Background: For complete disruption of the posterolateral corner (PLC) structures, operative treatment is most commonly advocated, as nonoperative treatment has higher rates of persistent lateral laxity and posttraumatic arthritis1-5. Some studies have shown that acute direct repair results in revision rates upwards of 37% to 40% compared with 6% to 9% for initial reconstruction3,6. In a recent study assessing the outcomes of acute repair of PLC avulsion injuries with 2 to 7 years of follow-up, patients with adequate tissue were shown to have a much lower failure rate than previously documented7. In the present video article, we demonstrate a transosseous Krackow pull-through technique for repair of acute avulsion-type PLC multiligamentous knee injuries with no midsubstance injury.
Description: An incision is made along the lateral aspect of the knee from the epicondyle to the fibular shaft. The soft-tissue avulsion injury is identified and tagged with suture. Locking Krackow sutures are placed into the injured structures without separating the soft-tissue sleeve avulsion. With fibular avulsions, fibular and tibial transosseous tunnels are drilled with 2 Beath pins through the fibular head and tibia, exiting through the anteromedial tibial cortex. Lateral collateral ligament (LCL) and anterior biceps sutures are passed through the anterior tunnel, and popliteofibular ligament (PFL) and posterior biceps sutures are passed through the posterior tunnel. A small incision is made over the anteromedial tibial cortex in order to tie the sutures over the same metallic button. In fibular head avulsion fractures, high-strength suture placed through the fibular neck can provide additional compression. For proximal PLC injuries, the iliotibial band is incised at the lateral epicondyle, and the proximal attachment sites of the LCL and popliteus are localized. Krackow locking sutures are placed within the LCL and popliteus tendon. Transosseous tunnels are drilled with Beath pins through the native attachment sites of the LCL and popliteus on the lateral condyle and are directed anteriorly to avoid convergence with a potential anterior cruciate ligament (ACL) femoral tunnel. Sutures are pulled through the femoral attachment sites and tied over the same metallic button.
Alternatives: For acute PLC injuries, nonoperative treatment is not endorsed for the majority of cases. Surgical options include direct repair, repair with augmentation, or reconstruction.
Rationale: The transosseous Krackow pull-through technique allows for an enhanced and secure soft-tissue repair while avoiding suture anchor pull-out from the metaphyseal fibular head bone, which can also be compromised by cortical avulsion fractures. This procedure avoids the cost of an allograft and the donor-site morbidity of an autograft that are associated with a reconstruction. For pat
Background: Whereas uncomplicated labral tears with preserved fibers can be effectively treated with use of labral repair techniques, complex tears and hypoplastic labra require labral reconstruction1-3. Standard reconstruction techniques feature grafted tissue that is added to existing, deficient tissue or that is utilized to replace a hypoplastic labrum entirely4-9. However, such approaches utilizing allografts or remote autografts are limited because they often necessitate extensive debridement of the existing labrum to prepare a site for graft implantation, an approach that can damage and devascularize the chondrolabral junction10-14. The presently described technique, arthroscopic capsular autograft labral reconstruction, is suitable for simple tears as well as hypoplastic, degenerative, and complex tears, and negates the challenges of utilizing allografts or remote autografts by supplementing the labrum. In addition, this technique avoids substantial resection, thus preserving the chondrolabral junction15-22.
Description: Following induction of anesthesia and appropriate patient positioning, puncture capsulotomy is performed to enter the hip joint26. In the presence of a sufficiently intact labrum, 3 to 5 mm of capsule is elevated to augment the labrum and preserve the blood supply. In the presence of a severely deficient or hypoplastic labrum, the capsule is elevated 5 to 10 mm to reconstruct the labrum. Following capsular augmentation and potential acetabuloplasty, 2.3-mm bioabsorbable composite anchors are utilized to secure the elevated capsular tissue and the remaining labral tissue to the acetabular rim. Loop suture or a vertical mattress suture technique is then utilized to complete the repair. A Weston knot and several half-hitches are placed while dynamically tensioning along the capsular aspect of the repair in order to secure the labral reconstruction to the acetabular rim with concurrent release of traction. Anchors are placed roughly 1 cm apart to prevent strangulation of the capsular vessels29.
Alternatives: Labral reconstruction options include autografts or allografts7. Potential allografts include the semitendinosus, tibialis anterior, iliotibial band, tensor fasciae latae, and peroneus brevis8-14. Remote autograft sites include the gracilis and quadriceps tendons16,17. These options are limited by increased donor site morbidity and operative time to obtain the grafts. Local autograft sites include the ligamentum teres, indirect head of the rectus femoris, iliotibial band, and hip capsule15,18-23,25.
Rationale: Relative to autografts, the allografts most commonly utilized in labral reconstruction feature a heightened risk of disease transmission, increased cost, and a potentially lengthened time to graft incorporation15. Among the local autograft sites, the uti
Metatarsal fractures are one of the most common injuries of the foot, accounting for approximately 5% to 6% of all fractures confronted in the outpatient setting1. Approximately 45% to 70% of these fractures involve the fifth metatarsal, which have been described using a 3 zonal approach in 1993 by Lawrence and Botte2. Zone 2 fractures are difficult to manage given their retrograde vascular supply, leading to higher rates of nonunion1,3. Jones fractures (zone 2) are primarily treated surgically, with the 2 main methods being intramedullary screw fixation and plate fixation3. Surgical management leads to higher rates of union when compared with nonoperative modalities. Presented here is a technique for zone 2 intra-articular Jones fractures with minimal to moderate displacement via open reduction and internal fixation. This technique is not recommended for comminuted fractures or those with proximal split fractures. Starting with the foot lateral, this technique requires meticulous marking of the anatomical landmarks of the distal fibula as well as the fifth metatarsal to establish the precise starting point for the guidewire. Using a mini c-arm, a high and inside positioning should be confirmed prior to advancing the guidewire from proximal to distal while remaining positioned in the center of the medullary canal. Capitalizing on the variable pitch of a 5.0-mm headless compression screw, the Jones fracture is compressed to ensure primary bone healing. The incision is then closed, and a soft wrap is utilized followed by 2 weeks of non-weight-bearing and progressive protective weight-bearing until a complete recovery is achieved.
Background: Open reduction and internal fixation (ORIF) for the operative treatment of zone-2 intra-articular Jones fractures with minimal to moderate displacement is recommended because of the high rate of nonunion associated with nonoperative treatment. The blood supply to this region is minimal because of its retrograde flow, leading to high rates of nonunion with nonoperative treatment. The presently described technique offers reduction and fixation of a zone-2 fracture, as well as improved functional outcomes and nonunion rates. This approach is minimally invasive, as it is performed percutaneously, leading to a decrease in soft-tissue damage, infection rates, and operative time.
Description: The zone-2 fifth metatarsal ORIF technique begins with the use of a marking pen to outline the distal fibula and the head of the fifth metatarsal for proper orientation. Fluoroscopy is utilized to identify the landmarks so that a guidewire can be placed into the proximal dorsal aspect of the fifth metatarsal. Placement is confirmed on multiple radiographic images. The guidewire is then slowly inserted down the medullary canal of the fifth metatarsal, with placement verified on multiple fluoroscopic images. Once placement is confirmed,
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：