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Journal of Wrist Surgery Feb 2024In symptomatic chronic injury of ulnar-sided tear of the triangular fibrocartilage complex, reconstruction techniques involving foveal reconstruction with palmaris...
In symptomatic chronic injury of ulnar-sided tear of the triangular fibrocartilage complex, reconstruction techniques involving foveal reconstruction with palmaris longus tendon graft using the method described by Bain have been described with good outcomes. With increasing popularity of wrist arthroscopy to address various wrist pathologies, we present our technique of arthroscopic foveal reconstruction. We also include a step-by-step description of the procedure with illustrations, with aims to aid surgeons in executing it Unlike other arthroscopic techniques described, this involves single osseous ulnar tunnel and performed completely arthroscopically, allowing an end result similar to Bain's open technique.
PubMed: 38264134
DOI: 10.1055/s-0042-1751017 -
Arthroscopy Techniques Apr 2022Avascular necrosis (AVN) of the humeral head is debilitating condition that, when left untreated, can progress to humeral head collapse and end-stage arthritis of the...
Avascular necrosis (AVN) of the humeral head is debilitating condition that, when left untreated, can progress to humeral head collapse and end-stage arthritis of the glenohumeral joint. Core decompression is widely regarded as a first-line surgical treatment for early-stage AVN, and when performed on the appropriate patient, core decompression is an effective treatment for improving symptoms and preventing progression and humeral head collapse. This article discusses operative indications and presents a relatively simple and effective arthroscopic method for core decompression of humeral head avascular necrosis.
PubMed: 35493042
DOI: 10.1016/j.eats.2021.11.016 -
Arthroscopy Techniques Oct 2016Surgical treatment of recalcitrant patellar tendinopathy includes both the open surgical approach and minimally invasive arthroscopic debridement. A variety of...
Surgical treatment of recalcitrant patellar tendinopathy includes both the open surgical approach and minimally invasive arthroscopic debridement. A variety of arthroscopic techniques have been described that involve the use of a standard 30° arthroscope and standard anterolateral and anteromedial portals. As a result, visualization of the infrapatellar region can be variable, and it may be necessary to create additional portals. A 70° arthroscope provides the advantage of a wider field of view to the surgeon. By placing a 70° arthroscope through a superolaterally created portal around the knee joint, the surgeon acquires a complete view of the infrapatellar region and patellar tendon. Thus, debridement of the pathologic area can be accomplished just by the use of an additional working portal, typically the anterolateral one. This technical note describes a technique that involves the use of a 70° arthroscope for the treatment of patellar tendinopathy.
PubMed: 27909679
DOI: 10.1016/j.eats.2016.05.014 -
Arthroscopy Techniques Jul 2022Snapping scapula syndrome (SSS) is a painful and debilitating condition that occurs as a result of disruption of normal scapulothoracic articulation and inflammation of...
Snapping scapula syndrome (SSS) is a painful and debilitating condition that occurs as a result of disruption of normal scapulothoracic articulation and inflammation of numerous soft tissue and bursal structures that function to facilitate scapulothoracic motion. Historically, when nonoperative management of SSS failed, patients progressed to open surgical management. However, as arthroscopic techniques have evolved, the condition has been increasingly treated arthroscopically because of the minimally invasive nature, periscapular muscle-preserving approach with decreased risk to surrounding neurovascular structures, better intraoperative visualization, and quicker patient recovery and rehabilitation. The objective of this Technical Note is to describe our arthroscopic approach for the management of SSS using two portals to complete a scapulothoracic bursectomy and partial scapulectomy of the superomedial scapula. Level of Evidence: Level I: shoulder.
PubMed: 35936838
DOI: 10.1016/j.eats.2022.02.028 -
Arthroscopy Techniques Oct 2015The role of bone loss from the anterior glenoid in recurrent shoulder instability has been well established. We present a completely arthroscopic technique for...
The role of bone loss from the anterior glenoid in recurrent shoulder instability has been well established. We present a completely arthroscopic technique for reconstructing the anterior glenoid with distal tibial allograft and without a subscapularis split. We perform the arthroscopy in the lateral position. We measure and size an allograft distal tibial graft and place it arthroscopically. We use an inside-out medial portal to introduce the graft into the shoulder, passing it through the rotator interval and above the subscapularis. A double-cannula system is used to pass the graft, which is temporarily fixed with K-wires and held in place with cannulated screws. We then perform a Bankart-like repair of the soft tissues to balance the shoulder and augment our repair. Our technique is not only anatomic in the re-creation of the glenoid surface but also anatomic in the preservation of the coracoid and subscapularis tendon and repair of the capsulolabral complex.
PubMed: 26697303
DOI: 10.1016/j.eats.2015.04.005 -
Arthroscopy Techniques Dec 2021Knee stiffness with severe flexion and extension impediment is a common clinical condition that challenges orthopaedic surgeons. Arthroscopic release techniques have...
Knee stiffness with severe flexion and extension impediment is a common clinical condition that challenges orthopaedic surgeons. Arthroscopic release techniques have been reported, mostly for slight extension or flexion deficits. However, for severe flexion- and extension-impeding knee stiffness, especially when there is no intra-articular space in which to place the arthroscope, effective arthroscopic release techniques are still being pursued. We introduce a systemic arthroscopic release technique to address this special condition, in which a trans-infrapatellar fat pad release technique is developed to obtain access to the joint and to perform intra-articular and periarticular release, as well as scar tissue removal. One critical point of this technique is to create the posteromedial and posterolateral portals to re-establish the posterior compartments, remove the fibrotic posterior septum, and release the posterior capsule. This technique combines almost all related arthroscopic techniques in the treatment of knee stiffness. We consider that the introduction of this technique will provide a useful guide when surgical release is selected for this special condition.
PubMed: 35004158
DOI: 10.1016/j.eats.2021.08.023 -
Orthopaedics & Traumatology, Surgery &... Jun 2019The majority of knee arthroscopic procedures are performed with 30° scope while the 70° arthroscope is mainly used for surgery of posterior compartments. In the...
The majority of knee arthroscopic procedures are performed with 30° scope while the 70° arthroscope is mainly used for surgery of posterior compartments. In the arthroscopic armamentarium, another scope, unknown to many surgeons, is also available: the 45° arthroscope. His field of view provides a wider intraoperative view than that of a 30° scope without the characteristic blind spot of a 70° scope. Therefore, the surgeon's orientation is not compromised. because the optic has always an element of forward vision. With these advantages, the 45° scope can be used in all knee surgical procedures without the need for having two scopes sterilized on the surgical table with less risk of contamination and less surgical time. The 45° scope may also be valuable for the arthroscopic surgery of other joints with the same advantages.
Topics: Anterior Cruciate Ligament; Arthroscopes; Arthroscopy; Equipment Design; Humans; Knee Joint; Meniscus; Posterior Cruciate Ligament
PubMed: 30853456
DOI: 10.1016/j.otsr.2019.02.003 -
Arthroscopy Techniques Jan 2021Biceps tenodesis is a common treatment method for biceps pathology. When tenodesis is located in intra-articular or suprapectoral areas, the biceps is fixed proximally...
Biceps tenodesis is a common treatment method for biceps pathology. When tenodesis is located in intra-articular or suprapectoral areas, the biceps is fixed proximally to the zone of degeneration and inflammation, which can cause residual pain as a possible postsurgical complication. The main advantage of this method is that this technique is comparatively easy and can be performed arthroscopically. Typically, in terms of professional athletes, the best post-biceps tenodesis results are observed after undergoing subpectoral tenodesis because of the solid fixation and localization distally to any kind of biceps tendon degeneration and inflammation zone. However, subpectoral tenodesis has several disadvantages, as it is an open procedure that can lead to possible scar and hematoma formation, infection, bioabsorbable screw reaction, neurovascular injury, and fractures. Soft-tissue tenodesis to the proximal part of pectoralis major tendon is a well-known step in shoulder arthroplasty surgery and shows acceptable results. We suggest a technique of proximal subpectoral arthroscopic tenodesis, which combines the advantages of the location in the subpectoral zone with an all-suture anchor and that of soft-tissue tenodesis to the pectoralis major tendon, which can be performed fully arthroscopically, improving results in terms of healing by increasing the contact area.
PubMed: 33532200
DOI: 10.1016/j.eats.2020.08.038 -
Journal of Hand and Microsurgery Aug 2020Patients with scaphoid nonunion and wrist pain may have a wide spectrum of potential concomitant pathologies that may be diagnosed and potentially managed...
Patients with scaphoid nonunion and wrist pain may have a wide spectrum of potential concomitant pathologies that may be diagnosed and potentially managed arthroscopically. The aim of this study is to assess the usefulness of wrist arthroscopy in the assessment and treatment of scaphoid nonunion and any associated injuries. We retrospectively reviewed 34 consecutive patients with established scaphoid nonunion between January 2006 and December 2012 who had undergone arthroscopic assessment. The average age of the patients was 40 years (range: 25-64), and all the patients had arthroscopic assessment of the wrist joint before definitive surgery. The patients with associated intra-articular problems, which could be addressed along with the scaphoid open reduction internal fixation (ORIF) and bone grafting (BG), had definite procedure in the same sitting. However, if the patients had major intra-articular pathology that needed change in the management plan, they had staged definitive treatment after discussing with them about the arthroscopic findings. Arthroscopic assessment of the 34 joints showed varying degrees of arthritis affecting radioscaphoid joint (41%) followed by injuries to the triangular fibrocartilage complex (TFCC) (35%), lunotriquetral ligament (LTL) tears (32%), and scapholunate ligament (SLL) injuries (26%). Concomitant procedures performed during the wrist arthroscopy included debridement of synovitis (62%), TFCC debridement (32%), loose body removal (17%), and DRUJ stabilization and TFCC repair (3%). Twenty-nine patients had arthroscopy and definitive procedure in the same sitting, and the remaining had staged or delayed definitive treatment. Our study highlights the usefulness of wrist arthroscopy in assessment and management of the scaphoid nonunion and associated pathologies. Besides in 18% of our patients, the initial management plan changed after arthroscopy. This is a Level IV study.
PubMed: 32788824
DOI: 10.1055/s-0039-1692929 -
Journal of Wrist Surgery Dec 2021The dorsal intercarpal ligament, whose role in dorsal stability of the wrist has been shown, can be harmed in case of injury to the dorsal scapholunate complex....
The dorsal intercarpal ligament, whose role in dorsal stability of the wrist has been shown, can be harmed in case of injury to the dorsal scapholunate complex. However, dorsal intercarpal ligament injury also seems to exist isolated posttraumatic forms of dorsal intercarpal ligament rupture, much rarer, through bony avulsion on its scaphoid insertion. The authors report the first description of this lesion, and propose a technique for arthroscopic repair. Radiocarpal arthroscopy will confirm the bony avulsion of the dorsal intercarpal ligament from the scaphoid. Under arthroscopic control, an anchor can be placed into the dorsal aspect of the scaphoid and the ligament can be reattached along with the dorsal capsule. Between 2018 and 2020, seven patients underwent arthroscopic repair of this particular injury. They presented a painful preoperative wrist with decreased range of motion, and were treated arthroscopically, with anchored reinsertion of the ligament on the scaphoid. After a mean follow-up period of 12 months, arthroscopic repair showed decreased pain (6.7 to 0.2), improved range of motion in flexion (66 to 82 degrees) and extension (57 to 87 degrees°), and improved Disabilities of the Arm, Shoulder, and Hand (DASH) score (68.45 to 2.23). This lesion has so far never been reported in the literature, and seems mechanically different from more common injuries of the scapholunate complex and dorsal capsulo-scapholunate septum with which dorsal intercarpal ligament ruptures are frequently associated. Arthroscopic repair with an anchor is possible without difficulty and seems to give very good results at 1-year follow-up (normal strength and range of motion).
PubMed: 34881111
DOI: 10.1055/s-0041-1728803