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Arthroscopy Techniques Jul 2022Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure, particularly with respect to tibial footprint debridement and tibial...
Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure, particularly with respect to tibial footprint debridement and tibial tunnel placement, where iatrogenic damage to anatomic structures is a well reported complication and incorrect tunnel placement can have functional implications. Preparation of the tibial component often involves switching between 30° and 70° arthroscopes and frequent portal swapping and reorientation, which can be inefficient and time-consuming. As the technology and picture resolution of needle arthroscopy has improved, its clinical application has widened. This manuscript describes the use of needle arthroscopy-assisted arthroscopic PCL reconstruction for optimal visualization of the PCL tibial footprint using an accessory posterolateral portal, while obviating the need of both 30° and 70° arthroscopes.
PubMed: 35936863
DOI: 10.1016/j.eats.2022.03.019 -
Arthroscopy Techniques Apr 2017The fabella is an anatomic variant not seen in all individuals and can potentially be a source of chronic knee pain due to chondromalacia, osteoarthritis, fractures, or...
The fabella is an anatomic variant not seen in all individuals and can potentially be a source of chronic knee pain due to chondromalacia, osteoarthritis, fractures, or biomechanical pressure against the lateral femoral condyle. It is situated intra-articular, close to the lateral femoral condyle, the lateral gastrocnemius head tendon, and the fabellofibular ligament. Given its rarity, the diagnosis of a symptomatic fabella is often overlooked when evaluating patients with persistent posterolateral knee pain. However, this diagnosis should always be considered, especially in high-performance runners, bikers, and triathletes. Although nonoperative management can potentially resolve symptoms associated with this condition, fabella excision via arthroscopically assisted surgery is a reliable and safe alternative to treat patients who do not benefit from nonsurgical treatment. We present our technique detailing fabella excision for treatment of posterolateral knee pain, which includes an arthroscopic evaluation of the fabella to assess damage to the femoral condyle and minimize over-resection and potential damage to surrounding structures.
PubMed: 28580255
DOI: 10.1016/j.eats.2016.10.011 -
Frontiers in Surgery 2022To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) repair and autograft ACL reconstruction for ACL ruptures. (Review)
Review
PURPOSE
To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) repair and autograft ACL reconstruction for ACL ruptures.
METHODS
PubMed, EMBASE, Scopus, Web of Science and The Cochrane Library were searched for relevant studies from 1 January 1990 to 21 March 2022. Two evaluators independently screened the literature, extracted data and assessed the methodological quality of the enrolled studies. Meta-analysis was conducted using RevMan 5.4 software.
RESULTS
Ten studies with mean follow-up periods from 12 to 36 months were included. For 638 patients with ACL ruptures, arthroscopic ACL repair showed statistically comparable outcomes of failure ( = 0.18), complications ( = 0.29), reoperation other than revision ( = 0.78), Lysholm score ( = 0.78), Tegner score ( = 0.70), and satisfaction ( = 0.45) when compared with autograft ACL reconstruction. A significantly higher rate of hardware removal ( = 0.0008) but greater International Knee Documentation Committee (IKDC) score ( = 0.009) were found in the ACL repair group. The heterogeneity of the side-to-side difference of anterior tibial translation (ΔATT) was high ( = 80%). After the sensitivity analysis, the decreased dramatically ( = 32%), and the knees with ACL repair showed significantly greater ΔATT ( = 0.04).
CONCLUSION
For proximal ACL ruptures, arthroscopic ACL repair showed similar clinical outcomes, and even better functional performance when compared to autograft ACL reconstruction. ACL repair has a higher rate of hardware removal, and might be related to greater asymptomatic knee laxity. More high-quality prospective trials are needed to confirm our findings.
PubMed: 35521430
DOI: 10.3389/fsurg.2022.887522 -
Current Reviews in Musculoskeletal... Oct 2020This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs). (Review)
Review
PURPOSE OF REVIEW
This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs).
RECENT FINDINGS
Historically, the LDT has been performed as an open (double-incision) procedure for neurologically intact, relatively young patients with irreparable posterosuperior RCTs with disabling loss of active external rotation with or without impaired active elevation. The transferred tendon reconstitutes the posterior rotator cuff and force couple, respectively and thus has the potential to function effectively as an external rotator and humeral head depressor. Long-term results of the open technique have demonstrated in the majority of patients substantial and durable improvements in shoulder function and pain relief at the 10-year benchmark. With the advancements of arthroscopic surgery, the LDT was expanded to an arthroscopically assisted procedure with promising short-term results. In addition to adequate technical performance, the success of the procedure depends on preoperative factors, such as exclusion of glenohumeral osteoarthritis and acromial acetabularization; intact or reparable subscapularis tendon; intact (or hypertrophic) teres minor muscle; adequate preoperative activity of the latissimus dorsi; and normal or mild impairment of overhead function. The LDT (open or arthroscopically assisted) is a reliable treatment option for patients with massive, irreparable posterosuperior RCTs with disabling loss of active external rotation, with or without diminished overhead function and without advanced glenohumeral osteoarthritis. Precise patient selection is of tremendous importance in the success of the LDT.
PubMed: 32661917
DOI: 10.1007/s12178-020-09659-3 -
BMC Musculoskeletal Disorders May 2020The aim is to describe a new arthroscopically assisted Latarjet technique.
BACKGROUND
The aim is to describe a new arthroscopically assisted Latarjet technique.
METHODS
We evaluated the clinical and radiological findings of 60 patients with chronic recurrent anterior gleno-humeral instability who underwent, between September 2013 and November 2014, an arthroscopically-assisted Latarjet procedure with double round endobutton fixation. Inclusion criteria were: chronic anterior recurrent instability, Instability Severity Index Score (ISIS) greater than three points, a glenoid bone defect > 15% or a Hill Sachs lesion with concomitant glenoid bone defect > 10%. During surgery the joint capsule and the anterior glenoid labrum were detached. Two drill tunnels perpendicular to the neck of the glenoid were made through a guide. An accessible pilot hole through the glenoid was created to allows the passage of guidewires for coracoid guidance and final fixation onto the anterior glenoid. Through a restricted deltopectoral access a coracoid osteotomy was made. Finally, the graft was prepared, inserted and secured using half-stitches.
RESULTS
The mean follow-up was 32.5 months (range 24-32 months). At a mean follow-up, 56 of the 60 subjects claimed a stable shoulder without postoperative complaints, two (3.3%) had an anterior dislocation after new traumatic injury, and two (3.3%) complained of subjective instability. At the latest follow-up, four subjects complained of painful recurrent anterior instability during abduction-external rotation with apprehension. At 1 year, the graft had migrated in one patient (1.7%) and judged not healed and high positioned in another patient (1.7%). Moreover, a glenoid bony gain of 26.3% was recorded. At the latest follow-up, three patients had grade 1 according to Samilson and Prieto classification asymptomatic degenerative changes. Nerve injuries and infections were not detected. None of the 60 patients underwent revision surgery. Healing rate of the graft was 96.7%.
CONCLUSIONS
This technique of arthroscopically assisted Latarjet combines mini-open and arthroscopic approach for improving the precision of the bony tunnels in the glenoid and coracoid placement, minimizing any potential risk of neurologic complications. It can be an option in subjects with anterior gleno-humeral instability and glenoid bone defect. Further studies should be performed to confirm our preliminary results.
TRIAL REGISTRATION
Trial registration number 61/int/2017 Name of registry: ORS Date of registration 11.5.2017 Date of enrolment of the first participant to the trial: September 2013 'retrospectively registered' LEVEL OF EVIDENCE: IV.
Topics: Adolescent; Adult; Arthroplasty; Arthroscopy; Bone Transplantation; Female; Follow-Up Studies; Humans; Joint Instability; Male; Osteotomy; Postoperative Care; Range of Motion, Articular; Retrospective Studies; Shoulder Dislocation; Shoulder Joint; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 32380996
DOI: 10.1186/s12891-020-03307-0 -
Orthopaedic Surgery Oct 2020To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic...
OBJECTIVE
To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation.
METHODS
From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks,8 weeks,3 months,6 months,1 year after surgery) regularly for at least 1 year. At the follow-up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed.
RESULTS
Of the 15 patients, there are seven cases of men, eight cases of women; aged 22-66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%-47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow-up was 38.2 months (range, 12-70 months), and one case was lost to follow-up. With fractures healing well, almost all patients had a good joint function. At the final follow-up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T level; the mean Constant-Murley score was 94.6 points (range, 70-100 points); the mean ASES score was 94.6 points (range, 79-100 points); and the mean VAS score was 0.4 points (range, 0-2 points). No recurrent instability or re-dislocation occurred. No patient had revision surgery.
CONCLUSION
Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow-up time of more than 3 years.
Topics: Adult; Aged; Arthroscopy; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Retrospective Studies; Scapula; Shoulder Fractures; Young Adult
PubMed: 33078582
DOI: 10.1111/os.12786 -
Arthroscopy Techniques Mar 2022There are various technique preferences when performing arthroscopic rotator cuff repair. Currently, most surgeons address all intra-articular pathology as well as...
There are various technique preferences when performing arthroscopic rotator cuff repair. Currently, most surgeons address all intra-articular pathology as well as assess the extent of a rotator cuff tear with the arthroscope in the joint prior to moving to the subacromial space, where they will initiate footprint preparation, anchor placement, and rotator cuff repair. Although this technique often yields good or at least acceptable visualization of the footprint, it does not always provide an optimal view of the medial footprint even when using a "50-yard line view" from a lateral portal. This can particularly be an issue with "cone-shaped" supraspinatus tears in which a smaller full-thickness bursal-sided tear often expands to a much larger articular-sided component. When surgeons are visualizing with the scope in the subacromial space, it is much more difficult to obtain a full appreciation of the extent of the articular-sided tear as well as optimal visualization of the medial footprint right up to the articular margin for both bone preparation and anchor placement. This article describes the benefit of keeping the arthroscope in the joint to facilitate footprint preparation and medial-row suture anchor placement prior to going to the subacromial space. This small technical modification can often offer surgeons far superior visualization of the entire greater tuberosity footprint especially when encountering a cone-shaped tear or high-grade articular-sided tear that requires repair. To further enhance viewing of the footprint with the scope intra-articularly, proficiency in using a 70° scope directed laterally will typically allow surgeons the most ideal view achievable. Once anchors are placed into the medial row, the arthroscope is inserted into the subacromial space to complete the repair.
PubMed: 35256975
DOI: 10.1016/j.eats.2021.10.029 -
Journal of Wrist Surgery Feb 2018Patients with scapholunate instability usually have pain in the dorsal wrist. This pain may occur due to the impingement between the scaphoid and the dorsal rim of...
Patients with scapholunate instability usually have pain in the dorsal wrist. This pain may occur due to the impingement between the scaphoid and the dorsal rim of the radius when the scaphoid is detached from the lunate. This pain appears as the scaphoid is displaced over the dorsal rim of the radius. The arthroscopic scaphoid 3D (dorsal, dynamic, displacement) test is described here to check this pathologic dorsal displacement of the scaphoid. The test should be performed both in the radiocarpal and midcarpal joints. Traction is released and the arthroscope is set under the lunate when tested in the radiocarpal joint and on the lunate when tested in the midcarpal joint. The scaphoid is manually pushed dorsally at the scaphoid tubercle. If there was no scapholunate instability, all the proximal row bones are minimally displaced: a negative test. If there was scapholunate instability, the scaphoid is displaced dorsally while the lunate remains static: evaluated as positive. This test can add information to the arthroscopic classifications of the scapholunate instability, which explore both the proximal to distal displacement of the scaphoid (the step-off) and the ulnar to radial displacement (the gap), as this test explores the volar to dorsal displacement.
PubMed: 29383283
DOI: 10.1055/s-0037-1601578 -
Knee Surgery, Sports Traumatology,... Dec 2015To carry out a systematic review of the literature on arthroscopic-assisted management (all types) of tibial plateau fractures to gain a more comprehensive understanding... (Review)
Review
PURPOSE
To carry out a systematic review of the literature on arthroscopic-assisted management (all types) of tibial plateau fractures to gain a more comprehensive understanding of clinical outcomes with this surgical technique, specifically to determine whether this may be a viable technique for the management of tibial plateau fractures.
METHODS
MEDLINE, Cochrane, and EMBASE databases were searched until July 2013 using combinations of the search terms: tibial plateau, fractures, and arthroscopically/arthroscopic/arthroscopy/percutaneous/minimally invasive. Inclusion criteria were observational study, patients with tibial plateau fractures, and clinical and radiological outcomes assessed using Rasmussen scoring system. The outcome measures of interest were clinical and radiological Rasmussen scores and the prevalence of secondary osteoarthritis.
RESULTS
A total of 12 studies, 5 prospective and 7 retrospective, involving 353 patients were included in the review. The majority of patients in most studies had Schatzker type I-III fractures. The graft material used varied between studies. The length of the follow-up was typically between 34 and 38 months. Mean clinical Rasmussen scores ranged from 25.5 to 28.4. In each study, the majority (≥80 %) of patients had excellent/good clinical Rasmussen scores. In each study, the majority (≥63 %) of patients had excellent/good radiological Rasmussen scores. The proportion of patients who experienced secondary osteoarthritis was variable, ranging from 0 to 47.6 %.
CONCLUSIONS
The results of this systematic review indicate that arthroscopic-assisted management of tibial plateau fractures can be effective. Surgeons should consider using this approach when treating patients with tibial plateau fractures.
LEVEL OF EVIDENCE
III.
Topics: Arthroscopy; Humans; Osteoarthritis; Radiography; Tibial Fractures; Treatment Outcome
PubMed: 25246171
DOI: 10.1007/s00167-014-3256-2 -
Current Reviews in Musculoskeletal... Oct 2020Functionally irreparable rotator cuff tears (FIRCTs) remain one of the most challenging pathologies treated in the shoulder. The lower trapezius transfer represents a... (Review)
Review
PURPOSE OF THE REVIEW
Functionally irreparable rotator cuff tears (FIRCTs) remain one of the most challenging pathologies treated in the shoulder. The lower trapezius transfer represents a very promising treatment option for posterosuperior FIRCT. This article reviews the role for the lower trapezius transfer in the treatment of patient with FIRCTs and highlights the tips and tricks to performing this arthroscopic-assisted procedure.
RECENT FINDINGS
The treatment of posterosuperior FIRCTs contemplates a wide array of surgical options, including partial repair, biceps tenodesis/tenotomy, superior capsule reconstruction, subacromial balloon, reverse shoulder arthroplasty, and open-/arthroscopic-assisted tendon transfers. Tendon transfers have emerged as very promising reconstructive options to rebalance the anterior-posterior force couple. Controversy remains regarding the relative indications of latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT). Initially used with very good success in patients with brachial plexus injuries, the open LTT has shown excellent clinical and radiographic outcomes in a recent series of patients with FIRCTs. However, this technique should be reserved for patients with an intact or reparable subscapularis tendon and no advanced glenohumeral arthritis or humeral head femoralization. With advancements in surgical technique, the arthroscopic-assisted LTT has shown similar promising results. However, studies on arthroscopically assisted LTT are limited to short-term follow-up, and future comparative trials with large patient numbers and longer follow-up are needed to better understand the indications for this novel tendon transfer in the treatment of FIRCT. The arthroscopic-assisted LTT is a novel, promising option for the treatment of patients with functional irreparable posterosuperior rotator cuff tears. Careful attention to indications and technical pearls are paramount when performing this procedure to optimize postoperative clinical outcomes.
PubMed: 32661919
DOI: 10.1007/s12178-020-09657-5