Arthroscopy Techniques最新文献

Patellar dislocations are common injuries that can lead to recurrent dislocations and instability. Patellar instability is a complex problem and requires a multifactorial approach. Over the years, many different repair and reconstruction techniques has been developed. The variety of techniques proves that there is no best procedure, and different options must be taken into consideration in every case. Many of these techniques are complicated and require graft harvesting or drilling through the patella. We present a technique of arthroscopic patellar stabilization with a single suture anchor and lateral release that is easy to perform, cost-effective, and does not require drilling tunnels through patella or graft harvesting.

Elbow stiffness can severely affect a patient’s quality of life. If conservative treatment is ineffective, surgical treatment including open or arthroscopic release could be applied. With the advantages of being minimally invasive, reducing pain and scars, accelerating early rehabilitation, and so on, arthroscopic release has increased in popularity compared with open surgery over the years, whereas limiting factors such as the close proximity of the neurovasculature to the working field and narrow working space still have to be faced by the elbow arthroscopist, with an increasing risk of iatrogenic injury with portal creation and operations adjacent to the nerves and vessels. When elbow arthritis occurs concomitantly with cubital tunnel syndrome, osteophytes on the medial ridge of the olecranon and trochlea occur as obstacles to the elbow extending or the posterior bundle of the medial collateral ligament has to be released for extension contractures, and open procedures for the medial gutter are routinely performed. To reduce the risk of injury and produce even less scar tissue, we present a surgical technique applicable to posteromedial elbow pathology by 2 medial portals. Through this technique, the entire course of the ulnar nerve is exposed and released under arthroscopy, with the ulnar nerve retracted medially, and medial gutter osteophytectomy and soft-tissue release can freely proceed.

A ganglion is the most common soft-tissue mass in the foot and can cause pain, paresthesia, or footwear problems. A ganglion can extend from the dorsum into the plantar compartment of the foot in the form of a horseshoe at the borders of the foot or in the form of an hourglass through the intermetatarsal space. Initial conservative management of a ganglion may entail observation and the use of padding for comfort, manual rupture, aspiration of the cyst contents, and steroid injection or sclerotherapy into the cyst. When the lesion is recurrent or painful, surgical excision is recommended. The purpose of this Technical Note is to describe the details of endoscopic resection of a horseshoe ganglion of the lateral midfoot. This technique has the advantages of being minimally invasive, with better cosmetic results and less surgical trauma to the soft tissue.

Osteoarthritis (OA) is characterized by articular cartilage degeneration, synovial inflammation, and subchondral bone thickening, affecting the synovial joint as an organ and leading to pain and disability. Subcutaneous stromal vascular fraction is safe and relieves pain, improves function, and repairs cartilage defects in patients with knee OA. Our goal is to describe step-by-step the arthroscopic treatment of mild to moderate knee OA with photo-stimulated stromal vascular fraction harvested from the thigh using a selective tissue engineering photo-stimulation (“One S.T.E.P.”) technique.

Anterior cruciate ligament (ACL) ganglion cysts and mucoid degeneration of the ACL are 2 distinct nontraumatic lesions of the ACL that occur discretely but can coexist. The exact etiopathogenesis still needs to be clarified. Mucoid degeneration presents as pain mainly on the posterior or posterolateral aspect of the knee and loss of terminal flexion and extension range of motion of the knee. There are several methods of treatment, including ultrasound-guided decompressions and arthroscopic decompression procedures. Arthroscopic decompressions include resecting the most affected posterolateral bundle and complete takedown of the ACL, with or without notchplasty. The reason for flexion deficit is the femoral-sided thickened ACL tissue (mucoid degeneration of the ACL) or the presence of a ganglion cyst. The impinging tibial insertion ganglion, the anvil osteophyte, or the thickened tibial stump of the ACL cause the extension deficit. Hence, addressing both anterior and posterior compartments is necessary for complete decompression. This Technical Note gives a stepwise approach to bicompartmental decompression using only anterior portals with the figure-of-4 positions.

The knee joint is surrounded by multiple bursae, which are fluid-filled sacs whose main function is to reduce friction during movement. Extrusion of fluid from the bursa sac due to trauma or overuse can lead to the formation of cysts in the adjacent region. Operative treatment for cysts involves excision, traditionally performed as open surgery, which is associated with complications such as poor wound healing or recurrence. This Technical Note describes the arthroscopic excision of a deep infrapatellar cyst as an alternative to open surgery.

Dysplasia epiphysealis hemimelica (Trevor disease) is a rare skeletal development disorder of childhood, characterized by irregular ossification centers, which may develop together or individually, leading to asymmetric epiphyseal cartilage overgrowth, affecting 1 side of the epiphyses or the epiphyses equivalents (the medial side being affected twice as often as the lateral), until skeletal maturity is reached. Trevor disease around the ankle is locally aggressive with a poor outcome, especially in tumors involving the articular surface. The purpose of this Technical Note is to describe the details of arthroscopic management of dysplasia epiphysealis hemimelica (Trevor disease) of the ankle.

It has been reported that anterior cruciate ligament reconstruction (ACLR) with the Ligament Advanced Reinforcement System (LARS) could obtain similar clinical outcomes to ACLR with autograft. However, in most related reports, single-bundle ACLR was performed. Given that double-bundle ACLR is more favorable than single-bundle ACLR biomechanically, it is reasonable to try double-bundle ACLR with the LARS clinically. Thus, we introduce an anatomic double-bundle transtibial ACLR technique with the LARS, in which the most critical step is to create a shallow tibial tunnel for the anteromedial bundle to further create the corresponding femoral tunnel in a transtibial manner, as well as to fix both bundles in full extension of the knee.

Articular cartilage injuries in young patients pose a notable treatment dilemma. Multiple reported techniques exist, although some of the most prominent methods currently rely on multiple procedures for chondrocyte harvest and colony expansion prior to implantation. The associated cost and effort this requires limits availability on a global basis, which creates a need for a more widely available cartilage procedure. This Technical Note describes a method for cartilage restoration that incorporates autologous chondrocytes in allogenic extracellular matrix, along with biologic augmentation all performed in a single stage.

Isolated distal rectus femoris avulsions from the common quadriceps tendon are rare and may be missed due to the integrity of the remaining extensor mechanism. In healthy, active patients, surgical repair is recommended due to the potential for persistent pain, cramping, and weakness. In the case of isolated distal rectus femoris avulsions, however, there are important surgical considerations and differences when compared with the treatment of complete quadriceps tendon ruptures. This Technical Note describes an open repair of an isolated distal rectus femoris rupture with reinsertion into the common quadriceps tendon.