Revision of anterior cruciate ligament (ACL) reconstruction presents numerous challenges not encountered in the primary setting and therefore requires thorough preoperative planning. Addressing tunnel widening is the primary concern, and therefore the appropriate graft choice is pivotal. Quadriceps tendon autograft recently has gained popularity for its dimensions and the possibility to harvest a bone block from the patella that can fill potential tunnel bone defects. Adjunctive procedures to isolated ACL reconstruction such as lateral extra-articular tenodesis (LET) may help in sharing the loads with the neoligament, with recent findings recommending LET in the revision setting. The technique presented in this Technical Note describes a 1-stage revision ACL combined with LET using a quadriceps tendon autograft with a bone plug.
{"title":"Anterior Cruciate Ligament Revision Using Quadriceps Tendon Autograft and Lateral Extra-Articular Tenodesis","authors":"Fabrizio Matassi M.D., Jacopo Corti M.D., Mattia Chirico M.D., Piero Franco M.D., Zyad Ayman Taha M.D., Roberto Civinini M.D.","doi":"10.1016/j.eats.2024.103163","DOIUrl":"10.1016/j.eats.2024.103163","url":null,"abstract":"<div><div>Revision of anterior cruciate ligament (ACL) reconstruction presents numerous challenges not encountered in the primary setting and therefore requires thorough preoperative planning. Addressing tunnel widening is the primary concern, and therefore the appropriate graft choice is pivotal. Quadriceps tendon autograft recently has gained popularity for its dimensions and the possibility to harvest a bone block from the patella that can fill potential tunnel bone defects. Adjunctive procedures to isolated ACL reconstruction such as lateral extra-articular tenodesis (LET) may help in sharing the loads with the neoligament, with recent findings recommending LET in the revision setting. The technique presented in this Technical Note describes a 1-stage revision ACL combined with LET using a quadriceps tendon autograft with a bone plug.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103163"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scapholunate instability can result in debilitating pain, dysfunction, and secondary arthritis. Diagnosis is primarily based on a combination of clinical and radiological parameters. However, wrist arthroscopy is regarded as the gold standard for definitive confirmation to identify the extent of a scapholunate instability, with specific attention to the integrity of the extrinsic ligamentous system, which is probably more important than the intrinsic ligament. We discuss how to perform a step-by-step, comprehensive, and complete arthroscopic assessment of the entire scapholunate complex.
{"title":"How to Perform a Complete Arthroscopic Assessment of the Scapholunate Joint Complex","authors":"Chul Ki Goorens M.D. , Kjell Van Royen M.D , Thierry Scheerlinck Ph.D. , Joris Duerinckx Ph.D. , Christophe Mathoulin Ph.D.","doi":"10.1016/j.eats.2024.103174","DOIUrl":"10.1016/j.eats.2024.103174","url":null,"abstract":"<div><div>Scapholunate instability can result in debilitating pain, dysfunction, and secondary arthritis. Diagnosis is primarily based on a combination of clinical and radiological parameters. However, wrist arthroscopy is regarded as the gold standard for definitive confirmation to identify the extent of a scapholunate instability, with specific attention to the integrity of the extrinsic ligamentous system, which is probably more important than the intrinsic ligament. We discuss how to perform a step-by-step, comprehensive, and complete arthroscopic assessment of the entire scapholunate complex.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103174"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103162
Ava G. Neijna B.A., Hailey P. Huddleston M.D., Andreas H. Gomoll M.D., Sabrina M. Strickland M.D.
Younger, working-age patients with early medial compartment arthritis are a unique patient population with limited treatment options, generally consisting of either an osteotomy or arthroplasty. Another surgical treatment option involves unloading the medial compartment with an implantable shock absorber, known as the MISHA Knee System (Moximed, Fremont, CA). One use of this implant is in the setting of medial meniscal root tears (MMRTs). MMRTs are important to address; left untreated, they can result in rapid degeneration of the medial tibiofemoral compartment with high rates of conversion to arthroplasty. Although MMRTs are important to address surgically, recovery can be difficult for the patient because they must adhere to 6 weeks of non-weightbearing. In this surgical technique, we describe combining an implantable shock absorber with a concomitant medial meniscal root repair to provide both protection of the medial tibiofemoral compartment and a faster return to weightbearing.
{"title":"Medial Meniscus Root Repair With Implantable Shock Absorber Placement: A Combined Technique for Early Partial Weightbearing","authors":"Ava G. Neijna B.A., Hailey P. Huddleston M.D., Andreas H. Gomoll M.D., Sabrina M. Strickland M.D.","doi":"10.1016/j.eats.2024.103162","DOIUrl":"10.1016/j.eats.2024.103162","url":null,"abstract":"<div><div>Younger, working-age patients with early medial compartment arthritis are a unique patient population with limited treatment options, generally consisting of either an osteotomy or arthroplasty. Another surgical treatment option involves unloading the medial compartment with an implantable shock absorber, known as the MISHA Knee System (Moximed, Fremont, CA). One use of this implant is in the setting of medial meniscal root tears (MMRTs). MMRTs are important to address; left untreated, they can result in rapid degeneration of the medial tibiofemoral compartment with high rates of conversion to arthroplasty. Although MMRTs are important to address surgically, recovery can be difficult for the patient because they must adhere to 6 weeks of non-weightbearing. In this surgical technique, we describe combining an implantable shock absorber with a concomitant medial meniscal root repair to provide both protection of the medial tibiofemoral compartment and a faster return to weightbearing.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103162"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103185
Gregory Cunningham M.D. , Andres Borgonovo M.D. , Mehmet Öztürk M.D. , Mehdi Hamani , Rodrigo Brandariz M.D. , Shana Mombelli M.D.
Glenoid bone loss is a risk factor for recurrent glenohumeral instability. Various techniques exist for glenoid bone graft augmentation, mostly relying on metallic hardware fixation. However, few data are available on traumatic instability with bipolar bone loss. We describe an all-arthroscopic double-bone block cerclage technique, using 2 tricortical iliac crest autografts, for bidirectional traumatic glenohumeral instability with bipolar glenoid bone loss.
{"title":"Arthroscopic Double-Bone Block Cerclage for Bipolar Glenoid Bone Loss","authors":"Gregory Cunningham M.D. , Andres Borgonovo M.D. , Mehmet Öztürk M.D. , Mehdi Hamani , Rodrigo Brandariz M.D. , Shana Mombelli M.D.","doi":"10.1016/j.eats.2024.103185","DOIUrl":"10.1016/j.eats.2024.103185","url":null,"abstract":"<div><div>Glenoid bone loss is a risk factor for recurrent glenohumeral instability. Various techniques exist for glenoid bone graft augmentation, mostly relying on metallic hardware fixation. However, few data are available on traumatic instability with bipolar bone loss. We describe an all-arthroscopic double-bone block cerclage technique, using 2 tricortical iliac crest autografts, for bidirectional traumatic glenohumeral instability with bipolar glenoid bone loss.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103185"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103175
Kepa Iglesias M.D., Guillaume Robert M.D., Emilie Roustan M.D., Michel Christofilis M.D.
Pedicular hamstring grafts have become increasingly popular for anterior cruciate ligament reconstruction, preserving sufficient blood supply to enhance bone-to-tendon healing while providing additional mechanical fixation on the tibial side. This Technical Note introduces an original approach utilizing a dual adjustable loop fixation for hamstring grafts, maintaining the tibial insertion, in anterior cruciate ligament reconstruction.
{"title":"Pedicular Hamstring With 2 Adjustable Loops for Anterior Cruciate Ligament Reconstruction: The Double-Loop Technique","authors":"Kepa Iglesias M.D., Guillaume Robert M.D., Emilie Roustan M.D., Michel Christofilis M.D.","doi":"10.1016/j.eats.2024.103175","DOIUrl":"10.1016/j.eats.2024.103175","url":null,"abstract":"<div><div>Pedicular hamstring grafts have become increasingly popular for anterior cruciate ligament reconstruction, preserving sufficient blood supply to enhance bone-to-tendon healing while providing additional mechanical fixation on the tibial side. This Technical Note introduces an original approach utilizing a dual adjustable loop fixation for hamstring grafts, maintaining the tibial insertion, in anterior cruciate ligament reconstruction.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103175"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103159
Raahil Patel M.D. , Richard J. Rivera B.S. , Sunny Parekh D.O. , Brandon Cabarcas M.D. , Brent Hill M.D. , Rachel Carlson P.A.-C. , Neil Kumar M.D., M.B.A.
Tibial tubercle osteotomy (TTO) is a surgical technique commonly indicated for patellofemoral instability and/or patellar chondral repair. In select patients, soft tissue procedures alone (medial patellofemoral ligament reconstruction) are not sufficient to address patellar instability due to significant bony malalignment, particularly in patients with a >20-mm tibial tubercle-trochlear groove distance on advanced imaging. For these cases, a TTO procedure may be used either in adjunct to medial patellofemoral ligament reconstruction or in isolation. Among the postoperative complications of TTOs, compartment syndrome poses a threat as one of the most severe. In this Technical Note, we present a technique that aims to reduce the risk of postoperative compartment syndrome by eliminating dissection of the anterior compartment musculature during the approach.
{"title":"Anterior Compartment Sparing Tibial Tubercle Osteotomy Using Back-Cut Technique","authors":"Raahil Patel M.D. , Richard J. Rivera B.S. , Sunny Parekh D.O. , Brandon Cabarcas M.D. , Brent Hill M.D. , Rachel Carlson P.A.-C. , Neil Kumar M.D., M.B.A.","doi":"10.1016/j.eats.2024.103159","DOIUrl":"10.1016/j.eats.2024.103159","url":null,"abstract":"<div><div>Tibial tubercle osteotomy (TTO) is a surgical technique commonly indicated for patellofemoral instability and/or patellar chondral repair. In select patients, soft tissue procedures alone (medial patellofemoral ligament reconstruction) are not sufficient to address patellar instability due to significant bony malalignment, particularly in patients with a >20-mm tibial tubercle-trochlear groove distance on advanced imaging. For these cases, a TTO procedure may be used either in adjunct to medial patellofemoral ligament reconstruction or in isolation. Among the postoperative complications of TTOs, compartment syndrome poses a threat as one of the most severe. In this Technical Note, we present a technique that aims to reduce the risk of postoperative compartment syndrome by eliminating dissection of the anterior compartment musculature during the approach.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103159"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103172
Michell Ruiz Suarez M.D., Ph.D., José Eduardo Torres Rangel M.D., Rafael Gamba Galeazzi M.D., Andrés Felipe Cobaleda Aristizabal M.D.
Posterolateral rotatory instability of the elbow is the most common form of lateral-sided instability; it is often the result of an injury to the lateral collateral ligament complex involving the lateral ulnar collateral ligament. Recently, the posterolateral capsule of the elbow has been recognized to play a major role in preventing posterolateral rotatory instability, identifying it as an independent ligament of the lateral complex (posterolateral ligament). We present our technique for posterolateral elbow stabilization through plication of the posterolateral ligament associated with repair of the lateral ulnar collateral ligament using an all-suture anchor.
{"title":"Open Posterolateral Ligament Plication and Lateral Ulnar Collateral Ligament Repair in Posterolateral Rotatory Instability of the Elbow Using an All-Suture Construct","authors":"Michell Ruiz Suarez M.D., Ph.D., José Eduardo Torres Rangel M.D., Rafael Gamba Galeazzi M.D., Andrés Felipe Cobaleda Aristizabal M.D.","doi":"10.1016/j.eats.2024.103172","DOIUrl":"10.1016/j.eats.2024.103172","url":null,"abstract":"<div><div>Posterolateral rotatory instability of the elbow is the most common form of lateral-sided instability; it is often the result of an injury to the lateral collateral ligament complex involving the lateral ulnar collateral ligament. Recently, the posterolateral capsule of the elbow has been recognized to play a major role in preventing posterolateral rotatory instability, identifying it as an independent ligament of the lateral complex (posterolateral ligament). We present our technique for posterolateral elbow stabilization through plication of the posterolateral ligament associated with repair of the lateral ulnar collateral ligament using an all-suture anchor.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103172"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103173
Fabien Meta M.D., Alexander C. Hayden M.D., Xuankang Pan B.S., Mario Hevesi M.D., Ph.D., Adam J. Tagliero M.D., Aaron J. Krych M.D.
Radial meniscal tears can be challenging to address and require advanced arthroscopic techniques for satisfactory repair. When radial tears occur in older patients, the surgeon often encounters suboptimal tissue integrity that presents its own challenges. Incorporating ripstop sutures in tie-grip repair constructs for radial tears has been documented in the literature with favorable biomechanical properties. This Technical Note and accompanying video present a reproducible method for incorporating tie-grip and mobile ripstop stitches to fortify traditional meniscal repair configurations for radial tears. This technique augments the biomechanical strength of repair and may prove useful in poor tissue quality and areas of small focal deficiency, especially in scenarios with repairable but degenerative meniscal tissue. This is particularly relevant considering many repairs fail due to pull-through of sutures within the meniscal tissue.
{"title":"Meniscus Ripstop Stitches: A Useful Technique for Arthroscopic Repair of Challenging Radial Tears of the Meniscus","authors":"Fabien Meta M.D., Alexander C. Hayden M.D., Xuankang Pan B.S., Mario Hevesi M.D., Ph.D., Adam J. Tagliero M.D., Aaron J. Krych M.D.","doi":"10.1016/j.eats.2024.103173","DOIUrl":"10.1016/j.eats.2024.103173","url":null,"abstract":"<div><div>Radial meniscal tears can be challenging to address and require advanced arthroscopic techniques for satisfactory repair. When radial tears occur in older patients, the surgeon often encounters suboptimal tissue integrity that presents its own challenges. Incorporating ripstop sutures in tie-grip repair constructs for radial tears has been documented in the literature with favorable biomechanical properties. This Technical Note and accompanying video present a reproducible method for incorporating tie-grip and mobile ripstop stitches to fortify traditional meniscal repair configurations for radial tears. This technique augments the biomechanical strength of repair and may prove useful in poor tissue quality and areas of small focal deficiency, especially in scenarios with repairable but degenerative meniscal tissue. This is particularly relevant considering many repairs fail due to pull-through of sutures within the meniscal tissue.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103173"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.eats.2024.103158
Jordan T. Willis M.D., Larry D. Field M.D.
When attempting to repair a large, retracted rotator cuff tear, the orthopaedic surgeon can use several techniques such as capsular release and interval slides that can aid in achieving a low-tension repair and thus allow the best environment for healing. One less commonly used strategy is medialization of the greater and lesser tuberosity anatomic rotator cuff footprint. Previous studies have shown that increased tension across the bone-tendon interface decreases healing rates. Medialization effectively decreases the repair tension by reducing the distance from the tendon to its insertion point. As a result, we commonly apply some degree of footprint medialization even for repair of some small- or medium-sized tears if intraoperative assessment shows that reapproximation of the rotator cuff tissue to the anatomic footprint may lead to excessive tension. The purpose of this article is to share our indications and to describe our technique for medialization of the rotator cuff footprint insertion.
{"title":"Rotator Cuff Footprint Medialization: Indications and Technique","authors":"Jordan T. Willis M.D., Larry D. Field M.D.","doi":"10.1016/j.eats.2024.103158","DOIUrl":"10.1016/j.eats.2024.103158","url":null,"abstract":"<div><div>When attempting to repair a large, retracted rotator cuff tear, the orthopaedic surgeon can use several techniques such as capsular release and interval slides that can aid in achieving a low-tension repair and thus allow the best environment for healing. One less commonly used strategy is medialization of the greater and lesser tuberosity anatomic rotator cuff footprint. Previous studies have shown that increased tension across the bone-tendon interface decreases healing rates. Medialization effectively decreases the repair tension by reducing the distance from the tendon to its insertion point. As a result, we commonly apply some degree of footprint medialization even for repair of some small- or medium-sized tears if intraoperative assessment shows that reapproximation of the rotator cuff tissue to the anatomic footprint may lead to excessive tension. The purpose of this article is to share our indications and to describe our technique for medialization of the rotator cuff footprint insertion.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"14 1","pages":"Article 103158"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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