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Arthroscopy Techniques Nov 2018Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment,...
Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment, these structures can cause extreme discomfort and morbidity, including pain from rupture and symptoms from neurovascular compromise. Prior to the development of the arthroscope, open treatment of popliteal cysts was not uncommon. Complications such as poor wound healing, cyst recurrence, and knee flexion contractures were reported after such treatment. Owing to the presence of a valve-type structure, also called the , there is 1-way flow of synovial fluid into the cyst. Although seldom described, there is a reproducible and relatively straightforward arthroscopic treatment for this pathology. This technical report will describe the arthroscopic treatment of popliteal cysts and clarify the posterior knee anatomy that gives the surgeon the landmarks to perform safe and effective arthroscopic treatment of popliteal cysts.
PubMed: 30533356
DOI: 10.1016/j.eats.2018.07.006 -
JBJS Essential Surgical Techniques Jun 2018The olecranon osteotomy-facilitated elbow release (OFER) is a safe and effective method for releasing severe posttraumatic elbow contractures. The OFER procedure is...
BACKGROUND
The olecranon osteotomy-facilitated elbow release (OFER) is a safe and effective method for releasing severe posttraumatic elbow contractures. The OFER procedure is easier, faster, and relatively less invasive, and appears to offer superior outcomes, compared with more traditional techniques.
DESCRIPTION
An olecranon osteotomy provides a trapdoor through which the surgeon will have circumferential access to the joint and will be able to address all intrinsic and extrinsic causes of contracture. Access from the posterior to the anterior compartment is achieved by detaching the origin of the medial collateral ligament (MCL) and hinging the joint from medially to laterally, pivoting around the intact lateral collateral ligament. Once the olecranon and MCL are repaired, the elbow is stable enough for the patient to participate in intensive rehabilitation protocols.
ALTERNATIVES
The first line of treatment for elbow contracture is physical therapy, focusing on range of motion and using modalities such as static-progressive and dynamic splinting protocols. In some select cases, there is also a role for manipulation under anesthesia. When nonoperative methods fail, elbow contractures may be treated surgically, using either open or arthroscopic techniques. Authors have described open release involving medial, lateral, and anterior approaches. The first outcome report of a posterior approach to treat elbow contractures has recently been published.
RATIONALE
An open approach usually utilizes 1 or possibly 2 large incisions and involves invasive dissection through muscle and nerve mobilization. This may result in a postoperative hematoma and usually substantial pain, posing a challenge for rehabilitation. Arthroscopic techniques are less invasive, with potentially fewer complications, but are far more technically challenging. Also, most extrinsic and some intrinsic causes cannot be adequately addressed through the arthroscope. The outcomes of OFER have been found to be superior to those reported after either arthroscopic or more conventional open procedures. In addition, we believe that the OFER procedure is substantially faster and technically easier than either other open or arthroscopic releases, although we are not aware of any studies addressing this topic.
PubMed: 30233986
DOI: 10.2106/JBJS.ST.17.00067 -
Arthroscopy Techniques Jun 2016Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi...
Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function.
PubMed: 27656385
DOI: 10.1016/j.eats.2016.02.007 -
Clinics in Sports Medicine Oct 1999Complications associated with arthroscopic shoulder stabilization are relatively common. Excluding recurrence, complications are rarely disabling. Current statistics... (Review)
Review
Complications associated with arthroscopic shoulder stabilization are relatively common. Excluding recurrence, complications are rarely disabling. Current statistics undoubtedly underestimate the true incidence of complications. Many complications, including neurovascular injuries and articular damage, are preventable and can be minimized through familiarity with anatomy, proper surgical technique and instrumentation, and clinical experience. Nevertheless, despite these efforts, a few complications, including recurrent instability, persist. Despite careful patient selection and attention to labral pathology and capsular laxity, arthroscopic repairs continue to have success rates lower than those achieved through open means. While cautiously proceeding toward a more complete understanding of the instability continuum, surgeons must maintain a high index of suspicion for new techniques that purport to "solve" the problem of arthroscopic shoulder stabilization, lest the history of enthusiastic but ultimately unsubstantiated claims is repeated. Outcomes must withstand the rigors of scientific scrutiny and the test of time. Without this cautious vigilance, the appeal of today's solutions becomes the fodder of tomorrow's articles about the complications of arthroscopic shoulder stabilization.
Topics: Arthroscopes; Arthroscopy; Blood Vessels; Humans; Incidence; Intraoperative Complications; Joint Capsule; Joint Instability; Patient Selection; Peripheral Nerve Injuries; Postoperative Complications; Recurrence; Shoulder Injuries; Shoulder Joint; Treatment Outcome
PubMed: 10553234
DOI: 10.1016/s0278-5919(05)70183-6 -
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 -
BMC Musculoskeletal Disorders Feb 2022Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments...
BACKGROUND
Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure.
METHODS
Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18-57 years), and the mean duration from injury to operation was 7.8 months (range, 3-25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12-26 months).
RESULTS
All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5 in both flexion and extension and around 4 in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities.
CONCLUSIONS
We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.
Topics: Adult; Arthroscopy; Humans; Ligaments, Articular; Range of Motion, Articular; Scaphoid Bone; Wrist Injuries; Wrist Joint
PubMed: 35177051
DOI: 10.1186/s12891-021-04857-7 -
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 Apr 2020The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability in the setting of significant or irreparable rotator cuff tears in elderly...
The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability in the setting of significant or irreparable rotator cuff tears in elderly patients. The procedure comprises an inferior closing wedge partial osteotomy of the coracoid process with fixation to the glenoid neck. This results in a lowered and medialized coracoid process that acts as a bone block and the conjoint tendon is brought closer to the glenohumeral joint, thus closing the subcoracoid space, which blocks humeral dislocation. We describe an arthroscopic step-by-step guided Trillat technique that is simple, efficient, and reproducible, while minimizing risk in the extra-articular subcoracoid space. Our technique does not require the release of the pectoralis minor tendon from the coracoid process, which reduces the risk of damaging the brachial plexus. We use a tight-rope fixation construct that allows progressive transfer of the coracoid process, limiting fracture risk and the risk of overtightening of the subscapularis muscle. Because there is a trend for more complex procedures being performed arthroscopically, it is important to develop and simplify operative techniques, aiding surgeons in achieving reproducible and reliable patient outcomes.
PubMed: 32368472
DOI: 10.1016/j.eats.2019.12.004 -
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 -
Journal of Surgical Case Reports Nov 2022We experienced a case of humeral head impression fracture accounting for approximately 20% of the anterior articular surface. Open reduction and internal fixation of the...
We experienced a case of humeral head impression fracture accounting for approximately 20% of the anterior articular surface. Open reduction and internal fixation of the proximal humeral fracture combined with arthroscope-assisted reduction and internal fixation of the humeral head impression fracture were performed, and good clinical and radiographic outcomes were obtained. Untreated impression fracture may be a potential risk for subluxation or osteoarthritis. However, our arthroscopic approach is minimally invasive and allows for the prevention of these risks.
PubMed: 36452285
DOI: 10.1093/jscr/rjac476