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David R Diduch

Publications and source records attributed to David R Diduch.

18 recordsLinked to original sources
PubMed2006

An intra-articular knee cyst in a 2-year-old associated with an aberrant anterior cruciate ligament.

Intra-articular ganglia of the knee occur infrequently, with an overall incidence estimated to be from 0.2 to 1.9%. To date, the youngest patient reported with an intra-articular ganglion was an adolescent. In this paper, we describe a 2-year-old patient with a massive intra-articular knee cyst and an aberrant anterior cruciate ligament (ACL) origin. The cyst was successfully treated with arthroscopic debridement. Proposed pathology and treatment recommendations for intra-articular cysts are reviewed.

Anterior Cruciate Ligament↗
PubMed2006

All-inside meniscal repair using a new flexible, tensionable device.

BACKGROUND: A new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking. HYPOTHESIS: The RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Retrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years' follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 arthrometry readings. Patients with symptoms consistent with meniscal repair failure underwent magnetic resonance arthrography and repeat arthroscopy. RESULTS: Twenty patients with 21 meniscal tears were excluded, resulting in 54 meniscal tears in 46 patients. At a mean follow-up of 34.8 months, the clinical success rate for meniscal repair was 90.7% (49/54), with 5 failures requiring meniscectomy. Univariate analysis revealed predictive variables for failure: bucket-handle configuration, multiplanar tears, tear length greater than 2 cm, and chronicity longer than 3 months. Non-predictive variables included compartment, zone, ligament graft choice, gender, age, follow-up, and visual analog scale score. Analysis of healed patients revealed a negative correlation between chronicity of tear and International Knee Documentation Committee score. CONCLUSIONS: The RapidLoc has an acceptable intermediate-term clinical healing rate in patients undergoing concurrent anterior cruciate ligament reconstruction. Predictive variables for failure should be considered during operative decision making.

Adolescent↗
PubMed2006

The meniscal ossicle revisited: etiology and an arthroscopic technique for treatment.

We describe a new arthroscopic technique for repair of meniscal ossicles in support of the theory that meniscal ossicles are traumatic in nature. Using a standard inferolateral portal, the arthroscope is passed under the posterior cruciate ligament to permit visualization of the "root" of the medial meniscus with a matching donor lesion on the tibia. A limited debridement should be performed of the donor site as well as the posterior horn of the meniscus if it has healed over with fibrocartilage to allow bone-to-bone healing. A posteromedial working portal is made at an angle amenable to the repair and a 6-mm cannula is placed. A Beath passing pin commonly used for anterior cruciate ligament reconstruction is used to pass suture for the outside-inside-out repair. The pin is passed through the cannula in the posterior medial portal. The root of the medial meniscus and the avulsed ossicle are pierced with the Beath pin and tensioned, after which the pin is drilled into the matching donor site and out through the tibia. Two passes are used to create a mattress suture through the ossicle, and the suture is tied over a bone bridge on the anterolateral tibia.

Adolescent↗
PubMed2005

Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up.

BACKGROUND: An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness. HYPOTHESIS: The Meniscus Arrow is comparable to conventional inside-out suture repair in accomplishing long-term healing of meniscal tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This study is an extended follow-up of an original series of 32 patients with outcomes analysis. All patients underwent meniscal repair with exclusive use of the arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, arthrometry, the International Knee Documentation Committee instrument, and the Knee Disorders Subjective History visual analog scale. Intermediate follow-up at a mean of 2.3 years yielded a success rate of 90.6%. The mean follow-up in the present study has been extended to 6.6 years. RESULTS: The extended follow-up analysis revealed a substantial attrition in the success rate of this series of patients undergoing meniscal repair with the arrow. A 90.6% success rate at a mean follow-up of 2.3 years deteriorated to 71.4% at 6.6 years. CONCLUSION: This study provides the longest follow-up in the literature of any of the all-inside meniscal repair implants. The Meniscus Arrow demonstrated long-term meniscal healing rates inferior to those found in the literature for inside-out suture repair techniques.

Anterior Cruciate Ligament↗
PubMed2005

An adenosine A2A receptor agonist reduces interleukin-8 expression and glycosaminoglycan loss following septic arthrosis.

The purpose of this study was to determine whether an adenosine A(2A) receptor agonist (ATL146e) might augment the current treatment regimen of antibiotics plus irrigation and debridement to prevent the arthritic effects associated with joint sepsis. Staphylococcus aureus bacteria were injected into knees of rabbits, which were divided into 4 treatment groups (12 rabbits per group): no treatment, ATL146e only, antibiotics only, or antibiotics plus ATL146e. Analysis at days 1, 3, and 7 consisted of gross joint appearance, synovial fluid, serum, histologic, immunohistochemical, and biochemical analysis. Synovial fluid cultures at day 7 were negative in all antibiotic and antibiotic plus ATL146e treated knees indicating clearance of bacteria. Average WBC counts from synovial fluid aspirates significantly decreased with treatment of antibiotics alone and antibiotics plus ATL146e. Treatment with antibiotics plus ATL146e significantly decreased the Interleukin-8 content when compared to other treatment groups (p<0.001) indicating inflammatory response suppression. Histologic grading resulted in notably improved scores in the antibiotics plus ATL146e group compared to other treatment groups (p < or =0.001). Glycosaminoglycan assay values were significantly greater in the ATL146e plus antibiotics group compared to the untreated control group (p<0.04) indicating chondroprotection. The results of this study indicate that administration of an adenosine A(2A) agonist in combination with antibiotic therapy diminishes joint WBC chemotaxis and reduces joint inflammation, while not compromising the clearance of intraarticular bacteria in a rabbit model. Early bacterial clearance with modulation of the inflammatory response appears to prevent the early degradative effects of joint sepsis.

Adenosine A2 Receptor Agonists↗
PubMed2005

Traumatic articular-bursal fistula in a collegiate football player.

A collegiate football player suffered a direct blow to the distal quadriceps mechanism, resulting in a partial tear of the vastus medialis obliquus. Over time, he began to develop activity-related swelling of his prepatellar bursa. By 6 weeks after his injury, an area of swelling the size of a golf ball would rapidly develop with just 5 minutes of quadriceps exercises. Swelling would diminish within a few hours of rest. A magnetic resonance imaging examination suggested a fistula track from the articular space through the vastus medialis obliquus into the prepatellar bursal area. When prolonged rest did not improve his symptoms, he was taken to surgery. Arthroscopic visualization confirmed a traumatic fistula between the articular space and the prepatellar bursa, allowing free egress of fluid. A spinal needle was used to localize the fistula tract to allow this to be identified for an open, layered suture closure. An area of traumatic chondrosis on the medial side of the patella with loose chondral flaps was also debrided as the probable "fluid generator." The patient enjoyed a full recovery and was back to playing college football 10 weeks after surgery.

Adult↗
PubMed2004

Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks.

Although it is still unclear what the ideal angle of the tibial tunnel in the coronal plane should be when performing anterior cruciate ligament (ACL) reconstruction using the endoscopic single-incision technique, researchers have recently shown that erroneous placement of the tibial tunnel in the coronal plane can lead to graft laxity and loss of extension. We have developed a simple, reproducible technique to provide an acceptable angle of the tibial tunnel in the coronal plane when using the endoscopic single-incision ACL reconstruction technique by using bony landmarks. With the ACL guide parallel to the femur, the external portion of the tibial tunnel guide is rotated so that the guidewire starting point is made at the bisection of a line between the tibial tubercle and the posteromedial border of the tibia. We have confirmed this technique in cadaver studies with angles of the tibial tunnel less than 75 degrees in the coronal plane in all cases. In addition, we have used this technique with good clinical results in over 100 ACL reconstructions.

Anterior Cruciate Ligament↗
PubMed2004

Arthroscopic repair of a posterior humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion.

Recently, the humeral avulsion of the inferior glenohumeral ligament (HAGL) has been described as a cause of shoulder instability. All documented cases in the literature describe the avulsion as an anterior and lateral disruption leading to anterior instability. We detail a previously unreported case of a HAGL lesion involving the posterior band of the inferior glenohumeral ligament. Arthroscopic reattachment using an additional posteroinferior portal resulted in a successful repair.

Adolescent↗
PubMed2004

Split-line pattern and histologic analysis of a human osteochondral plug graft.

The split-line pattern of collagen fibers in articular cartilage is oriented according to weight-bearing stresses. The importance of aligning the split-line pattern of articular cartilage in human osteochondral plug grafts relative to the surrounding cartilage has been proposed but not evaluated clinically. The purpose of this case report is to compare the articular split-line pattern with the histologic analysis of a specimen obtained from a patient who underwent an osteochondral plug transfer procedure with subsequent conversion to joint arthroplasty. The fresh osteochondral section obtained at total knee arthroplasty, including the area treated 18 months earlier with an osteochondral plug transfer, was fixed in formalin. Split-lines were demonstrated on the surface using a needle dipped in India ink. After decalcification and paraffin embedding, the specimen was sectioned and stained with Safranin O and fast green for histologic analysis. The split-line pattern of the anterior portion of the graft was oriented parallel to the resident cartilage; however, collagen orientation was divergent (approximately 30 degrees oblique) to the surrounding cartilage near the posterior portion of the graft. It was at this margin that further resident articular degeneration was noted despite the plug articular surface remaining relatively intact. Although bony incorporation of the plug occurred, there was a residual chondral cleft at the graft-host interface. Our report suggests that an osteochondral plug transfer can survive despite a slightly divergent collagen split-line pattern of plug relative to the resident articular bed. Perhaps more important to the clinical outcome is the selection of true focal, traumatic lesions rather than lesions degenerative in etiology, no matter how focal they appear.

Aged↗
PubMed2004

Reducing joint destruction due to septic arthrosis using an adenosine2A receptor agonist.

We assessed the efficacy of a new adenosine A2A agonist ATL146e, a potent inhibitor of white blood cell chemotaxis, to reduce cartilage damage in the treatment of septic arthrosis. A live septic arthrosis model was created using Staphylococcus aureus in rabbit knees. Animals were divided into five treatment groups: (1) untreated infected control, (2) antibiotics control, and antibiotics plus ATL146e for (3) 24, (4) 48, or (5) 72 h and assessed at 1, 4, and 7 days. Knees in all ATL146e treated animals exhibited no detectable effusion, and histologic examination revealed near normal cartilage and diminished synovial inflammatory response. Synovial WBC counts decreased with the addition of ATL146e when compared to infected and antibiotic controls. Histologic grading of osteochondral specimens demonstrated improved scores for animals treated with ATL146e compared to infected (p<0.00004) and antibiotics controls (p<0.05). Analysis of glycosaminoglycan content revealed significantly decreased loss of articular cartilage following infection in the ATL146e groups when compared to infected (p<0.03) and antibiotics controls (p<0.05). Addition of an adenosine A2A agonist to antibiotic therapy decreases joint inflammation and articular cartilage destruction without compromising bacterial clearance in rabbit knees following intraarticular bacterial infection. The use of adenosine agonists selective to the A2A receptor to augment conventional treatment of joint sepsis may be chondroprotective and ultimately help prevent arthrosis.

Adenosine A2 Receptor Antagonists↗
PubMed2003

The use of absorbable co-polymer pads with alginate and cells for articular cartilage repair in rabbits.

PURPOSE: To determine the effect of polyglycolic acid (PGA)-polylactic acid (PLA) co-polymer pads with calcium alginate on chondrogenic gene expression for chondrocytes cultured in vitro. We also evaluated the ability of these absorbable pads with alginate to deliver chondrocytes and influence osteochondral defect repair in vivo in immature rabbit knees. METHODS: Rabbit rib chondrocytes were suspended in calcium alginate and co-polymer pads composed of either 47.5/52.5 PGA-PLA or 90/10 PGA-PLA at two different cell concentrations and cultured in vitro for 1, 3, and 5 days. Analysis was performed using RT-PCR for chondrogenic gene expression of aggrecan, type II collagen, and type I collagen. Cells labeled with a traceable green fluorescent protein (GFP) marker in vitro were suspended within the pads to analyze for dispersion and attachment to the pad. An in vivo study was performed in which full-thickness (3x4mm(2)) osteochondral defects were made in 60 rabbit knees. The study comprised four treatment groups based on the type of implant into the defect (empty, alginate alone, or either type of co-polymer pad) and harvested at either 6 or 12 weeks. Two independent blinded observers analyzed and scored the defects grossly and histologically. RESULTS: In vitro analysis of the chondrocytes after 1, 3, and 5 days in culture showed no statistical differences between the types of PGA/PLA co-polymer pad with regard to expression of aggrecan, type II collagen, or type I collagen. However, although statistically insignificant, the expression of aggrecan and type II collagen was found to be greater than that for type I collagen in both types of pads, confirming the chondrogenic effect of suspension culture for this system. The addition of alginate to polymer pads allowed costal chondrocytes to be implanted in vivo, as evidenced by the attachment of the cells to the fibers and the uniform dispersion of the GFP-labeled cells through the pad as seen on fluorescent microscopy. Histologic results showed improved scores for the 47.5/52.5 PGA-PLA group (21.3) and the 90/10 PGA-PLA group (18.3) when compared to empty (15.3) or alginate alone (15.1) defects at 12 weeks. CONCLUSION: The addition of calcium alginate to the co-polymer pads offers a new approach to deliver cells to an osteochondral defect and may enhance cartilage regeneration. Future application of this model may allow for an arthroscopic delivery system to assist the healing of cartilage defects.

Absorbable Implants↗
PubMed2003

Chondrocyte transplantation into articular cartilage defects with use of calcium alginate: the fate of the cells.

BACKGROUND: The fate of transplanted chondrocytes used to elicit the repair of osteochondral defects is unknown. The objective of this study was to examine the fate and the expression of cartilage-specific genes in chondrocytes when the chondrocyte phenotype was maintained preoperatively by alginate suspension culture, the cells were labeled with enhanced green fluorescent protein, and the chondrocytes in alginate were then implanted into full-thickness osteochondral defects in rabbits. METHODS: To determine the effect of alginate on rabbit chondrocytes in vitro, cells were grown in monolayer or in alginate suspension culture, and gene expression for aggrecan, type-I collagen, and type-II collagen was analyzed by reverse transcription-polymerase chain reaction. Cells were genetically labeled with the gene for enhanced green fluorescent protein, and the effect of transfer of the gene for enhanced green fluorescent protein on chondrocyte phenotype was assessed in vitro. Chondrocytes labeled with enhanced green fluorescent protein that were embedded in alginate were implanted into osteochondral defects in rabbit knees, either immediately after creation of the defects or after the cells had been preconditioned in alginate suspension culture for two weeks. The repair tissue within the osteochondral defects was assessed at one to four weeks. Cells labeled with enhanced green fluorescent protein were quantified by confocal microscopy, and the repair tissue was examined histologically with safranin O. RESULTS: Gene expression by chondrocytes demonstrated a selective upregulation of cartilage-specific genes in alginate suspension culture. This effect was less pronounced in cells that were transduced with enhanced green fluorescent protein. Chondrocytes transplanted in vivo were detected in the repair tissue for the entire period of observation with diminishing cell density over time. At one week, the cell density of the transplanted chondrocytes was 100% of the initial density; at two and three weeks, the cell density was 70%; and, after four weeks, the cell density had decreased to 15%. Safranin-O staining of histological sections indicated cartilage-specific matrix production in vitro and in vivo. Integration of transplanted cells into the host repair tissue was not observed. The two-week period of preconditioning in alginate suspension culture had no apparent influence on the temporal fate of the cells or the histological appearance of the repair tissue. CONCLUSIONS AND CLINICAL RELEVANCE: Alginate promotes expression of cartilage-specific genes and allows delivery of chondrocytes into osteochondral defects. Transgenic chondrocytes labeled with enhanced green fluorescent protein are detectable in the defect, but they do not appear to form repair tissue and they decrease in number with time. In view of the clinical application of cell-based cartilage repair, understanding the fate of transplanted cells becomes increasingly relevant. Transgenic chondrocytes are an effective tool to study the role of transplanted chondrocytes in articular cartilage repair.

Alginates↗
PubMed2003

Osteochondral autograft plug transfer: achieving perpendicularity.

Although osteochondral autograft plug transfer is a common clinical procedure, few authors have addressed the outcomes or how variations and surgical technique can influence results. Variations in arthroscopic versus open harvesting techniques, as well as intercondylar notch versus lateral trochlear ridge harvest locations, influence the ability to obtain the most perpendicular osteochondral grafts. Eight fresh-frozen cadaveric knees were studied. Four plugs were harvested from each knee, two from the superior lateral intercondylar notch area and two from the superior lateral trochlear ridge area. Plugs harvested from the lateral trochlear ridge (86.9 degrees) were statistically more perpendicular than the plugs harvested from the intercondylar notch (83.3 degrees) (P=.02). No statistically significant difference was noted between the open (86.4 degrees) and arthroscopic (83.8 degrees) harvesting techniques (P=.11).

Aged↗
PubMed2003

Meniscal repair with the Rapid Loc device: a cadaveric study.

The devices available for all-inside meniscal repair were evaluated using a cadaver model. Rapid Loc devices (Mitek, Westwood, Mass) were inserted arthroscopically into 8 fresh-frozen cadaveric knees (age range: 66-78 years) in the posterior regions of the menisci at 5- to 7-mm intervals. Forty-eight devices were placed (3 in each meniscus), and the knees were subsequently dissected to determine the location of the inserted devices. Devices were correctly inserted in 40 (833%) of 48 knees. No problems were noted with loss of fixation on the periphery of the meniscus. Entrapment of the popliteus tendon (3 of 8) and superficial medial collateral ligament (2 of 16) were the only major problems with the device.

Aged↗
PubMed2002

Transforming growth factor-beta in calcium alginate beads for the treatment of articular cartilage defects in the rabbit.

PURPOSE: Articular cartilage has only limited capability for intrinsic repair. The use of growth factors has been suggested to improve the repair of cartilage after injury. Reliable delivery systems for these agents are needed. In this study we tested calcium alginate for the delivery of TGF-beta in the treatment of osteochondral defects in the rabbit knee. TYPE OF STUDY: Randomized trial animal study and basic science study. METHODS: In vitro, to establish the kinetics of TGF-beta release from the alginate, 125I- labeled TGF-beta was suspended in 1.2% sodium alginate at concentrations of 1 microg/mL and 10 microg/mL. Beads were formed from 50 microL aliquots and placed into standard culture medium by immersion in calcium chloride solution and incubated at 37 degrees C. A gamma counter was used to measure the amount of TGF-beta that was released into the medium at various time points. In vivo, osteochondral defects were created in the trochlear grooves of 32 New Zealand White rabbits. Defects were treated with plain alginate or with alginate containing TGF-beta at 20 ng/mL or 2,000 ng/mL. Untreated defects served as a control. Animals were killed after 6 and 12 weeks. Knee joints were evaluated grossly with a 12-point grading scale. Histologic sections of the repair tissue were stained with Safranin O and evaluated using a 24-point grading scale by 2 independent blinded observers. Mean scores and standard deviations were calculated. P values were determined using the Student t test. RESULTS: The TGF-beta was released at a surprisingly slow but steady rate. Release rates extrapolated from the gamma counter measurements were 0.25% per hour and 0.33% per hour, for the 1 microg/mL and 10 microg/mL beads, respectively. Gross analysis scores at 6 and 12 weeks resulted in higher scores for both TGF-beta groups without reaching statistical significance. The lower TGF-beta concentration reached the highest scores, whereas the higher concentration (2,000 ng/mL) resulted in increased osteophyte formation. Histologic analysis at 6 weeks resulted in average scores ranging from 14.5 for empty defects and 18.1 for alginate-treated defects, to 20.0 and 20.3 for the 2,000 ng/mL and 20 ng/mL TGF-beta groups, respectively (P <.05). At 12 weeks, histologic scores ranged from 14.9 for empty and 14.5 for alginate to 20.1 and 20.5 for the 2,000 ng/mL and 20 ng/mL TGF-beta groups, respectively (P <.05). These results indicate a significant improvement of the quality of the repair tissue at 6 and 12 weeks with TFG-beta treatment, especially at the lower concentration. CONCLUSIONS: The use of alginate allows the controlled delivery of TGF-beta selectively to the site of injury, potentially avoiding systemic side effects. Furthermore, treatment with TGF-beta appears to improve the repair of articular cartilage defects. Longer-term studies are needed to assess whether the benefits of the TGF-beta treatment can be sustained.

Alginates↗
PubMed2002

Systemically administered mesenchymal stromal cells transduced with insulin-like growth factor-I localize to a fracture site and potentiate healing.

OBJECTIVE: To determine to the ability of systemically administered pluripotential mesenchymal stromal cells to localize to a fracture site and whether transduction with a therapeutic gene, insulin-like growth factor-I (D1-IGF-I), could potentiate healing. DESIGN: Murine model, basic science study. SETTING: Laboratory. SPECIMENS: Closed, transverse, mid-shaft femur fractures were produced in 108 Balb/c mice after intramedullary stabilization. INTERVENTIONS: A cloned, pluripotential, mesenchymal cell line, termed D1, was stably transfected with either the gene beta-galactosidase (D1-BAG) as a histologic marker or with the gene IGF-I (D1-IGF-I) growth factor. Mice received systemic injections of either D1-BAG cells for in vivo localization or D1-IGF-I for therapeutic intervention. A third group received lactated Ringer's solution and served as control. MAIN OUTCOME MEASUREMENTS: Sections obtained from the fracture site and contralateral femurs were examined histologically and by deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) to detect the presence of transplanted cells at 2, 4, and 6 weeks after fracture. Matrix mineralization and callus maturation were evaluated by histology. RESULTS: At all time points, using histologic staining with X-gal and deoxyribonucleic acid-polymerase chain reaction for marker genes, there was a statistically greater number of transplanted cells ( p< 0.001) and significantly higher DNA-PCR for marker genes ( p< 0.001) in the fractured femurs than in the nonfractured femurs. Mice receiving D1-IGF-I cells demonstrated a greater percent of mineralized callus than controls at two weeks (p < 0.05). At 4 and 6 weeks, treated mice demonstrated on average greater mineralized matrix and accelerated progression to an osseous callus as compared with the control group. CONCLUSIONS: Cell-based gene therapy has the potential to deliver higher therapeutic levels of growth factors specifically at the site of cell localization while minimizing wider systemic side effects. This study demonstrates that systemically injected IGF-I transduced, mesenchymal cells are able to return to and repopulate the bone marrow. More importantly, these cells localize preferentially to a fracture site and accelerated fracture healing.

Animals↗
PubMedDate not supplied

Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction.

PURPOSE: To determine the healing rate of meniscal repair using the Meniscus Arrow (Bionx, Blue Bell, PA) in patients undergoing concurrent anterior cruciate ligament (ACL) reconstruction and to evaluate patient outcomes with the International Knee Documentation Committee (IKDC) form and a visual analog scale (VAS). TYPE OF STUDY: Case series with outcomes analysis. METHODS: We retrospectively analyzed 38 consecutive patients with 39 meniscal tears in knees undergoing concurrent endoscopic ACL reconstruction whose menisci were repaired with the Meniscus Arrow system. All meniscal tears were deemed amenable to repair according to length, stability, morphology, and zone of tear. There were 31 medial and 8 lateral meniscal tears, with an average tear length of 2.1 cm. An average of 2.5 arrows were used to repair each tear. All 39 tears were located in the posterior horn of the meniscus or extending into the body of the meniscus from the posterior horn. Follow-up was assessed by clinical examination, the knee disorders subjective history, VAS, and the IKDC evaluation form. Reconstructed ACL laxity was assessed by KT-2000 arthrometry and clinical evaluation. RESULTS: At an average follow-up of 2.3 years (range, 18-39 months), 32 patients have been surveyed to date. The success rate was 90.6% (29 of 32 patients) with 3 patients going on to arthroscopic partial meniscectomy. KT-2000 arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. Clinical criteria for success in the rest of the repaired menisci included (1) the absence of locking, catching, or giving way; (2) no history of recurrent effusions; (3) no joint line tenderness; (4) a negative McMurray test; and (5) no subsequent surgical procedures on the repaired meniscus. Additionally, the VAS showed the ability of these patients to return to a high level of activity, including competitive sports, without symptoms suggestive of a meniscal tear. The IKDC showed normal or nearly normal function of all success knees. CONCLUSIONS: The study shows that a high rate of meniscus healing can be achieved by the all-inside, bioabsorbable Meniscus Arrow system in conjunction with ACL reconstruction. Also, patients have excellent function of their knee and are able to return to a high level of activity. Our healing rates are comparable to those previously reported with the inside-out suture techniques without the need for an additional posterior incision that would increase operative time and risk to neurovascular structures.

Anterior Cruciate Ligament↗