantly between surgeon volume groups, with low-volume surgeons using more bone-patellar tendon-bone (P < .001) and less semitendinosus allograft (P= .01) than high-volume surgeons. No differences in revision rate were observed based on allograft type (P= .71). There was a greater revision rate following primary allograft ACLR among low-volume surgeons compared with high-volume surgeons. Low-volume surgeons also used allograft in a younger population than did high-volume surgeons. Level III, retrospective comparative prognostic trial.

Surgical Approach to Full Thickness Cartilage Defect With Patellar Instability: Combined Matrix-Associated Chondrocyte Implantation (MACI) and Medial Patellofemoral Ligament (MPFL) Reconstruction

Background: Cartilage injury in the setting of acute patellar dislocation is a devastating condition that can lead to decreased quality of life and can progress to early osteoarthritis of the knee if not treated adequately. Indications: Matric-associated chondrocyte implantation (MACI) with concomitant medial patellofemoral ligament reconstruction (MPFLR) is indicated for young, high-demand patients with a symptomatic, full-thickness chondral lesions &gt;2 cm2 that have failed an initial trial of conservative management or are found to have evidence of extensive cartilage damage or loose body that is not amenable to fixation. Technique Description: The MACI technique requires a 2-stage procedure. An initial diagnostic arthroscopy aids in characterization of the chondral lesion with regard to lesion size, depth, and morphology. Hyaline cartilage was harvested and autologous chondrocytes are seeded onto a MACI scaffold to grow. At the second stage, an MPFLR is planned alongside MACI. First a midline incision is made. Notably, instead of performing the capsulotomy at this stage, we proceed with the dissection for the MPFLR first creating a plane between layer #2 and #3 for easier graft retrieval later. The defect site is prepared, and the MACI graft is seated in the defect and secured. Medial patellofemoral ligament reconstruction is then begun by fixing the preloaded semitendinosus allograft to the patella. Shottle point is confirmed via fluoroscopy and dissection down to the femoral condyle is performed. The graft is retrieved between the 2 layers that were dissected earlier in the procedure and fixed within the femoral tunnel. Finally, the synovial layer is closed deep to the MPFL graft and the vastus medialis oblique (VMO) layer is closed superficial to it before closing the wound in the standard fashion. Results: The MACI procedure demonstrates high rates of satisfaction for relief of pain and significant improvements in clinical outcomes with generally low incidence of complications. Matric-associated chondrocyte implantation has been shown to be superior to microfracture in the treatment of larger (&gt;3 cm2) symptomatic articular defects at 5 years. Discussion/Conclusion: Matric-associated chondrocyte implantation procedure with concomitant MPFLR should be considered in indicated patients with full thickness cartilage defects that are not amenable to fixation. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Floating Clavicle: Surgical Technique for Management of an Ipsilateral Acromioclavicular and Sternoclavicular Joint Dislocation

Bipolar “floating” clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture.

The delta-snook ankle ligament reconstruction for combined deltoid insufficiency and lateral ankle instability

BackgroundAnkle sprains are one of the most common injuries amongst the general population and affect all spectrums of activity levels. While the anterior talofibular and calcaneal fibular ligaments are most prevalently injured during sprains there are instances when chronic lateral ankle instability leads to rotational ankle instability and attenuate the deltoid ligament. The few literature that exists concerning lateral and medial ankle ligament reconstruction focus on an arthroscopic approach. AimThe goal of this current work is to describe a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. Surgical TechniqueA singular semitendinosus allograft is utilized to reconstruct the anterior deltoid, anterior talofibular and calcaneofibular ligaments. Canals are reamed for anchoring of the allograft through the medial malleolus, anterior talar body, distal fibula, and midline calcaneus. The anterior talar body, distal fibula and midline calcaneus are reamed fully to allow for pull through technique of the allograft. The medial malleolus and talar neck are anchored first, followed by the anterior fibula, and lastly the lateral calcaneus. All anchoring is performed with the ankle in a neutral position. ConclusionThis work successfully describes a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. This technique affords the surgeon greater control over the final product and allows for a repair in a neutral position. The semitendinosus allograft also allows for a more anatomic repair with less incidence of stiffening at the ankle joint. The authors’ have noted good results and return to full activity for the patients that have undergone this procedure.

Tibial Tubercle Osteotomy With Concomitant Medial Patellofemoral Ligament Reconstruction

Background: Patellofemoral anatomy allows for substantial freedom of motion. Medial patellofemoral ligament (MPFL) tears occur in up to 96% of lateral patellar dislocations. Risk factors for subsequent instability include maltracking and increased tibial tubercle to trochlear groove (TT-TG) distance. Indication: Medial patellofemoral ligament reconstruction (MPFLR) with concurrent tibial tubercle osteotomy (TTO) is indicated in patients with recurrent dislocation or unresolved apprehension. Concurrent TTO should be considered for TT-TGs 15-20 mm depending on overall clinical picture and risk factors. We strongly consider TTO for TT-TGs ≥20 mm and for revision procedures. Technique Description: Following diagnostic arthroscopy, a midline incision is made from the inferior patellar pole to 3 cm beyond the tibial tubercle. The anterior compartment is incised and retracted laterally. An osteotomy guide is affixed to the tibia and an osteotomy cut is made with a saw, leaving a small bridge of periosteum distally. The osteotomy is competed proximally with osteotomes, then medialized and held in place with two 4.5-mm screws. An incision is made on the superomedial patella and two 0.045 inch guidewires are placed at the MPFL insertion and overdrilled with a 3.5-mm drill. A 22-cm semitendinosus allograft is prepared and fixed to the patella using two 3.5-mm anchors. An incision is made over the medial epicondyle and a 2.4-mm beath pin is placed at Schöttle point. Isometry is confirmed and the pin is overdrilled with a 6-mm reamer. The allograft is passed just superficial to capsule from the peripatellar incision to the medial incision, docked into the femur, and secured with a 6-mm interference screw at 30° of flexion after confirmation of appropriate graft length. Results: Studies have demonstrated improved outcomes for patients undergoing MPFLR + TTO compared with isolated MPFL in the setting of maltracking and increased TT-TG distance. In addition, a recent meta-analysis demonstrated no negative effect of concurrent TTO on return to sport timeline. Discussion/Conclusion: MPFLR with concurrent TTO is effective, with surgical correction of underlying maltracking and satisfactory return to sport. Consideration to MPFL + TTO should be given to patients with recurrent instability and pathologically increased TT-TG. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Proximal Tibiofibular Joint Reconstruction With a Semitendinosus Allograft for Chronic Instability

Whereas acute proximal tibiofibular joint (PTFJ) dislocation may require urgent reduction, chronic or recurrent instability may initially be approached with conservative treatment. Indications for PTFJ reconstruction include persistent lateral knee pain and/or tibiofibular instability for which conservative treatment has failed. Owing to the low incidence of diagnosed isolated PTFJ instability, there is still no consensus regarding the optimal surgical treatment, with an array of options having been previously described. We describe the treatment of isolated PTFJ instability using an anatomic reconstruction with semitendinosus allograft for chronic instability.

Dual Semitendinosus Allograft Reconstruction of Chronic Achilles Tendon Ruptures: Operative Technique and Outcomes.

Dual semitendinosus allograft reconstruction of chronic Achilles tendon ruptures has several potential benefits including superior tensile strength compared with a turndown construct and avoidance of the morbidity and operative time associated with autograft augmentation. We present a series of chronic Achilles tendon ruptures reconstructed with dual semitendinosus allograft. We retrospectively reviewed the charts of patients aged 18 years and older who underwent reconstruction of chronic Achilles tendon ruptures using dual semitendinosus allograft. The primary outcome of this study was to evaluate the need for revision surgery. Secondary outcomes included patient-reported outcomes, for which Achilles Tendon Rupture Scores (ATRS) were collected at final follow-up. Nine patients with a mean age of 58.9 (range, 43-75) years met inclusion criteria. Median follow-up was 66 months (range, 27-121 months). One patient (11.1%) required revision reconstruction after sustaining graft failure 9.5 years after her index procedure, and 1 patient reported a poor ATRS score at the 27-month final follow-up despite an intact surgical repair. At final follow-up, no patient required the use of an assistive device for ambulation or a walking boot. The median ATRS at final follow-up was 93 (range, 30-100). Good clinical outcomes without rerupture were observed in 7 of 9 patients (77.8%) at short- to midterm follow-up, suggesting that dual semitendinosus allograft reconstruction is a viable option for the reconstruction of chronic Achilles tendon tears. Level IV, case series.

Anatomical acromioclavicular joint stabilization with chemically sterilized tendon allografts: A retrospective study.

The purpose of this retrospective study was to analyze whether chemically sterilized tendon allografts perform as well as other non-sterilized allografts and autografts as described in the literature for anatomical acromioclavicular joint stabilization for the treatment of Rockwood III-V. Allografts are still described as a factor for higher re-rupture rates. Retrospective data were collected from 21 acromioclavicular joint stabilizations performed by a single surgeon and performed between 2011 and 2014 using sterilized semitendinosus allografts. The primary endpoints were re-rupture and complication rates. Secondary endpoints were AC-joint stability, pain level, return to work and sport and the range of motion. No re-ruptures occurred during the mean follow-up time of 33 months. Zero complications occurred directly after surgery, but three complications later than three weeks after surgery. All cases resolved without further surgery. After surgery, stability significantly improved for all patients. Post-surgery, 19 patients had stable acromioclavicular joints and only two patients showed minor instabilities. Range of motion returned to the range of the healthy shoulders for all patients. Chemically sterilized semitendinosus allograft use for anatomic AC-joint stabilization is equivalent to the use of other allografts or autografts and required no hardware removal. No donor age or graft size dependence was observed, due to zero re-ruptures.

Medial Patellofemoral Ligament Reconstruction

Background: Recurrentlateral patellar dislocation is a devastating condition associated with different pathologies, including medial patellofemoral ligament (MPFL) injury, increased tibial tubercle to trochlear groove (TT-TG) distance, and trochlear dysplasia. This video aims to provide an overview of isolated MPFL reconstruction in a patient with recurrent patellar dislocation and chronic MPFL injury. Indications: Isolated MPFL reconstruction is indicated for patients with recurrent lateral patellar instability following an initial trial of nonoperative management, in the absence of other contributing anatomic factors. Candidates for isolated MPFL reconstruction should have a TT-TG distance of &lt;20 mm, and normal or Dejour type A trochlear morphology. Technique Description: Semitendinosus allograft is used to reconstruct the torn or attenuated MPFL. Following diagnostic arthroscopy, an incision is made over the medial border of the patella and dissection is carried through the skin and subcutaneous tissue to the fascia. Two K-wires are over-drilled and two 3.5-mm Arthrex SwiveLock anchors are placed. The allograft is prepared and whipstitched on both sides. The central portion of the graft is tide down to the anchors. A second incision is then made on the medial side of the knee over the epicondyle. Dissection is carried down to the fascia, and palpation is used to identify Schottles’ point. This is confirmed with fluoroscopy. An 8-mm drill bit is then used to drill to a depth of 60 mm on the femoral side. The grafts are passed one at a time through the femoral tunnel. The femoral side is fixed with an Arthrex BioComposite Interference Screw and the incisions are subsequently irrigated and closed in a layered fashion. Results: MPFL reconstruction demonstrates good functional and clinical outcomes with high rates of patient satisfaction and low rates of failure. A recent systematic review demonstrated an 84% rate of return to sport, improved postoperative outcomes, and pooled risks of recurrent instability and reoperation of less than 5% following isolated MPFL reconstruction. Conclusion: Isolated MPFL reconstruction should be considered for patients with recurrent patellar instability in the absence of other clinical risk factors. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player

Background: Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible. Case Presentation: We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free. Conclusion: Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.

Lateral Ankle Ligament Allograft Reconstruction Technique

Ankle inversion sprains represents the most common musculoskeletal injury in the United States. Most of these injuries recover uneventfully with appropriate conservative management. A subset of patients do not heal adequately and develop chronic lateral ankle instability that requires surgical stabilization. Within this group of patients are those that will benefit from allograft reconstruction to augment the lateral ligamentous repair in cases of poor native tissue or high force demands on the ankle. The authors present their technique for lateral ankle ligament allograft reconstruction with semitendinosus allograft.

Medial Patellofemoral Reconstruction With a Hamstring Allograft

Background: Lateral patellar instability is common in young, active patients. Patients who fail conservative treatment may benefit from medial patellofemoral ligament (MPFL) reconstruction. Indications: Recurrent lateral patellar instability. Technique Description: Examination assesses patellar translation, eversion and range of instability. Diagnostic arthroscopy is performed for loose bodies, cartilage damage, trochlear dysplasia, and tracking. A longitudinal incision is made from superomedial to mid-body of the patella. The plane between the capsule and retinaculum is developed for palpation of the medial epicondyle and adductor tubercle. Electrocautery and rongeur are used to create a trough on the patella from centromedially to superomedially. Two suture anchors are placed at the proximal and distal trough. Fluoroscopy is utilized to identify Schöttle point with a perfect lateral radiograph. A 3-centimeter incision is made, and blunt dissection connects the 2 incisions in the developed plane. A guidepin is advanced at Schöttle point, and suture anchor sutures are shuttled through the plane, posterior to the guidepin. There should be loosening of tension with knee flexion. A semitendinosus allograft is whipstitched with terminal tapering. The whipstitched end is tunneled around the guidepin and brought back to the patella, so that both ends have an excess of 20 to 25 millimeters, and excess graft is trimmed from the free end prior to whipstitching. The doubled graft is sized. The midportion of the tendon is tagged and passed through both anchors. The graft is tensioned to the patellar trough and the graft ends are advanced through the developed plane. The femoral tunnel is reamed, and the graft is tensioned into the tunnel after nitinol wire placement with the knee in full extension. Isometry and lateral patellar translation are assessed, aiming for 1 quadrant with firm endpoint. The patella is proximalized and the tensioned graft is secured with an interference screw. Results: MPFL reconstruction is successful for the majority of patients, with 1.2% reporting instability, 3.6% apprehension, and 3.1% reoperation. Possible complications include patellar fracture, patellofemoral pain, and knee stiffness (loss of range of motion). Discussion/Conclusion: Lateral patellar instability is common, and MPFL reconstruction is typically successful for the majority of patients.