Employing this dual unicortical button technique enables early range of motion, the recovery of the distal footprint, and a reinforced biomechanical structure, proving invaluable for elite, highly active military personnel.
A range of surgical strategies for posterior cruciate ligament reconstruction have been articulated and subsequently analyzed in depth. A surgical procedure employing a full-thickness quadriceps tendon-patellar bone autograft for single-bundle, entirely-internal posterior cruciate ligament reconstruction exhibits notable advantages over conventional methods. This technique effectively minimizes tunnel widening and convergence, while concurrently safeguarding bone stock, eliminating the inherent 'killer turn,' allowing for optimal stabilization via suspensory cortical fixation, and facilitating accelerated graft integration using a bone plug.
The challenge of irreparable rotator cuff tears in young patients falls upon both the patient and the orthopaedic surgeon, demanding a delicate balance of care. Interposition rotator cuff reconstruction has become a more frequently applied surgical approach for individuals with retracted tears and a capable rotator cuff muscle belly. biomimetic channel 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. Clinical outcomes in younger patients with a functional rotator cuff muscle belly and an adequate acromiohumeral distance may benefit from reconstructing both the superior capsule and rotator cuff tendon in situations of an irreparable tear.
The last ten years have witnessed a proliferation of diverse anterior cruciate ligament (ACL) preservation techniques, concurrent with a renewed focus on selective arthroscopic ACL preservation approaches. 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. For the purpose of augmenting the ligament-bone contact surface and replicating the anatomical orientations of the native bundles, a PL compression stitch is executed, thus establishing a more anatomically correct and biomechanically sound construct. Minimally invasive, this technique avoids graft harvesting and tunnel drilling, resulting in decreased pain, faster return of full range of motion, and quicker rehabilitation, with failure rates comparable to standard ACL reconstruction. Employing suture anchor fixation, we outline an advanced surgical approach for anatomic arthroscopic primary repair in patients with proximal ACL tears.
Several anatomical, clinical, and biomechanical studies, demonstrating the significance of the anterolateral periphery in maintaining knee rotational stability, have considerably amplified the indications for combining anterior cruciate ligament reconstruction with anterolateral ligament reconstruction in recent times. 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. An anterior cruciate ligament reconstruction using a triple-bundle semitendinosus tendon graft, performed via an all-inside technique, is detailed in this study, combined with anterolateral ligament reconstruction, maintaining the gracilis tendon's tibial insertion within independent anatomical tunnels. Hamstring autografts were uniquely employed to reconstruct both structures, minimizing the risk of damage to other potential donor sites, while also allowing for stable graft fixation without any tunnel convergence.
A possible consequence of anterior shoulder instability is anterior glenoid bone loss, this may be joined with a posterior humeral deformity known as bipolar bone loss. The Latarjet procedure, a frequently used surgical method, is an option in such cases. Despite its effectiveness, the procedure suffers from complications in up to 15% of instances, often attributable to an improper positioning of the coracoid bone graft and screws. Given the potential for reduced complications through the recognition of patient anatomy and intraoperative surgical planning, we outline the employment of 3D printing methods to create a personalized 3D surgical guide for the Latarjet procedure. These tools, in contrast to other available options, possess both advantages and constraints, which are also detailed in this article.
Among the causes of debilitating pain in stroke-affected hemiplegic patients, inferior glenohumeral subluxation stands out. In instances where medical intervention using orthosis or electrical stimulation is unsuccessful, surgical suspensionplasty has been reported to provide favorable results. GDC-0068 clinical trial An arthroscopic glenohumeral suspensionplasty technique, specifically utilizing biceps tenodesis, is presented here for the treatment of painful glenohumeral subluxation in hemiplegic patients.
The use of ultrasound in surgery is becoming more established and integral to the medical field. Employing imagery within ultrasound-guided surgical procedures may enhance the precision and safety of surgical interventions. The ability to synchronize MRI or CT images with ultrasound images, provided by fusion imaging (fusion), leads to this. We describe a successful application of intraoperative CT-ultrasound fusion-guided hip endoscopy in the removal of a problematic impinging poly L-lactic acid screw, that proved difficult to visualize with fluoroscopy during surgery. Fusion technology, which integrates the real-time guidance of ultrasound with the panoramic view offered by CT or MRI, facilitates a less invasive, more precise, and safer approach to arthroscopic and endoscopic surgery.
Early-stage senior patients commonly encounter posterior root tears within their medial meniscus. Based on biomechanical data, the anatomical repair procedure showcased a recovery of contact area and contact pressure exceeding that of the non-anatomical repair. Following a non-anatomical repair of the medial meniscus posterior root, the area of contact between the tibia and femur was reduced, while the contact pressure was augmented. Several surgical repair techniques were documented in the published research. Unfortunately, no exact arthroscopic landmark was cited to demarcate the anatomical footprint of the medial meniscus' posterior root attachment. Employing the meniscal track, an arthroscopic landmark, we suggest accurately locating the anatomical footprint of the medial meniscus posterior root attachment.
In cases of anterior shoulder instability with glenoid bone defects, arthroscopically placed distal clavicle autografts provide a readily accessible bone block augmentation source. biohybrid structures Distal clavicle autograft application, as evidenced in both anatomic and biomechanical studies, shows a comparable ability to restore glenoid articular surface compared to coracoid grafts, with the theoretical benefit of minimizing complications, including neurologic damage and coracoid fracture, that accompany coracoid transfer procedures. The current method modifies prior techniques by utilizing a mini-open approach for distal clavicle autograft harvest, orienting the medial clavicle graft against the glenoid in a congruent arc configuration, an entirely arthroscopic graft passage technique, and securing the graft with specialized drill guides and four suture buttons, followed by final capsulolabral advancement for extra-articular positioning.
Patellofemoral instability can be caused by a variety of soft tissue and osseous conditions, with femoral trochlear dysplasia particularly increasing the likelihood of recurrent instability events. Surgical planning and decision-making are entirely reliant on two-dimensional imaging metrics and classification schemes, even though trochlear dysplasia-induced aberrant patellar tracking presents a three-dimensional challenge. For a deeper understanding of the complex anatomy in patients presenting with recurrent patella dislocation and/or trochlea dysplasia, 3-D reconstructions of the patellofemoral joint (PFJ) could be considered a valuable assessment technique. 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. Given their spatial relationship, these lesions could be difficult to visualize during a conventional anterior arthroscopy. Within this technical note, the Recife maneuver is described. Injuries to the posterior horn of the medial meniscus are diagnosed using this maneuver, further involving arthroscopic management through a standard portal. The Recife maneuver is undertaken while the patient maintains a supine position. The posteromedial compartment is reached via a transnotch perspective (a modified Gillquist view), with a 30-degree arthroscope introduced through the anterolateral portal. A valgus stress test with internal rotation is performed on the 30-degree knee flexion in the proposed maneuver, which is subsequently followed by palpation of the popliteal region and application of digital pressure to the joint interline. Enhanced visualization of the posterior compartment through this maneuver allows for a safer diagnostic assessment of meniscus-capsule integrity, enabling the identification of ramp tears without the creation of a posteromedial portal. For a more comprehensive evaluation of meniscal status during anterior cruciate ligament reconstruction procedures, we suggest the inclusion of the diagnostic posteromedial compartment visualization described by the Recife maneuver.