Arthroscopy portals

BACKGROUND/OBJECTIVE: Arthroscopic lateral ligament repair (ALLR) for chronic lateral ankle instability (CLAI) has been improving with technical innovations. However, there is a lack of information regarding mid- and/or long-term clinical outcomes after the introduction of ALLR. This study aimed to report mid-term clinical outcomes of ALLR with a knotless anchor. METHODS: Thirty-two patients (11 men and 21 women; mean age, 28 ± 14 years) who underwent ALLR with a knotless anchor from December 2015 to October 2020 were included...

BACKGROUND: To assess the clinical and functional outcomes of all-inside arthroscopic anatomical repair of anterior talofibular ligament (ATFL) for management of chronic lateral ankle instability (CLAI) in a considerable number of patients during medium-term follow-up. METHODS: A retrospective analytic study was performed on 100 patients with CLAI who presented between August 2015 and July 2020 (average age: 32.9 years; range: 16-54 years). All-inside arthroscopic ATFL direct repair was performed in all patients through 2 portals only with fixation using 2 knotless anchors...

Bone-patellar tendon-bone (BTB) is a graft material used in anterior cruciate ligament (ACL) reconstruction. We describe creating a femoral tunnel using an inside-out posteromedial (PM) portal technique during anatomic double-bundle ACL reconstruction with a hamstring graft. We hypothesized that applying this femoral tunnel creation method to the revision ACL reconstruction using BTB would enable reconstruction in 1 stage. In this technique, an anteromedial, an anterolateral, and a PM portal are created to confirm the original ACL footprint and location and direction of the bone tunnel during primary reconstruction...

Ulnar bursa of the hand invaginates the flexor digitorum superficialis and flexor digitorum profundus tendons of the little, ring, long, and index fingers. Distension of this bursa can have an inflammatory or infective cause. It can also originate from pathology of another site (e.g., degenerative wrist joint). Because of the tough overlying palmar aponeurosis, distended ulnar bursa can have swelling at a remote site. The distended ulnar bursa can also have compressive neuropathy to the ulnar nerve and median nerve...

Arthroscopic posterior bone block procedure using cortical screws has been reported since 2012 for management of recurrent posterior instability associated with bone defects. To avoid screw complications, we describe a full arthroscopic technique based on cortical button fixation. With 4 portals (posterior, poster lateral, anterior, and anterolateral), we use a specific glenoid guiding system (to perform 2 tunnels) and 2 cortical buttons fixation. With a specific glenoid guide, the iliac crest bone graft (ICBG) is secured to the posterior glenoid rim by fixation with 2 cortical buttons...

The posterior cruciate ligament (PCL) is an important restraint to posterior tibial translation. PCL reconstruction is one of the most challenging procedures, with the literature having described many techniques for reconstruction. Protecting the neurovascular structures, overcoming the "killer turn," preserving bone, and reducing morbidity and postoperative pain are a few of the technical challenges that surgeons often encounter during PCL reconstruction. We describe a technique using a graft-link construct through the anteromedial portal for all-inside PCL reconstruction with remnant preservation that protects the graft from the killer turn of the tibia by smooth passage of the graft over the remnant and improves proprioception, thereby reducing postoperative pain and morbidity and achieving excellent functional outcomes...

A ramp lesion is a specific type of tear in the meniscocapsular junction of the posterior horn of the medial meniscus, usually associated with anterior cruciate ligament (ACL) injury. Biomechanical cadaveric studies have shown that ACL injury combined with ramp lesions significantly increases anterior tibial translation and external rotation, which ACL reconstruction alone cannot completely control. Additionally, ramp lesions are sometimes associated with medial meniscal defects, especially in cases of chronic ACL deficiency after repetitive traumatic events, in which the anatomical repair of the meniscocapsular junction is infeasible...

Arthroscopy and endoscopic hip surgery have attracted increasing attention in the orthopedic field. In the case of arthroscopy, portals and their relationships with neurovascular bundle structures at risk are well established. However, studies on endoscopic portals used for the repair of hamstring tendon injuries are insufficient. Hamstring injuries are the most common muscle injury in sports medicine, and up to 12% can present as a tendon rupture. Endoscopic surgery is advantageous because it has a lower rate of bleeding and avoids excessive handling of the gluteal muscles...

Elbow arthroscopy is an important surgical technique for the treatment of various elbow pathologies. Range of indications for elbow arthroscopy include, but are not limited to, diagnostic evaluation, removal of loose bodies, synovectomy, contracture releases, lateral epicondylitis treatment, and adjunct use for fracture reduction. Surgeons' understanding of anatomy and portal placement is critical for successful treatment. This article reviews the relevant surgical anatomy, portal placement, patient positioning, surgical indications, and complications for this technique...

INTRODUCTION: Meniscal pathology constitutes a major reason for a vast number of patients suffering from knee pain. It is, in general, attributed either to meniscal tearing or degeneration. Debridement and partial meniscectomy, or repair, when possible, is the mainstay surgical approach for refractory knee pain from meniscal degeneration or tears. Sometimes, the patient has clinical symptoms of meniscal pathology, but despite those highly suggestive clinical symptoms, the patient turns out, during knee arthroscopy, to have meniscal degeneration and hardening of the meniscus without frank tearing of the meniscus...

Elbow arthroscopy enables surgeons to treat a vast range of elbow injuries and pathologies in a minimally invasive manner. It has a lower morbidity rate and is often followed by a faster recovery than traditional open surgery unless it is followed by a serious complication. Although most complications are minor and transient, the incidence of both minor and major complications is considerably higher than that after arthroscopy of other joints, specifically the risk of neurovascular injury including permanent nerve injury because of the proximity of neurovascular structures...

The surgical management of medial meniscus ramp lesions can be challenging. Currently, repairs are performed via a trans-notch view, combined with a single posteromedial working portal. This technique, however, does not allow for a direct and complete visualization of the structures being injured, making a precise appreciation of the injured structures, as well as an anatomical repair, difficult. To overcome this limitation, a 2-portal posteromedial approach has recently been described. It allows better visualization of the mediolateral extent of the tear and a precise identification of the injured structures...

INTRODUCTION AND IMPORTANCE: Primary Synovial chondromatosis is a rare disease characterized by metaplastic cartilaginous nodules originating from the synovium, which rarely involves the ankle joint. To date, there has been a limited number of reported cases regarding the arthroscopic treatment of this disease, which can be attributed to its rare incidence. This article aims to illuminate the advantages and challenges of this technique by presenting a case study. Furthermore, we delve into the existing literature to assess the different treatments used for this disease and their outcomes...

Cam-type femoroacetabular impingement is characterized by a pathologic asphericity of the femoral head-neck junction, and arthroscopic femoral osteoplasty is indicated to correct the bony abnormality and restore normal hip mechanics when symptomatic. Residual femoroacetabular impingement deformity after arthroscopy is a leading cause of failure, and it is therefore critical to perform a thorough fluoroscopic and dynamic assessment when addressing cam deformities arthroscopically. The fluoroscopic assessment uses 6 anteroposterior views, including 3 in hip extension (30° internal rotation, neutral rotation, and 30° external rotation) and 3 in 50° flexion (neutral rotation, 40° external rotation, 60° of external rotation), performed before, during, and after the femoral resection...

Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the "reverse wafer procedure" for ulnar impaction syndrome...

Wrist arthroscopy could be a treatment option for dorsal ganglion cysts. To achieve a thorough dorsal capsulectomy for the removal of midcarpal ganglion cysts, it is commonly necessary to combine both the radiocarpal and midcarpal portals. We present a modified method using radiocarpal portals only for arthroscopically excising dorsal midcarpal ganglion cysts. No extra midcarpal portals are necessary, and the method potentially generates satisfactory results.

INTRODUCTION: Tibial spine avulsion injury, tibial eminence injury, tibial spine fracture, and anterior cruciate ligament (ACL) avulsion are multiple terms that express the same pathological condition. It can be encountered both in the pediatric and adult population. A wide array of surgical techniques have been proposed to manage displaced tibial spine avulsions. Anyway, insufficient evidence is currently available to prefer one fixation technique over another, and a gold-standard arthroscopy-based technique is still missing...

BACKGROUND: As a common disease in orthopedic clinics, popliteal cysts often coexist with intra-articular lesions. Compared with traditional open surgery, arthroscopic treatment of popliteal cysts is less traumatic, and intra-articular lesions can be treated. The 'one-way valve' mechanism of the popliteal cyst can be removed by expanding the communication between the articular cavity and the cyst to avoid cyst recurrence. In terms of arthroscopic techniques, the comparison of clinical effects between the double posteromedial portal (DPP) and single posteromedial portal (SPP) has rarely been studied...

OBJECTIVE: To evaluate the feasibility of feline diagnostic coxofemoral arthroscopy. STUDY DESIGN: Ex vivo feline cadaveric descriptive study. ANIMALS: Seven feline cadavers (14 hips). METHODS: Gross dissection of two feline hips was performed to evaluate anatomic landmarks, guide arthroscopic portal development, and determine optimal limb positioning. A 1.9 mm, 0° arthroscope, inserted through a supratrochanteric lateral portal, was used to assess intraarticular structures in 12 feline cadaver hips...

BACKGROUND: Arthroscopic suture repair is the main treatment option for hip labral tears; however, anchor insertion and placement from arthroscopic portals is difficult. PURPOSE: To quantitatively evaluate the safety of various arthroscopic portals for suture anchor placement during hip labral repair. STUDY DESIGN: Descriptive laboratory study. METHODS: The computed tomography scans of 20 patients with normally developed hip joints were used to create 3-dimensional models...