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International Orthopaedics Apr 2021The purpose of this article is to describe the novel technique of arthroscopic-assisted reduction and internal fixation (ARIF) of talar neck fractures, presenting also...
PURPOSE
The purpose of this article is to describe the novel technique of arthroscopic-assisted reduction and internal fixation (ARIF) of talar neck fractures, presenting also the outcomes of this treatment method in a series of four patients.
METHODS
Between 2011 and 2019, we have treated in our service a number of four patients with talar neck fractures, by the arthroscopic technique. The surgical intervention consists in arthroscopic exploration of tibiotalar and subtalar joints, arthroscopic lavage and debridement, reduction, and osteosynthesis with two cannulated screws under both arthroscopic and fluoroscopic control. Post-operative care consists in non-weightbearing immobilization for 6 weeks, followed by partial loading under the protection of a walking brace for the next six weeks and ROM exercises. The patients were followed up at three months, when a CT scan was performed, and at one year, when X-ray images showed the consolidation of fractures.
RESULTS
Normal or slightly reduced ROM of the ankle and hindfoot was noted in three out of four patients, absence of any pain, or disability (3 patients). The AOFAS' Ankle-Hindfoot scale showed good and excellent results; mean score was 92.75 points (86-98p) at one year after the surgery.
CONCLUSION
Arthroscopic-assisted management of talar fractures offers the advantages of minimally invasive surgery combined with good visualization of the fracture, good control of anatomic reduction, and the possibility to treat associated lesions. Main disadvantages of the method are technical difficulties, requires a prolonged learning curve, and offers limited fixation alternatives.
Topics: Ankle Fractures; Arthroscopy; Fracture Fixation; Fracture Fixation, Internal; Humans; Minimally Invasive Surgical Procedures; Talus; Treatment Outcome
PubMed: 33078205
DOI: 10.1007/s00264-020-04859-5 -
Computer Methods and Programs in... Mar 2023Intraoperative joint condition is different from preoperative CT/MR due to the motion applied during surgery, inducing an inaccurate approach to surgical targets. This...
BACKGROUND AND OBJECTIVES
Intraoperative joint condition is different from preoperative CT/MR due to the motion applied during surgery, inducing an inaccurate approach to surgical targets. This study aims to provide real-time augmented reality (AR)-based surgical guidance for wrist arthroscopy based on a bone-shift model through an in vivo computed tomography (CT) study.
METHODS
To accurately visualize concealed wrist bones on the intra-articular arthroscopic image, we propose a surgical guidance system with a novel bone-shift compensation method using noninvasive fiducial markers. First, to measure the effect of traction during surgery, two noninvasive fiducial markers were attached before surgery. In addition, two virtual link models connecting the wrist bones were implemented. When wrist traction occurs during the operation, the movement of the fiducial marker is measured, and bone-shift compensation is applied to move the virtual links in the direction of the traction. The proposed bone-shift compensation method was verified with the in vivo CT data of 10 participants. Finally, to introduce AR, camera calibration for the arthroscope parameters was performed, and a patient-specific template was used for registration between the patient and the wrist bone model. As a result, a virtual bone model with three-dimensional information could be accurately projected on a two-dimensional arthroscopic image plane.
RESULTS
The proposed method was possible to estimate the position of wrist bone in the traction state with an accuracy of 1.4 mm margin. After bone-shift compensation was applied, the target point error was reduced by 33.6% in lunate, 63.3% in capitate, 55.0% in scaphoid, and 74.8% in trapezoid than those in preoperative wrist CT. In addition, a phantom experiment was introduced simulating the real surgical environment. AR display allowed to expand the field of view (FOV) of the arthroscope and helped in visualizing the anatomical structures around the bones.
CONCLUSIONS
This study demonstrated the successful handling of AR error caused by wrist traction using the proposed method. In addition, the method allowed accurate AR visualization of the concealed bones and expansion of the limited FOV of the arthroscope. The proposed bone-shift compensation can also be applied to other joints, such as the knees or shoulders, by representing their bone movements using corresponding virtual links. In addition, the movement of the joint skin during surgery can be measured using noninvasive fiducial markers in the same manner as that used for the wrist joint.
Topics: Humans; Augmented Reality; Wrist; Arthroscopy; Wrist Joint; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 36608430
DOI: 10.1016/j.cmpb.2022.107323 -
Arthroscopy : the Journal of... Mar 2021The Latarjet procedure is a well-established treatment for shoulder instability. It is traditionally used for recurrent instability with significant bone loss (i.e....
The Latarjet procedure is a well-established treatment for shoulder instability. It is traditionally used for recurrent instability with significant bone loss (i.e. >20%) or after failed soft tissue procedures. It can be done open or arthroscopically with either a subscapularis takedown or a split. It has good long-term results regarding recurrence and clinical outcomes. Unfortunately, it has higher complication rates in comparison to its alternative procedures such as arthroscopic Bankart repair or open Bankart repair. These complications may be due to the learning curve of performing the procedure and lack of proper training. The Latarjet procedure is a necessary tool to treat shoulder instability. We need better training and exposure to Latarjet procedures in residency, fellowship, and clinical practice so that more providers can do this procedure for our patients, but we need to do it more safely.
Topics: Arthroscopy; Humans; Joint Instability; Recurrence; Retrospective Studies; Shoulder; Shoulder Dislocation; Shoulder Joint; Venous Thromboembolism
PubMed: 33673964
DOI: 10.1016/j.arthro.2020.12.202 -
Plastic and Reconstructive Surgery Dec 2022Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the...
BACKGROUND
Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the results obtained by reconstructing the scapholunate ligament with a bone-ligament-bone autograft through an arthroscope-assisted minimally invasive approach.
METHODS
Thirty-six patients were enrolled initially but only 31 constituted the final population study (23 male, eight female; median age, 38 years; age range, 18 to 55 years). Radiographic (posteroanterior and true lateral radiographs to assess the scapholunate gap, radiolunate, and capitolunate angles; computed tomographic scan; magnetic resonance images), functional [grip strength (Jamar test and pinch test), active range of motion], and subjective (patient-rated wrist evaluation test) outcome measurements were collected. Minimum follow-up was 50 months.
RESULTS
Grip strength and wrist mobility were significantly improved from the preoperative values and improved over time. No scapholunate synostosis or carpal bone necrosis was observed. No wrist showed any sign of arthrosis or progression towards wrist instability. Only four patients had scapholunate gap greater than 3 mm.
CONCLUSIONS
The proposed technique for scapholunate reconstruction, providing a biologic reconstruction of both the volar and dorsal portion of the scapholunate ligament and avoiding extensive capsulotomy, obtained significant functional outcomes improvement that was maintained over time and prevented degenerative changes to the articular surfaces.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Humans; Male; Female; Adult; Adolescent; Young Adult; Middle Aged; Lunate Bone; Scaphoid Bone; Arthroscopes; Retrospective Studies; Ligaments, Articular; Wrist Joint; Joint Instability; Range of Motion, Articular
PubMed: 36126203
DOI: 10.1097/PRS.0000000000009736 -
Arthroscopy Techniques Jul 2022Posterior shoulder instability is increasingly recognized and represents a complex continuum of pathology that can be challenging to diagnose and treat. Current surgical...
Posterior shoulder instability is increasingly recognized and represents a complex continuum of pathology that can be challenging to diagnose and treat. Current surgical options involve posterior labral repair with or without capsular plication, as well as bony procedures, including glenoid bone grafting and glenoid osteotomy when indicated, often in the setting of revision. There is presently a dearth of surgical options to directly address the root cause of soft tissue failure, including a diminutive posterior labrum, chondrolabral retroversion, and thin or hyperelastic posterior capsule. This article presents a technique for arthroscopically augmenting the posterior capsulolabral complex in the setting of soft tissue insufficiency, laxity, or poor prognostic factors for failure. Secondarily, this technique provides a lower risk revision option for reconstruction in failed posterior instability without glenoid bone defect.
PubMed: 35936859
DOI: 10.1016/j.eats.2022.03.010 -
Arthroscopy : the Journal of... Mar 2021The pros and cons of open and arthroscopic shoulder stabilization procedures have been studied exhaustively. Yet, in many situations, the rates of recurrent instability...
Editorial Commentary: Arthroscopic Glenoid Reconstruction With Subscapularis Tenodesis Results in Promising Clinical Outcomes, but Concerns Regarding Graft Resorption Rates Persist: A Long Way Toward a More Perfect Union.
The pros and cons of open and arthroscopic shoulder stabilization procedures have been studied exhaustively. Yet, in many situations, the rates of recurrent instability and overall complications associated with these techniques remain unacceptably high. Perhaps paradoxically, the refinement of arthroscopic shoulder stabilization techniques has only intensified the debate between proponents of either open or arthroscopic approaches, and although significant (however "significant" is defined), anteroinferior glenoid bone loss has historically been thought to constitute a relatively strong indication for an open bone augmentation procedure, surgeons, to their great credit, continue to push the limits of what can be accomplished arthroscopically. Arthroscopic glenoid reconstruction has emerged as a viable option that may represent "the best of both worlds." Although modifications to the originally described arthroscopic glenoid reconstruction technique are promising, concerns persist regarding the fate of the graft and the durability of the procedure beyond short-term follow-up.
Topics: Allografts; Arthroscopy; Humans; Ilium; Joint Instability; Rotator Cuff; Shoulder; Shoulder Dislocation; Shoulder Joint; Tenodesis
PubMed: 33673965
DOI: 10.1016/j.arthro.2021.01.009 -
Orthopaedics & Traumatology, Surgery &... May 2022Ramp lesions are found in 16% to 40% of patients undergoing anterior cruciate ligament reconstruction. The repair technique traditionally involves using a suture hook...
BACKGROUND
Ramp lesions are found in 16% to 40% of patients undergoing anterior cruciate ligament reconstruction. The repair technique traditionally involves using a suture hook through a posteromedial portal, with the arthroscope positioned in the intercondylar view via an antero-lateral portal. Ramp lesions may be difficult to visualize and repair, even with a 70° arthroscope. The objective of this study was to assess the feasibility of suturing ramp lesions via dual posteromedial portals for the arthroscope and instruments.
HYPOTHESIS
Dual posteromedial arthroscopic portals allow good visualisation and high-quality suturing of ramp lesions, without inducing specific iatrogenic injuries.
MATERIAL AND METHODS
We used 11 fresh cadaver knees. Two posteromedial portals were created under visualisation via an arthroscope introduced through an antero-lateral portal: one was the traditional instrumental portal and the other, located more proximally, was the optical portal. A 2-cm long ramp lesion was created. A suture hook was used to place one or two stitches of PDS n°0 suture. A probe was used to test the quality and stability of the suturing. The posteromedial plane was then dissected to evaluate the anatomical relationships of the portals.
RESULTS
The dual posteromedial approach allowed the visualisation and hook suturing of the ramp lesions in all 11 cases. A single stitch was placed in 4 cases and two stitches in 7 cases. The suture was always of good quality and stable when tested with the probe. The dissection found no injuries to nerves, blood vessels, or tendons.
CONCLUSION
Ramp lesions can be repaired through a dual posteromedial arthroscopic approach. This surgical technique provides good visibility of these lesions and allows high-quality suturing, with no specific iatrogenic injuries. It is an alternative to ramp lesion repair via a single posteromedial portal, which can be challenging.
LEVEL OF EVIDENCE
IV, experimental study with no control group.
Topics: Anterior Cruciate Ligament Injuries; Arthroscopy; Cadaver; Feasibility Studies; Humans; Iatrogenic Disease; Menisci, Tibial; Tibial Meniscus Injuries
PubMed: 34906726
DOI: 10.1016/j.otsr.2021.103175 -
Arthroscopy Techniques Sep 2022Meniscal tears are among the most common injuries in the knee, and partial as well as total meniscectomy has been advocated as the treatment for meniscal injury. Over...
Meniscal tears are among the most common injuries in the knee, and partial as well as total meniscectomy has been advocated as the treatment for meniscal injury. Over the years, the role of the meniscus as a shock absorber, load transmitter, and secondary anterior stabilizer, along with its proprioceptive and lubrication role, has been well established, and meniscal repair is recommended, especially in younger individuals. Factors such as tear location, pattern, chronicity, size, and extent; repair technique; and patient age and habits can influence meniscal repair, and to enhance meniscal healing, a variety of augmentation techniques have been introduced. These include needling, trephination, synovial abrasion, and the use of adjuvants such as platelet-rich plasma, platelet clots, fibrin clots, bone marrow clots, and stem cells. A second-generation platelet derivative called "platelet-rich fibrin" (PRF) has predictable platelet, growth factor, and cell mediator concentrations without using any anticoagulants. We describe a reproducible and simple way to harvest PRF and create and use a PRF clot, along with detailed instructions on how to integrate the clot with a meniscal repair arthroscopically.
PubMed: 36185123
DOI: 10.1016/j.eats.2022.05.001 -
Arthroscopy Techniques Apr 2024Tendinopathy of the long head of biceps is a relatively common pathology that we usually see in most of our shoulder arthroscopy procedures. Surgical treatment for long...
Tendinopathy of the long head of biceps is a relatively common pathology that we usually see in most of our shoulder arthroscopy procedures. Surgical treatment for long head of biceps tendinopathies ranges from simple biceps tenotomy to biceps tenodesis depending on many factors, two of which are the age and the patient's level of activity. Various techniques in the literature for biceps tenodesis have been described, such as whether to do it open or arthroscopically, suprapectoral or subpectoral, as well as the type of fixation to be used. However, the optimal option is still debatable. In this Technical Note, we describe an arthroscopic technique for distal suprapectoral biceps tenodesis using a knotless corkscrew anchor that has many advantages, such as being an all-arthroscopic with the ability to retension the tendon after implantation. We support our technique with photos and videos with detailed explanations of the technique.
PubMed: 38690349
DOI: 10.1016/j.eats.2024.102922 -
Arthroscopy : the Journal of... Oct 2023Cam-type femoroacetabular impingement is characterized by a pathologic asphericity of the femoral head-neck junction, and arthroscopic femoral osteoplasty is indicated...
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. The dynamic assessment includes evaluation of impingement-free range of motion and "end feel" (a subjective description of the tactile feedback during assessment of hip motion), and should be performed before and after the femoral resection in 3 specific positions (extension/abduction, flexion/abduction, and flexion/internal rotation). Although the anterior aspect of the head-neck junction is readily accessed through standard arthroscopic portals with the hip in 30 to 50° of flexion, the posterolateral, posteromedial, and posterior extent of the femoral head-neck junction are challenging to address. The natural external rotation of the proximal femur during flexion and internal rotation during extension can be used to gain posterior lateral and medial access. Antero/posteromedial femoral access can be obtained with >50° of hip flexion with the burr in the anteromedial portal. Posterolateral femoral access is achieved with hip extension with the burr in the anterolateral portal, and further posterolateral access can be achieved with the addition of traction, allowing resection of posterolateral deformities extending beyond the lateral retinacular vessels while remaining proximal to the vessels. This comprehensive intraoperative fluoroscopic and dynamic assessment and surgical technique can lead to a predictable correction of most cam-type deformities.
Topics: Humans; Femoracetabular Impingement; Plastic Surgery Procedures; Femur; Femur Head; Rotation
PubMed: 37716787
DOI: 10.1016/j.arthro.2023.04.019