Browsing by Author "Gudeman, Andrew"

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    How to salvage the delivery of a wrong-sided meniscal allograft: A rare case series
    (Elsevier, 2021) Gudeman, Andrew; Murray, Iain; Sherman, Seth L.; Farr, Jack; Orthopaedic Surgery, School of Medicine
    Introduction: Although rare, tissue processing errors have occurred during meniscal transplantation. The anatomic differences between the lateral and medial menisci makes this problematic for surgeons who find themselves with an incorrectly labeled graft. Objective: To describe the management of a wrong-sided meniscal allograft transplant (MAT) and technical pearls when converting a lateral to a medial MAT. Methods: Retrospective case series of two patients with a wrong-sided MAT. Results: Both patients were found to have a properly sized left lateral MAT for a planned right medial MAT and the decision was made to proceed with surgery. Converting the bone tunnel to bone plugs and suturing the body to bone are key technical steps to replicate the biomechanics of the medial meniscus in these circumstances. Acceptable long-term outcomes were seen in the patient with available follow-up data. Conclusion: The decision to proceed with surgery in these circumstances should be made on an individual basis considering graft, patient, and surgeon factors. Knowledge of the technique for converting a wrong-sided meniscal transplant may reduce waste of grafts and prevent patients from being exposed to additional anesthesia.
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    Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up
    (Sage, 2021-01-19) Gudeman, Andrew; Wischmeier, Dillen; Farr, Jack; Orthopaedic Surgery, School of Medicine
    Background: Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments. Hypothesis: We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores. Study design: Case series; Level of evidence, 4. Methods: Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure. Results: The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation. Conclusion: Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.
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    Surgical Management of Concomitant Proximal Tibiofibular Instability and Medial Collateral Ligament Tear: A Case Report
    (Indian Orthopaedic Research Group, 2020-12) Gudeman, Andrew; Siparsky, Patrick; Orthopaedic Surgery, School of Medicine
    Introduction: Proximal tibiofibular instability is a relatively rare cause of lateral-sided knee pain, and it can be difficult to diagnose. However, medial collateral ligament (MCL) tears are much more common and are much easier to diagnose. Concomitant management of these injuries, however, is uncommon and not well described. Case report: We present the case of a 26-year-old female who was struck on the lateral side of the knee by a motor vehicle. She suffered a Grade III MCL tear involving both the superficial and deep bands of the ligament, as well as proximal tibiofibular instability. She failed a course of non-operative management with bracing, and the decision was made to proceed with surgery. The procedure entailed peroneal nerve neurolysis, proximal tibiofibular joint stabilization with Tight Rope™ construct, deep MCL repair, and the superficial MCL reconstruction. Conclusion: A heightened suspicion for proximal tibiofibular instability must be had in patients with trauma to the knee and lateral-sided pain. In this case, concurrent MCL reconstruction and proximal tibiofibular joint stabilization were necessary to return the knee to normal kinematics.