Minimally Invasive Functional Reconstruction of the Knee

Description

The book provides essential surgical techniques to restore knee function, in addition to the anatomical reconstruction. It introduces 44 techniques in separated chapters, which are composized with the same text structure and high-resolution photos.  The authors are good at managing and teaching these techniques. The step-by-step descriptions and illustrations are very helpful for the readers of orthopaedic and sports medicine surgeons. Contents Part I: Knee Basics 1: Arthroscopic Knee Examination The Diagnostic Value of Arthroscopic Knee Examination Procedures of Arthroscopic Knee Examination Patient Position Portal Establishment The Suprapatellar Pouch The Lateral Gutter The Patellofemoral Joint Viewed from the Lateral Side The Medial Synovial Plica and the Medial Gutter Anterior Compartment The Patellofemoral Joint Viewed from the Distal Side The Femoral Notch Medial Compartment Posteromedial Compartment Lateral Compartment The Posterolateral Compartment Comments on Current Procedures References 2: Treatment Strategies of Meniscus Injuries Anatomy of the Menisci Symptoms and Sources of Pain of Meniscus Injury Types, Functions, and Treatment Strategies of Meniscus Injury Longitudinal Vertical Tear of the Meniscus Ramp Lesion of the Meniscus Horizontal Tear of the Meniscus Radial Tear of the Meniscus Root Tear of the Meniscus Flap and Mixed Tear of the Meniscus Discoid Meniscus and Injury Surgical Technique for Meniscus Injuries Resection of the Posterior Horn of the Medial Meniscus Technique Repair of the Bucket-Handle Tear and Ramp Tear of the Medial Meniscus Repair of Root Tear of the Posterior Horn of the Medial Meniscus Lateral Meniscus Plasty and Repair Repair of the Root Tear of the Posterior Horn of the Lateral Meniscus References 3: Arthroscopic Meniscus Repair with Autograft Tendon Fibers Introduction Technique Preparation of Autograft Tendon Fibers Suture Suture Passing Tools Meniscal Lesion Management Suture Techniques Introducing the Guiding Suture Introducing the Autograft Tendon Strips and Fixation Checking the Tendon Suture Combined Injuries Treatment Comments on Current Technique References 4: Outside-In Transfer All-Inside Meniscus Repair Introduction Technique Comments on Current Technique Conclusions References 5: Lateral Meniscus Posterior Root Repair Introduction Technique Side-to-Side Repair Pullout Repair Outcomes References 6: Combined Pullout Repair and Centralization for Medial Meniscus Posterior Root Tear Introduction Surgical Techniques Surgical Indications for MMPRT Trans-Tibial Pullout Repair Technique and Meniscus Centralization Surgical Approach Evaluation of MMPRT Suture of Medial Meniscus Posterior Root Establish the Tibial Tunnel Fixation at the Tibial Side Meniscus Centralization Open Wedge HTO References 7: Arthroscopic Synovectomy Introduction Surgical Indications Rheumatoid Arthritis/Synovitis Sero-Negative Arthritis/Reactive Arthritis Rheumatic Arthritis Gout Arthritis/Synovitis Synovial Chondromatosis Villonodular Synovitis Tuberculous Synovitis Suppurative Arthritis Hemorrhagic Synovitis Traumatic Synovitis Preoperative Preparation Surgical Techniques Patient Position and Portals Debridement in the Anterior, Medial, and Lateral Compartment Debridement in the Posterior Compartments Debridement in the Suprapatellar Pouch and the Medial and Lateral Gutters Postoperative Treatment Complications References 8: Arthroscopic Treatment of Pigmented Villonodular Synovitis of the Knee Principles of Treatment of Villonodular Synovitis Preoperative Preparation Surgical Procedures of Arthroscopic Synovectomy for Diffused PVNS of the Knee Clearing the Anterior Compartment and the Medial and Lateral Joint Space Preliminary Debridement in Posteromedial Compartment Preliminary Debridement of the Posterolateral Compartment Removal of the Posterior Septum Complete Debridement in the Posterior Compartments Debridement of the Posterior Outlet of the Femoral Notch Debridement of the Medial and Lateral Gutter and Suprapatellar Pouch Postoperative Rehabilitation References 9: Hamstring Tendon Harvesting Harvesting the Semitendinosus Tendon Surgical Methods Simultaneous Harvesting of the Semitendinosus Tendon and Gracilis Tendon Surgical Methods References 10: Harvesting the Anterior Half of the Peroneus Longus Tendon Surgical Methods Harvesting the AHPLT Through One Incision Harvesting the AHPLT Through Two Incisions References 11: Preparation of Autogenous Tendon Tendon Braiding Tendon Folding The Folding Method to Make a Four-Stranded Graft The Folding Method to Make a Three-Stranded Graft Measurement of the Graft Pretension of the Graft Calculating the Required Length of the Loop at the Proximal End of the Graft Complex Proximal Marking of the Graft Internal Bracing Reference 12: Graft Length in the Tunnel in Cruciate Ligaments Reconstruction Introduction The Length and Zero-Time Biomechanics of the Graft in the Tunnel The Length of the Graft in the Tunnel and the Tendon–Bone Healing Internal Fixation Method and Length of Tendon Graft in Tunnel Clinical Procedures Regarding the Length of the Graft in Tunnel References Part II: Anterior Cruciate Ligament 13: Principles of Anterior Cruciate Ligament Reconstruction Indications of Operation Symptoms After ACL Injury Treatment Strategies Surgical Indications The Timing of Surgery Preoperative Examination Medical History Physical Examinations Imaging Examinations Instrumental Measurement Functional Evaluation Ultra-Strong ACL Reconstruction The Rationale for Ultra-Strong ACL Reconstruction The Methods and Feasibility of Ultra-Strong ACL Reconstruction References 14: Isometric Single-Bundle Trans-Tibial Anterior Cruciate Ligament Reconstruction Introduction Basic Concepts in Isometric ACL Reconstruction Where to Locate the Femoral Tunnel During Isometric Single-Bundle ACL Reconstruction? Where Is the Over-the-Top Position? Is Clock Face Reference Reliable? What Is the Difference Between the Intercondylar Ridge and the Residence Ridge? Surgical Techniques Graft Preparation Locating the Tibial Tunnel Locating the Femoral Tunnel Creating the Tibial Tunnel Creating the Femoral Tunnel Adjusting the Adjustable Loop Graft Placement and Proximal Fixation Graft Fixation on the Tibial Side Technical Comments References 15: Single-Bundle Isometric ACL Reconstruction with Remnant Preservation Introduction Surgical Technique Graft Preparation Locating the Femoral Tunnel Locating the Tibial Tunnel Creating the Femoral Tunnel Creating the Tibial Tunnel Graft Placement and Proximal Fixation Graft Fixation on the Tibial Side Comments on Current Technique References 16: Anatomical Transtibial Single-Bundle Anterior Cruciate Ligament Reconstruction Basic Concepts How to Locate the Tibial Tunnel During Anatomical Single-Bundle ACL Reconstruction? How to Locate the Femoral Tunnel During Anatomical Single-Bundle ACL Reconstruction? Surgical Techniques of Anatomical Transtibial Single-Bundle Anterior Cruciate Ligament Reconstruction Graft Preparation Locating the Tibial Tunnel Locating the Femoral Tunnel Creating the Tibial Tunnel Creating the Femoral Tunnel Graft Placement and Proximal Fixation Graft Fixation on the Tibial Side Comments on Current Technique References 17: Treatment Strategies of a Partial ACL Injury The Concept of Partial ACL Injury The Diagnosis of Partial ACL Injury The Principle of Treatment of Partial ACL Injury The Strategies of Surgical Treatment of Partial ACL Injury Isolated Anteromedial Bundle Reconstruction of the ACL Arthroscopic Examination Graft Preparation Creating the Tibia Tunnel Creating the Femoral Tunnel Treatment of the Femoral Notch Graft Implantation and Fixation Isolated Posterolateral Bundle Reconstruction of the ACL Arthroscopic Examination Graft Preparation Creating the Tibial Tunnel Creating the Femoral Tunnel Graft Implantation and Fixation References 18: Single-Bundle Anatomical Hardware-Free ACL Reconstruction Surgical Techniques Grafting Harvesting and Preparation Locating the Tibial and the Femoral Tunnels Creating the Tibial Tunnel Creating a Y-Shaped Femoral Tunnel Graft Implantation Proximal Fixation Distal Fixation Discussions References 19: Anterior Cruciate Ligament Reconstruction with Internal Bracing Surgical Technique Internal Tension-Relieving Brace Augmentation and Graft Preparation Graft Passage and Fixation The Rehabilitation Protocol After ACL Reconstruction Comments on Current Technique References 20: Anatomical Double-Bundle Transtibial Anterior Cruciate Ligament Reconstruction Surgical Technique Graft Preparation Locating the Femoral Tunnels Creating the Tibial Tunnels Creating Femoral Tunnels Graft Placement and Proximal Fixation Graft Fixation on the Tibial Side Comments on the Current Technique Basic Concepts Regarding Anatomical Double Bundle ACL Reconstruction The Purpose of Anatomical ACL Reconstruction The Methods of Tunnel Creation The Optimal Number of Strands of the Grafts The Optimal Length of the Grafts in the Tunnel Graft Fixation Methods Femoral Notch Plasty References 21: Double-Bundle Anterior Cruciate Ligament Reconstruction with Remnant Preservation Surgical Procedure Tendon Harvesting and Graft Preparation Ligating the Remnant Femoral Notch Plasty Locating the Femoral and the Tibial Tunnels Creating the Tibial Tunnels Creating the Femoral Tunnels Debridement in the Posterior Compartments of the Knee Pulling the Remnant to the Femoral Tunnel Graft Implantation and Proximal Fixation Graft Fixation on the Tibial Side Technical Considerations Basic Concepts Regarding Remnant Preservation in ACL Reconstruction The Definition of Remnant in ACL Injury The Significance of Remnant Preservation The Disadvantage of Remnant Preservation Surgical Indication and Remnant Preservation Methods References 22: Combined ACL-Mimicking Anterolateral Structure Reconstruction and Single-Bundle Anterior Cruciate Ligament Reconstruction Surgical Techniques Graft Preparation Locating the Femoral Tunnel Creating the Tibial Tunnel for ALS Reconstruction Creating a Common Femoral Tunnel Creating the Tibial Tunnel for ACL Reconstruction Graft Placement Graft Fixation on the Tibial Side Comments on the Current Technique References 23: Combined ACL-Mimicking Anterolateral Structure Reconstruction and Double-Bundle Anterior Cruciate Ligament Reconstruction Surgical Techniques Graft Preparation Locating the Femoral Tunnel Creating Tibial Tunnel for the ALS Creating the Common Femoral Tunnel for the ALS and the PL Bundle of the ACL Creating Two Tibial Tunnels for ACL Bundles Creating Femoral Tunnel for AM Bundle Placement of the Combined Graft Placement of the AM Bundle Graft Graft Fixation on the Tibial Side Comments on the Current Technique References 24: Slope-Reducing High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction Introduction Technique Graft Preparation Arthroscopic Evaluation and Tibial Tunnel Drilling Slope-Reducing High Tibial Osteotomy Graft Passage and Fixation Postoperative Rehabilitation Protocols Comments on the Current Technique References 25: Basic Concepts in Revision Anterior Cruciate Ligament Reconstruction The Causes of Failure After ACL Reconstruction Trauma Surgical Technique Error Overlooking Combined Structural Deficiency Failed Graft–Tunnel Healing Failed Graft Ligamentization Strategies and Indications of Revision Operation Preoperative Planning and Preparation Review of Medical Histories Physical Examination Imaging Examination Selection of Grafts Revision Methods References 26: Three-in-One Procedure for Revision ACL Reconstruction Free Tendon Graft Preparation Locating the Femoral Tunnel Creating the Tibial Tunnel for the ALS Iliotibial Band Preparation Creating the Common Femoral Tunnel Creating the Tibial Tunnel for ACL Reconstruction Graft Placement Graft Fixation on the Tibial Side Postoperative Rehabilitation Discussion References 27: Basic Concepts in the Treatment of Tibial Avulsion Fracture of the Anterior Cruciate Ligament Anatomy Epidemiology Mechanism of Injury Diagnosis Imaging Examination Arthroscopic Examination Classification of ACL Tibial Avulsion Fracture Treatment Strategies for Acute ACL Tibial Avulsion Fracture Treatment Strategies for Malunion of ACL Tibial Avulsion Fracture Treatment Strategies for Nonunion of ACL Tibial Avulsion Fracture Fracture Fixation Methods References 28: Arthroscopic Suture-to-Adjustable Loop Fixation of Adult ACL Tibial Avulsion Fracture Surgical Technique Creating Portals Preparation of the Bone Bed Ligating the ACL and the Bone Fragment Creating Tibial Tunnels Fracture Reduction Fracture Fixation Postoperative Management Comments on the Current Technique References 29: Arthroscopic Epiphyseal Plate-Sparing Fixation of ACL Tibial Avulsion Fracture in Skeletally Immature Patients Surgical Procedures Creating Portals Exposing the Bone Fragment Preparation of the Bone Bed Ligating the ACL and the Bone Fragment Fracture Reduction Fracture Fixation Rehabilitation Comments on the Current Technique References 30: Suture Bridge Fixation for Adolescent ACL Tibial Avulsion Fracture Surgical Technique Preoperative Planning Patient Position and Anesthesia Treatment of Concomitant Injuries Exposing the Avulsed Bone Fragment and the Bone Bed Drilling in the Guide Wires for Anchor Placement Placement of the Posterior Anchor Creating the Tibial Tunnels Passing the Sutures Through the ACL Pulling the Sutures Through the Tibial Tunnels Fixation of the Bone Fragment Postoperative Rehabilitation Core Technology References Part III: Posterior Cruciate Ligament 31: Ultra-strong Posterior Cruciate Ligament Reconstruction Rationale of Ultra-strong Posterior Cruciate Ligament Reconstruction Suitable Graft Type and Volume for Ultra-strong PCL Reconstruction How to Make Use of the Autogenous Tendons to Realize Ultra-strong PCL Reconstruction Double-Bundle PCL Reconstruction Remnant Preservation PCL Reconstruction with Internal Bracing References 32: Single Bundle Posterior Cruciate Ligament Reconstruction Without Remnant Preservation Basic Concept of Single Bundle Posterior Cruciate Ligament Reconstruction Isometric Posterior Cruciate Ligament Reconstruction Anatomical PCL Reconstruction Single Bundle PCL Reconstruction Without Remnant Preservation Surgical Procedures Tendon Harvesting and Preparation Creating Arthroscopic Portals and Performing Debridement Placing Guide Wire to Create the Tibial Tunnel Creating the Femoral Tunnel Creating the Tibial Tunnel Graft Implantation and Fixation Postoperative Rehabilitation Comments on the Current Technique References 33: Single-Bundle Anatomical Posterior Cruciate Ligament Reconstruction with Remnant Preservation Surgical Techniques Tendon Harvesting and Preparation Establishing of Surgical Portals Exposing the Tibial Insertion of the PCL Placing the Guide Wire for the Creation of the Tibial Tunnel Creating the Femoral Tunnel Creating the Tibial Tunnel Placing the Guide Suture Graft Implantation Graft Fixation Comment on the Current Technique References 34: Lower Tibial Tunnel Placement in Transtibial PCL Reconstruction Introduction Surgical Technique Graft Preparation Locating and Creating the Tibial Tunnel Locating and Creating the Femoral Tunnel Graft Placement and Fixation Postoperative Rehabilitation Comments on the Current Technique References 35: Four-Tunnel Double-Bundle Anatomical Posterior Cruciate Ligament Reconstruction Without Remnant Preservation Surgical Technique Preparation of the Grafts Debriding the Femoral Attachment Debriding the Tibial Attachment of the PCL Placing the Guide Wires to Create the Tibial Tunnels Creating the Femoral Tunnels Creating the Tibial Tunnels Placing Guide Suture Loop for Graft Implantation Implantation and Proximal Fixation of the Grafts Distal Fixation of the Grafts Postoperative Treatment and Rehabilitation Comments on the Current Technique References 36: Sandwich-Style Posterior Cruciate Ligament Reconstruction: Four-Tunnel Double-Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation Surgical Technique Graft Preparation Creation of Posteromedial and Posterolateral Portals Exposing PCL Tibial Insertion Site Placing Guide Wires for the Tibial Tunnels Creating Femoral Tunnels Creating the Tibial Tunnels Placing Guide Suture Loop for Graft Implantation Implantation and Proximal Fixation of the Grafts Distal Fixation of the Grafts Postoperative Treatment and Rehabilitation Comments on the Current Technique References Untitled 37: Basic Concepts in the Treatment of Tibial Avulsion Fracture of the Posterior Cruciate Ligament Anatomy Epidemiology Mechanism of Injury Symptoms and Signs Imaging Examination Classification Treatment Principle The Acute PCL Tibial Avulsion Fracture Chronic Injuries Judgment of Fracture Displacement Degree Surgical Choices for PCL Tibial Avulsion Fracture References 38: Arthroscopic Suture to Loop Fixation of PCL Tibial Avulsion Fracture Surgical Procedures Creating Anterolateral and Anteromedial Portals Creating the Posteromedial Portals Debridement of the Bone Bed Creating the Posterolateral Portal Exposing the Bone Ridge Between the Tibial Recess and the Proximal Posterior Tibia Ligating the PCL Creating Tibial Tunnels Out-Pulling of the Fixing Sutures Fixing the Bone Fragment Postoperative Treatment and Rehabilitation Comments on the Current Technique References Part IV: Collateral and Multi Ligaments 39: The Basic Concept in Treatment of Injuries of the Posteromedial Corner of the Knee Functional Anatomy of the Posteromedial Side of the Knee Injury Mechanism Diagnosis Symptoms and Signs Auxiliary Examination Principles of Treatment Treatment of Isolated MCL Injury Treatment of MCL Injury Combined with ACL Injury Treatment of the PMC Injury Surgical Techniques References 40: Structural Augmentation of the Posteromedial Corner of the Knee Introduction Indications of Operation PMC Augmentation Anatomic PMC Augmentation of Knee Graft Preparation Creating the Femoral Tunnels Creating the Femoral Tunnels Tendon Implantation and Fixation Reverse V-Shaped Augmentation of Knee PMC Tendon Preparation Creating Femoral Tunnel Creating Tibial Tunnel Tendon Implantation and Fixation Span Augmentation of Knee PMC Tendon Preparation Tunnel Creation Graft Implantation and Fixation Postoperative Rehabilitation References 41: Basic Concept in the Treatment of Knee Posterolateral Corner Injury Applied Anatomy of the Posterolateral Corner of the Knee Biomechanics of the Posterolateral Knee Evaluation of Posterolateral Knee Instability Classification of Posterolateral Knee Instability Treatment Principle of Acute PLC Injury Femoral Attachment Avulsion Avulsion of the Fibular Head Attachment Avulsion Fracture of the Fibular Head or the Styloid Process of the Fibular Head Ligament Ruptures Avulsion Fracture of the Lateral Edge of the Tibial Plateau Treatment Principle of Chronic PLC Injury Surgical Methods for Chronic PLC Injury Posterolateral Functional Tissue Adjustment Posterolateral Augmentation Posterolateral Reconstruction References 42: Knee Posterolateral Corner Reconstruction with a Single Tendon Surgical Techniques Graft Preparation Surgical Approaches Creating Bone Tunnels Tendon Implantation and Fixation Comments on the Current Technique References 43: Arthroscopic Popliteal Tendon Reconstruction for Type A PLC Injury Introduction Methods Pre- and Postoperative Assessments Surgical Technique Graft Preparation Femoral Tunnel Tibial Tunnel Passage of Graft Fixation of Graft Results Conclusions References 44: The Lateral Gutter Drive-Thru Sign and Drive-Thru Test Part I: The “Lateral Gutter Drive-Thru” Sign: An Arthroscopic Indicator of Acute Femoral Avulsion of the Popliteus Tendon in Knee Joints Technique Arthroscopic Evaluation of the Lateral Compartment Arthroscopic Findings of the Lateral Gutter Repair Procedures Discussion Part II: Validity of a Novel Arthroscopic Test to Diagnose Posterolateral Rotational Instability of the Knee Joint: The Lateral Gutter Drive-Through Test Methods Study Design Inclusion and Exclusion Criteria Patient Characteristics Evaluation Methods Results Validity of LGDT Test Discussion Conclusions References 45: Basic Concepts in the Treatment of Knee Dislocation Knee Dislocation/Multiple Ligament Injuries/Multidirectional Instability Anatomical and Histological Changes Related to Knee Dislocation Blood Vessel Injury Nerve Damage Deep Venous Embolism Fracture Knee Extension Device Injury Ligament Injury Internal Environment Disorder Classification of Knee Dislocation Treatment Protocols of Acute Knee Dislocation Evaluation of the General Situation Holistic Assessment, Treating Life-Threatening Injuries First Assessing and Monitoring Blood Supply to Limbs Examination of Knee Dislocation and Nerve Function of Lower Limbs Imaging Examination Trying to Reduce the Knee Knee Stability Examination Principles of Treatment of Acute Knee Dislocation Indications for Emergency Surgery Treatment of Reduced Acute Closed Knee Dislocation Treatment of Non-reduced Acute Closed Knee Dislocation Surgical Reduction in Acute Stage Release and Reduction Under Arthroscopy Indications Surgical Technique Mini-Open Reduction Indications Surgical Techniques Extensive Open Surgery for Reduction Indications Surgical Techniques Ligament Repair and Reconstruction in Acute Stage References 46: Treatment Strategies for Multi Ligament Injuries of the Knee Introduction Etiology and Mechanism of the Injury History and Physical Examination History of Injury Symptoms Physical Signs Preoperative Imaging Diagnosis Treatment Timing of Treatment for Multiple Ligament Injuries of the Knee Joint Repair or Reconstruction of Ligaments Repair of Joint Capsule Rehabilitation References 47: Simultaneous Anterior Cruciate Ligament, Posterior Cruciate Ligament, Posteromedial Corner, and Posterolateral Corner Reconstruction of the Knee Surgical Techniques Graft Harvesting and Preparation Creating Bone Tunnels Graft Placement and Proximal Fixation Distal Fixation of the Grafts Postoperative Management Comments on the Current Technique References Part V: Patellofemoral Joint 48: Basic Concepts in the Diagnosis and Treatment of Patella Instability and Dislocation The Causes of Patella Dislocation Skeletal Abnormalities Abnormal Bone Alignment Soft Tissue Abnormality Diagnosis and Treatment of Primary Patella Dislocation in Acute Stage Clinical Manifestations in Acute Stage Imaging Findings Treatment of Primary Patella Dislocation in Acute Stage Diagnosis and Treatment of Primary Patella Dislocation in Chronic Stage Clinical Manifestations Imaging Examination Physical Examination Treatment of Primary Patella Dislocation in Chronic Stage Diagnosis and Treatment of Recurrent Patella Dislocation Clinical Manifestations Treatment Strategies for Recurrent Patella Dislocation Diagnosis and Treatment of Fixed Patella Dislocation Classifications Etiology Clinical Manifestations Imaging Examinations Treatment Strategies for Fixed Patella Dislocation Surgical Procedures for Patella Dislocations References 49: Wide-Patellar Insertion Medial Patellofemoral Ligament Reconstruction with Internal Bracing Surgical Procedures Tendon Harvesting Debridement of the Knee Lateral Retinaculum Release Creating the Patella Tunnels Tendon Implantation Through the Patella Tunnels Creating the Femoral Tunnel Tendon Connection to a Cortical Fixation Device Tendon Implantation into the Femoral Tunnel Comments on the Current Technique References 50: Polyethylene Suture Augmentation of the Medial Patellofemoral Ligament in Skeletally Immature Patients with Recurrent Patella Dislocation Surgical Procedures Debridement of the Knee Lateral Retinaculum Release and Quadriceps Rebalance Creating the Patellar Tunnels Placing Augmenting Sutures Through the Patellar Tunnels Creating the Femoral Tunnels Placing Sutures Through the Femoral Tunnels Retrieving Sutures Through the Space Resulted from Lateral Retinaculum Release Fixing the Augmentation Sutures Postoperative Rehabilitation Comments on the Current Technique References 51: Arthroscopic Release of the Lateral Retinaculum of the Patella Indications/Contraindications for Lateral Retinaculum Release Preoperative Planning and Preparation Surgical Procedures The Route of the Standard Release of the Lateral Retinaculum The Route of Short Medial Branch Y-Shaped Release of the Lateral Retinaculum Arthroscopic Standard Release of the Lateral Retinaculum of the Patella Postoperative Management and Rehabilitation References 52: Tibial Tubercle Transfer: Indications and Modified Fulkerson Osteotomy Indications for Tibial Tubercle Transfer Indications for Medial Transfer of the Tibial Tubercle Indications of Lateral Tibial Tubercle Transfer Indication for Distal Transfer of the Tibial Tubercle Indications for Proximal Tibial Tubercle Transfer Modified Fulkerson Osteotomy Indications/Contraindications for Modified Fulkerson Osteotomy Preoperative Planning and Preparation Surgical Procedures Comments on the Current Technique References 53: Surgical Treatment of Habitual Patellar Dislocation with Patella Baja: Tibial Tubercle Proximalization Radiological Imaging Surgical Techniques “Step-by-Step” Extensive Lateral Release Tibial Tubercle Proximalization and Medialization Postoperative Rehabilitation Results Conclusion References 54: Derotational Distal Femoral Osteotomy for Recurrent Patellar Dislocation Introduction Indication for DDFO Surgical Technique Comments on Current Techniques References 55: Biplanar Knee Derotation Osteotomy in the Treatment of Patella Instability Basic Concepts of Knee Derotation Osteotomy Surgical Indications and Preoperative Preparation Surgical Technique Reconstruction of the Medial Patellofemoral Ligament Placing the Guide Pins for Rotation and Alignment Control Derotation of the Distal Femur Derotation at the Proximal Tibia Comments on the Current Technique References 56: Rebalance of the Quadriceps Femoris Classification and Diagnosis Preoperative Preparation Surgical Techniques Skin Incision Detachment and Preparation of the Vastus Medialis Lateral Retinaculum Release Detachment and Preparation of the Vastus Lateralis Release the Lateral Parts of the Rectus Femoris and Vastus Intermedius Transfer of the Lateral Quadriceps Structure Transfer of the Vastus Medialis Subsequent Operations Comments on the Current Technique References 57: Arthroscopic Patellofemoral Arthroplasty for Isolated Patellofemoral Osteoarthritis Preoperative Planning Surgical Technique Femoral Trochlea Denervation Patella Denervation Femoral Trochlea Plasty Patella Plasty Removal of the Infrapatellar Pad Lateral Retinaculum Release Comments on the Current Technique References Part VI: Knee Osteoarthritis and Stiffness 58: Arthroscopic Arthroplasty for Knee Osteoarthritis Surgical Procedures Debridement of the Medial and Lateral Compartment of the Knee Releasing the Medial Collateral Ligament Femoral Notch Plasty Debridement in the Posterior Compartments Plasty and Denervation of the Posterior Femoral Condyles Release of Posterior Capsule and Muscles Distal Femur Denervation from the Anterior, Medial, and Lateral Sides Denervation at the Anterior Side of the Proximal Tibia Denervation of Anteromedial Side of the Tibia Patella Plasty and Denervation Comments on the Current Technique References 59: Anterior Proximal-to-Posterior Distal Oblique Proximal Tibial Osteotomy Surgical Procedures Preoperative Planning and Preparation Patient Position Arthroscopic Surgery Placement of Reference K Wires Marking the Osteotomy Line Tibial Osteotomy Tibial Deformity Correction and Fixation Postoperative Management Comments on the Current Technique References 60: Basic Concepts in the Treatment of Knee Stiffness Treatment Strategies for Flexion-Impeding Knee Stiffness Etiology and Pathological Anatomy of Flexion-Impeding Knee Stiffness Principles of Surgical Treatment for Flexion-Impeding Knee Stiffness Contraindications for Surgery for Flexion-Impeding Knee Stiffness Treatment Methods for Flexion-Impeding Knee Stiffness Principles of Surgical Treatment of Extension-Impeding Knee Stiffness Etiology and Pathological Anatomy of Extension-Impeding Knee Stiffness Diagnosis of Extension-Impeding Knee Stiffness Treatment of Extension-Impeding Knee Stiffness References 61: Arthroscopic Release of Severe Flexion- and Extension-Impeding Knee Stiffness with Inaccessible Joint Indications and Contraindications Preoperative Planning Surgical Techniques Creating Working Space in the Infrapatellar Fat Pad Medial Retinaculum Release Lateral Retinaculum Release Detachment of the Lateral Extensor from the Femoral Condyle Detach the Infrapatellar Fat Pad from the Patella Reestablishing the Suprapatellar Pouch Reestablishing the Medial Gutter Reestablishing the Lateral Gutter Quadriceps Plasty in Case of Extensor Contracture Eliminating Anterior Impingement Creating the PM and PL Portals Reestablishing the Posterior Compartments Posterior Capsule Release Postoperative Management Comments on the Current Technique References 62: Zhao Quadriceps Plasty Indications and Contraindications Surgical Technique Incision Step 1: Release of the Vastus Lateralis and the Lateral Retinaculum Step 2: Release of the Distal Quadriceps and Femur and Recreation of the Suprapatellar Pouch Step 3: Release of the Patellofemoral Joint, the Patella Tendon, and the Infrapatellar Fat Pad Step 4: Release of the Medial Retinaculum Step 5: Release of the Adhesion Between the Retinaculum and the Femoral Condyles and Recreation of the Medial and Lateral Gutters Step 6: Distal Dissociation of the Rectus Femoris Tendon Step 7: Proximal Dissociation of the Vastus Intermedius Step 8: Transection of the Anterolateral and Anteromedial Capsule-Ligament Step 9: Overlapping Z-Plasty of the Rectus Femoris and Vastus Intermedius Step 10: Transfer of the Vastus Lateralis Postoperative Management and Rehabilitation Comments on the Current Technique References