Heterotopic ossification (HO) is the process of ectopic bone formation in the periarticular soft tissues and is usually formed in the elbow, hip and knee joint as a complication of trauma, burns, brain injury or surgical procedures. The development of HO around the elbow joint can cause a severe limitation of range of motion (ROM) and may affect daily activities of the patient. Treatment of ectopic bone formation around the elbow is a challenge for many surgeons. Non-operative treatment usually fails to restore the ROM of the elbow joint; thus, surgery is necessary to restore the function of the joint. In the past, many surgeons suggested that a delayed excision of HO, until maturation of the ectopic bone, is the best option in order to avoid any possible recurrence. However, many authors now suggest that this delay may lead to complications such as muscular atrophy and formation of soft tissue contractures that can cause a greater impairment of elbow function; thus, early excision is a better option and can better restore the elbow ROM. We performed a literature research of articles that investigated which is the best time of HO excision and we also evaluated if the tethering effect of HO can lead to a greater impairment of the elbow function. We found numerous studies suggesting that a limitation in ROM of the elbow can appear from the tethering of the ectopic bone formation and not only from primary HO. Concerning the HO excision, there were no significant differences between patients who underwent delayed and early excision, concerning the recurrence rate of HO around the elbow. Patients who underwent early excision had better restoration of elbow ROM; thus, early excision, combined with a rehabilitation program, is reported to be the best option for these patients.

Tenosynovial giant-cell tumor (GCT) arising from cruciate ligaments consists a rather rare entity. Predominantly areas where this tumor appears are the palmar sides of fingers and toes. The involvement of larger joints such as the knee or the ankle is rather rare, but, in the case of synovial joints, the knee joint is particularly affected. Furthermore, rare seems to be the intra-articular localization of the tenosynovial GCT of the tendon sheath. Hereby, we present an arthroscopic approach of treatment with two cases. The first case was a 32-year-old male with a GCT arising from the anterior cruciate ligament (ACL). The second case was a 26-year-old male with a GCT arising from the posterior cruciate ligament (PCL). In the first case, a round-shaped mass with a reddish-brown color was located just anterior to the ACL and impeded the full extension of the knee joint, while, in the second case, a well-circumscribed oval-shaped mass was found with a peduncle attached to the synovium of the PCL. After arthroscopic excision, both patients became asymptomatic, with complete lack of pain and full ROM. There is a lack of clinical features for the GCT of the knee, and thus, a thorough clinical examination is prudent. Usually, the diagnosis is set after an investigation based on suspicion. This entity can present with symptoms of instability and patients may present signs of mechanical derangement. With the knee joint, meniscal symptoms and locking are often present. The best non-invasive technique to diagnose this tumor has been reported to be the magnetic resonance imaging. Arthroscopic excision has been reported as a safe and effective procedure for treatment.

Introduction: Many orthopedic surgeons recommend ischemic tourniquets during arthroscopic anterior cruciate ligament (ACL) repair to reduce blood loss and improve visibility. However, their use remains controversial due to potential complications. Similarly, the practice of postoperative drainage is debated. While its proponents argue it reduces limb swelling, DVT, adhesions, and stiffness, others contend that it may increase infection risk or harm the ACL graft and joint surfaces. Materials and Methods: A total of 456 patients underwent anterior cruciate ligament reconstruction between September 2015 and December 2024, without the use of a tourniquet or drainage. The patients were 334 men with a mean age of 34.7 years and 122 women with a mean age of 32.3 years. In 389 cases the graft type was a hamstring autograft, in 55 cases a patellar tendon autograft (BPTB) was used, and in 12 cases a quadriceps tendon autograft was used. Results: The mean operative time was 61 min (range 52–79). No cases experienced visual impairment or required ischemia to enhance visibility. Bleeding sites were successfully cauterized during arthroscopy. Postoperative complications included knee hematoma in three patients (0.7%), resolved after drainage on day one, and two infections (0.4%), treated successfully with arthroscopic drainage and implant removal. No further complications were reported. Conclusion: Although many orthopedic surgeons prefer arthroscopic ACL repair with a tourniquet for better visibility and reduced intraoperative blood loss, this approach carries risks such as nerve palsy, joint swelling, stiffness, muscle weakness, and vascular changes. Not using a tourniquet can help to identify bleeding sites and allows for a more thorough procedure. The literature suggests that avoiding a tourniquet also reduces postoperative pain and accelerates recovery. The mean operative time for ACL reconstruction was consistent with the literature, indicating that avoiding a tourniquet did not cause delays. Additionally, the absence of postoperative drainage did not lead to complications, with most patients showing no issues like bleeding, hematoma, ischemia, or poor wound healing.