Arthroscopy Techniques

In this study, we introduce an arthroscopic acromioplasty technique based on original bony landmarks, namely biplanar acromioplasty. This technique focuses on smoothing both the coronal and transverse plane of acromion, corresponding to the anterior and inferior acromial surface, and restores the acromion to its original shape. We believe this technique is effective, time-saving, and reproducible.

We present a convenient and safe arthroscopic technique for suturing the lateral meniscus. In this technique, the clinician establishes a conventional posteromedial approach in the figure-of-four position of the knee by using the anterolateral and anteromedial observation approaches. Behind the posterior cruciate ligament, an operational approach is formed through the posterior mediastinum of the knee joint. Through this approach, suture hook can be brought to the posterior horn and body of the lateral meniscus, thus simplifying the suture of the lateral meniscus...

Horizontal cleavage meniscus tears occur more frequently in older patient populations with degenerative changes within the meniscus. Traditionally, they have been managed with nonsurgical interventions or with partial meniscectomy. As increasing evidence demonstrates the link between partial meniscectomy and progressive osteoarthritis with these types of tears, as well as worse long-term outcomes and reduced cost savings, surgical repair of horizontal cleavage meniscal tears has increased in appropriate patients...

An enchondroma is a benign tumor in the medullary cavity of bone, which is composed of mature hyaline cartilage. It has a predilection for the ulnar-sided tubular bones of the hand and occurs most commonly in the proximal phalanx, and less commonly in the middle phalanx and metacarpals, and rarely in the distal phalanx. The treatment options for enchondromas include conservative regular follow-up or surgery. Operation is indicated in symptomatic enchondroma or lesions larger than 3 to 4 cm. The purpose of this Technical Note is to report the technical details of endoscopic curettage and bone grafting of enchondroma of proximal phalanx of finger...

Several surgical techniques have been described to restore the anatomy of the medial collateral ligament, involving suture repair and reconstruction, with the latter having been associated with superior postoperative outcomes. Recently, a growing interest in anatomic isometric medial collateral ligament reconstruction (MCLR) has been developed, involving careful evaluation and finding the most appropriate location for the femoral placement of the allograft. Therefore, the purpose of this article is to describe anatomic MCLR aiming to restore medial knee stability by focusing on isometric positions within the native anatomy of the MCL...

Attempts to restore the anatomical footprint during rotator cuff repair for retracted, relatively immobile tears can be difficult. In some cases, it can lead to excessive tension of the repair. Previous studies have noted improved clinical outcomes when repair tension is not excessive, and medialization of the anatomical footprint has been suggested as a technique that can help surgeons repair large, retracted tears without excessive tension and achieve improved clinical outcomes. Of note, excessive tension when restoring the rotator cuff tendon to the anatomical footprint is not limited to large, retracted tears...

Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft...

Management of ankle sprains is still being discussed. For athletes, recent studies recommend surgical treatment for acute grade III rupture, because of better long-term ankle stability. The purpose of this technical note is to describe the arthroscopic acute double-row repair for proximal disinsertion of collateral lateral ligament ankle. With the patient in dorsal decubitus under spinal anesthesia, the foot and ankle are extended beyond the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon in which the arthroscope is introduced...

The long head of the biceps (LHB) tendon is a common cause of shoulder pain. Biceps tenodesis is commonly used to address biceps and superior labrum pathology, reducing pain and restoring function. There are numerous techniques for biceps tenodesis, and it is unclear as to which single technique and approach provides significantly superior outcomes. In this technical note, we present an arthroscopic suprapectoral approach with release of the LHB from the bicipital groove and subsequent fixation with suture anchor...

Radial meniscus tears occur commonly as traumatic tears in younger patients, as well as in association with concomitant degenerative changes. Traditional management of these tears has centered around partial meniscectomy; however, there has been a more recent trend toward preserving the meniscus and attempting repair. Because of the gapping and displacement that frequently occurs with these tears, repair is often challenging and is done under high amounts of tension. The following article describes a technique using a traction suture to aid in maintaining reduction throughout repair...

In the presence of bone loss, the Bristow or Latarjet procedure is used to alleviate anterior glenohumeral instability. The techniques have gradually improved under arthroscopy. However, such an arthroscopic procedure has a steep learning curve, lengthy operation time, and considerable risk of complications, inhibiting its rapid development. The current method of modified arthroscopic Bristow procedure with screw fixation without subscapularis split reduces surgical time, reduces the risk of nerve damage consequences, and is simple to apply...

Bone tunnel creation in the anatomical location is essential in anterior cruciate ligament (ACL) reconstruction with an autogenous graft and is commonly performed with a drill bit matched to graft diameter. Anatomic rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone autograft has been developed to anatomically create bone tunnels inside the ACL footprints and has been reported to achieve excellent outcomes. To make the rectangular tunnel, the surgeon needs to dilate 2 adjacent bone tunnels after creation of 2 round tunnels with a drill bit, while the tunnel wall occasionally cracks during dilating...

Adequate arthroscopic visualization in the subacromial space is a necessity to appropriately characterize rotator cuff tears and to subsequently develop a suture construct that best reduces the cuff tear with the least tissue tension possible for optimal healing. The purpose of this article and corresponding video is to demonstrate a technique for carrying out a limited deltoid fasciectomy, resulting in enhanced visualization of the rotator cuff through the lateral viewing portal.

The long head biceps tendon is a common culprit of anterior shoulder pain and dysfunction that can be surgically treated with tenotomy or tenodesis. Many techniques exist for tenodesis. This article submits an arthroscopic technique using two loop-and-tack sutures and a knotless suture anchor to tenodese the long head biceps tendon in the proximal bicipital groove in situ. The advantage of this technique is that it maintains the biceps in its native position by performing tenodesis before tenotomy. Most other techniques attempt to restore native position of the biceps through approximation...

In the management of multidirectional type of shoulder instability (MDI), arthroscopic surgical stabilization is a preferred treatment option after failed conservative therapy regimens because of the ability to easily access all aspects of the capsule with one surgical procedure. As arthroscopic techniques have evolved, factors critical to postoperative success have been elucidated. Currently, optimal arthroscopic treatment of MDI involves circumferentially restoring labral integrity, a tailored, patient-specific surgical reduction of capsular volume, and adequately managing potential lesions of the biceps anchor...

Surgical repair of proximal hamstring injuries can relieve pain and restore lower extremity function in active individuals. Whereas traditional surgical techniques are performed via an open approach, more recent endoscopic proximal hamstring repair techniques have proven safe, effective, and potentially associated with fewer complications than open repair. One theorized disadvantage of existing endoscopic techniques is reduced security at the suture-tendon interface, as compared to open surgery, during which a running suture technique, such as a Krackow stitch, may be employed...

Capsule closure during hip arthroscopy is increasingly being shown to optimize outcomes and minimize complications. Although various techniques and suture configurations have been described, closure of the hip capsule remains a technically challenging step for many hip arthroscopists. The purpose of this Technical Note is to summarize capsular management in arthroscopic hip-preservation surgery and to outline a technique of passing capsule sutures under hip traction. This technique is useful, as it facilitates adequate visualization of the vertical limb of the T capsulotomy and interportal capsulotomy, which is difficult when attempted with the hip out of traction and flexed...

Human meniscal treatment with an arthroscopic matrix-based meniscal repair technique is a promising procedure. Heretofore, the procedure has required a skilled surgeon with a great amount of experience in knee arthroscopic surgery and meniscal suturing. A surgical technique using a "goat" delivery clamp has been developed. Technique development followed extensive review and the application of earlier arthroscopic matrix-based meniscal repair techniques, along with cadaveric refinement of the proposed arthroscopic technique...

All-suture anchors (ASA) are newer anchors that anchor soft tissues to the bone. It has several biomechanical and clinical advantages; however, the high cost of this anchor limits its use in low socioeconomic countries. The cost of the anchor dramatically increases the cost of surgery; hence, acceptance of surgery is also affected if patients have to pay their expenditure from their pocket. We have designed a simple, cost-effective method of making an ASA, which can be made instantly and used during surgery; hence, the name "make-and-use anchor...

Intramedullary nailing remains the most popular and preferred method of fixation for tibial shaft fractures. The infrapatellar approach through the patellar tendon has long been considered the gold standard. However, the suprapatellar approach has gained popularity because of the advantages of being easier to perform when treating proximal shaft and metaphyseal fractures and there being less postoperative anterior knee pain. Despite increased use of this approach, the removal of the implant from the same suprapatellar approach is tricky, and in most cases, the removal is performed through a new transpatellar tendon approach...