Arthroscopy Techniques最新文献

Hamstring tendon autografts have emerged as the graft of choice by over 50% of sports surgeons worldwide performing anterior cruciate ligament reconstruction. A more recent technique in harvesting the semitendinosus tendon, the posteromedial approach, afforded multiple benefits compared with the anteromedial approach. However, for the inexperienced surgeon, the current techniques may not be as simple because of decreased tendon tension after general anesthesia induction and subcutaneous layer dissection, making it difficult to palpate the semitendinosus tendon. By utilizing ultrasound to assist us during our harvest, we can perform the procedure with increased accuracy and efficiency, which leads to a safer, more proficient, and less invasive procedure.

Patients with recurrent patellofemoral instability in whom prior medial patellofemoral ligament (MPFL) reconstruction fails present unique challenges for revision soft-tissue stabilization owing to scar tissue formation, limited patellar bone stock for anchor placement, and increased risk of patellar fracture. We describe a technique for revision patellofemoral soft-tissue stabilization that combines MPFL and medial quadriceps tendon–femoral ligament reconstruction techniques through combined fixation to the patella with 1 suture anchor and soft-tissue fixation to the quadriceps tendon. The proposed technique maximizes restoration of resistance to lateral translation by attempting to re-create the native MPFL attachment and minimizes patellar fracture risk in the setting of poor bone stock through the use of a single 1.8-mm all-suture suture anchor rather than bone tunnels or multiple anchor placement for bony fixation.

The dorsal intercarpal ligament (DICL) is crucial for carpal stability and is frequently associated with injuries to other carpal ligaments, notably the scapholunate and lunotriquetral interosseous ligaments. Although isolated DICL injuries are uncommon, they can manifest as ligament avulsions, bony avulsions, or attenuations from chronic injury. Surgical repair of isolated DICL tears may be necessary when conservative management fails. We have previously described the first isolated DICL avulsion from the scaphoid dorsal ridge, suggesting an arthroscopic repair via the radiocarpal joint. This article details a repair technique through the midcarpal joint.

Multiligament knee reconstruction surgery is technically challenging, requiring careful planning and execution. Accurate placement of bone tunnels is important for graft function and there is an inherent risk of tunnel collision, which can compromise graft integrity. In this proof-of-concept study, we present a technique using computer navigation to help optimize tunnel placement and to avoid collision during multiligament knee reconstruction. A computed tomography (CT)-based navigation system was used to plan and execute femoral tunnel placement on a Sawbones model, for a Schenck KD-IV multiligament knee reconstruction. After CT scanning of the Sawbones model, commercially available software was used to plan tunnel trajectories for reconstruction of the posterolateral corner, medial ligament complex, and both cruciate ligaments. Tunnel entry points and trajectories were based on bony landmarks as identified on CT. The model was successfully registered with an accuracy of <0.5 mm. Execution of tunnel drilling was carried out for 7 femoral tunnels, guided by computer navigation. A postprocedure CT scan was then performed and superimposed over the preoperative planning scan. This demonstrated excellent correlation between planned and executed tunnels with no evidence of tunnel collision. This study supports the idea of using computer navigation to plan and execute tunnels in multiligament knee reconstruction.

The portal of Willingboro is a unique portal designed as a means of all arthroscopic biceps tenodesis for biceps tendinopathy. The portal allows for tenodesis to be efficiently and effectively performed in the subgroove space with low technical demand. This Technical Note provides detailed descriptions of the anatomical structures and standard shoulder arthroscopy portals relevant to the location of the portal of Willingboro. The structures discussed include the standard anterior, posterior, and lateral shoulder arthroscopy portals along with the axillary and musculocutaneous nerves, subscapularis and pectoralis major tendons, axillary artery, and major bony anatomic landmarks of the shoulder region. These descriptions may be used as a guideline or reference for safe creation of the portal of Willingboro.

We describe a surgical technique to repair medial meniscus posterior root tears through a transtibial pullout repair with a subcortical button for tibial fixation. This technique allows progressive tensioning of the repaired root without losing tension both during suturing of the knots above the button and after the procedure, owing to the specific button configuration.

Optimal graft choice and fixation technique are still ongoing topics of debate for primary and revision anterior cruciate ligament reconstruction. Interference screws are frequently used as graft fixation devices but can sometimes lead to tunnel widening, cyst formation, chronic inflammation, screw breakage, and persistent pain. Tibial tunnel widening is of special concern because it is often associated with graft failure. This technical note introduces a graft technique with a periosteum–patellar tendon–bone autograft and a press-fit tibial fixation approach that could be a viable option for secure anterior cruciate ligament reconstruction while offering the possibility of a quicker postoperative recovery, less pain, and a quicker return to everyday activities.

The medial patellofemoral complex (MPFC) refers to the primary static restraint to lateral patellar translation. Originally thought of as the medial patellofemoral ligament, anatomic studies over the past 10 years have identified the additional fibers that attach to the quadriceps tendon, which some have termed the medial quadriceps tendon femoral ligament. Anatomic studies have demonstrated that the MPFC midpoint is at the junction of the medial border of the quadriceps tendon and the articular surface of the patella, indicating that fixation can be on either structure. This technique describes a single-bundle reconstruction technique with anatomic fixation on the quadriceps tendon at the MPFC midpoint that involves fixation on the extensor mechanism first.

Medial meniscus ramp lesions are commonly associated with anterior cruciate ligament injury. They are one of the causes of positive pivot shift and can lead to failure to obtain rotary stability if missed during the surgical procedure. Several repair methods use a suture lasso from 2 posteromedial portals to attach the posteromedial capsule to the meniscus. Because it was concluded at the consensus meeting of the European Society for Sports Traumatology, Knee Surgery and Arthroscopy in 2019 that ramp lesions are not considered a meniscal tear and the lesion is essentially in either the articular capsule, meniscal capsular ligament, or meniscotibial ligament (MTL), it should be considered as a peel-off injury of the posteromedial capsule. This lesion is a meniscocapsular separation with or without MTL injury. Thus, reattaching the capsule and MTL to the bone on the posteromedial aspect would provide adequate anatomical repair. The prevailing repair methods suture the capsule to the meniscus, ignoring the MTL attachment. This technique addresses the refixation of the meniscal capsular ligament and MTL to the bone where it is attached instead of suturing it to the meniscus, thus providing sounder anatomical repair.

This article aims to provide a new surgical technique for rotational instability in the setting of anterior cruciate ligament rupture. Two main groups of surgical procedures can be identified in the treatment of anterolateral knee instability: lateral extra-articular tenodesis and anterolateral ligament reconstruction. Although the importance of anterior cruciate ligament reconstruction in anterolateral complex injuries is well known, the superiority of lateral extra-articular tenodesis over anterolateral ligament reconstruction or vice versa has not yet been shown. Both techniques show improved outcomes and reduced graft failure rates. The presented procedure can be considered a modification of the technique first described by Lemaire. Better tensioning can be achieved through cortical suspension by identifying the anisometric point on the lateral femur and performing a medial pullout on the femoral side. The advantages of this technique are better fine-tuning and tensioning, less invasiveness, and adjustable cortical fixation, which allows for a precise, incremental tensioning of the graft, ensuring circumferential healing of the graft within the socket and reducing the risk of graft laceration, which may happen with interference screws. Internal bracing provides excellent contact pressure between the femoral button and femoral cortex, ensuring that adequate tensioning is applied to the graft.