If the physes have closed, the leading differential diagnosis is GCT (Figure 16), which nearly always extends to the articular margin
of a bone.
Histopathological characteristics include a progressive degeneration of the articular cartilage (Cledes et al., 2006), fibrillation and erosion of the articular surfaces, proliferation of chondrocytes, eburnation of the articular cartilage, synovitis, changes and exposure in the subchondral bone and formation of osteophytes at the articular margin
(Cledes et al.; Guler et al.).
Create the medial-row holes for the anchor implant (2.8 mm anchor) using appropriate bone punch at the articular margin
of the footprint.
This complex consists of anterior and posterior bands, in addition to an interposed axillary pouch that attaches to the humerus just below the articular margin
of the humeral head in two distinct configurations: a collar-like attachment or V-shaped attachment (6).
A second guide wire was passed through intercondylar area parallel to first one just distal to it without breaching the articular margin
. A cannulated cancellous drill bit was used to drill the first guide wire from medial to lateral side.
The repairs used two medial 4.5 mm PEEK FT corkscrew anchors (Arthrex, Naples, FL) in all specimens; the anchors were inserted just lateral to the articular margin
of the humeral head into punched holes.
These irregular stresses result in chondrocyte necrosis, release of degradative enzymes, synovitis and continued cartilage destruction, inflammation, increased density of subchondral bone at points of physical stress and proliferation of bone and cartilage at the articular margin
. Abnormal cartilage congruency and joint capsule anatomy can further lead to alteration in normal joint biomechanical function.
The device is then placed as close as possible to the articular margin
. Proper positioning was ensured by the anterosuperior arthroscopic portal.
On examination there was tenderness between inferior pole of patella and tibial articular margin
, hoffas test positive, flexion extension arc 10-90[degrees], with diffuse palpable soft swelling measuring 5x4cm in the anterior knee between inferior pole of patella and tibial tuberosity.
They were evenly spaced over the greater tuberosity, with three tunnels at the articular margin
spaced 10 mm apart from anterior to posterior and three created directly 10 mm lateral to the initial set.
There was an interruption of the articular margin
, an invasion of the lateral and posterior cortex with soft tissue extension, and advanced osteoarthritic changes (Figure 1).
One method involves placing the anterolateral tunnel in a right knee at the 1:00 o'clock position, 6 mm off the articular margin
, and the posteromedial tunnel at the 2:30 o'clock position, 4 to 5 mm off the articular margin