Authors:J. Mattison Pike, Suvleen K. Singh, W. Ben Kibler, Josef K. Eichinger Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Superior labrum anterior posterior (SLAP) lesions are prevalent in athletes and the elderly. Therefore, acquiring accurate diagnoses is beneficial for improvement in return to play for athletes and quality of life. A well-done clinical examination can help detect these lesions leading to an early and accurate diagnosis.Indications:Being able to perform a clinical examination for diagnosing SLAP lesions is an important tool for a doctor to know. Currently, there is not a centralized location with published videos that show how to perform these examinations and describe their attributes. This video helps clinicians quickly ascertain how to perform these examinations and learn about the statistical measures associated with them.Technique Description:The 7 exams shown are as follows: modified dynamic labral shear (DLS) test, speed’s test, active compression test (O’Brien test), anterior slide test, crank test, Kim test, and the Jerk test.Results:These tests have a wide variety of statistical measures making different ones useful for specific results such as ruling in or ruling out labral lesions. The tests with the highest sensitivity are the modified dynamic labral shear test (72%) and Kim test (61%-92%). The tests with the highest specificity are the modified dynamic labral shear test (98%), anterior slide test (81%-89%), Kim test (88%-99%), and the Jerk test (94%-99%). All of these have a 95% confidence interval except DLS test.Discussion/Conclusions:Some of these tests are more reliable than others when diagnosing labral lesions. Since the dynamic labral shear test and Kim test have the highest sensitivity, they are the most useful tests at ruling out labral lesions. These tests along with the anterior slide test and the Jerk test are the most useful for ruling in labral lesions due to their high specificity. Even though these tests have been proven to be more reliable than others, it still matters which tests the doctors feel comfortable performing accurately for them to use in the clinical setting. Citation: Video Journal of Sports Medicine PubDate: 2022-06-14T11:00:00Z DOI: 10.1177/26350254221083317 Issue No:Vol. 2, No. 3 (2022)
Authors:Cally McGee, Michael R. Baria, Corey Gatewood, Maneesh Tiwari, W. Kelton Vasileff, Chad Lavender Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Orthobiologics are increasingly used to treat musculoskeletal (MSK) conditions. Adipose may be a useful source of autologous cells for orthobiologic interventions. The lipoaspiration and processing techniques necessary to obtain these cells are not traditionally taught in most orthopedic training programs. Therefore, the goal of this video is to review the technique for adipose harvest and preparation to create microfragmented adipose tissue (MFAT).Indications:Currently, all MFAT applications are off-label. In practice, this is most commonly used for osteoarthritis and tendon disease.Technique Description:After local anesthesia is administered, a 17-gauge trochar is inserted into the subcutaneous adipose, and tumescent solution is injected. After a 5-minute waiting period, a separate 17-gauge harvest trochar is attached to the Autopose double-syringe (Arthrex; Naples, Florida) and is inserted into the subcutaneous adipose. Lipoaspiration is performed by moving the harvest device back and forth in a fan-like pattern. After 20 mL of lipoaspirate has been harvested from the first site, the lipoaspiration process is repeated on the contralateral side. After 40 mL of lipoaspirate has been harvested, the device is removed and decanted for 3 to 5 minutes. Then, 10 mL of sterile saline solution is injected into the device using the Luer lock attachment. This rinse process is repeated a second time. Once the excess fluid has been removed, the device is capped, and the outer syringe is slowly pushed down to move the tissue through the resizing filter. The inner syringe is removed and contains the final MFAT product.Discussion/Conclusion:Lipoaspirate is a simple technique that can be performed in the clinic or operating room to create MFAT. This provides a unique population of autologous cells that may be beneficial for treating MSK pathology. Citation: Video Journal of Sports Medicine PubDate: 2022-06-09T11:00:00Z DOI: 10.1177/26350254221076855 Issue No:Vol. 2, No. 3 (2022)
Authors:Michael Simon, Christoph Lutter, Thomas Tischer, Volker Schöffl Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Closed finger flexor tendon pulley injuries occur most frequently in rock climbing but also during other heavy finger strength work or exercises. While single pulley injuries receive a conservative therapy, multiple pulley injuries often require a surgical repair, as otherwise they will lead to contracture and loss of range of motion and functionality. While established surgical techniques, which use bone encircling tendon graft techniques, were found to produce osteonecrosis of the phalanx, our new transosseous technique avoids this problem.Indications:All triple pulley injuries (A2,3,4) (grade-4b injuries) and double pulley injuries (A2,3 or A3,4) (grade-4a injuries) are indicated, if the injury is older than 10 days at the point of therapy start or the flexor tendons bowstringing is either not redressable in the ultrasound or extended. Also, grade-4a injuries are indicated, if a secondary contracture starts to build.Technique Description:Standard palmar-sided incision, followed by debridement of the tendon sheath, pulley flap, and, if applicable, scare tissue in between the flexor tendons and the bone is performed. Wire-guided 3.0-mm drill holes at the base phalanx at the level of the former distal portion of the A2 pulley are completed. Passing of the palmaris longus tendon through the drill hole and interlacing it as a “loop and a half” follows. Distal continuation through lacing the transplant through the remaining rims of the former pulleys and the flexor tendon sheath is then performed. Securing the repair after tendon gliding control to itself is completed. Postsurgically, the splint is immobilized for 2 weeks, followed by the use of a thermoplastic pulley support ring for 4 weeks with active mobilization.Results:No complications occurred during or after the surgery. In few cases, a restricted range of motion in the proximal interphalangeal (PIP) joint of the respective finger of up to 3 to 5 grade occurred. One patient, who had a presurgical PIP extension deficit of 30°, which was released during the surgery, developed over time again a 20° extension deficit. The functional outcome score ranged between good and excellent, with one case being only satisfactory. The sport-specific outcome score was either good or excellent for all patients, with one patient with contracture where it was satisfactory. No osteonecrosis of the phalanx was recorded.Discussion:For multiple pulley ruptures, various surgical techniques are described. We favored a modified “loop and a half” technique with a distal continuation to the A3 pulley. This combines the advantages of the “loop and a half” technique, as the strongest, and the Weilby repair, as the most functional repair. We recently noticed some cases with osseous necrosis of the phalanx following this repair, likely due to the high pressure of the circulation of the tendon graft onto the bone and its blood vessels. Therefore, we have modified our procedure into a transosseous repair, which is presented in this article. This approach was first evaluated in a cadaver study to exclude a potential risk of osseous failure (fracture) during stress caused by the drill hole. After ruling out this risk, the transosseous technique became our standard approach, as it combines the advantages of the “loop and a half” technique with those of the Weilby repair and decreases the pressure onto the dorsal cortex of the fingers base phalanx and thus the risk of osteonecrosis. Citation: Video Journal of Sports Medicine PubDate: 2022-05-31T11:00:00Z DOI: 10.1177/26350254221079624 Issue No:Vol. 2, No. 3 (2022)
Authors:Kyle R. Wagner, Mario Hevesi, Joshua T. Kaiser, Zachary D. Meeker, Brian J. Cole Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Cartilage defects of the humeral capitellum most frequently present as osteochondritis dissecans (OCD) in young overhead athletes, such as baseball players. Historically, surgical options have included debridement, marrow stimulation, and osteochondral autograft transplantation. Fresh osteochondral allograft (OCA) transplantation comprises an additional treatment option that can structurally restore osteochondral defects and has demonstrated satisfactory outcomes without the donor-site morbidity associated with osteochondral autograft transplantation.Indication:OCA transplantation provides structural restoration of the articular surface and can be used for large (>1 cm diameter) lesions not amenable to refixation. Additionally, OCA transplantation can address both chondral and subchondral pathology and is suited for the treatment of failed previous surgical interventions, such as debridement or marrow stimulation.Technique Description:Following diagnostic arthroscopy, an anconeus splitting mini-open approach was performed to expose the capitellar defect. The defect was measured to be 10 mm, and a central guide pin was placed. A 10-mm reamer was used to prepare the defect bed to a depth of 8 mm. An OCA plug was then cut from a fresh femoral hemicondyle to match the prepared defect. The graft was soaked in bone marrow aspirate concentrate harvested from the iliac crest, and the plug was then inserted into the defect and tamped to be concentric with the surrounding articular cartilage.Results:OCA transplantation of the capitellum allows for the restoration of the articular surface with a structural graft and can be used for large defects and revision cases. While OCA transplantation is well described in the knee with long-term efficacy, the application of this technique to the capitellum is relatively recent. Recent case series for the capitellum have displayed significant improvements in patient-reported outcome measures and predictable return to sports.Discussion/Conclusion:OCA transplantation for the humeral capitellum provides an effective treatment option for large, unstable cartilage lesions not amenable to refixation. The procedure allows for restoration of the articular surface and can provide improvements in pain and function as well as return to sport. Citation: Video Journal of Sports Medicine PubDate: 2022-05-24T11:00:04Z DOI: 10.1177/26350254221079621 Issue No:Vol. 2, No. 3 (2022)
Authors:Jesse H. Morris, Gustavo A. Barrazueta, Gregory L. Cvetanovich Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Traumatic anterior glenohumeral instability is a commonly encountered shoulder pathology among young active patients. Nonoperative management and arthroscopic techniques are associated with high rates of reoccurrence, particularly in patient populations with known major risk factors.Indications:The coracoid process transfer (Latarjet procedure) is typically reserved for cases of anterior glenohumeral instability where glenoid deficiency exceeds 20% to 25% or when soft tissue stabilization techniques have failed.Technique Description:We use a standard open deltopectoral approach. The coracoid process is exposed and released from the pectoralis minor and coracoacromial ligament. An osteotomy is performed using an oscillating saw and completed with an osteotome to harvest the bone block, leaving the conjoint tendon intact. Soft tissue is cleared from the graft, and it is predrilled/measured. We use a subscapularis splitting technique to access the joint and expose the anterior glenoid. All bony surfaces are prepared. We drill into the glenoid at the premeasured offset. The graft is provisionally fixed into place with K wires, then secured with 2 parallel cannulated screws. The capsule is repaired to make the graft extraarticular. The subscapularis split is repaired in addition to standard closure.Results:The Latarjet procedure is very successful for restoring stability. Rates of recurrent dislocation range from 0% to 10% across various studies, and revision rates are as small as 3%. This is much lower than those seen following soft tissue stabilization, particularly in high-risk patient populations. Patient reported outcomes show good function and high rates of return to sport. Complication rates are generally higher, with some studies reporting up to 25% incidence. Musculocutaneous and axillary nerve injuries may occur, and graft overhang can lead to glenohumeral arthritis. Certain complications are unique to the procedure, including graft lysis, coracoid fracture, nonunion, and hardware issues.Discussion/Conclusion:The Latarjet procedure is very useful in cases of anterior glenohumeral instability with significant glenoid bone loss or following failed soft tissue stabilization. Its utilization may continue to grow in future years as technique innovations develop and surgical indications expand. Citation: Video Journal of Sports Medicine PubDate: 2022-05-17T11:00:00Z DOI: 10.1177/26350254211073340 Issue No:Vol. 2, No. 3 (2022)
Authors:Navya Dandu, Michael P. Fice, Edward Hur, Monica Kogan, Adam B. Yanke Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Patellar instability is a common clinical condition in skeletally immature individuals. Surgical treatment is considered when risk of recurrence is high.Indications:Distal femoral osteotomy is indicated in the setting of obligate flexion dislocation where femoral valgus contributes to a shortened lateral column, with concurrent quadriceps procedures considered for chronic contracture and medial patellofemoral ligament (MPFL) reconstruction for added stabilization.Technique Description:This procedure is performed in a stepwise manner as some components may not be necessary based on the patient’s specific anatomy. The procedure begins with a lateral iliotibial (IT) band soft tissue release or lengthening if possible. The distal femoral osteotomy is then performed utilizing a lateral opening wedge technique. Bone graft is placed in a structural fashion to maintain the correction while a locking plate is inserted. In patients with chronic lateral patellar dislocation, correction of bony alignment may not completely restore tracking. If lateral maltracking persists after further distal soft tissue release, a VY-lengthening quadricepsplasty can be considered. To perform this, the vastus lateralis (VL) is first released. In this patient, the patella was able to be stabilized centrally after VL release, and therefore, the VY-plasty was not performed. The soft tissue attachments for the final MPFL reconstruction are then prepared, including two at the superomedial and midbody of the patella and one at the adductor tendon. The whip-stitched graft is then passed through the adductor sling followed by the patellar periosteal tunnels with the knee in slight flexion to ensure centralization within the trochlear groove. Examination under anesthesia before final fixation of the reconstruction should demonstrate 1A lateral translation.Results:Correction of distal femoral valgus with osteotomy, in isolation or in combination with other patellar stabilizing procedures, has demonstrated significant improvement in patient-reported outcomes and reduced redislocation rates. However, large cohort studies are limited.Discussion/Conclusion:Both osseous and soft tissue abnormalities are important to consider in since they can contribute in varying degrees to patellar maltracking. Therefore, assessment of patellar tracking should be performed frequently to guide extent of surgical correction necessary. Citation: Video Journal of Sports Medicine PubDate: 2022-05-10T11:00:14Z DOI: 10.1177/26350254211062904 Issue No:Vol. 2, No. 3 (2022)
Authors:Benjamin Kerzner, Hasani W. Swindell, Suhas P. Dasari, Zeeshan A. Khan, Jorge Chahla, Nikhil N. Verma Abstract: Video Journal of Sports Medicine, Volume 2, Issue 3, May-June 2022. Background:Massive rotator cuff tears lead to superior humeral head translation and may prevent successful repair. Superior capsular reconstruction (SCR) can overcome this by improving the compression and depressor effects of the rotator cuff and joint capsule simultaneously.Indications:SCR is indicated in young, active patients with massive rotator cuff tears or a functional cuff deficiency from a failed previous rotator cuff repair without significant arthritis, articulation of the humeral head with the acromion, or dysfunctional deltoid.Technique Description:During the procedure, repair of the subscapularis is performed using a polydioxanone (PDS) suture shuttling device to pass suture through the subscapularis in an inverted mattress knotless configuration. Posterior infraspinatus tendon fibers are reduced and the tuberosity is abraded and decorticated followed by completion of the partial repair of the posterior cuff. Anchors are placed on the glenoid and articular margins followed by preparation of the dermal allograft with luggage tags medially and perforation laterally. The graft is passed and secured in a double row configuration laterally with apposition of the graft to the remnant, repaired rotator cuff posteriorly.Results:Passive range of motion (ROM) is begun at week 4, followed by progressive active ROM at weeks 6 to 12, and advancement of full ROM and advanced strengthening begun at 3 months. With SCR, a patient can expect maximal strength and function to be regained at 1 year postoperatively. Significant clinical improvement following SCR has been seen in visual analog scale (VAS) and American Shoulder and Elbow Surgeons Shoulder Score (ASES) scores for most patients, although there is a varied degree of return to sport following this procedure.Discussion/Conclusion:Clinical evidence suggests that SCR is a beneficial therapeutic intervention for short to medium term outcomes in younger patients with massive, irreparable rotator cuff tears. More studies are needed to identify the optimal thickness of the graft. Citation: Video Journal of Sports Medicine PubDate: 2022-05-03T11:00:03Z DOI: 10.1177/26350254211073143 Issue No:Vol. 2, No. 3 (2022)
Open Access journal
