Bancha Chernchujit

Meniscal allograft transplantation is an effective surgical option for patients with irreparable meniscal pathology, including chronic root tears, complex or radial tears, and prior meniscectomy. This Technical Note describes an all‐inside, all‐soft‐tissue, anchor‐free arthroscopic technique for meniscal allograft transplantation designed to maintain a truly minimally invasive approach. Standard anteromedial, anterolateral, and mid‐medial collateral ligament portals are used to prepare the meniscocapsular junction and create tibial tunnels for the anterior and posterior roots. The meniscal allograft is sequentially implanted from posterior to anterior, with meniscus‐to‐meniscus hand‐tied sutures providing secure fixation without the use of anchors. The technique allows precise graft adjustment to accommodate minor size mismatch and minimizes risks associated with anchor displacement or failure. Concomitant procedures such as ligament reconstruction or high tibial osteotomy can be performed simultaneously. This anchor‐free, all‐soft‐tissue technique offers a reproducible, cost‐effective alternative to conventional fixation methods while preserving minimal invasiveness and ensuring strong graft integration by continuous fixation of the allograft to the native meniscocapsular junction, anatomic restoration of both meniscal roots, and robust hand‐tied suture fixation that provides controlled tensioning and uniform graft compression without reliance on anchors.

Successful postoperative recovery among anterior cruciate ligament reconstruction patients constitutes both surgical reconstruction and donor‐site morbidity. This article proposes a reproducible method using a mini‐incision, thus decreasing donor‐site morbidity and postoperative pain and among patients who undergo anterior cruciate ligament reconstruction. This technique does not rely on any integrated quadriceps tendon harvest guide systems while ensuring adequate graft size and length and preserving good quadriceps strength postoperatively. Technique Video: video See video under supplementary data.

Background: Posterior cruciate ligament (PCL) injury is a relatively common musculoskeletal condition. However, there is currently a lack of consensus on decision-making, treatment and postoperative management for such injuries. Objectives: To use the modified Delphi method to reach expert consensus on the management of PCL injury. Methods: A literature search of PubMed, Cochrane Library, Embase, and Web of Science for articles up to 17 October 2024, to support the development of recommendation statements. An Expert Panel of 90 experienced clinicians from orthopedics and sports medicine participated in a two-round Delphi process. Each statement was evaluated in two parts: the first part assessed content appropriateness (score of 7–9 indicating appropriateness and 4–6 indicating possible appropriateness), while the second part assessed agreement (score of 5–9 indicating agreement). Results: The panel members developed 11 statements using the Delphi process, addressing the following topics: (1) clinical decision-making, (2) treatment, and (3) postoperative management about PCL injuries. The final consensus was reached on 11 statements and we eventually translated these statements into a corresponding table of expert recommendations. Conclusion: Consensus was reached on 11 statements regarding three aspects of PCL injury management. These findings provide a foundation for developing evidence-based guidelines that can enhance clinical decision-making, improve treatment strategies, and optimize postoperative care for patients with PCL injuries.

Purpose Vascular injuries are rarely associated with severe knee injuries; nonetheless, it is imperative to efficiently detect this condition and plan for either immediate or definitive treatment at later stages. The diagnosis and management of multiligament knee injuries still present unresolved issues, particularly in the early detection of vascular issues and the sequential stabilisation of ligaments. High-energy trauma is a frequently encountered cause, however, even low-energy trauma in those who are morbidly obese might pose a significant risk. Advancements in detection and management methods have greatly decreased the occurrence of vascular complications and amputation rates over time. MLKIs after transient knee dislocations are frequently misdiagnosed for vascular injuries, underscoring the necessity for improved diagnostic techniques to avoid avoidable amputations. Methods This article is a new conceptual review of vascular injuries associated with MLKIs. It provides a full overview of these conditions and includes a review of the most recent literature. We have included pertinent citations from the literature, together with suggestions derived from the latest studies. This review article had additional evaluation by proficient specialists with commendable outcomes and more than a decade of expertise in surgical techniques. Results This article offers a detailed overview of orthopaedic management, including new definitions and summaries of the causes, evaluation of patients, clinical assessment, identification of vascular injuries, and initial management in patients with vascular impairment following major limb and joint injuries (MLKIs). Conclusion MLKIs (patients with lower limb ischaemia) who have vascular damage necessitate meticulous physical assessment and sophisticated treatments in order to decrease amputation rates. Prompt identification and timely treatment of vascular lesions, namely in the popliteal artery, can substantially reduce the occurrence of amputations. Emerging research suggests that there is a heightened risk in low-energy situations, particularly amongst individuals who are extremely obese. Progress in vascular intervention has led to a reduction in amputation rates, whilst the implementation of new guidelines has enhanced identification. Thorough patient assessment is essential, utilising physical examinations and imaging techniques such as Computed tomography angiography, magnetic resonance angiography (CTA or MRA) to guide treatment decisions. MRA, in particular, is capable of identifying both vascular and knee structural damage. Level of Evidence Level IV, Literature reviews.

Chronic osteomyelitis is still a serious health problem that causes disabling conditions and has an impact on the quality of life. The objective of this study was to determine the clinical efficacy and safety of localized antibiotics delivery via impregnated microporous nanohydroxyapatite (nHA-ATB) beads for chronic osteomyelitis treatment. A total of 62 patients were enrolled in this study. After radical surgical debridement, the bone defect was filled with three types of antibiotics (vancomycin or gentamicin or fosfomycin) impregnated HA beads. The follow-up period was 48 weeks. It was found that the success rate was approximately 98% with a re-infection in only one patient. Quality of life of all patients after treatment improved significantly over time. Systemic exposure to vancomycin and gentamicin after beads implantation was limited and high local antibiotics concentrations were found in wound drainage fluid at 24, 48 and 72 h. Blood biochemistry measurements did not show any nephrotoxic or hepatotoxic effects. 20 adverse events were reported, but 90% of the events were resolved without having to remove the beads and the patients recovered. Satisfactory outcomes were observed in terms of success rate, quality of life and adverse effect. nHA-ATB beads impregnated by vancomycin or gentamicin or fosfomycin could potentially be employed as an alternative product of choice for localized antibiotics delivery in chronic osteomyelitis treatment.