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Arthroscopy Techniques

Trai Promsang, Kitiphong Kongrukgreatiyos, Somsak Kuptniratsaikul
A SLAP lesion can be found with a concomitant spinoglenoid notch cyst. The cyst can cause suprascapular nerve compression, resulting in shoulder pain and weakness of external rotation. Their management varies from conservative treatment to operative treatment. Cyst decompression through the labral tear is our preferred treatment. Previous studies demonstrated a good result after arthroscopic decompression of the cyst through the labral tear combined with SLAP repair. Many surgeons usually use 3 portals to perform this procedure...
September 2018: Arthroscopy Techniques
Nelson Ponzo, Juan Del Castillo, José Fregeiro, Mitchell I Kennedy, Robert F LaPrade
It is well known that the posterior cruciate ligament (PCL) is the main stabilizer to posterior tibial translation in the knee. Anatomic double-bundle reconstruction has recently been proposed to best restore posterior and rotational tibial instability, especially compared with a single-bundle PCL reconstruction (PCLR). Most publications in the peer-reviewed literature on double-bundle PCLR have used allografts. However, in many countries, allografts are not available. This Technical Note describes an all-autograft arthroscopic technique for PCLR using the quadriceps and semitendinosus tendons...
September 2018: Arthroscopy Techniques
Mark R Wilson, Adam C Field, Larry D Field
Combined lesions of the glenoid labrum are a relatively common finding in shoulder instability patients. Even so, relatively few studies have been published evaluating outcomes after repair of these complex labral detachments. To achieve a successful outcome, accurate identification of all pathologic lesions in the shoulder combined with an organized, stepwise approach to sometimes circumferential labral fixation is required. Repair of 360° labral tears can be effectively and efficiently achieved by implementing the reproducible steps and sequence described to reconstruct these circumferential labral tears...
September 2018: Arthroscopy Techniques
George W Byram, Adam C Field, Larry D Field
Locked posterior shoulder dislocations occur relatively uncommonly but pose aunique array of challenges for the treating surgeon. Posterior labral detachments and capsular damage along with reverse Hill-Sachs lesions are commonly present in these patients and must often be addressed at the time of surgical intervention. Multiple open and arthroscopic procedures that address these pathologic lesions have been described. Arthroscopic shoulder stabilization for patients with locked posterior shoulder dislocations for whom significant posterior instability and subluxation persist following closed reduction is described...
September 2018: Arthroscopy Techniques
Mathieu Thaunat, Goran Vrgoc, Padhraig F O'Loughlin, Nicolas Jan, Gilles Clowez, Jean Marie Fayard, Bertrand Sonnery-Cottet
Management of intrasubstance horizontal cleavage meniscal lesions of microtraumatic origin remains poorly defined in young patients. For grade 2 lesions resistant to conservative measures, the standard technique is debridement of the intrasubstance tear and open suture repair via a posteromedial approach. The objective of this Technical Note is to propose an arthroscopic alternative to this open technique, using an arthroscopic additional posteromedial portal. This technique facilitates an approach to the lesion via its peripheral portion without creating an iatrogenic lesion of the free edge of the meniscus, which is located in the white zone and thus exhibits limited vascularity...
September 2018: Arthroscopy Techniques
Michael M Murphy, Robert Z Tashjian, Robert T Burks
Various surgical techniques exist for rotator cuff repair that provide a suitable environment for tendon-bone healing. Arthroscopic recreation of transosseous repairs, which had previously been performed by open or miniopen techniques, can now be performed; however, arthroscopic, transosseous passage of suture material can be challenging technically. There are potential biologic and cost-saving advantages of arthroscopic transosseous rotator cuff repair that make an efficient and reproducible technique desirable for arthroscopists...
September 2018: Arthroscopy Techniques
David P Trofa, Julian J Sonnenfeld, Daniel J Song, T Sean Lynch
The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Given its extra-articular location, the MCL has great healing capacity such that the mainstay of treatment for most injuries remains conservative management. However, certain injury patterns place patients and athletes at risk of residual valgus laxity, which may require delayed surgical care and prolonged time out from sports. As such, identifying the specific injuries known to place patients at risk for failure with nonoperative management is of paramount importance...
September 2018: Arthroscopy Techniques
Sivashankar Chandrasekaran, Mary R Close, John P Walsh, Edwin O Chaharbakhshi, Parth Lodhia, Mitchell R Mohr, Benjamin G Domb
Pathology of the iliopsoas may cause painful internal snapping of the hip or labral damage from soft impingement. Favorable outcomes have been reported after arthroscopic release or fractional lengthening of the iliopsoas. In patients with risk factors for instability, restoration of other soft-tissue constraints such as the labrum and capsule should be performed if iliopsoas fractional lengthening is undertaken. The purpose of this article is to detail the step-by-step surgical technique of arthroscopic iliopsoas fractional lengthening, in addition to the indications, pearls, and pitfalls of the technique...
September 2018: Arthroscopy Techniques
Paul E Caldwell, Christopher S Evensen, Nicholas G Vance, Sara E Pearson
Distal triceps ruptures are uncommon injuries resulting in loss of elbow extension strength and necessitating surgical repair to ensure optimal functional outcome. Traditional fixation techniques using running, locking sutures through the tendon secured through bone tunnels have been shown to poorly restore the anatomic footprint and are mechanically inferior to anatomic repairs. We endorse restoring the anatomic footprint of the distal triceps, similar to the well-researched rotator cuff repair model.
September 2018: Arthroscopy Techniques
William M Cregar, Ian S MacLean, Nikhil N Verma, Scott W Trenhaile
Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation...
September 2018: Arthroscopy Techniques
Vikas R Singh, Gregory I Bain
Olecranon spur is a common underlying clinical problem in patients with inflammatory conditions such as triceps tendonitis, olecranon bursitis, and gout. It is often managed conservatively. Conventionally, symptomatic olecranon spurs that have failed conservative management are excised along with the overlying bursa using an open technique. We describe an endoscopic extrabursal technique, where the spur is dissected out and excised in its entirety under endoscopic vision. Using this technique, a satisfactory view is achieved with less morbidity compared with the open excision; it also avoids a wound over the sensitive skin over the olecranon...
September 2018: Arthroscopy Techniques
Michael Rose, Ryan McNeilan, James Genuario, Theodore Schlegel
Postoperative scarring is a known complication after arthroscopic anterior ligament reconstruction of the knee. The anterior interval of the knee has been previously identified as a common location for anterior scar formation. The anterior interval is defined as the space between the infrapatellar fat pad and the anterior border of the tibia. Patients with anterior interval scarring often present with lack of terminal knee extension, anterior knee pain, decreased patellar mobility, and quadriceps atrophy. The goal of this paper is to describe the technique for anterior interval release of the knee...
September 2018: Arthroscopy Techniques
Iñaki Mediavilla, Mikel Aramberri, Giovanni Tiso, Jorge A Murillo-González
A double-bundle anterior cruciate ligament (ACL) reconstruction associated with an anterolateral ligament (ALL) reconstructions is performed. The semitendinosus and gracilis are harvested. At knee maximum flexion, the anteromedial (AM) femoral tunnel is performed in the AM footprint area. Through the anterolateral portal, the tip of the outside-in femoral guide is placed in the posterolateral footprint area. The guide sleeve is pushed onto the lateral femoral cortex at the ALL attachment. At 110° knee flexion, the posterolateral-ALL tunnel is performed...
August 2018: Arthroscopy Techniques
Colin M Robbins, Colin P Murphy, Blake T Daney, Anthony Sanchez, Matthew T Provencher
In recent years there has been increased attention on preserving the menisci because they perform vital roles in maintaining knee joint homeostasis. The anterolateral (AL) meniscal root is particularly vulnerable during anterior cruciate ligament reconstruction. When the AL root is iatrogenically injured, it is imperative that it is repaired in a timely fashion to prevent early-onset osteoarthritis. In this article we outline our knotless suture anchor repair for AL root tears.
August 2018: Arthroscopy Techniques
Thibault Lafosse, Malo Le Hanneur, Ion-Andrei Popescu, Thomas Bihel, Emmanuel Masmejean, Laurent Lafosse
Due to recent progress in shoulder arthroscopy, all-endoscopic brachial plexus (BP) dissection has progressively become a standardized procedure. Based on previously described techniques, we present an additional neurological procedure that may be performed all-endoscopically, that is, the excision of an infraclavicular BP schwannoma. Starting from a standard shoulder arthroscopy with posterior and lateral portals, additional anterior and medial portals are progressively opened outside the joint under endoscopic control to access the BP...
August 2018: Arthroscopy Techniques
Mitsuaki Kubota, Ryuichi Ohno, Taisuke Sato, Daiju Yamada, Shin Fukusato, Kazuo Kaneko
The ToggleLoc with ZipLoop is an adjustable suspensory device for anterior cruciate ligament reconstruction. However, there is no string to flip the button in the device because it has only one hole and one string. Therefore, the surgeon cannot use the button flip technique. The purpose of this article is to present the pearls and pitfalls of using ToggleLoc with ZipLoop. While preparing the ACL graft, we draw a 15- to 20-mm-width marking in the adjustable loop at the same length as the femoral tunnel depth...
August 2018: Arthroscopy Techniques
Michael M Hadeed, Michelle Post, Brian C Werner
Snapping biceps femoris is a rare phenomenon in which the biceps femoris tendon subluxates over the fibular head when the leg is brought into deep flexion. Two primary pathologies have been identified: biceps insertion tears/anatomic variants and/or an enlarged fibular head. Often, it can be treated nonoperatively; however, if symptoms are severe enough and refractory to conservative treatments, the underlying pathology can be corrected surgically to alleviate symptoms. The diagnosis is made clinically; the subluxation should be reproducible with deep flexion and should abate with manual compression of the biceps muscle and internal rotation of the tibia...
August 2018: Arthroscopy Techniques
Nicholas Elena, Brittany M Woodall, Asher Mirvish, Cameron M Brown, Patrick J McGahan, Neil P Pathare, Edward C Shin, James L Chen
The anterior cruciate ligament (ACL) is commonly injured, especially in athletes performing twisting and pivoting motions. ACL reconstruction is a standard procedure; however, there is no way to intraoperatively assess one of the causes of failure: the lack of adequate graft fixation on the tibial side. Different fixation devices can be used to ensure fixation, but there is as yet no consensus on which is the most effective. Moreover, there is no reliable way to assess their strength in the intraoperative setting...
August 2018: Arthroscopy Techniques
Gregory R Sprowls, Brett N Robin
The quadriceps tendon autograft has become an attractive option for anterior cruciate ligament reconstruction (ACLR) because of its robust size and versatility as a graft. Emerging literature has shown impressive biomechanical viability and promising clinical outcomes. The substantial size of a quadriceps graft and the shorter graft requirement of the all-inside approach obviate the need to harvest a bone plug for supplemental graft length and allow the use of an all-soft-tissue graft. The recent development of sophisticated harvest tools has mitigated prior issues reported with quadriceps tendon harvest...
August 2018: Arthroscopy Techniques
Anne Jonkergouw, Jelle P van der List, Gregory S DiFelice
Knee dislocations often result in a severe multiligament injured knee (MLIK) with complex instability. Multiligament reconstruction can successfully restore knee stability and is commonly recommended, although surgical morbidity is induced by graft harvesting and tunnel drilling, and convergence of multiple tunnels can complicate the surgery. Therefore, as an alternative, primary repair of knee ligaments is currently reconsidered. The main advantages of primary repair consist of tissue preservation and decrease of surgical morbidity, which might improve knee functionality...
August 2018: Arthroscopy Techniques
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