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Arthroscopy Techniques

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https://www.readbyqxmd.com/read/28626630/arthroscopic-removal-of-proximal-humerus-plates-in-chronic-post-traumatic-shoulder-stiffness
#1
Deepak N Bhatia
Proximal humerus fracture fixation may be complicated by persistent postsurgical stiffness or implant-related problems. Arthroscopic plate removal is a cosmetic and functionally beneficial procedure; however, the procedure is technically difficult in the presence of severe subdeltoid scarring. The technique described here shows an arthroscopic subdeltoid adhesiolysis and proximal humerus plate removal using systematic access to 5 regions of screw positions on the plate. After initial glenohumeral adhesiolysis, a thorough subacromial and subdeltoid bursectomy is performed...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580274/hip-arthroscopy-capsular-closure-the-figure%C3%A2-of-eight-technique
#2
Stephen K Aoki, Michael R Karns, Takehito Hananouchi, Dane C Todd
Hip arthroscopy techniques have continued to evolve for femoroacetabular impingement and other intra-articular pathologies. However, there is still debate about the importance and technique of routine capsular closure. We present an efficient and reliable technique for creating a watertight capsular closure to prevent iatrogenic macro and microinstability. This Technical Note details our stepwise technique using figure of eight sutures to obtain a complete and secure capsular closure.
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580273/all-suture-repair-for-compressive-rotator-cuff-tears-reducing-the-traction-of-the-tissue
#3
Néstor A Zurita Uroz, Ferran Abat, Angel Calvo Diaz
Tears of the rotator cuff are a frequent pathology, but the best surgical procedure remains unclear. The arthroscopic approach has become the gold standard, but there are many different suture configurations that can be used. We describe an all-suture repair system with which the anatomical reduction of the rotator cuff is achieved performing traction from the anchor of the lateral row to subsequently performing a suture bridge suture from the medial row. The major advantage of this technique is that it creates compression forces and minimizing tensioning of the tissue...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580272/proximal-patellar-tendon-repair-internal-brace-technique-with-unicortical-buttons-and-suture-tape
#4
George Sanchez, Marcio B Ferrari, Anthony Sanchez, Gilbert Moatshe, Jorge Chahla, Nicholas DePhillipo, Matthew T Provencher
Patellar tendon ruptures may be considerably limiting, especially in younger and highly active patients. These injuries ultimately result in a complete inability to maintain extension of the knee, thereby placing strict impediment on physical activity. As a result, a durable repair construct via surgery is necessary to allow patients to return to their preinjury activity level. Because of the inherent difficulty in maintaining patellar tendon position after repair, and to avoid failure of the tendon healing to the patella, we recommend using an internal brace construct...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580271/meniscal-allograft-transplantation-with-soft-tissue-in-bone-socket-fixation-arthroscopic-technique-with-technical-pearls
#5
Troy A Roberson, Douglas J Wyland
Meniscal allograft transplantation may slow the progression of degenerative changes in the meniscus-deficient knee. The current literature suggests patients can experience good early to mid-term satisfaction and patient-reported outcomes with reasonable expectations of return to work. More ambitious applications in athletes have also shown good results although long-term data are lacking. Traditionally, meniscal allograft transplantation has been considered an open procedure with incorporation of bone blocks from the allograft source...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580270/anatomical-glenoid-reconstruction-using-fresh-osteochondral-distal-tibia-allograft-after-failed-latarjet-procedure
#6
Anthony Sanchez, Marcio B Ferrari, Ramesses A Akamefula, Rachel M Frank, George Sanchez, Matthew T Provencher
In the treatment of recurrent anterior glenohumeral instability, the Latarjet procedure has been shown to fail. This results in a need for viable revisional procedures for patients who present with this challenging pathology. We report our preferred technique for anatomical glenoid reconstruction using a fresh osteochondral distal tibia allograft after a failed Latarjet procedure. This bony augmentation technique employs a readily available dense, weight-bearing osseous tissue source that has excellent conformity, as well as the added benefit of a cartilaginous surface to correct chondral deficiencies...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580269/complete-arthroscopic-synovectomy-in-management-of-recalcitrant-septic-arthritis-of-the-knee-joint
#7
Tun Hing Lui
Septic arthritis of the knee is a potentially life-threatening condition and can be associated with many late complications. The key of success of management of septic arthritis of the knee joint is early aggressive treatment of surgical debridement and decompression and antibiotic therapy. In adults, arthroscopic drainage with synovectomy is the treatment of choice in septic arthritis of the knee, with lower rates of infectious recurrence than needle aspiration and better functional results than open surgery...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580268/endoscopic-resection-of-medial-extra-articular-cysts-of-the-knee
#8
Tun Hing Lui
Although most of the parameniscal cysts are very small and asymptomatic, some of them can present with a painful mass or snapping knee. Because parameniscal cysts are almost always associated with horizontal meniscal tears, arthroscopic partial meniscectomy of the involved part of meniscus and intra-articular cyst drainage has become the most accepted procedure. However, arthroscopic cyst decompression through partial meniscectomy to the meniscocapsular junction to expose the communication between the cyst and the knee joint may sacrifice some of the healthy parts of the meniscus especially when meniscal tear is peripheral...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580267/fatigue-behavior-of-nitinol-anterior-cruciate-ligament-graft-and-inappropriate-femoral-tunnel-placement-single-stage-revision-anterior-cruciate-ligament-reconstruction-surgery
#9
Fatih Karaaslan, Sinan Karaoğlu
Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and progressive instability and disability may develop in a significant number of patients. The incidence of ACL reconstruction is rapidly increasing, as is the number of failures. Although ACL reconstruction is a common procedure, less than satisfactory outcomes have been reported to occur in up to 25% of patients. The reasons for clinical failure after ACL reconstruction are numerous but can be broadly separated into 3 categories: technical, biological, and mechanical failures...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580266/open-patellar-tendon-tenotomy-debridement-and-repair-technique-augmented-with-platelet-rich-plasma-for-recalcitrant-patellar-tendinopathy
#10
Bradley M Kruckeberg, Jorge Chahla, Marcio B Ferrari, George Sanchez, Gilbert Moatshe, Robert F LaPrade
Patellar tendinopathy is a disabling condition that frequently affects the athletic population, especially athletes undergoing repetitive impact forces as a result of jumping and landing activities. Most cases are initially treated conservatively, but if symptoms persist, surgical treatment is warranted. Options for surgical treatment include both arthroscopic and open techniques. The purpose of this Technical Note is to detail our open patellar tendon tenotomy, debridement, and repair technique augmented with platelet-rich plasma...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580265/bone-marrow-aspirate-concentrate-harvesting-and-processing-technique
#11
Jorge Chahla, Sandeep Mannava, Mark E Cinque, Andrew G Geeslin, David Codina, Robert F LaPrade
Bone marrow obtained by iliac crest aspiration is a common source for harvesting mesenchymal stem cells, other progenitor cells, and associated cytokine/growth factors. Recent studies have reported good to excellent outcomes with the use of bone marrow aspirate concentrate (BMAC) for pain relief in the treatment of focal chondral lesions and osteoarthritis of the knee. However, the harvesting and processing technique are crucial to achieve satisfactory results. Several studies have examined outcomes after BMAC injection, with encouraging results, but there is a lack of consensus in terms of the frequency of injection, the amount of BMAC that is injected, and the timing of BMAC injections...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580264/correction-of-recurred-hallux-valgus-deformity-by-endoscopic-distal-soft-tissue-procedure
#12
Tun Hing Lui
The underlying reason for recurrence of hallux valgus deformity after bunion surgery is multifactorial and includes surgeon-based and patient-based factors as well as original components of deformity initially unaddressed at the index procedure. Surgical treatment of a recurred hallux valgus deformity should be undertaken using the same guidelines for correction of a primary hallux valgus deformity. It requires correction of bony alignment, restoration of joint congruity, and achievement of soft tissue balance...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580263/flexor-hallucis-longus-tenosynovitis-and-first-metatarsophalangeal-synovitis-after-penetrating-nail-prick-injury-treated-by-zone-3-flexor-hallucis-longus-tendoscopy-and-metatarsosesamoid-arthroscopy
#13
Tun Hing Lui
Pedal penetrating nail prick injury around the first metatarsal head can result in persistent synovitis of the first metatarsophalangeal joint and tenosynovitis of the flexor hallucis longus tendon. Exploration and debridement is indicated if the condition does not improve with antibiotics. Open surgery requires extensive dorsal and plantar incisions. The purpose of this Technical Note is to report the combined arthroscopic and tendoscopic approaches to address the first metatarsophalangeal joint and flexor hallucis longus tendon pathologies...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580262/minimally-invasive-combined-anterior-and-anterolateral-stabilization-of-the-knee-using-hamstring-tendons-and-adjustable-loop-suspensory-fixation-device-surgical-technique
#14
Achilleas Boutsiadis, Paul Brossard, Jean-Claude Panisset, Nicolas Graveleau, Johannes Barth
Despite the numerous techniques described regarding isolated anterior cruciate ligament (ACL) reconstruction, many authors have reported that residual knee rotational instability is not always eliminated. The combination of lateral extra-articular knee tenodesis and ACL reconstruction is an alternative surgical approach with very promising clinical results. The purpose of this article is to describe a reliable and reproducible technique of combined ACL reconstruction and lateral extra-articular knee tenodesis using a continuous looped hamstring tendon autograft...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580261/all-arthroscopic-coracoclavicular-ligament-reconstruction-surgical-technique-using-a-semitendinosus-allograft-and-tenodesis-screws
#15
Xinning Li, Anand Padmanabha, Justin Koh, Antonio Cusano
Acromioclavicular joint injuries account for 9% of shoulder girdle injuries and are most often associated with direct blows to the shoulder or axially directed forces onto the ipsilateral extremity. Type IV, V, and VI injuries are generally managed surgically, whereas type I and II injuries are treated with sling immobilization, early shoulder range of motion, and physical therapy. Type III injuries are more controversial but are generally managed surgically in the active and high-demand patient. When surgical treatment is indicated, the primary goal of a coracoclavicular (CC) ligament reconstruction is to restore anatomic reduction of the acromioclavicular joint and reconstruct the biomechanical forces of the CC ligaments...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580260/posterolateral-rotatory-instability-of-the-elbow-part-ii-supplementary-examination-and-dynamic-imaging-techniques
#16
Christopher L Camp, Jay Smith, Shawn W O'Driscoll
Currently, a number of examination and imaging techniques exist for diagnosing posterolateral rotatory instability of the elbow. Although the posterolateral rotatory drawer is the primary examination maneuver, other special tests include the lateral pivot-shift test, prone push-up test, chair push-up test, and tabletop push-up test. In addition, posterolateral rotatory instability can be evaluated using radiography, magnetic resonance imaging, dynamic fluoroscopy, or dynamic ultrasound. In this Technical Note, each of these tests is described in detail...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580259/posterolateral-rotatory-instability-of-the-elbow-part-i-mechanism-of-injury-and-the-posterolateral-rotatory-drawer-test
#17
Christopher L Camp, Jay Smith, Shawn W O'Driscoll
Posterolateral rotatory instability (PLRI) is the most commonly encountered pattern of elbow instability. It is the result of disruption of the lateral collateral ligament complex leading to a posterolateral rotatory subluxation of the ulna and radial head. A number of examination maneuvers have been described to assist in clinical identification of PLRI. Despite this, some inconsistency in the description of these techniques remains in the orthopaedic literature. This Technical Note details the mechanism of injury and patient presentation, and emphasizes the primacy of the posterolateral rotatory drawer test in the assessment of PLRI while providing video instruction on how it should be performed...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580258/a-method-for-capsular-management-and-avoidance-of-iatrogenic-instability-minimally-invasive-capsulotomy-in-hip-arthroscopy
#18
Csaba Forster-Horvath, Benjamin G Domb, Lyall Ashberg, Richard F Herzog
Most surgeons create a T-shaped or interportal capsulotomy to ensure good visibility when performing hip arthroscopy. This entails transecting the iliofemoral ligament, which may or may not be repaired at the end of the procedure. Cases of iatrogenic hip instability and pain after hip arthroscopy suggest that the iliofemoral ligament plays a crucial role in the stability of the hip joint, and thus preservation should be a goal in hip arthroscopy. We describe a minimally invasive iliofemoral ligament-sparing capsulotomy, guided by the reflected head of the rectus tendon, that can be easily repaired after arthroscopic rim trimming, labral refixation, and offset correction...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580257/posterior-surgical-approach-to-the-knee
#19
Scott C Faucett, James Gannon, Jorge Chahla, Marcio B Ferrari, Robert F LaPrade
Posterior knee approaches are reliable techniques to address the treatment of various pathologies of the posterior region of the knee, including Baker cyst excision, tibial plateau fracture fixation, posterior cruciate ligament avulsions and inlay reconstructions, femoral condyle cartilage procedures, posterior meniscal repair and loose body removal among others. Surgery in the posterior knee region can be challenging because of the presence of neurovascular structures including the tibial nerve, popliteal artery and vein, and common peroneal nerve; thus, it is less commonly performed...
April 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28580256/biologic-inlay-osteochondral-reconstruction-arthroscopic-one-step-osteochondral-lesion-repair-in-the-knee-using-morselized-bone-grafting-and-hyaluronic-acid-based-scaffold-embedded-with-bone-marrow-aspirate-concentrate
#20
Boguslaw Sadlik, Alberto Gobbi, Mariusz Puszkarz, Wojciech Klon, Graeme P Whyte
Cartilage injury of the knee that is associated with significant subchondral bone loss can result in great morbidity, and treatment options that provide durable repair are limited. Osteochondral autograft and allograft reconstruction of these lesions has been used extensively; however, these techniques often require a more invasive surgical exposure, and restoring the natural articular surface radius of curvature can be challenging, particularly in larger lesions. Cell-based repair of these lesions, using autologous chondrocytes in conjunction with bone grafting, has been used with success, although this procedure requires the patient to undergo 2 operations, and access is often restricted due to the high associated costs...
April 2017: Arthroscopy Techniques
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