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Arthroscopy Techniques

Philippe Valenti, Charbel Maroun, Bradley Schoch, Santiago Ordoñez Arango, Jean-David Werthel
The Trillat procedure has been proposed to treat chronic anterior shoulder instability by performing a closing wedge osteotomy of the coracoid process fixed with a coracoscapular screw above the subscapularis. The goal of this osteotomy is to distalize and medialize the coracoid tip to place the conjoint tendon in front of the glenohumeral joint. This in turn distalizes and reinforces the subscapularis in abduction and allows the conjoint tendon to act as a sling and push the humeral head posteriorly. It is commonly accepted to perform this surgery for patients with chronic shoulder anterior instability associated with massive irreparable rotator cuff tear (to preserve and retension the residual subscapularis muscle) or in patients with anterior instability and hyperlaxity...
February 2019: Arthroscopy Techniques
Carl H Wierks
Acetabular labral repair requires positioning the labrum on the edge of the acetabulum with appropriate tension and rotation to recreate the suction seal with the femoral head. Considering that the labrum is a triangular shape in cross-section, rotation of the articular face of the labrum relative to the femoral head also affects the suction seal. The purpose of the toggle suture technique described herein is to control the rotation of the labrum to allow the articular face to directly contact the femoral head and optimize the suction seal...
February 2019: Arthroscopy Techniques
Naser M Selim
Combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries are the most common type of combined ligamentous injury of the knee. The optimal treatment for these combined injuries is controversial. Combined ACL and MCL-posterior oblique ligament (POL) reconstruction avoids late anteromedial rotatory instability and chronic valgus instability of the knee and decreases the increased stress on the ACL graft. Graft choice (hamstring tendon autograft, quadriceps bone-patellar tendon-bone autograft, or Achilles tendon allograft) and anatomic restoration of the medial and posteromedial corner of the knee are challenges of this combined reconstruction...
February 2019: Arthroscopy Techniques
Jannik Frings, Jan P Kolb, Tobias C Drenck, Matthias Krause, Lena Alm, Ralph Akoto, Karl-Heinz Frosch
Injuries of the posterolateral corner (PLC) of the knee lead to chronic lateral and external rotational instability. Successful treatment of PLC injuries requires an understanding of the complex anatomy and biomechanics of the PLC. Several open PLC reconstruction techniques have been published. It is understood that anatomic reconstruction is superior to extra-anatomic techniques, leading to better clinical results. An open, anatomic, fibula-based technique for reconstruction to address lateral and rotational instability has been described...
February 2019: Arthroscopy Techniques
Daniel B Haber, Petar Golijanin, Genevra L Stone, Anthony Sanchez, Colin P Murphy, Liam A Peebles, Connor G Ziegler, Jonathan A Godin, Jake A Fox, Matthew T Provencher
Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, particularly among young athletes participating in contact sports. Injuries to the AC joint most commonly occur from direct impact at the acromion and are classified as types I to VI. Although most AC joint injuries can be treated nonoperatively, types IV to VI are best treated with surgery, with type III being controversial and most surgeons recommending an initial trial of nonoperative treatment. Although numerous surgical techniques have been described, no gold standard technique has been established...
February 2019: Arthroscopy Techniques
Mitchell I Kennedy, Ramesses Akamefula, Nicholas N DePhillipo, Catherine A Logan, Liam Peebles, Robert F LaPrade
Fibular collateral ligament (FCL) injuries can present as lateral-sided knee pain with feelings of side-to-side instability during activity. Patients with FCL injuries can have accompanying symptoms related to irritation of the common peroneal nerve. Preoperative diagnosis is imperative and should include a thorough physical examination complemented with varus stress radiographs before surgical reconstruction is indicated. In the adolescent cohort, surgical planning can be complicated by the presence of open physes, and caution must be taken to avoid drilling through or placing screw fixation across the physes...
February 2019: Arthroscopy Techniques
Konrad Malinowski, Adrian Góralczyk, Krzysztof Hermanowicz, Robert F LaPrade
The medial meniscus is one of the most commonly injured structures in the knee. When the importance of its proper function is well understood, an adequate management in meniscus tear is a key issue for whole knee joint well-being. Although it has been proven that meniscal repairs have better long-term results than meniscectomy, there is still no consensus as to which suturing technique is the best. An all-inside technique seems to allow for the most anatomic repairs with the greatest preservation of surrounding soft tissues...
February 2019: Arthroscopy Techniques
Graham Tytherleigh-Strong, Alex Mulligan
Failure, in the form of recurrent shoulder instability, following a coracoid transfer procedure presents a challenging problem. Successful treatment with a revision Eden-Hybinette procedure, by both an open and arthroscopic approach using screws to secure the bone graft, has previously been reported. However, both the open and arthroscopic approach have required careful dissection through the distorted soft-tissue anatomy in the anterior compartment in front of subscapularis to gain access to the front of the glenoid through a muscle split...
February 2019: Arthroscopy Techniques
Adam Yiu Chung Lau, Tun Hing Lui
Stenosing tenosynovitis of the posterior tibial tendon is a cause of posteromedial ankle pain. Conservative treatment is often ineffective, and surgery is usually required for alleviation of symptoms. Stenosis of the tendon sheath can be overcome by release of the tendon sheath or deepening of the retromalleolar groove. These procedures can be performed endoscopically. The purpose of this Technical Note is to describe the technical details of endoscopic release of the posterior tibial tendon sheath with the advantage of minimal soft tissue dissection and titrated tendon sheath release according to the extent of stenosis...
February 2019: Arthroscopy Techniques
Tun Hing Lui, Adam Yiu Chung Lau
Stenosing tenosynovitis of the extensor carpi ulnaris is one of the causes of dorsoulnar wrist pain. Conservative treatment is usually effective to alleviate the pain. Surgical release of the retinaculum of the sixth extensor compartment is indicated if conservative treatment cannot alleviate the pain. The purpose of this Technical Note is to describe the technical details of endoscopic release of the sixth extensor compartment via a 2-portal approach. Endoscopic resection of a ganglion over the sixth compartment can also be performed via the same approach...
February 2019: Arthroscopy Techniques
Chun Lok Chow, Tun Hing Lui
Tuberosity avulsion fractures of the fifth metatarsal are common and the lateral band of the plantar aponeurosis as the structure more likely to cause these fractures. Most tuberosity avulsion fractures heal by 8 weeks with conservative treatment. Symptomatic nonunion can occasionally occur. Internal fixation with or without bone graft is the treatment of choice for painful nonunion if conservative treatment fails. The purpose of this Technical Note is to describe the details of endoscopic management of nonunion of the tuberosity of the fifth metatarsal without diastasis...
February 2019: Arthroscopy Techniques
Remko J A Sonnega, Job L C van Susante, Enrico de Visser
Osteochondritis dissecans of the hip is a rare condition with limited treatment options. For patients who have undergone arthroscopic microfracture and chondroplasty, long-term results showing clinical improvement are scarce. Although open osteochondral grafting is a demanding and invasive procedure, promising results are reported after short-term follow-up. We present a technique for an arthroscopic autologous osteochondral transplantation with a graft from the ipsilateral knee to the femoral head.
February 2019: Arthroscopy Techniques
Lewis L Shi, Andrew K Sohn, Xiexiang Shao, Peng Wang, Xiaoming Xu, Fangwei Zou, Jianhua Wang
Intra-articular glenohumeral injection is an important technique used to diagnose and treat shoulder disorders. However, it is frequently performed as an image-guided technique with the use of fluoroscopy, ultrasound, computed tomography, or magnetic resonance. The purpose of this Technical Note is to describe a transcoracoacromial ligament glenohumeral injection technique that uses anatomic surface landmarks to avoid the need for radiographic guidance. After identification of the anterolateral corner of acromion, the superior lateral border of the coracoid tip, and the curved depression of the distal clavicle, the needle entry site is determined at the trisection point between the distal and middle thirds of the line formed by the superior lateral border of the coracoid tip and the curved depression of the distal clavicle...
February 2019: Arthroscopy Techniques
Jorge Chahla, Benjamin Sherman, Frank Wydra, Michael B Gerhardt
Hip arthroscopy is commonly performed for the treatment of femoroacetabular impingement and labral pathology. When arthroscopy for femoroacetabular impingement is performed, a capsulotomy is often utilized to maximize access and allow for improved visualization. When an extended interportal or T capsulotomy is performed, the iliofemoral ligament is transected, which can lead to micro or gross instability. The purpose of this Technical Note is to describe an alternative approach to the standard T capsulotomy using a pie crusting technique, which provides improved visualization of the femoral head-neck junction during the femoroplasty without the need for an extended capsulotomy and can also serve to create venting holes that prevent hematoma formation within the capsule...
January 2019: Arthroscopy Techniques
Richard A C Dimock, Christina Kontoghiorghe, Paolo Consigliere, Shadi Salamat, Mohamed A Imam, A Ali Narvani
Distal triceps rupture is an uncommon but debilitating injury, and surgical fixation is almost invariably warranted. A number of techniques have been described in the literature in which combinations of transosseous tunnels and bone anchors have been used. We describe a modification to existing techniques-the triceps pulley-pullover technique with all-suture anchors. This technique minimizes bone loss, while maximizing the bone-tendon contact area and creating a double-row repair to optimize strength and healing...
January 2019: Arthroscopy Techniques
Tun Hing Lui, Chun Lok Chow
Osteochondral lesions of the talar head can be classified into 4 types: type 1 is located at the anterior part of the talar head, type 2 is at the plantar side of the talar head, type 3 is at the plantar lateral side of the talar head, and type 4 is at the plantar medial aspect of the talar head. The purpose of this Technical Note is to describe the details of arthroscopic management of an osteochondral lesion of the plantar medial talar head. It includes arthroscopic synovectomy of the medial recess of the anterior subtalar joint, debridement, and microfracture of the osteochondral lesion...
January 2019: Arthroscopy Techniques
Ryan J McNeilan, Michael Rose, Omer Mei-Dan, James Genuario
Hip adduction is accomplished through coordinated effort of the adductor magnus, brevis, and longus and the obturator externus and pectineus muscles. Each of these muscles may be injured at its proximal or distal insertion or in its midsubstance. The incidence of injuries to the adductor complex is difficult to determine in sport because of players' underreporting and playing through minor strains. The most commonly injured adductor muscle is the adductor longus muscle. The injury most frequently occurs at the proximal or distal musculotendinous junction, but several case reports of origin and insertional ruptures of the adductor longus exist in the literature...
January 2019: Arthroscopy Techniques
Sung-Jae Kim, Woo-Hyuk Chang, Su-Keon Lee, Ju-Hwan Chung, Keun-Jung Ryu, Sul-Gee Kim
Large posterolateral corner loss type of discoid lateral meniscus tear is unsalvageable. Therefore, subtotal meniscectomy has been the only treatment option in this case. However, long-term results of subtotal or total meniscectomy have shown a high prevalence of early degenerative changes. Persistent symptoms, such as increased pain, snapping, giving way, locking, and limited extension, can be attributed to progressive loss of posterior tibial meniscal attachment and meniscal degeneration, especially in the posterior horn...
January 2019: Arthroscopy Techniques
Sheeba M Joseph, John P Fulkerson
Medial patellofemoral ligament reconstruction risks patellar fracture with the osseous violation necessary for patellar attachment. Anatomic studies identify an entire medial patellofemoral complex of structures responsible for medial restraint to patellar lateral instability. One specific component of this complex is the medial quadriceps tendon femoral ligament (MQTFL). This note presents the technique, pearls and pitfalls, and critical surgical anatomy necessary for successful MQTFL reconstruction-a treatment strategy for patellar instability with no increased risk for patellar fracture...
January 2019: Arthroscopy Techniques
William T Pennington, Steven W Chen, Brian A Bartz, Joann M Pauli
Massive irreparable rotator cuff tears in the younger, active patient can be one of the most challenging pathologies to treat in shoulder surgery. Over the last few years, the superior capsular reconstruction (SCR) technique, which has shown favorable initial clinical results, has emerged as a promising new technique that aims to restore glenohumeral mechanics and improve patient function. SCR can be technically challenging, and improvements have been made consistently to the technique. In this Technical Note, we present our knotless technique of glenoid fixation using push-in anchors and suture tapes...
January 2019: Arthroscopy Techniques
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