Despite advancements in surgical techniques for anterior cruciate ligament reconstruction, some patients still experience rotational instability after surgery. Anterior cruciate ligament and anterolateral ligament reconstruction have been described using hamstring tendon autograft while preserving the insertion of the semitendinosus tendon. This article describes a combined anterior cruciate ligament and anterolateral ligament reconstruction using a hamstring tendon autograft with a suspensory button fixation.

Peroneal intrasheath instability is a painful popping sensation and audible clicking of the lateral ankle. This condition is not commonly reported, and its exact incidence remains unknown. It consists of a transient retromalleolar subluxation of the peroneal tendons, with an abnormal motion of the peroneal tendons relative to each other, with the superior peroneal retinaculum intact. Diagnosis requires high clinical suspicion and dynamic ultrasound is the best imaging study to evaluate peroneal instability when the superior peroneal retinaculum is intact, for diagnosing peroneal intrasheath instability. The goal of the present study is to describe how to reach the diagnosis and to describe and evaluate the surgical technique for the treatment of this pathology. In the present report, we describe three cases of this pathology that received successful surgical treatment with peroneal groove-deepening procedure and retinaculoplasty of the superior retinaculum. This surgical technique provides good outcomes when conservative treatment fails.

Case: A 49-year-old patient with an indolent history of ankle pain and edema presented to the orthopaedic clinic with a documented anterior tibial tendon rupture with a gap of 6 cm. The patient underwent anterior tibial tendon reconstruction with a hamstring autograft and extensor retinaculum preservation. Conclusion: The use of a hamstring autograft in tibialis anterior reconstruction yields positive clinical outcomes. This surgical approach effectively restored the postoperative ankle range of motion and enhanced tendon strength in both inversion and dorsiflexion.

Humeral shaft fractures are common, but proximal metadiaphyseal fractures are unusual and represent challenging injuries.Their treatment is still controversial and debatable.Lateral minimally invasive osteosynthesis (MIPO) represents an alternative treatment for those fractures, but there is still a lack of studies describing this technique.We retrospectively reviewed six patients with proximal metadiaphyseal humeral fractures treated with lateral MIPO.All the patients reached consolidation.We had one case of postoperative radial neuropraxia that entirely resolved with time, and there was no other complication.We reviewed and summarized the available literature, and our outcomes were similar to those described.The mean shoulder ROM was 143º ± 12,4º of abduction; 145º ± 9,1º of forward elevation; 33,8º ± 4,8º of external rotation; most patients reached L1 level with internal rotation, with no statistically significant difference between the affected and non-affected arm.The mean Constant score was 88 ± 5,4; the mean Q-DASH score was 8 ± 1,3; and the mean UCLA score was 28,8 ± 2,6º.The lateral MIPO approach permits a good shoulder function and a high union rate.Radial neuropraxia is the most common complication described in the literature and usually entirely resolves with time.Orthopaedic and trauma surgeons dedicated to shoulder injuries should know different approaches and fixation methods.MIPO should also be in their arsenal, with the lateral approach advantageous in proximal metadyaphiseal fractures and a reproductive technique.

BackgroundNeglected knee dislocations and knee septic arthritis are two uncommon pathologies that require prompt treatment.Case ReportWe report a case of a bedridden 77-year-old women that presented at the emergency room with a septic arthritis in a chronically dislocated knee. The treatment chosen was a knee arthrodesis in order to solve both conditions in the same surgery. After 1 year follow-up, there were no signs of infection or reported knee pain.ConclusionWe conclude that knee arthrodesis is a viable option as salvage procedure in complex cases of knee infection and/or chronically dislocated knees in low demand patients.

Resumo A instabilidade intrabainha fibular provoca dor com estalo e clique audível na lateral do tornozelo. Esta doença é pouco relatada e sua incidência exata é desconhecida. Consiste em uma subluxação retromaleolar transitória dos tendões fibulares com movimento anormal dos tendões fibulares entre si e integridade do retináculo fibular superior. O diagnóstico requer alta suspeita clínica e a ultrassonografia dinâmica é o melhor estudo de imagem para avaliação da instabilidade fibular quando o retináculo fibular superior está intacto para detecção de instabilidade intrabainha fibular. O objetivo do presente estudo é descrever como chegar ao diagnóstico e relatar e avaliar a técnica cirúrgica para o tratamento desta doença. Neste relato, descrevemos três casos da doença que foram submetidos ao tratamento cirúrgico com sucesso com procedimento de aprofundamento do sulco fibular e retinuloplastia do retináculo superior. Esta técnica cirúrgica proporciona bons resultados em caso de falha do tratamento conservador.

Septic arthritis of the ankle after arthroscopy represents a rare but serious condition. Specifically, to the best of our knowledge, there have been no reports for septic arthritis of the ankle caused by Citrobacter Koseri. A 42-year-old man, otherwise healthy, presented to our consultation with ankle pain and the MRI revealed compatible with intra-articular body’s compatible with osteochondromatosis. The patient underwent anterior and posterior ankle arthroscopy and four weeks after surgery, he presented to our consultation with wound dehiscence of the previously healed anterolateral portal. Following the diagnostic work-up, he was submitted to arthroscopic irrigation and debridement. Citrobacter Koseri was isolated. After surgical intervention and antibiotic administration, the patient’s symptoms gradually improved. Six months later, the patient had no ankle pain or restriction of ankle motion. Clinical symptoms of septic arthritis after ankle arthroscopy can be very mild and for that reason a low threshold for its diagnosis is necessary.

Introduction: Traumatic dislocation of the posterior tibial tendon (PTT) is portrayed as a rare and challenging to diagnose lesion, even more so in association with flexor digitorum longus tendon (FDL) dislocation. This article aims to bring awareness to this condition and present a reasonable and reproducible surgical solution.Case report: A 19-year-old male was admitted after a car accident. An isolated posterior malleolus fracture was identified among other lesions, and surgery was proposed. A cord-like structure over the medial malleolus was identified during surgery, and a PTT and FDL dislocation was diagnosed. The flexor retinaculum was avulsed and was re-inserted with suture anchors, and the tendons remained stable without any additional gesture. At follow-up, good results were obtained.Discussion: PTT dislocations probably occur more frequently than thought, but the association with flexor digitorum longus tendon dislocation seems even rarer. This entity should be known by the common trauma professional since it can be mistaken for an ankle sprain or not noticed in a polytrauma patient. This case brings awareness to vital signs to not miss the diagnosis and a reliable, easy, and reproducible surgical option.