This approach, involving dual unicortical buttons, promotes early range of motion, restores the integrity of the distal footprint, and strengthens the biomechanical construct, proving exceptionally valuable for highly active, elite military service members.
Multiple surgical approaches used in posterior cruciate ligament reconstruction have been outlined and subsequently subjected to thorough investigation. We discuss a surgical method of single-bundle, all-inside posterior cruciate ligament reconstruction that involves the use of a full-thickness quadriceps tendon-patellar bone autograft. The technique's superiority over traditional approaches lies in its mitigation of tunnel widening and convergence, preservation of bone stock, elimination of the 'killer turn,' optimal stabilization achieved through suspensory cortical fixation, and accelerated graft incorporation via a bone plug.
Young patients experiencing irreparable rotator cuff tears find themselves confronted by a complex problem, challenging for both them and their orthopaedic surgeon. Surgical interventions for rotator cuff tears, particularly interposition reconstruction, are increasingly used for patients with retracted tears and a functioning rotator cuff muscle belly. Steroid biology Emerging as a restorative treatment, superior capsular reconstruction strives to reinstate the natural functions of the glenohumeral joint by implementing a superior constraint, ensuring a stable glenohumeral fulcrum. Restoring both the superior capsule and rotator cuff tendon in the context of an unfixable tear, particularly in younger patients with robust rotator cuff muscle tissue and an acceptable acromiohumeral spacing, could yield improved clinical results.
In the past decade, a spectrum of innovative anterior cruciate ligament (ACL) preservation strategies have emerged, mirroring the contemporary resurgence of selective arthroscopic ACL preservation. Despite the broad spectrum of suturing, fixation, and augmentation strategies within surgical approaches, a unifying concept, considering critical anatomical and biomechanical properties, is conspicuously missing. In this technique, the focus is on the precise anatomical realignment of both the anteromedial (AM) and posterolateral (PL) bundles to their appropriate femoral attachment sites. A PL compression stitch is carried out to enhance the ligament-bone interface and replicate the anatomical vectors of the native bundles, hence resulting in a more anatomical and biomechanically sound construct. The minimally invasive procedure, devoid of graft harvesting or tunnel drilling, translates to lower pain levels, a faster restoration of full range of motion, quicker recovery, and failure rates that appear similar to those seen in ACL reconstructions. Employing suture anchor fixation, we outline an advanced surgical approach for anatomic arthroscopic primary repair in patients with proximal ACL tears.
Since several anatomical, clinical, and biomechanical studies have shown the significance of the anterolateral periphery for knee rotational stability, the indications for combining anterior cruciate ligament reconstruction with anterolateral ligament reconstruction have increased substantially in recent years. The manner in which these techniques are combined, encompassing the selection of grafts and fixation, while concurrently mitigating tunnel convergence, remains the subject of much discussion. This research explores anterior cruciate ligament reconstruction using a triple-bundle semitendinosus tendon graft, employing an all-inside technique, integrated with anterolateral ligament reconstruction, ensuring the tibial attachment of the gracilis tendon is maintained within independent anatomical tunnels. By utilizing only hamstring autografts, we successfully reconstructed both structures, reducing the need for donor tissue from other areas, and enabling stable graft fixation without the requirement of tunnel convergence.
Anterior shoulder instability can sometimes cause anterior glenoid bone loss, this is frequently accompanied by a posterior humeral deformity presenting as bipolar bone loss. Cases of this nature frequently benefit from the Latarjet procedure, a common surgical intervention. Complications are observed in up to 15% of cases following this procedure, often linked to the inaccurate placement of the coracoid bone graft and the securing screws. To decrease the likelihood of complications, which are potentially minimized with the knowledge of patient anatomy and intraoperative surgical planning, we describe the use of 3D printing technology in the creation of a patient-specific 3D surgical guide for the Latarjet procedure. Compared to other existing tools, these instruments possess both positive aspects and restrictions, which are also discussed thoroughly in this article.
Inferior glenohumeral subluxation is a contributing factor to the debilitating pain some hemiplegic stroke patients experience. Suspensionplasty surgery, a surgical procedure, has been reported to offer positive outcomes when conservative treatments such as orthosis or electrical stimulation do not effectively address a medical condition. Osteoarticular infection This article describes a novel arthroscopic technique for glenohumeral suspensionplasty via biceps tenodesis, specifically for cases of painful glenohumeral subluxation in hemiplegic patients.
Ultrasound technology is being more frequently incorporated into surgical methods, becoming a standard procedure in medical settings. The use of imagery within ultrasound-guided surgical interventions may potentially lead to more accurate and safer outcomes in surgical procedures. Fusion imaging (fusion), a technique that synchronizes MRI or CT images with ultrasound images, is the method to achieve this. The intraoperative CT-ultrasound fusion-guided technique for hip endoscopy is described, highlighting the successful removal of an impinging poly L-lactic acid screw, whose location was difficult to ascertain through fluoroscopy during surgery. Fusion technology merges the real-time guidance of ultrasound with the comprehensive anatomical visualization offered by CT or MRI, resulting in minimally invasive, precise, and safer arthroscopic and endoscopic surgery.
Elderly patients, particularly in the early stages of their advanced years, frequently experience medial meniscus posterior root tears. The biomechanical study demonstrated that the anatomical repair process led to a significantly improved contact area and contact pressure, as opposed to the non-anatomical repair. Repairing the posterior root of the medial meniscus with a non-anatomical technique diminished the tibiofemoral contact area and increased the contact pressure accordingly. The medical literature contained accounts of multiple surgical repair approaches. Unfortunately, no exact arthroscopic landmark was cited to demarcate the anatomical footprint of the medial meniscus' posterior root attachment. By utilizing the meniscal track, an arthroscopic landmark, we aim to accurately guide the determination of the medial meniscus posterior root attachment's anatomical footprint.
Patients with anterior shoulder instability and glenoid bone loss can benefit from the arthroscopic application of autografts harvested from the distal clavicle to augment the bone block. PT 3 inhibitor Research encompassing both anatomy and biomechanics supports the use of distal clavicle autografts in glenoid articular surface restoration, providing results comparable to those achieved with coracoid grafts while potentially minimizing neurologic injury and coracoid fracture risks often associated with coracoid transfer procedures. This technique represents a modified approach to prior methods, employing a mini-open distal clavicle autograft harvest, orienting the distal and medial clavicle grafts against the glenoid in a congruent arc, an all-arthroscopic graft passage procedure, and securing the graft with specialized drill guides and four suture buttons, followed by capsulolabral advancement to create extra-articular placement.
The intricate interplay of soft tissue and osseous factors can result in patellofemoral instability, with the dysplasia of the femoral trochlea being a critical element in the predisposition to recurrent episodes of instability. Despite the reliance on two-dimensional imaging in surgical planning and decision-making, the three-dimensional nature of aberrant patellar tracking in trochlear dysplasia poses a significant challenge. In patients with recurrent patella dislocation and/or trochlea dysplasia, 3-D reconstructions of the patellofemoral joint (PFJ) might offer a more comprehensive view of the complex anatomy involved. This integrated system allows for analysis of 3-D PFJ reproductions, leading to enhanced surgical decision-making for this condition and contributing to optimal joint stability and long-term preservation.
Intra-articular injury to the posterior horn of the medial meniscus is a common finding in cases of chronic anterior cruciate ligament tears. The increased attention to ramp lesions, a specific type of medial meniscal injury, stems from both their high incidence and the diagnostic difficulties they present. These lesions' placement might render them invisible during standard anterior arthroscopic procedures. In this Technical Note, a description of the Recife maneuver is presented. This maneuver, through a standard portal, diagnoses injuries to the posterior horn of the medial meniscus using additional arthroscopic management. In the supine position, the medical procedure of the Recife maneuver is performed on the patient. By way of the anterolateral portal, a 30-degree arthroscope is inserted to access the posteromedial compartment, which is visualized from a transnotch perspective, a modified Gillquist view. Within the proposed maneuver, a valgus stress test incorporating internal rotation is performed on a knee in 30 degrees of flexion, which is then followed by palpating the popliteal region and applying digital pressure to the joint interline. The posterior compartment's visibility is enhanced by this maneuver, enabling a safer evaluation of meniscus-capsule integrity and facilitating the identification of ramp tears, eliminating the requirement for a posteromedial portal. As part of routine anterior cruciate ligament reconstruction, we propose incorporating the visualization of the posteromedial compartment using the Recife maneuver, to thoroughly assess meniscal condition.