Fully arthroscopic treatment of medial Hoffa fracture associated with anterior cruciate ligament tear: case report and surgical technique

A Hoffa fracture is a rare intra-articular injury consisting of a coronal plane fracture of one or both of the distal femoral condyles. Because of the rarity of medial Hoffa fractures, only a few reports have described this injury and its arthroscopic management. In this article, we present a rare case involving a 32-year-old man with a displaced medial Hoffa fracture associated with a proximal anterior cruciate ligament tear. He was treated by a single-stage fully all-inside arthroscopic technique. Arthroscopic-assisted internal fixation ensured fragment stability and enabled us to visualize the fracture reduction, monitor the screw insertion, and reconstruct the anterior cruciate ligament tear at the same time. This technique is a novel but demanding treatment method for medial Hoffa fractures and is particularly useful for properly selected patients with associated intra-articular knee injuries.

Fraturas da Eminência da Tíbia na Infância – Descrição de Abordagem Artroscópica e Resultados Funcionais

Pediatric fractures of the tibial eminence are relatively rare, equivalent to the anterior cruciate ligament rupture in the adult. Severely displaced tibial eminence fractures should be treated surgically. Arthroscopy is preferred as it allows for accurate diagnosis and treatment of associated lesions and reduction and fixation of all types of tibial spine fractures while reducing the morbidity associated with open techniques. We report the clinical and radiological results of two cases with displaced tibial eminence fractures, submitted to surgical treatment and the arthroscopic technique of internal fixation with absorbable suture. After a follow-up of 18 months both patients had great improvement. Radiographic exams confirm complete fracture healing at 6 weeks of follow-up. The International Knee Documentation Committee subjective score were excellent (96 and 98 points) and the range of motion of the injured knees were also similar to the no-injured knees. This arthroscopic technique is simple, reproducible and very useful in dealing with these fractures, allowing to obtain excellent functional results.

Arthroscopic Treatment of Capitate Nonunion: A New Technique

Isolated fractures of the capitate are very rare which means that their nonunion is even rarer. Repair techniques have always been performed by open surgery which may result in loss of mobility due to the capsulotomy. The typically used surgical techniques such as arthrodesis of the carpal or wrist bones can have irreversible consequences on range of motion. No arthroscopic technique has ever been described for this condition. Here, we describe a case of isolated capitate nonunion without ligament tears or other carpal fractures in a 21-year-old male, following a capitate fracture 10 years prior. We describe our arthroscopic treatment technique for this capitate nonunion.

Minimally Invasive Arthroscopic Treatment of Patients with Medial Epicondylitis

Background. There is not enough research on the topic of arthroscopic treatment of medial epicondylitis. Topographic studies are needed to justify surgical approaches with minimal trauma to the medial collateral ligament and ulnar nerve. The aim of the study was to optimize the arthroscopic treatment of medial epicondylitis and evaluate its clinical effectiveness based on the results of the topographic and anatomical study. Materials and Methods. The material for the topographic and anatomical study was 12 «fresh» anatomical preparations of the human elbow joint, of which 6 were taken from female cadavers, and 6 — from men. The features of the structure and topography of the elbow medial collateral ligament were studied, and the safety and effectiveness of arthroscopic approaches to the elbow for the flexor carpi radialis release were determined. A prospective cohort comparative study was performed, which included 70 patients. Two comparative groups were formed. In the group I (35 patients) surgical treatment was carried out by the open method. The group II included 35 patients who underwent minimally invasive surgical treatment using arthroscopic technique. The results were evaluated by Mayo Elbow Perfomance Score (MEPS) and VAS before surgery and 1, 6, and 9 weeks after. Results. Functional results in 9 weeks: group I — 81.77 (95% CI 81.13; 82.41); group II — 92.66 (95% CI 91.61–93.70) points. The average score for VAS in the same period: group I — 34.30 (31.89–36.68) points; group II — 1.5 (0.46–2.45) points. Conclusion. The safe zone is located above the midline of the humeroulnaris joint by 2 (1.0–3.2) mm. The risk of the medial ulnar collateral ligament anterior bundle injury is minimal in this area. Treatment of patients with the medial epicondylitis according to the developed arthroscopic technique can significantly improve the patients functional state and quality of life.

A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture

This case-series outcome study presents a new arthroscopic technique for tibial eminence avulsion fracture (TEAF) with double-tunnel using two tightrope suture buttons. From May 2017 to July 2020, we performed a new arthroscopic technique for TEAF with double tunnels, using two tightrope suture buttons on 13 patients. Clinical assessments included anterior drawer, Lachman, and pivot shift tests, the International Knee Documentation Committee (IKDC), Lysholm knee scores, visual analog scale (VAS) scores, and range of motion (ROM). An independent observer noted conditions before surgery and during the last follow-up. The patients had an average follow-up of 26.2 months, ranging from 15 to 37 months. During the last postsurgical follow-up, the anterior drawer, Lachman, and pivot shift tests were negative in all the cases. According to the IKDC, Lysholm, and VAS final scores, all patients presented a significant knee function improvement at last follow-ups compared with preoperatively. The study shows that satisfactory results about an anatomic reduction of the fragment, knee stability, function, and strength can be achieved with the new arthroscopic technique for TEAF with double tunnels using two tightrope suture buttons. This study is a therapeutic case series and its level of evidence is IV.