Arthroscopy Techniques最新文献

Anterior open-wedge high tibial osteotomy of the proximal tibia is a reliable surgical procedure to treat genu recurvatum secondary to decreased posterior tibial slope. It is also useful in cases of posterior cruciate ligament (PCL) deficiency, especially after a failed PCL reconstruction procedure as reversal of posterior tibial slope is a common risk factor for failure of PCL reconstruction. In some knee joints, reversed tibial slope may be associated with varus or valgus deformity. We describe correction of reverse posterior slope along with varus deformity, which may result from a poorly performed high tibial osteotomy leading to failure of reconstructed PCL. In our technique, both of the above deformities are corrected simultaneously, thereby addressing the sagittal and coronal malalignments of the knee with one osteotomy.

Meniscus is an important structure within the knee to maintain stability and load gravity distribution. Compared with meniscectomy, timely meniscal repair can reduce the risk of knee regression and laxity. Various methods have been studied to repair the meniscus. Among them, the outside-in technique is appropriate to repair anterior and middle segments of the meniscus. A number of modifications of this technique have been described in previous literatures. However, it still has disadvantages, such as complex intra-articular maneuvers, requiring extra devices sometimes. Therefore, we have developed the modified outside-in technique using thin steel wire to introduce the suture from the outside to the inside and then to the outside. We then make a knot outside the capsule. The advantages of our technique are that it is easy to perform, is reproducible, and avoids making multiple intra-articular suture loops.

The anterolateral ligament has gained attention as a secondary stabilizer of anterolateral rotatory stability of the knee. This has had implications among sports medicine specialists as an adjunct procedure with anterior cruciate ligament reconstruction to improve stability. As indications have evolved for its use as an anterior cruciate ligament reconstruction augment, so have the techniques for reconstruction. As such, we present a simple, efficient, and reproducible technique for all-onlay reconstruction with low-profile instrumentation that mitigates concerns for tunnel convergence.

This technical note outlines a minimalist arthroscopic approach to anterior cruciate ligament avulsion fracture fixation using a bioabsorbable knotless suture anchor. This method represents a less invasive alternative to traditional techniques, catering specifically to fractures classified as Meyers and McKeever type II or III. The procedure is performed through standard anterolateral and anteromedial portals without the need for additional incisions or bone tunnel drilling, making it particularly suitable for children and adolescent patients with open physes. The technique involves the use of a suture hook to pass a double-stranded suture through the anterior cruciate ligament, anchored eccentrically to the anterior tibial incline with a knotless suture anchor. This approach allows for anatomic reduction with adjustable tension and without the potential risk of iatrogenic osteochondral injury. Nonetheless, it should be acknowledged that prospective biomechanical studies and larger patient samples are necessary to validate this technique compared with existing fixation methods.

Meniscal stabilization with saucerization has recently been recommended for discoid lateral meniscus (DLM) to preserve the meniscus shape and prevent the progression of osteoarthritis. However, axial alignment of the lower limb causes a significant valgus change after arthroscopic partial meniscectomy and can lead to progressive lateral osteoarthritic changes. Thus, valgus knees in patients with DLM are a suspected predictive factor for poor outcomes after DLM surgery. Valgus malalignment in pediatric patients can be corrected by temporarily tethering one side of the open physis using implant-mediated guided growth to generate differential growth in the coronal plane. This Technical Note describes simultaneous arthroscopic meniscal surgery and temporary hemiepiphysiodesis to treat DLM with valgus deformities to reduce the risk of future chondral damage to the lateral knee compartment.

Presented here is a modified technique for bridge-enhanced anterior cruciate ligament repair using adjustable-loop cortical suspensory femoral fixation. Advantages include the elimination of the need for a larger femoral-side incision and elimination of the risk of knot slippage while securing fixation of the anterior cruciate ligament repair suture.

The US Food and Drug Administration approved matrix-induced autologous chondrocyte implantation (MACI) for use in the United States in 2016, and it has proven to be an effective treatment for articular cartilage defects in the knee. Concomitant patellar stabilization and realignment procedures, such as tibial tubercle osteotomy (TTO) and medial patellofemoral ligament (MPFL) reconstruction, are often performed with MACI to prevent further damage to the knee and to sustain the integrity of the cartilage repair. This Technical Note aims to describe MACI in the patella with concomitant patellar stabilization and realignment and to provide a treatment algorithm for when various simultaneous procedures are indicated. The authors believe that correction of patellar malalignment and instability is crucial to the success of cartilage repair procedures. Therefore, we recommend that TTO and MPFL reconstruction be performed with MACI procedures of the patella when the anatomic pathology and pertinent patient history, such as articular cartilage defects with patellar instability and abnormal patellar alignment, are present.

Anterior cruciate ligament (ACL) injury is a common knee sports injury, with proximal ACL tears accounting for most cases. Arthroscopic ACL preservation has shown great potential in repairing ACL anatomic and biological function, with less tissue damage and slightly higher failure rates. Although many techniques for repairing the ACL have been developed, there are still many problems with the existing technology, such as the cumbersome operation of the traditional hook and needle breakage of the Scorpion suture passer (Arthrex). Herein, to further improve operational convenience and reliability, we developed a continuous bundle suture technique for primary repair of proximal ACL tears with suture anchor fixation. This technique aims to achieve continuous suturing with no additional auxiliary suture for guiding suturing by using a passer as a pusher in the suture hook to push out the suture loaded in the tip of the hook after the hook passes through the ligament. This technique takes advantage of the economics of the suture hook and the convenience of the Scorpion suture passer, allowing for flexible application of the suture hook to conveniently achieve anteromedial and posterolateral bundle repair for patients with proximal ACL tears.

The menisci have a poor intrinsic healing capability. Biological augmentation is used to promote meniscal healing in conjunction with suture techniques as the result of their poor healing rate. A fibrin clot (FC) is a well-known treatment option for meniscal injuries that are difficult to heal. Several methods for delivering FCs to target sites have been reported; however, all available methods have drawbacks such as unstable delivery, low maneuverability, and/or clot sizes that are too large. We use a dedicated device to efficiently deliver FCs of a suitable size for the tear. In this method, an FC formed to a size of 5 mm is stored and delivered in a thin syringe with a built-in plunger. This method enables an accurate delivery of a suitably sized FC to the desired location and fixes FCs to the tear site when used in combination with conventional suture methods. In this report, we will succinctly describe how to make and deliver an FC using the aforementioned device with a step-by-step instructional technique and an illustrative video.

We describe all-endoscopic deep gluteal syndrome treatment and sciatic nerve decompression at the infrapiriformis space. Surgery is performed with the patient in the prone position with the usual arthroscopic instruments and pump. The first step includes performing placement of 2 initial portals (medial and median) without fluoroscopy in the area of the ischial tuberosity and conjoint tendon, as well as release in this area with a subsequent shift in the lateral direction. The second step includes performing placement of an additional lateral portal for instruments, switching the camera into the median portal, and visualizing the sciatic nerve and its decompression at the infrapiriformis space and upper part of the thigh area. The postoperative period includes early activation, immediate passive and active motion after surgery, and full weight bearing the day after surgery.