Hevesi, Mario

Abstract Meniscal extrusion (ME) is a valuable, noninvasive diagnostic tool for meniscus pathology. In addition, ultrasound can allow for instant results in the office. However, ME is a fragile metric in the degree of millimeters. The inconsistent techniques used by different authors in the literature and the additional operator variability that ultrasound technology introduces make it important a systematic approach is used. The purpose of this study is to propose a reproducible technique. The current authors recommend having the patient in (1) 30° of knee flexion while weight‐bearing, (2) capturing the image at the posterior border of the medial collateral ligament, (3) using a reference line parallel to the articular margin of the tibia, and (4) measuring ME at the coronal midpoint of the outermost edge of the meniscus. Technique Video video See video under supplementary data.

Abstract Capsular management in hip arthroscopy has recently become a popular topic in the literature. Various approaches have been developed around the critical balance between safe and satisfactory exposure while maintaining hip joint stability and the restoration of capsular integrity at the conclusion of the case. Advocates for capsular closure recognize the role of the capsule in providing hip joint stability and aim to reestablish normal hip biomechanics through capsule preservation. Several recent studies have also shown capsular management strategies to influence both clinical outcomes and risk of revision surgery. We present an effective method for capsular management in hip arthroscopy that consistently allows excellent exposure and working space while allowing for facile, anatomic closure. Technique Video video See video under supplementary data.

Abstract Anterior cruciate ligament (ACL) reconstruction using the quadriceps tendon (QT) autograft is an increasingly utilized technique that confers less donor site morbidity and comparable outcomes to other historically used graft options. The graft harvest and implantation process present vast variability—particularly regarding the achievement of adequate graft site visualization, consistently attaining a uniform and appropriately sized graft, and subsequent reconstruction of the ACL with the all‐soft tissue graft. The purpose of this Technical Note and video is to describe and demonstrate minimally invasive quadriceps tendon autograft harvesting using the Quadriceps Tendon Harvest Guide System (QUADTRAC), and its subsequent implantation within a single‐bundle ACL reconstruction with suspensory fixation. Technique Video video See video under supplementary data.

Abstract The medial collateral ligament serves as the primary stabilizer to valgus stress on the medial side of the knee and is the most commonly injured ligament in the knee. Medial collateral ligament reconstruction can provide improved stability and clinical outcomes for patients. Advancements in techniques, including the use of an adjustable‐length‐loop suspensory fixation device through a longitudinal incision, have been introduced in recent years. The purpose of this Technical Note and video is to provide a minimally invasive method for medial collateral ligament reconstruction with adjustable‐loop femoral fixation and posteromedial corner plication. Technique Video video See video under supplementary data.

Purpose To perform a systematic review of the literature to evaluate (1) activity level and knee function, (2) reoperation and failure rates, and (3) risk factors for reoperation and failure of autologous osteochondral transfer (AOT) at long‐term follow‐up. Methods A comprehensive review of the long‐term outcomes of AOT was performed. Studies reported on activity‐based outcomes (Tegner Activity Scale) and clinical outcomes (Lysholm score and International Knee Documentation Committee score). Reoperation and failure rates as defined by the publishing authors were recorded for each study. Modified Coleman Methodology Scores were calculated to assess study methodological quality. Results Twelve studies with a total of 495 patients and an average age of 32.5 years at the time of surgery and a mean follow‐up of 15.1 years (range, 10.4‐18.0 years) were included. The mean defect size was 3.2 cm 2 (range, 1.9‐6.9 cm 2 ). The mean duration of symptoms before surgery was 5.1 years. Return to sport rates ranged from 86% to 100%. Conversion to arthroplasty rates ranged from 0% to 16%. The average preoperative International Knee Documentation Committee scores ranged from 32.9 to 36.8, and the average postoperative International Knee Documentation Committee scores at final follow‐up ranged from 66.3 to 77.3. The average preoperative Lysholm scores ranged from 44.5 to 56.0 and the average postoperative Lysholm scores ranged from 70.0 to 96.5. The average preoperative Tegner scores ranged from 2.5 to 3.0, and the average postoperative scores ranged from 4.1 to 7.0. Conclusions AOT of the knee resulted in high rates of return to sport with correspondingly low rates of conversion to arthroplasty at long‐term follow‐up. In addition, AOT demonstrated significant improvements in long‐term patient‐reported outcomes from baseline. Level of Evidence Level IV, systematic review of Level I‐IV studies.

Abstract Quadriceps tendon autografts are an increasingly popular choice for anterior cruciate ligament (ACL) reconstruction, with decreased donor‐site morbidity alongside good patient outcomes. Although harvesting of the tendon can be done in a minimally invasive fashion, this introduces some difficulty with visualization and consistency of graft sizing. The purpose of this Technical Note and video is to provide a method of quadriceps tendon autograft harvesting using the Quadriceps Tendon Harvest Guide System (QUADTRAC) in a single‐bundle ACL reconstruction. Technique Video video See video under supplementary data.

Abstract Iliopsoas tendinitis following total hip arthroplasty has been linked to retroverted acetabular cup position with associated anterior overhang. For severely malpositioned components, preferred treatment is in the form of revision arthroplasty. However, for a substantial number of cases, iliopsoas tendinitis as well as associated pain and disability are observed in the presence of modest acetabular overhang. In such cases, patients may benefit substantially from arthroscopic iliopsoas fractional lengthening. Given altered postarthroplasty anatomy, we present an arthroscopic approach employing an iliopsoas air bursogram. In such a way, safe and predictable access can be provided for efficient tendon lengthening without capsular violation or inadvertent instrumentation of the nearby medial neurovascular bundle. Technique Video video See video under supplementary data.

» Gluteal tendinopathy/greater trochanteric pain syndrome (GTPS) is the most prevalent of all lower limb tendinopathies, affecting 1 in 4 women older than 50 years and commonly individuals within their fifth and sixth decades of life regardless of activity level. » The condition is believed to originate from age-related degenerative changes about the hip abductor tendon insertions and the surrounding bursae, and is exacerbated by congenital and acquired abnormal hip biomechanics. » Treatment of gluteal tendinopathy/GTPS often begins with noninvasive nonoperative modalities such as activity modifications, nonsteroidal anti-inflammatory drugs, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies have been used; however, there remains a lack of comparative efficacy between these adjunct treatments. » In this article, we examine the available literature regarding the nonoperative management of gluteal tendinopathy/GTPS and provide insight into the effectiveness of current treatment modalities.

Purpose To evaluate long‐term patient‐reported outcomes and achievement rates of patient acceptable symptomatic state (PASS) in young athletes undergoing hip arthroscopy, and to report long‐term sports continuance and reoperation. Methods Inclusion criteria consisted of age <24 years at surgery, femoroacetabular impingement undergoing primary hip arthroscopy with labral repair, and participation in sport with intent to return to sport after surgery. The enrollment period was from April 2009 to June 2014. Modified Harris Hip Scores (mHHS), Hip Outcome Score (HOS), HOS Activities of Daily Living (HOS‐ADL), and HOS Sport (HOS‐Sport) were collected preoperatively, 2 years’ postoperatively, and final follow‐up. Patients were evaluated for PASS achievement, reoperation, and sports participation. Results Forty‐two hips in 37 patients (11 male, 26 female, age: 17.7 ± 2.1 years, range 13.6‐23.0, body mass index 22.8 ± 2.9, range 17.6‐33.7) met inclusion criteria and were followed for 10.0 ± 1.3 years (range 8.5‐13.0) postoperatively. Mean mHHS, HOS‐ADL and HOS‐Sports outcome scores at minimum 8.5 years were 82.2 ± 12.9, 89.6 ± 10.9, and 81.8 ± 16.4, respectively, with significant ( P < .001) postoperative improvements. Thirty survey respondents (83%) met PASS for mHHS, 27 (75%) for HOS‐ADL, and 24 (67%) for HOS‐Sports. At minimum 8.5‐year follow‐up, only 9 of 37 (24%) cited their hip as the reason for stopping sport. Of the remaining patients, 17 of 28 (61%), continued playing their initial sport. There was no difference in patient‐reported outcomes between patients who endorsed sports continuance and patients who did not report sports continuance and did not cite their hip as a reason ( P ≥ .229). At final follow‐up, 4 hips (10%) had undergone subsequent surgical intervention at a mean of 4.8 ± 3.3 years (range 1.0‐8.4) postoperatively. Conclusions Durable mid‐term outcomes and satisfactory PASS achievement rates are observed in young amateur athletes undergoing primary hip arthroscopy. At minimum 8.5‐year follow up, approximately 1 in 4 patients discontinue their sports due to hip related reasons. Level of Evidence Level IV, case‐series.

Purpose To (1) evaluate the efficacy of surgery for arthrofibrosis (AF), as measured by preoperative and postoperative range of motion (ROM), and (2) evaluate patient‐reported outcomes at mid‐ to long‐term follow‐up. Methods We performed a retrospective review of a prospectively collected database including patients who sustained multiligamentous knee injuries (MLKIs) managed surgically, sustained loss of ROM after surgical intervention, and underwent subsequent lysis of adhesions (LOA) and/or manipulation under anesthesia (MUA). Loss of ROM was defined as clinically symptomatic loss of terminal extension (flexion deformity) and/or flexion compared with the contralateral side. Results In total, 12 patients (6 male and 6 female patients; age, 36.0 ± 8.7 years; body mass index, 36.3 ± 8.7) met the inclusion criteria and underwent LOA and/or MUA at a mean of 14 ± 27 months (median, 4.0 months; interquartile range, 3.5‐9.3 months) after MLKI surgery. Prior to AF intervention, patients showed mean flexion of 75.9° ± 36.0° (range, 30°‐129°), mean extension of 3.2° ± 5.2° (range, 0°‐12°), and a mean arc of motion of 72.7° ± 34.1° (range, 30°‐117°). At a mean follow‐up of 7.0 ± 3.9 years (range, 2.4‐16.6 years) after AF intervention, patients showed a significant increase in knee flexion of 49° ( P = .003), a significant increase in arc of motion of 51° ( P = .002), and an increase in extension of 3° ( P = .086). The mean final International Knee Documentation Committee score was 59.5 ± 23.9; Lysholm score, 72.1 ± 20.6; Tegner activity scale score, 5.6 ± 2.8; visual analog scale score at rest, 1.0 ± 1.6; and visual analog scale score with use, 3.3 ± 2.5. At final follow‐up, 2 patients (17%) had undergone conversion to total knee arthroplasty (TKA) at 10.3 and 24.8 years after MLKI surgery. Of the 10 patients who did not go on to TKA, 9 (90%) reported that they were satisfied or very satisfied with their AF knee surgery. Conclusions At mid‐term follow‐up, LOA and/or MUA for symptomatic AF after multiligamentous knee surgery results in high rates of patient satisfaction and improved knee ROM and pain scores, as well as durable and satisfactory functional outcomes in patients not undergoing TKA. Level of Evidence Level IV, therapeutic case series.