Papers by Theofilos Dimitriadis
Arthroscopy Techniques, 2024
Meniscal root tear is an increasingly recognized pathology with well-studied consequences in knee... more Meniscal root tear is an increasingly recognized pathology with well-studied consequences in knee biomechanics. Meniscal root fixation can restore normal knee biomechanics, and this seems to be the optimal treatment. Several repair techniques have been proposed and studied so far to determine efficacy and simplicity. In this technical note, we describe a durable, reproducible, and easy-to-perform transtibial pull-out technique, using a single suture tape and a simple configuration to accomplish the repair.
Annals of Royal College of Surgeons of England, 2024
Patellar comminuted fracture represents a challenging procedure with several proposed fixation te... more Patellar comminuted fracture represents a challenging procedure with several proposed fixation techniques, including tension banding, cerclage wiring, low-profile plates and headless screws [1–3].
Sultan Qaboos University medical journal, Mar 21, 2024
Surgical and radiologic anatomy, Mar 9, 2024
Purpose: The present study aims to report the arthroscopic, radiological and clinical appearance ... more Purpose: The present study aims to report the arthroscopic, radiological and clinical appearance of a rare anatomical varia- tion of a hypertrophied medial parapatellar plica with its response to arthroscopic treatment. Case presentation: A 14-year-old female handball athlete presented with a history of left knee injury during her participa- tion in a handball training session and subsequent locked knee at 20o flexion. Tenderness was located at the medial joint line. Plain radiographs of the injured knee were normal. The magnetic resonance imaging revealed a hypertrophic medial parapatellar plica and a horizontal tear of the medial meniscus. A standard knee arthroscopy was performed. An extremely hypertrophied medial plica was identified, covering a great part of the medial femoral condyle extending up to the femoral trochlea. Distally, it was attached into the inter-meniscal ligament. The plica was excised and the medial meniscus tear was repaired. At 1-month post-operatively, the patient was completely asymptomatic and at 3-months she returned to her weekly training routine. Conclusions: This study presented a rare anatomical variation of a hypertrophied medial parapatellar plica with atypical course in the medial patellofemoral compartment and insertion into the inter-meniscal ligament. In combination with a medial meniscus tear led to a locked knee. Arthroscopic medial meniscus repair and plica excision resulted in complete resolution of symptoms.
Journal of ISAKOS, 2024
We report a case of a 12 years old boy that underwent Anterior Cruciate Ligament (ACL) reconstruc... more We report a case of a 12 years old boy that underwent Anterior Cruciate Ligament (ACL) reconstruction and lateral meniscus repair. The all-epiphyseal, all-inside technique, with quadriceps tendon autograft and adjustable suspensory button fixation was utilized due to the open physes. Intraoperative fluoroscopy confirmed optimal position of the buttons, while arthroscopic evaluation of the graft showed proper tension, with full range of motion and knee stability. Nevertheless, routine radiographic evaluation of the knee, six hours postoperatively, revealed tibial button migration through the tunnel into the knee joint, while the knee was unstable in clinical examination. The graft was removed and reloaded with extended buttons. The femoral socket was retained in the revision surgery while a new tibial socket was drilled with the transphyseal technique (all-inside technique). The postoperative course was uneventful. The patient returned to unrestricted activities at twelve months after revision surgery and remains fully active two years postoperatively.
This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
Journal of Research and Practice on the Musculoskeletal System, 2018
Material and Methods We retrospectively reviewed the data of files of 1972 patients with ACL rupt... more Material and Methods We retrospectively reviewed the data of files of 1972 patients with ACL rupture, which were treated with ACL reconstruction in our Department over the last 27 years. ACL reconstruction complications were divided in two main categories: intraoperative complications and postoperative complications. All complications occurred during the operation and up to 2 (two) years postoperatively were recorded and included in this study. The term "preoperative complications" has been used by other authors 2 in ACL reconstruction, but in our opinion is not accurate. Preoperative planning is very important in the final outcome of ACL reconstruction, but wrong decisions are not complications. As a result, preoperative planning is not discussed in this article. In our perspective, graft failure is a bad clinical outcome and not a complication. Consequently, graft failure will not be reported as a complication in this study.
JBJS Case Connector, 2020
Case: Isolated popliteus tendon avulsion is an extremely rare injury with no consensus in the lit... more Case: Isolated popliteus tendon avulsion is an extremely rare injury with no consensus in the literature, regarding the therapeutic approach. In our case, the patient presented with rotational instability of the knee, and he was treated surgically. A fully arthroscopic technique with suture anchors was used, and this is the first report of such a repair in the literature. Knee stability was successfully restored, and the patient remains asymptomatic 2 years postoperatively. Conclusion: Isolated popliteus tendon avulsion can result in knee instability. Arthroscopic repair with suture anchors is an efficient way of treatment.
Sultan Qaboos University Medical Journal,, 2024
Anterior cruciate ligament reconstruction with quadriceps tendon autograft has gained popularity ... more Anterior cruciate ligament reconstruction with quadriceps tendon autograft has gained popularity in recent years, while many harvesting techniques were described with the use of different harvesting systems available on the market. There are multiple techniques varying from transverse to longitudinal skin incision, from open to minimally invasive approach. Despite the preferred technique, it seems that there is a reported learning curve as with the majority of surgical procedures. The present technical note makes an effort to present a straightforward harvesting method of quadriceps tendon autograft with the use of a simple vaginal speculum and direct visualization with the scope. Our technique is minimally invasive, easily reproducible from every surgeon despite the level of experience, with short learning curve, requiring no additional cost or technical support during the procedure, while creating a stable working space with freedom of manipulation of the surgical instruments and arthroscope.
Surgical and Radiologic Anatomy, 2024
Purpose: The present study aims to report the arthroscopic, radiological and clinical appearance ... more Purpose: The present study aims to report the arthroscopic, radiological and clinical appearance of a rare anatomical varia- tion of a hypertrophied medial parapatellar plica with its response to arthroscopic treatment.
Case presentation: A 14-year-old female handball athlete presented with a history of left knee injury during her participa- tion in a handball training session and subsequent locked knee at 20o flexion. Tenderness was located at the medial joint line. Plain radiographs of the injured knee were normal. The magnetic resonance imaging revealed a hypertrophic medial parapatellar plica and a horizontal tear of the medial meniscus. A standard knee arthroscopy was performed. An extremely hypertrophied medial plica was identified, covering a great part of the medial femoral condyle extending up to the femoral trochlea. Distally, it was attached into the inter-meniscal ligament. The plica was excised and the medial meniscus tear was repaired. At 1-month post-operatively, the patient was completely asymptomatic and at 3-months she returned to her weekly training routine.
Conclusions: This study presented a rare anatomical variation of a hypertrophied medial parapatellar plica with atypical course in the medial patellofemoral compartment and insertion into the inter-meniscal ligament. In combination with a medial meniscus tear led to a locked knee. Arthroscopic medial meniscus repair and plica excision resulted in complete resolution of symptoms.
Journal of Arthroscopic Surgery and Sports Medicine
Quadriceps tendon (QT) graft utilization for anterior cruciate ligament reconstruction has gained... more Quadriceps tendon (QT) graft utilization for anterior cruciate ligament reconstruction has gained popularity among surgeons lately, due to the favorable biomechanical characteristics and clinical results. The growing interest in this graft has resulted in the development of minimal invasive harvesting techniques. Nevertheless, QT graft harvesting is considered a technically demanding procedure with a steep learning curve. This technical note describes the endoscopic approach of QT graft harvesting and aims in helping the surgeon to safely harvest the graft and to minimize the complication rate.
Arthroscopy Techniques, 2022
Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction has been we... more Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction has been well studied and recognized as the cause of unsatisfactory clinical results. Various anterolateral techniques have been described as an adjunct to the ACL reconstruction to improve clinical outcomes. Modified deep Lemaire lateral extra-articular tenodesis has been tested both biomechanically and clinically and proved an efficient solution in controlling tibia internal rotation, when performed in conjunction with ACL reconstruction. We describe a simple, versatile, effective, and reproducible technique of lateral extra-articular tenodesis, using common suspensory femoral fixation, with no additional cost and surgical risk.
Arthroscopy Techniques
Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction has been we... more Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction has been well studied and recognized as the cause of unsatisfactory clinical results. Various anterolateral techniques have been described as an adjunct to the ACL reconstruction to improve clinical outcomes. Modified deep Lemaire lateral extra-articular tenodesis has been tested both biomechanically and clinically and proved an efficient solution in controlling tibia internal rotation, when performed in conjunction with ACL reconstruction. We describe a simple, versatile, effective, and reproducible technique of lateral extra-articular tenodesis, using common suspensory femoral fixation, with no additional cost and surgical risk.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
The RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixat... more The RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixation of graft in ACL reconstruction. In some cases, though, cross pins miss the femoral tunnel resulting in inadequate proximal graft fixation. We present a simple test to detect the incorrect placement of cross pins. The pinholes are drilled through the guide frame, leaving 2 sleeves for cross pins insertion. The manufacturer's recommendations, at this stage, are to reinsert the femoral tunnel guidewire, remove the guide frame, and insert the graft without verifying accurate pinhole positioning. We reinsert the femoral tunnel guidewire without removing the guide frame, and a second guidewire is introduced through each of the sleeves in turn. In case of appropriate pinhole placement, the 2 guidewires will meet in the cannulated rod of the guide frame and the surgeon will have the metal-to-metal feeling. If the pinhole misses the femoral tunnel, the 2 guidewires will not meet and the surgeon will not have the metal-to-metal feeling. In our practice, 9 cases of inaccurate pinhole placement were detected with this test and verified by direct vision of the femoral tunnel with the arthroscope. We find this test simple, reliable, and not time consuming.
Sultan Qaboos University Medical Journal [SQUMJ]
A simple arthroscopic technique was introduced without the need for further staff during the oper... more A simple arthroscopic technique was introduced without the need for further staff during the operation. A 2.4 mm pin is positioned through the sleeve of an ACL tibial guide and it is marked with a steri-strip at its body, aiming at 5-10 mm distance between the tips of guide and the pin. The steri-strip serves as a mark and as a stop for inadvertent violation of the cartilage. The tip of the ACL is positioned just over the bone lesion, while the marked 2.4 mm pin is inserted through the ACL tibial guide from anterior surface of the femur. A stab incision is made and without advancing the sleeve to the bone, the pin is drilled to the marked position while cartilage integrity is confirmed arthroscopically. Our arthroscopic technique is simple, fast and effective and it is performed without the need of a special equipment. Keywords: Avascular necrosis; Osteonecrosis; Knee joint; Arthroscopic; Decompression.
Sultan Qaboos University Medical Journal, 2022
A simple arthroscopic technique was introduced without the need for further staff during the oper... more A simple arthroscopic technique was introduced without the need for further staff during the operation. A 2.4 mm pin is positioned through the sleeve of an ACL tibial guide and it is marked with a steri-strip at its body, aiming at 5-10 mm distance between the tips of guide and the pin. The steri-strip serves as a mark and as a stop for inadvertent violation of the cartilage. The tip of the ACL is positioned just over the bone lesion, while the marked 2.4 mm pin is inserted through the ACL tibial guide from anterior surface of the femur. A stab incision is made and without advancing the sleeve to the bone, the pin is drilled to the marked position while cartilage integrity is confirmed arthroscopically. Our arthroscopic technique is simple, fast and effective and it is performed without the need of a special equipment.
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Papers by Theofilos Dimitriadis
This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
Case presentation: A 14-year-old female handball athlete presented with a history of left knee injury during her participa- tion in a handball training session and subsequent locked knee at 20o flexion. Tenderness was located at the medial joint line. Plain radiographs of the injured knee were normal. The magnetic resonance imaging revealed a hypertrophic medial parapatellar plica and a horizontal tear of the medial meniscus. A standard knee arthroscopy was performed. An extremely hypertrophied medial plica was identified, covering a great part of the medial femoral condyle extending up to the femoral trochlea. Distally, it was attached into the inter-meniscal ligament. The plica was excised and the medial meniscus tear was repaired. At 1-month post-operatively, the patient was completely asymptomatic and at 3-months she returned to her weekly training routine.
Conclusions: This study presented a rare anatomical variation of a hypertrophied medial parapatellar plica with atypical course in the medial patellofemoral compartment and insertion into the inter-meniscal ligament. In combination with a medial meniscus tear led to a locked knee. Arthroscopic medial meniscus repair and plica excision resulted in complete resolution of symptoms.
This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
Case presentation: A 14-year-old female handball athlete presented with a history of left knee injury during her participa- tion in a handball training session and subsequent locked knee at 20o flexion. Tenderness was located at the medial joint line. Plain radiographs of the injured knee were normal. The magnetic resonance imaging revealed a hypertrophic medial parapatellar plica and a horizontal tear of the medial meniscus. A standard knee arthroscopy was performed. An extremely hypertrophied medial plica was identified, covering a great part of the medial femoral condyle extending up to the femoral trochlea. Distally, it was attached into the inter-meniscal ligament. The plica was excised and the medial meniscus tear was repaired. At 1-month post-operatively, the patient was completely asymptomatic and at 3-months she returned to her weekly training routine.
Conclusions: This study presented a rare anatomical variation of a hypertrophied medial parapatellar plica with atypical course in the medial patellofemoral compartment and insertion into the inter-meniscal ligament. In combination with a medial meniscus tear led to a locked knee. Arthroscopic medial meniscus repair and plica excision resulted in complete resolution of symptoms.