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Distally Based Patella Tendon Shortening With Medial Patellotibial Ligament Reconstruction 髌胫韧带内侧重建术中的髌腱远端缩短术
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103066
Harris S. Slone M.D., Jonathan Pire M.D., Cody Ashy M.D., Henry Baird B.S., W. Michael Pullen M.D.
Patella alta is a common pathoanatomic contributor to various knee pathologies, including patella instability, fat pad impingement, and patellar tendinopathy. The 2 most common surgical techniques used to treat patella alta include a distalizing tibial tubercle osteotomy and patella tendon imbrication. Although these 2 surgical techniques are effective, they are associated with significant surgical morbidity and a limiting postoperative course with prolonged rehabilitation. In this Technical Note, we propose a simple means of distalizing the patella and improving patella maltracking via the addition of a medial patellotibial ligament reconstruction. The described technique is easy to perform, has little postoperative morbidity, and is familiar to most knee surgeons who perform anterior cruciate ligament reconstruction.
髌骨外翻是导致各种膝关节病变的常见病理解剖因素,包括髌骨不稳、脂肪垫撞击和髌骨肌腱病。治疗髌骨外翻最常用的两种手术方法包括胫骨结节远端截骨术和髌骨肌腱嵌顿术。虽然这两种手术方法效果显著,但手术发病率高,术后康复时间长。在本技术说明中,我们提出了一种简单的方法,通过增加髌胫韧带内侧重建来使髌骨远端化并改善髌骨追踪不良。所描述的技术操作简单,术后发病率低,对于大多数进行前交叉韧带重建术的膝关节外科医生来说并不陌生。
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引用次数: 0
Arthroscopic All-Inside Posterior Cruciate Ligament Avulsion Fracture Suture Fixation With Double-Tunnel Pullout and High-Strength Suture Tape Augmentation Using Trans-septal Approach 关节镜下全内侧后交叉韧带撕脱性骨折缝合固定术,双隧道牵引和高强度缝合带增强,采用经关节腔入路
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103091
Marcello Capella M.D. , Davide D’Antonio M.D. , Luca Drocco M.D. , Luca Barberis M.D. , Daniele Vezza M.D. , Fortunato Giustra M.D. , Alessandro Massè M.D.
This technical note aims to provide a detailed description of our arthroscopic technique for suture fixation of posterior cruciate ligament (PCL) tibial avulsion fractures. Various surgical approaches have been described, including both open and arthroscopic techniques. The arthroscopic approach can be less disruptive and more accurate in visualizing anatomic landmarks. It also may ensure good and reliable fracture reduction and fixation. This article describes a technique for arthroscopic all-inside fixation of PCL avulsion fractures using a double-tunnel pullout method. The procedure involves trans-septal visualization and whipstitching suturing of the PCL with 1.5-mm high-strength, nonresorbable transverse ribbon suture (LabralTape; Arthrex, Naples, FL) and a crosstie-like suture with a high-strength, nonresorbable suture tape (FiberTape; Arthrex) embracing the PCL from anterior to posterior. Finally, the avulsion fracture is secured by tensioning a high-strength suture tape from the femur to the tibia along the PCL structure as an InternalBrace ligament augmentation (Arthrex). This technique allows for anatomic reduction and stable fixation of the displaced fracture through optimal trans-septal visualization and the PCL whipstitching technique, further secured by the InternalBrace ligament augmentation, enabling early and intensive rehabilitation.
本技术说明旨在详细介绍我们在关节镜下缝合固定后交叉韧带(PCL)胫骨撕脱骨折的技术。目前已有多种手术方法,包括开放手术和关节镜技术。关节镜方法的破坏性较小,且能更准确地观察解剖标志。它还能确保良好可靠的骨折复位和固定。本文介绍了一种使用双隧道牵引法在关节镜下对 PCL撕脱骨折进行全内侧固定的技术。手术过程包括经关节腔观察,用 1.5 毫米高强度、不可吸收的横向带状缝合线(LabralTape;Arthrex,佛罗里达州那不勒斯市)对 PCL 进行鞭状缝合,并用高强度、不可吸收的缝合带(FiberTape;Arthrex)从前方到后方对 PCL 进行交叉式缝合。最后,将高强度缝合带从股骨沿 PCL 结构拉伸至胫骨,将撕脱性骨折固定,作为 InternalBrace 韧带增强(Arthrex)。这项技术通过最佳的经胫骨可视化和 PCL 鞭状缝合技术,对移位骨折进行解剖复位和稳定固定,并通过 InternalBrace 韧带增强装置进一步固定,从而实现早期强化康复。
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引用次数: 0
Arthroscopic Biologic Acromiotuberoplasty for Irreparable Rotator Cuff Tears 关节镜下生物喙突成形术治疗无法修复的肩袖撕裂
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103073
Jarod A. Richards M.D., David R. Woodard M.D., H. Mike Kim M.D.
Recent attention has turned toward the prevention of acromiohumeral abutment in the treatment of irreparable rotator cuff tears (IRCTs). This can be achieved through tendon transfer with a bridging allograft, superior capsular reconstruction, dermal allograft application to the greater tuberosity (biologic tuberoplasty), bursal acromial reconstruction, or subacromial balloon spacer placement. Recent literature has demonstrated increased graft thickness is associated with improved clinical outcomes after superior capsular reconstruction, suggesting a potential role of a direct bone-to-bone contact between the greater tuberosity and acromion in symptom generation in patients with IRCTs. In keeping with this ethos and building on the principle of both biologic tuberoplasty and bursal acromial reconstruction, the authors propose biologic acromiotuberoplasty as a treatment for IRCTs wherein a 3-mm dermal allograft is fixated to both the greater tuberosity of the humerus and the undersurface of the acromion for a total of 6 mm of allograft interposition.
最近,在治疗无法修复的肩袖撕裂(IRCTs)时,人们开始关注如何防止肩峰与肱骨的连接。可通过肌腱转移与桥接同种异体移植、上关节囊重建、大结节真皮同种异体移植(生物结节成形术)、滑囊肩峰重建或肩峰下球囊垫片置入等方法实现。最近的文献表明,上关节囊重建术后,移植物厚度的增加与临床疗效的改善有关,这表明大结节与肩峰之间的骨与骨直接接触对 IRCT 患者症状的产生具有潜在的作用。根据这一理念,并基于生物结节成形术和滑囊肩峰重建术的原理,作者提出了生物肩峰成形术作为IRCTs的治疗方法,即在肱骨大结节和肩峰下表面固定3毫米的真皮同种异体移植物,以实现总共6毫米的同种异体移植物互植。
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引用次数: 0
“Mini-Incision” Transtendon Double-Pulley Suture-Bridge Repair of PASTA Lesion "微型切口 "经腱双滑轮缝合桥修复 PASTA 病损
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103068
Transtendon repair is increasingly applied in the treatment of PASTA (partial articular supraspinatus tendon avulsion) lesions, but a “tendon hole” from anchor insertion, which will break the intact bursal layer and potentially result in tear completion, is an unavoidable problem. The “mini-incision” transtendon double-pulley suture bridge presented in the study is a pragmatic technique in treatment of PASTA lesion. The 4 suture strands on the medial-row anchor provide enough biomechanical strength on the reattached articular layer, the “mini-incision” minimizes iatrogenic trauma on the bursal layer, and double-pulley suture-bridge smoothly covers the “mini-incision” so as to achieve anatomical reduction of articular and bursa side of supraspinatus tendon. The surgical technique is described, as well as pearls, pitfalls, advantages, and disadvantages.
经腱修复术越来越多地应用于 PASTA(部分关节冈上肌腱撕脱)病变的治疗,但锚插入时产生的 "腱孔 "会破坏完整的滑囊层,并可能导致撕裂完成,这是一个不可避免的问题。本研究提出的 "小切口 "经腱双滑轮缝合桥是治疗 PASTA 病变的实用技术。内侧排锚上的 4 股缝线为重新连接的关节层提供了足够的生物力学强度,"小切口 "将滑囊层的先天性创伤降至最低,双滑轮缝合桥顺利覆盖 "小切口",从而实现冈上肌腱关节侧和滑囊侧的解剖学缩小。文中介绍了手术技巧,以及珍珠、陷阱、优点和缺点。
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引用次数: 0
Olecranon Fossa Fenestration Approach to the Coronoid and Anterior Elbow: The Way OFF. 肘关节冠状窝和肘关节前部栅栏入路:关闭方法。
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103078
Paolo Arrigoni M.D. , Valeria Vismara M.D. , Alfonso Liccardi M.D. , Jane Messina M.D. , Pietro Simone Randelli M.D.
Hypertrophic osteoarthritis of the elbow is a challenging condition that can vary from mild to severe, affecting patients’ quality of life due to pain and loss of range of motion. A consensus about its treatment does not exist. Open arthrolysis with capsular release, synovectomy, Outerbridge-Kashiwagi fenestration, and removal of loose bodies and osteophytes demonstrated good results. In more recent times, an arthroscopic procedure has been shown to have the same efficacy as the open one. The aim of this Technical Note is to describe an all-arthroscopic procedure to reach the coronoid tip, in a safe and reproducible manner, through an olecranon fossa fenestration with a direct transtricipital posterior portal and an anterior cruciate ligament guide.
肘部肥大性骨关节炎是一种具有挑战性的疾病,病情可轻可重,患者会因疼痛和活动范围减小而影响生活质量。目前对其治疗方法尚未达成共识。通过关节囊松解术、滑膜切除术、Outerbridge-Kashiwagi 开孔术以及松动体和骨质增生切除术进行的开放性关节切除术取得了良好的效果。近来,关节镜手术被证明具有与开放手术相同的疗效。本技术说明的目的是描述一种全关节镜手术,通过直接经膝后入口和前十字韧带导引,以安全、可重复的方式,通过锁骨窝开孔到达冠状面顶端。
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引用次数: 0
Arthroscopic Subpectoral Tenodesis of the Long Head of the Biceps Brachii 关节镜下肱二头肌长头腱鞘切除术
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103079
The long head of the biceps brachii is a common pain generator in the shoulder that is often managed surgically with tenotomy or tenodesis. The clinical outcomes after tenotomy and tenodesis are comparable. However, tenodesis is preferred in the active population owing to complications associated with tenotomy, including cosmetic deformity, early fatigue, and cramping. Controversy surrounds both the approach and location of tenodesis. Both open and arthroscopic techniques have been described. An arthroscopic approach is used for tenodesis within the intertubercular groove between the humeral head articular margin and superior border of the pectoralis major but has the drawback of pathologic tendon retained in the groove. An open approach is generally reserved for subpectoral tenodesis, which has the advantage of no retained pathologic tendon but has the drawbacks of an open approach. We describe an all-arthroscopic technique for subpectoral tenodesis of the long head of the biceps brachii at the lower border of the pectoralis major.
肱二头肌长头是肩部常见的疼痛源,通常采用腱切开术或腱鞘切除术进行手术治疗。腱切开术和腱鞘切除术的临床效果相当。不过,由于腱切开术会引起外观畸形、早期疲劳和痉挛等并发症,因此在活动人群中更倾向于腱鞘切除术。围绕腱鞘切除术的方法和位置存在争议。开放式和关节镜技术均有描述。关节镜方法用于在肱骨头关节边缘和胸大肌上缘之间的肱骨间沟内进行腱膜挛缩,但缺点是沟内会保留病理性肌腱。胸大肌下腱膜挛缩通常采用开放式方法,这种方法的优点是没有病理肌腱残留,但也有开放式方法的缺点。我们介绍了一种全关节镜技术,用于胸大肌下缘肱二头肌长头的胸骨下腱鞘切除术。
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引用次数: 0
Arthroscopic Debridement and Fixation of Osteochondritis Dissecans Lesions of the Medial Femoral Condyle 关节镜下股骨内侧髁骨软骨炎脱落病变的清创和固定术
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103111
Charles L. Holliday M.D., Xuankang Pan B.S., Adam J. Tagliero M.D., Daniel B.F. Saris M.D., Ph.D., Todd A. Milbrandt M.D., Aaron J. Krych M.D., Mario Hevesi M.D., Ph.D.
Unstable osteochondritis dissecans lesions of the medial femoral condyle have classically been treated with open reduction and fixation under direct visualization through an open arthrotomy. Given the value of avoiding open arthrotomies, we present an arthroscopic approach for lesion elevation, debridement, and fixation. The lesion is first elevated using an arthroscopic elevator, leaving a laterally based osseous hinge. Once elevated, fibrous debris is debrided from the base of the lesion. Subsequently, the fragment is reduced, and percutaneous transpatellar instrumentation is used for fixation. The use of this technique allows for excellent mobilization, debridement, and fixation of the osteochondritis dissecans lesion while minimizing violation of periarticular soft tissues.
股骨内侧髁不稳定的骨软骨炎病变通常是通过开放性关节切开术在直视下进行切开复位和固定治疗。考虑到避免开放性关节切开术的价值,我们提出了一种在关节镜下进行病变抬高、清创和固定的方法。首先使用关节镜提升器抬高病变部位,留下侧向的骨性铰链。抬高后,从病变基底部剥离纤维碎片。随后,将碎片缩小,并使用经皮经髌骨器械进行固定。使用这种技术可以很好地移动、清创和固定骨软骨炎的病变,同时最大限度地减少对关节周围软组织的损伤。
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引用次数: 0
Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using the Superficial Layer Quadriceps Tendon Graft: Surgical Technique Description 使用浅层股四头肌肌腱移植重建前交叉韧带和前外侧韧带:手术技术描述
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103067
Bernardo Garcia Barroso M.D. , Sergio Marinho de Gusmão Canuto M.D. , Camilo Partezani Helito M.D., Ph.D. , Márcio Cabral Fagundes Rêgo M.D. , Felipe Silveira Martins M.D. , Marcelo Cabral Fagundes Rêgo M.D.
We present a technique for the combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction using the superficial layer quadriceps tendon graft. Anatomic reconstruction is achieved with outside-in femoral tunnel drilling. The femoral drill guide has an intra-articular placement at the femoral footprint of the ACL and an extra-articular placement at the femoral ALL attachment. This surgical technique does not need any special instruments and consists of 3 bone tunnels. The long length and customized superficial quadriceps tendon graft is harvested in a minimally invasive manner and allows an accessible and low-cost reconstruction of both ligaments.
我们介绍了一种使用浅层股四头肌腱移植进行前交叉韧带(ACL)和前外侧韧带(ALL)联合重建的技术。通过股骨外隧道钻孔实现解剖重建。股骨钻孔导向器在关节内的位置是前交叉韧带的股骨足迹,在关节外的位置是股骨 ALL 连接处。这种手术技术不需要任何特殊器械,由 3 个骨隧道组成。以微创方式获取长而定制的股四头肌浅肌腱移植物,可以方便、低成本地重建两条韧带。
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引用次数: 0
Revision Meniscal Repair With Amniotic Membrane Augmentation 羊膜增强翻修半月板修复术
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103072
Meniscal injury is common, and despite modern techniques, the failure rate following repair remains high. While there are recent treatment advances in the form of biologics, there is limited evidence and agreement on these emerging therapies and their role in meniscal healing. Amniotic tissue (umbilical cord allograft) is a biologic augmentation therapy that has been utilized in other musculoskeletal applications but has not been reported for use in meniscal repair. We describe a technique to deliver an allograft amniotic membrane into a meniscus tear repair site, potentially optimizing healing.
半月板损伤很常见,尽管采用了现代技术,但修复后的失败率仍然很高。虽然近期生物制剂治疗取得了进展,但关于这些新兴疗法及其在半月板愈合中的作用的证据和共识却很有限。羊膜组织(脐带同种异体移植)是一种生物增量疗法,已被用于其他肌肉骨骼领域,但还没有用于半月板修复的报道。我们介绍了一种向半月板撕裂修复部位输送异体羊膜的技术,这种技术有可能优化愈合。
{"title":"Revision Meniscal Repair With Amniotic Membrane Augmentation","authors":"","doi":"10.1016/j.eats.2024.103072","DOIUrl":"10.1016/j.eats.2024.103072","url":null,"abstract":"<div><div>Meniscal injury is common, and despite modern techniques, the failure rate following repair remains high. While there are recent treatment advances in the form of biologics, there is limited evidence and agreement on these emerging therapies and their role in meniscal healing. Amniotic tissue (umbilical cord allograft) is a biologic augmentation therapy that has been utilized in other musculoskeletal applications but has not been reported for use in meniscal repair. We describe a technique to deliver an allograft amniotic membrane into a meniscus tear repair site, potentially optimizing healing.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"13 10","pages":"Article 103072"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141414719","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}
引用次数: 0
Microfragmented Adipose Tissue Associated With Collagen Membrane in the Treatment of Focal Knee Cartilage Defect 与胶原蛋白膜相关的微碎脂肪组织在治疗局部膝关节软骨缺损中的应用
IF 1.2 Q3 ORTHOPEDICS Pub Date : 2024-10-01 DOI: 10.1016/j.eats.2024.103075
Focal articular cartilage defects are an important factor that leads to dysfunction of the knee joint. Several different surgical approaches have been tried, most of them showing poor results in the long term. The use of orthobiologics in the context of focal chondral lesion has emerged as a potential tool in the treatment of this condition. In this article, we present a surgical technique for the treatment of focal chondral lesions using a collagen membrane associated with microfragmented adipose tissue graft.
局灶性关节软骨缺损是导致膝关节功能障碍的一个重要因素。目前已尝试过多种不同的手术方法,但大多数方法的长期效果不佳。在治疗病灶性软骨损伤方面,骨生物制剂已成为一种潜在的治疗手段。在这篇文章中,我们介绍了一种使用胶原蛋白膜和微碎屑脂肪组织移植治疗局灶性软骨损伤的手术技术。
{"title":"Microfragmented Adipose Tissue Associated With Collagen Membrane in the Treatment of Focal Knee Cartilage Defect","authors":"","doi":"10.1016/j.eats.2024.103075","DOIUrl":"10.1016/j.eats.2024.103075","url":null,"abstract":"<div><div>Focal articular cartilage defects are an important factor that leads to dysfunction of the knee joint. Several different surgical approaches have been tried, most of them showing poor results in the long term. The use of orthobiologics in the context of focal chondral lesion has emerged as a potential tool in the treatment of this condition. In this article, we present a surgical technique for the treatment of focal chondral lesions using a collagen membrane associated with microfragmented adipose tissue graft.</div></div>","PeriodicalId":47827,"journal":{"name":"Arthroscopy Techniques","volume":"13 10","pages":"Article 103075"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279343","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}
引用次数: 0
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Arthroscopy Techniques
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