Arthroscopy Techniques最新文献

The ramp area, which is the junction between the posterior horn of the medial meniscus and the synovium, prevents anterior knee translation, transmits and distributes load, and assumes some rotational stability. Ramp lesions occur in approximately 9% to 15% of patients with anterior cruciate ligament tears. We describe an all-inside repair technique with suture for a meniscotibial ligament tear–type ramp lesion of the posterior horn of the medial meniscus.

Multiple risk factors for anterior cruciate ligament (ACL) reconstruction graft failure have been reported, including improper tunnel placement, unrepaired meniscus or ligamentous injuries, and coronal/sagittal malalignment. Various biomechanical studies have reported on the increased forces experienced by the ACL graft when there is valgus malalignment or increased posterior tibial slope. This technique describes an opening-wedge distal femoral osteotomy to correct valgus alignment and a closing-wedge proximal tibial osteotomy to correct increased posterior tibial slope in the setting of an ACL reconstruction graft failure. This technique is the first stage of a 2-stage surgery in which the second stage is the revision ACL reconstruction. By performing both osteotomies first, the patient can begin weight bearing earlier after the revision ACL reconstruction.

Suprascapular nerve (SSN) entrapment is a rare but significant cause of posterior shoulder pain and weakness. Compression of the nerve at the level of the spinoglenoid notch leads to weakness and atrophy of the infraspinatus. A detailed history and physical examination along with appropriate workup are paramount to arrive at this diagnosis. Surgical decompression is indicated in cases refractory to conservative management. In this Technical Note, we describe our technique for open decompression of the SSN at the spinoglenoid notch. This approach permits direct visualization of the SSN and allows for a safe, reliable, and thorough decompression.

The femoroacetabular contact force and pressure are increased in the anterosuperior segment of the acetabulum in femoroacetabular impingement syndrome. We developed a special device for femoroacetabular contact force measurement in hip arthroscopy and present the surgical technique for measuring femoroacetabular contact force in the intact joint with a cam morphology and after cam resection, with the hip in different positions in a cadaver specimen. The device is introduced into the joint peripheral compartment. After joint distraction, the sensor is deployed through the cannula and advanced into the central compartment under direct arthroscopic control. We show a decrease in the contact force measured with this device after cam resection. This force analysis is limited to the anterosuperior femoroacetabular junction, which is the most frequent location for labral and chondral pathology in cam-type femoroacetabular impingement syndrome. We believe that this device also can be used in the evaluation of the contact forces in other joint conditions and in the assessment of diverse techniques of labral repair or reconstruction.

Bony changes such as glenoid bone defects and Hill-Sachs lesions are responsible for recurrent anterior shoulder dislocations. With the development of arthroscopic techniques as well as arthroscopic surgical instruments, arthroscopic repair of bony structures has become an important surgical procedure for the treatment of recurrent shoulder dislocation. In this Technical Note, we used screws to fill Hill-Sachs lesions and autologous iliac bone grafts combined with soft tissue to repair the glenoid bone defects. In the surgical procedures within the shoulder, all operations are done arthroscopically, are minimally invasive, and achieve the goal of repairing composite shoulder injuries.

Arthroscopic capsular release is required in some patients with frozen shoulder (FS). In some cases of recalcitrant FS, arthroscopic capsular release is difficult because of the abnormal narrowing of the joint space. The aim of this article is to introduce an arthroscopic double posterior approach combined with lateral and anterior approaches that is used to complete release of the glenohumeral joint capsule at 360°, subacromial debridement, and long head of biceps tenotomy. This article shows that this double posterior technique is a safe and highly effective totally intra-arthroscopic release technique for recalcitrant FS.

Congenital pseudarthrosis of the clavicle is a rare phenomenon with multiple proposed causes. Surgical management is typically indicated either because of the cosmetic appearance of the irregularity or, less commonly, for pain, particularly in adolescent patients. Multiple surgical methods have previously described in the literature, which have raised concern owing to the persistently high rate of nonunion postoperatively. This article describes management of congenital pseudarthrosis of the clavicle with open reduction and internal fixation using a T-shaped iliac crest autograft.

The incidence of a subscapularis tear combined with any other rotator cuff tear is around 19% to 49% among all rotator cuff lesions. On the contrary, less attention has been given to the treatment of anterosuperior rotator cuff tears, particularly by arthroscopic methods. Subscapularis lesions are hard to access and require advanced surgical technique along with optimum visualization to achieve an anatomic repair. Use of an anterior portal helps in obtaining a good visualization with a 30° arthroscope in viewing the tendon along its axis as well as the posterior, superior, and anterior sides. Incorporation of the biceps tendon along with supraspinatus repair helps strengthen the supraspinatus repair as well as preserve the acromiohumeral index. Double-row repair of both subscapularis and supraspinatus ensures an adequate bone bed for tendon healing.

Chronic patellar tendinosis is an overuse pathology affecting both adolescents and adults who participate in jumping sports. It often can be managed with nonoperative modalities. Chronic patellar tendinosis is associated with degenerative changes to the proximal, posterior patellar tendon. Operative treatments include open or arthroscopic debridement of the pathologic tissue. When a debridement is performed, the resulting defect forms a void at the posterior segment of the proximal patellar tendon. The authors assert this defect should be addressed in elite athletes with a graft as opposed to tendon debridement alone to prevent recurrence and maximize tendon strength. Described herein is the senior author’s preferred technique for open patellar tendon debridement and allograft reinforcement with suture tape augmentation for chronic patellar tendinosis. This technique creates both a tension band construct with allograft to offload the tendon proximally and an InternalBrace construct longitudinally for patellar tendon load sharing.

Intra-articular distal radius fractures with significant articular step-off and gapping are associated with high risk of developing symptomatic arthritis and poor functional outcome. The use of arthroscopy for distal radius fixation had been well published in the literature. It allows the surgeon to fine-tune intra-articular fragments to achieve articular congruency, address ligamentous disruption, and check for screw penetration within the joint. Various techniques have been reported, including volar locking plate presetting to aid in arthroscopic reduction. Here, we demonstrate our arthroscopic-assisted distal radius fixation technique using a 1.9-mm miniature scope NanoScope (Arthrex, Naples, FL).