Superior capsule reconstruction, while successful in recovering joint movement, yields to the lower trapezius transfer's strength in generating external rotation and abduction. The purpose of this article was to describe a simple and reliable technique for combining both strategies during one surgical procedure, thereby maximizing functional recovery through the restoration of both motion and strength.
The hip joint's functional integrity relies significantly on the acetabular labrum, which plays a crucial role in maintaining joint congruity, stability, and its negative pressure suction seal. Overuse, injuries sustained previously, long-standing developmental problems, or the failure of a primary labral repair may result in a state of functional labral insufficiency. Appropriate management of this condition mandates labral reconstruction. Antiviral bioassay While options for hip labral reconstruction utilizing grafts are plentiful, a definitive gold-standard approach has not been established. To achieve optimal function, the graft should mirror the native labrum's geometry, structural integrity, mechanical properties, and durability. Sickle cell hepatopathy A new arthroscopic labral reconstruction technique, utilizing fresh meniscal allograft tissue, has resulted from this.
The long head of the biceps tendon, a frequent source of pain in the anterior shoulder, is frequently accompanied by other shoulder conditions, including subacromial impingement, rotator cuff tears, and labral tears. The mini-open onlay biceps tenodesis, fixed with all-suture knotless anchors, is described in this technical note. Reproducible with ease, this technique is characterized by its efficiency and unique ability to maintain a consistent length-tension relationship, thereby lessening the chance of peri-implant reactions, fractures, and compromising the fixation's strength.
Symptomatic presentations of anterior cruciate ligament (ACL) intra-articular ganglion cysts are exceedingly uncommon, as are cases of the cyst itself. Yet, cases exhibiting symptoms remain a significant issue for the orthopedic community, as no universal agreement exists regarding the most effective treatment approach. Surgical treatment of an ACL ganglion cyst, outlined in this Technical Note, involves arthroscopic resection of the complete posterolateral ACL bundle using a figure-of-four positioning after prior conservative treatment has failed.
A Latarjet procedure, despite persistent glenoid bone loss, can still experience recurrence of anterior instability due to issues with the coracoid bone block, including resorption, movement, or improper location. Autografts, such as iliac crest and distal clavicle bone transfers, and allografts, including distal tibia allografts, provide multiple avenues for managing anterior glenoid bone loss. The coracoid process remnant is explored as a treatment alternative for glenoid bone loss that persists following a failed Latarjet surgical intervention. Within the glenohumeral joint, the remnant coracoid autograft, harvested and transferred through the rotator interval, is secured using cortical buttons. The arthroscopic procedure involves the use of glenoid and coracoid drilling guides for precise graft placement, enhancing reproducibility and safety. Further, a suture tensioning device is utilized to facilitate intraoperative graft compression, thereby optimizing bone graft healing.
A considerable reduction in ACL reconstruction failure rates has been observed in studies employing extra-articular reinforcement strategies, such as the use of the anterolateral ligament (ALL) or iliotibial band tenodesis (ITBT) with the modified Lemaire technique. Although the ALL reconstruction method demonstrates a decreasing trend in ACL reconstruction failure rates, the unfortunate reality is that instances of graft rupture will likely continue to exist. More alternative methods are needed for revision in these instances, presenting a challenge for surgeons, particularly with lateral approaches, since the lateral anatomy has been altered by earlier reconstruction, previous reconstruction tunnels are present, and fixation materials are already in place. We introduce a technique that offers both safety and exceptional stability in graft fixation. A single tunnel accommodates both ACL and ITBT grafts, culminating in a single point of fixation. By adopting this strategy, we carried out a lower-cost surgical procedure, decreasing the likelihood of lateral condyle fracture and tunnel confluence. This method is suggested for post-operative revisions when combined ACL and ALL reconstruction has proven unsuccessful.
Femoroacetabular impingement syndrome and labral tears in adults and adolescents are typically treated with hip arthroscopy, the gold standard, often involving a central compartment approach under fluoroscopy and continuous distraction. For optimal visualization and instrument movement during a periportal capsulotomy procedure, applying traction is necessary. selleck chemicals llc To ensure the femoral head cartilage remains unscathed, these particular maneuvers are performed. Precise force application is essential during hip distraction in adolescents to avoid iatrogenic neurovascular damage, avascular necrosis, and possible lacerations of the genitals and foot/ankle. Global experts in surgical techniques have refined an extracapsular hip procedure, minimizing capsular incisions while maintaining a remarkably low rate of complications. The hip's approach, characterized by heightened security and simplicity, has garnered attention among adolescents. Since the capsulotomy is done first, the need for distracting forces is proportionally less. The cam morphology is observable through this surgical procedure that enters the hip without causing any distraction. When considering treatment options for labral tears and femoral acetabular impingement syndrome in the pediatric and adolescent demographic, an extracapsular approach merits consideration.
Ultra-high molecular weight polyethylene sutures serve to repair and reconstruct extra-articular ligaments within the knee, elbow, and ankle. Suture augmentation techniques involving these sutures have gained popularity in recent years, finding application in the reconstruction of the anterior cruciate ligament, an intra-articular ligament within the knee joint. Although numerous surgical techniques are outlined within Technical Notes, every case study presented involves single-bundle reconstruction only, and no instance exists of applying this method to double-bundle reconstruction. This technical note comprehensively describes a suture-augmented, anatomical double-bundle anterior cruciate ligament reconstruction procedure.
An intramedullary nail, positioned retrogradely, serves as a viable implant option for tibiotalocalcaneal arthrodesis, bolstering mechanical strength and compression at the fusion site, and minimizing soft tissue encroachment. Yet, certain instances of fusion failure lead to the excessive burdening of the implant, ultimately causing the implant to falter. Due to the stress accumulated at the subtalar joint, implant breakage is anticipated. The proximal part of the fractured tibiotalocalcaneal nail is exceptionally hard to dislodge. The medical literature has recorded several surgical processes intended for the removal of the broken tibiotalocalcaneal nail. We delineate a surgical approach to extract a fractured tibiotalocalcaneal nail, specifically targeting the proximal portion with a pre-bent Steinmann pin. The method's minimal invasiveness is coupled with the unnecessary requirement for specialized tools to extract the nail.
Mounting evidence sheds light on the intricacies of the anterolateral ligament (ALL) in the knee. Despite the abundance of cadaveric, biomechanical, and clinical research, the anatomical structure, biomechanical function, and the very existence of the ALL continue to be points of contention. This article, including video examples, explains the surgical dissection of the ALL in human fetal lower limbs and also determines the specific anatomical and histological characteristics of the ALL throughout fetal development. Histologic analysis of dissected fetal knees revealed the clear presence of ALL, characterized by well-organized, dense collagenous tissue fibers alongside elongated fibroblasts, indicative of a ligament.
The anterior glenoid's bony Bankart lesions, a consequence of traumatic glenohumeral instability, can contribute to recurrent instability if surgical intervention is not timely. Anatomical repair of large bony fragments leads to impressive stability and favorable functional results; however, the techniques used to accomplish this repair are frequently either precarious or unduly cumbersome. We present, in this technique guide, a repair methodology for the glenoid articular surface, grounded in robust biomechanical principles, leading to a dependable, anatomic outcome. This technique is readily applicable in most bony Bankart settings, easily accomplished using standard anterior labral repair instrumentation and implants.
Many instances of shoulder joint diseases involve a co-occurrence of abnormalities in the long head biceps tendon (LHBT). Tenodesis is a highly effective treatment option for the shoulder pain often originating from biceps pathology. Various fixation methods and diverse locations are employed in the performance of biceps tenodesis. Using a 2-suture anchor, the article introduces a novel all-arthroscopic method for suprapectoral biceps tenodesis. The Double 360 Lasso Loop repair technique for the biceps tendon required only one puncture, which led to minimal damage and prevented the suture from slipping and failing.
Direct surgical repair is the usual method for a complete tear of the distal biceps tendon; however, chronic tears, especially mid-substance or musculotendinous ones, create complex surgical predicaments. Considering direct repair strategies, severe retraction or tendon insufficiency may necessitate a reconstructive intervention. The technique for distal biceps reconstruction, as described by the authors, uses an allograft with a Pulvertaft weave, achieved via a standard anterior incision, similar in approach to primary repair, with the assistance of a smaller proximal incision for tendon retrieval.