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Arthroscopy Techniques

Ashley Whelan, Catherine Coady, Ivan Ho-Bun Wong
Anterior capsular reconstruction needs to be done for most cases of anterior shoulder instability. Several surgical techniques using tendinous allografts and autografts have been used for the treatment of anterior glenohumeral capsular reconstruction. However, the outcomes of these procedures are not satisfactory. This study describes a comparatively new technique of using human acellular dermal allograft (GraftJacket: Wright Medical Group, Memphis, TN) in the reconstruction of the anterior capsule to restore anterior glenohumeral stability...
November 2018: Arthroscopy Techniques
Samy Bouaicha, Karl Wieser, Florian Grubhofer
Finding the way back into the glenohumeral space after a time-consuming rotator cuff reconstruction is not always easy because of swelling of the surrounding soft tissues. We present a safe and quick technical tip on how to reintroduce the arthroscope by means of a transarticular suture. After primary work in the glenohumeral space is performed and before the arthroscope is withdrawn from the joint, a monofilament suture is channeled from the anterior working portal through the glenohumeral joint to exit from the posterior portal...
November 2018: Arthroscopy Techniques
Michael G Saper
Anterior cruciate ligament (ACL) injuries are common among adolescent athletes and are rising with increased participation in higher level athletics at earlier ages. In these young patients, often with open physes, soft tissue grafts continue to be the primary graft choice for ACL reconstruction. Reinjury continues to be a concern in this high-risk age group, with failure rates 2 to 3 times higher than in adults. Recently, primary ACL reconstruction with suture tape augmentation/reinforcement has been described in both hamstring autografts and allografts...
November 2018: Arthroscopy Techniques
Aaron K Black, Calvin Schlepp, Matthew Zapf, John B Reid
Deep medial collateral ligament (MCL) injury leads to meniscal lift-off and extrusion of the medial meniscus, resulting in instability and increased medial compartment pressures with subsequent cartilage damage. Repair of the deep MCL meniscotibial ligament in concert with superficial MCL repair or reconstruction is intended to restore the native anatomy , stability, and function of the medial meniscus. We present an arthroscopically assisted technique using standard arthroscopy portals and a medial open approach...
November 2018: Arthroscopy Techniques
Pierre Imbert, Philippe D'Ingrado, Maxime Cavalier, Charles Bessière, Christian Lutz
The following surgical technique is intended for patients with chronic valgus laxity and rotational knee instability. It is a percutaneous 2-bundle ligament reconstruction method that uses the semitendinosus tendon, allowing it to remain pedicled to its distal tibial insertion. The aim is to correct the laxity without otherwise limiting the motion of the knee.
November 2018: Arthroscopy Techniques
Joong-Bae Seo, Kang Heo, Seong-Jun Kim, Jae-Uk Jung, Jae-Sung Yoo
An arthroscopic technique for the surgical treatment of acute acromioclavicular (AC) joint injuries is presented in this study. This procedure aims to achieve both vertical and horizontal stability through the healing of both coracoclavicular (CC) and AC ligaments. As a routine maneuver, arthroscopic CC stabilization was applied using the dog bone button to obtain only vertical stability. Additional arthroscopic AC joint fixation with suture tape augmentation is simple and easy and provides a safe technique to achieve horizontal stability of the joint and to increase the vertical stability to minimize the complications of standard CC reconstruction techniques...
November 2018: Arthroscopy Techniques
Jose Maria Silberberg Muiño, Alessandro Nilo Fulvi, Martin Gimenez, Jose Ramon Muina Rullan
The current understanding of the biomechanical role of the meniscus, in conjunction with the increasing efforts to achieve its preservation within the orthopaedic community during treatment of meniscal lesions, has prompted the development of different meniscal repair techniques. The outside-in technique is recommended for anterior horn and middle-segment meniscal tears and has been recognized as a low-cost procedure with a low incidence of complications. Diverse modifications of this technique have been published over the past decade...
November 2018: Arthroscopy Techniques
Justin L Makovicka, Karan A Patel, John M Tokish
Superior capsular reconstruction has emerged as a promising technique in the treatment of massive irreparable rotator cuff tears. The technical aspects of the surgery continue to evolve, and scientific studies to evaluate these techniques are emerging. One such area of interest concerns the appropriate thickness of the graft and its role as a spacer. The original description of the graft was an autograft tensor fascia lata, which was folded to achieve a thickness of around 8 mm. It has been demonstrated that an 8-mm graft is superior biomechanically to a 4-mm graft, which exceeds the typical human dermal allograft thickness...
November 2018: Arthroscopy Techniques
Brittany M Woodall, Gun Min Youn, Nicholas Elena, Alexander Rosinski, Moyukh Chakrabarti, James Gwosdz, Edward C Shin, Neil Pathare, Patrick J McGahan, James L Chen
Distal biceps tendon ruptures are uncommon injuries responsible for only 3% of all injuries to the biceps tendon. For most of these cases, unless the patient is elderly or infirm, conservative management should be avoided and the injury should be treated with a surgical procedure to reattach the bicep tendon to the radial tuberosity. In this Technical Note and accompanying video, we describe an anatomic single-incision technique using 2 intramedullary soft anchors, which decreases the likelihood of complications associated with bicortical drilling and metal suspensory fixation...
November 2018: Arthroscopy Techniques
Gun Min Youn, Brittany M Woodall, Nicholas Elena, Edward C Shin, Neil Pathare, Patrick J McGahan, James L Chen
Bone marrow aspirate concentrate is commonly harvested to obtain mesenchymal stem cells, progenitor cells, and growth factors. The iliac crest is the most common donor site for bone marrow harvesting and is associated with donor site morbidity of an additional incision and pain from the harvest. Iliac crest harvesting can be cumbersome because it often requires different patient positioning from the surgical procedure and additional sedation or anesthesia for the harvest prior to repositioning. The purpose of this Technical Note and accompanying video is to describe a technique to arthroscopically aspirate bone marrow from the intercondylar femoral notch, reducing the need for iliac crest harvesting...
November 2018: Arthroscopy Techniques
Antonio Porthos Salas, Jacek Mazek, Daniel Araujo-Reyes, Mauricio Gonzalez-Campos, Ara Castillo-Trevizo, Jose Misael Garcia
Hip arthroscopy has been increasing tremendously in the past decade and is a very common surgical procedure to repair femoroacetabular impingement. To access the hip joint, distraction is mandatory to treat intra-articular disorders such as labral tears, cartilage loose bodies, and ligamentum teres tears and to evaluate the condition of the femoral head and acetabular cartilage. To distract the hip, counterdistraction is needed, and this is achieved with placement of a bulky and cushioned perineal post. Most of the described techniques in hip arthroscopy use a perineal post, whereas others use beanbags to place the patient's body on the surgical table...
November 2018: Arthroscopy Techniques
Naser M Selim
There is no ideal surgical technique for the treatment of acromioclavicular (AC) dislocations. Reconstruction of the coracoclavicular ligaments (CCLs) for the treatment of AC dislocations is evolving. Many techniques for CCL reconstruction have been described. They differ mainly in the method of fixation, number of tunnels, and graft used. The surgeon should select among hamstring autograft reconstruction, coracoacromial ligament transfer, and conjoint tendon transfer for CCL reconstruction. Early on, conjoint tendon transfer to the lateral clavicle was described for the treatment of high-grade AC dislocation...
November 2018: Arthroscopy Techniques
Nicholas Elena, Brittany M Woodall, Katie Lee, Patrick J McGahan, Neil P Pathare, Edward C Shin, James L Chen
Subchondral lesions are the result of osseous modifications seen in a different array of pathologies such as osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition, and osteonecrosis. The physiopathologic changes in all of the aforementioned pathologies are not clear yet. What is clear is that the development of a cystic change in the subchondral bone can cause pain and can lead to modification of the activity of daily life. To provide relief and treatment for such a condition, there are different options with joint replacement as last resort when the cyst develops in communication with the joint; if the cyst is not in communication with the joint, it is possible to perform a bioplasty as we present in this technical report...
November 2018: Arthroscopy Techniques
David R Maldonado, Justin M LaReau, Ajay C Lall, Muriel R Battaglia, Mitchell R Mohr, Benjamin G Domb
In the setting of true hip dysplasia, the high prevalence of intra-articular pathology may lead to recurrent symptoms and failure after periacetabular osteotomy (PAO). Femoral neck osteochondroplasty, microfracture, removal of loose bodies, and labral repair are examples of procedures that are performed with concomitant arthroscopy. When damage to the labrum is too severe to repair, reconstruction instead of extensive debridement before PAO can be more effective in restoring the labral seal to maintain joint lubrication and chondral protection...
November 2018: Arthroscopy Techniques
Konrad Malinowski, Adrian Góralczyk, Krzysztof Hermanowicz, Robert F LaPrade, Rafał Więcek, Marcin E Domżalski
Knee flexion contracture is a clinically important complication that can be observed after trauma, after knee surgery, or as a result of osteoarthritis. When it is left untreated, knee shearing forces increase not only in the affected joint but also in the contralateral knee, leading to mechanical overload in both limbs. Conservative management is a first-line treatment option for extension deficits, but when it fails, surgical treatment is necessary. Open as well as arthroscopic techniques focus mainly on an anterior arthrolysis and a posterior capsular release...
November 2018: Arthroscopy Techniques
Mitchell I Kennedy, Nicholas N DePhillipo, Jorge Chahla, Christopher Armstrong, Connor G Ziegler, Patrick S Buckley, Andrew S Bernhardson, Robert F LaPrade
A snapping biceps tendon is an infrequently seen and commonly misdiagnosed pathology, leaving patients with persistent symptoms that can be debilitating. Patients will present with a visible, audible, and/or painful snap over the lateral aspect of their knee when performing squats, sitting in low seats, or participating in activities with deep knee flexion. A thorough knowledge of the anatomy is essential for surgical treatment of this pathology, which is caused by a detachment of the direct arms of the long and short heads of the biceps femoris off the fibular styloid...
November 2018: Arthroscopy Techniques
Somsak Kuptniratsaikul, Thun Itthipanichpong, Vanasiri Kuptniratsaikul
Acute partial injury of the anterior cruciate ligament (ACL) is a challenging condition without a standard treatment. Although ACL reconstruction provided a better outcome previously, recent studies have shown that preserving the ACL stump yields promising results in terms of better vascularization, proprioception, and ligamentization. ACL augmentation is becoming more popular. Therefore, we propose a technique to augment an acute partial ACL injury with synthetic suture material to stabilize the unstable cruciate ligament...
November 2018: Arthroscopy Techniques
Daniel McNeil, Cathy Coady, Ivan H Wong
Recurrent shoulder instability is highly associated with glenoid bone loss. Traditionally, bony procedures to address this bone loss have described nonanatomic, coracoid transfer procedures. More recently, anatomic glenoid reconstruction procedures have been described. These were first described as open procedures, and subsequently there have been several arthroscopic procedures described. We provide a description of an arthroscopic anatomic glenoid reconstruction approach with allograft.
November 2018: Arthroscopy Techniques
Brett G Brazier, Stephen A Sudekum, Paul M DeVito, Julie A Dodds
Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment, these structures can cause extreme discomfort and morbidity, including pain from rupture and symptoms from neurovascular compromise. Prior to the development of the arthroscope, open treatment of popliteal cysts was not uncommon. Complications such as poor wound healing, cyst recurrence, and knee flexion contractures were reported after such treatment...
November 2018: Arthroscopy Techniques
Michael Marsalli, Nicolás Moran, Jose I Laso
High-grade acromioclavicular (AC) injuries are frequent in the active population, and their treatment in the acute setting has reduced sequelae such as chronic pain, functional impairment, and inability to return to sports. Multiple techniques have been described to achieve reduction and fixation of the AC joint, but still there is no consensus. The objective of this Technical Note is to describe the reduction and internal fixation under arthroscopic assistance of the AC joint with the use of a double button implant plus high-strength tape in the acute setting...
November 2018: Arthroscopy Techniques
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