Arthroscopy Techniques最新文献

Anterior cruciate ligament (ACL) mucoid degeneration is an underdiagnosed condition that occurs when mucinous material develops in the ACL in the absence of synovial lining. Several authors have diagnosed this condition, discussed their own personal observations, and put forward their own suggestions for management. When diagnosed, one important strategy for management entails “debulking” the ACL using an arthroscopic debridement. No protocol has been described on the sequence of steps for ACL debridement during arthroscopy. We present our own in this Technical Note, with the addition of video footage that describes our arthroscopic technique for ACL mucoid degeneration debridement using radiofrequency ablation and the sequence of steps. This Technical Note aims to demonstrate the procedure needed for arthroscopic debulking of a mucoid ACL, which will lessen ACL impingement while maintaining a stable knee.

High-grade the acromioclavicular joint (ACJ) dislocations can be treated surgically. Endoscopic techniques to stabilize the ACJ using an EndoButton suture technique for coracoclavicular (CC) fixation have been shown to be safe and reproducible. Several studies have demonstrated the benefit of stabilizing the ACJ to reduce postoperative horizontal instability. This Technical Note presents a full-endoscopic technique for acute ACJ dislocations using a double-stranded EndoButton cerclage technique for CC reconstruction and an additional coracoacromial ligament transfer for acromioclavicular reconstruction. An autologous coracoacromial ligament transfer to the lateral clavicle increases stability in the horizontal plane and reduces the risk of anteroposterior recurrent instability. Clinical studies need to show whether additive ACJ fixation in addition to the all-endoscopic double cerclage EndoButton CC stabilization technique is in fact beneficial.

Historically, the treatment of anterior cruciate ligament (ACL) injuries shifted from primary repair to reconstruction because the native, intrasynovial location of the ACL precluded the formation of a fibrin-rich clot needed for ligament healing. However, increasing attention has been paid to augmenting the biological environment surrounding the ACL to facilitate its healing after arthroscopic repair. The bridge-enhanced ACL restoration implant uses resorbable collagen mixed with autologous blood to provide a biological scaffold for tissue healing. The short-term results of this procedure are promising, showing noninferiority to traditional ACL reconstruction at 2 years postoperatively and a higher rate of return to sport at 6 months. Our technique for performing the bridge-enhanced ACL repair is efficient, is easy to learn, and achieves excellent fixation of the ACL stump augmented with an internal brace.

Scapular spine fractures following reverse shoulder arthroplasty have been associated with complications that include nonunion and fixation failure. This Technical Note presents a surgical approach for enhancing the stability and strength of spine fracture osteosynthesis. The method involves the utilization of double plating in conjunction with fibular allograft reinforcement anchored in the supraspinous fossa to provide support under the acromion. The allograft, offering an enhanced structural integrity, may contribute to an improved rate of bone fusion and clinical outcomes without donor site morbidity.

The anterior horn lateral meniscus tear often is accompanied by perimeniscal cysts, which are treated with arthroscopic cyst excision with outside-in repair of the anterior horn. After cyst excision, there is a large gap between the thin anterior capsule and the anterior horn, which sometimes does not allow a stable repair. The suture knots may be palpable below the skin postoperation and cause irritation. A recently published technique repairs the anterior horn with a suture anchor using a suture lasso technique. We suggest a modification using a knotless anchor instead of a suture anchor, which allows a predictable tension across the repair when deployed. This technique can be used for both anterior horn lateral meniscus and anterior horn medial meniscus repairs. This technique is easy to perform, less time consuming, and reproducible.

The anteroinferior tibiofibular ligament (AITFL) is 1 of the 4 ligaments forming the distal tibiofibular syndesmosis. When damaged, it is crucial to assess and address the lesion properly because a neglected or underdiagnosed lesion may invoke ankle osteoarthritis with underlying tibiofibular joint instability. In this technical note, we present a fully arthroscopic stabilization of the AITFL without the need for soft-tissue grafting. Our technique aims to create horizontal suture fixation over the damaged AITFL that serves as a mechanically efficient stabilization for the anterior aspect of the distal tibiofibular syndesmosis.

Correction of the varus deformities in the tibia is necessary because of the excessive pressure exerted on the medial compartment of the knee, which intensifies the degenerative process. Correction strategies encompass a variety of approaches and depend on the patient’s individual characteristics, age, soft tissue condition, and the orthopaedic surgeon’s experience with different surgical materials. Size and location of the deformity, whether gradual or acute, play crucial roles in choosing the most appropriate material and shape. The gradual correction is especially indicated for patients with severe deformities, soft tissue involvement, and a history of bone infections. This study aimed to introduce a gradual correction technique for varus deformities in the tibia using a unilateral external fixator and to describe the postoperative follow-up. This technique offers notable advantages, including accurate correction, better patient acceptance, lighter assembly, less risk of pseudarthrosis, and shorter distraction process owing to the use of a single piece. In addition, the operated limb can support the load on the day after surgery, and dynamic follow-up is performed on an outpatient basis.

Anterior shoulder dislocations often are associated with cartilage defects of the anterior glenoid (glenolabral articular disruption, or GLAD lesions). However, the importance of GLAD lesions for shoulder stability is usually greatly underestimated. Moreover, glenoid cartilage defects may have a high clinical relevance as the result of persistent pain and possible progression to osteoarthritis. Therefore, surgical treatment appears to be necessary. Although in older patients prosthetic arthroplasty is a useful treatment option for progressive symptomatic cartilage defects, there is still disagreement about the ideal joint-preserving method for the treatment of isolated glenoid cartilage defects, especially in younger and more active patients. In recent years, autologous chondrocyte implantation has been established as a promising treatment option for focal cartilage defects. However, most autologous chondrocyte implantation techniques have the disadvantage of requiring 2 surgical procedures and the availability of specialized laboratories, making the techniques complex and expensive. In contrast, the AutoCart procedure (Arthrex, Munich, Germany) is a cost-effective one-step procedure in which the cartilage defect is filled with a mixture of minced autologous cartilage and autologous conditioned plasma and has already shown good clinical results in the knee joint. We present an arthroscopic technique for use in glenoid cartilage defects.

Pullout repair of medial meniscal posterior root tears (MMPRTs) is generally recommended for patients with well-aligned knees, whereas open-wedge high tibial osteotomy (OWHTO) is often recommended for patients with MMPRTs and varus osteoarthritis. Although the management of MMPRTs with OWHTO has been controversial, retaining meniscal function can be expected through pullout repair. Conventionally, bone tunnels in pullout repair are created from the proximal anteromedial tibia. However, this technique could cause a killer angle of the repaired meniscus and could have a risk of turning the guidewire toward the neurovascular band. Therefore, we create a bone tunnel from the proximal anterolateral tibia combined with open-wedge distal tibial tubercle osteotomy, which can prevent an increase in postoperative patellofemoral contact stress; moreover, the bone tunnel can be created easily from the lateral tibia compared with OWHTO. This Technical Note describes the combined surgical procedure for patients with MMPRTs and varus osteoarthritis, which has advantages including physiological pullout direction of the repaired meniscus, lower risk of neurovascular damage, and placement of a longer plate screw that could interfere with the bone tunnel. We highlight the meticulous consideration given to the interference of the bone tunnel between the osteotomy line and plate screw.

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.