Authors:Adam J. Tagliero, Vaibhav R. Tadepalli, Brian C. Werner Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Snapping biceps femoris syndrome (SFS) represents a rare clinical entity in which the biceps femoris subluxates over the fibular head in deep flexion. Two primary pathophysiologies have been described including a prominent or abnormal fibular head morphology. Others have implicated an anomalous biceps femoris insertion. The diagnosis is made clinically, with operative and nonoperative intervention strategies available for treatment.Indications:SFS often results in audible snapping and associated pain at the lateral fibular head. When recalcitrant to nonoperative management, surgical intervention can lead to resolution of symptoms. We present the case of a college-aged male who has bilateral symptoms, worse on the right, which have resulted in significant activity modification and daily discomfort recalcitrant to anti-inflammatory medication and physical therapy.Technique Description:The patient was placed supine on the operating room table with an ipsilateral bump under the hip to assist in exposure of the lateral aspect of the knee. Examination under anesthesia (EUA) confirmed the snapping biceps femoris. A lateral approach to the knee and a common peroneal neurolysis was performed. The biceps femoris insertional anatomy was examined for anomalous tendon insertion or insertional tearing. The prominent fibular head was exposed and resected, with careful attention not to disrupt the lateral collateral ligament or popliteofibular ligament insertion sites. The biceps femoris was then repaired to the prepared bony bed of the fibula with one double-loaded suture anchor. Repeat EUA confirmed complete resolution of snapping even with maximal internal rotation of the tibia; this was carefully examined again with the tourniquet deflated to ensure its compressive effect was not partially responsible for the resolution.Results:Published data pertaining to SFS is limited to case reports and small case series. With appropriate indications, surgical intervention yields promising results with a high percentage of patients returning to prior level of activity or prior participation level in sport.Discussion/Conclusion:SFS can be diagnosed with a careful clinical assessment. When recalcitrant to nonoperative management, it is effectively treated with surgical intervention to restore normal fibular anatomy, and prevent recurrent instability and persistent pain. The presented technique allows for appropriate management of these rare injuries.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-08-06T10:00:03Z DOI: 10.1177/26350254241239978 Issue No:Vol. 4, No. 4 (2024)
Authors:Nicholas M. Tranchitella, Paul J. Pottanat, Matthew Sherrier Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Ulnar neuropathy at the elbow (UNE) is common, and treatment ranges from bracing and nonsteroidal anti-inflammatory drugs (NSAIDs) to surgical decompression. Prior to surgical intervention, some patients may opt to receive perineural injections to the ulnar nerve. The goal of this injection is to reduce pain, improve symptoms, and decrease nerve cross-sectional area through mechanical decompression. While the use of hydrodissection as a treatment for carpal tunnel syndrome has been well studied, there are few studies evaluating its utility in UNE.Indications:Ultrasound-guided perineural injections can be used to alleviate symptoms of UNE caused by compression. The use of a gel stand-off technique is helpful in maintaining adequate visualization of the needle with a steeper needle angle.Technique Description:The procedure was carried out with patient supine, shoulder abducted to 90°, and the forearm supinated. A 15-6 MHz linear array ultrasound transducer was used to localize the right ulnar nerve proximal to the retrocondylar groove at an area of focal hypoechogenicity and increased nerve cross-sectional area. A 3 mL mixture of 2 mL of 1% lidocaine and 1 mL of 10 mg/mL dexamethasone was injected using a sonographically guided in-plane anterior-to-posterior technique.Results:Our patient was seen 3 weeks after her right-sided ulnar nerve hydrodissection and had experienced temporary reduction in symptoms.Discussion/Conclusion:UNE is a common cause of focal neuropathy. Most patients will experience adequate relief of symptoms with conservative treatment modalities. If patients do not experience adequate symptom relief, ultrasound-guided ulnar nerve injection is a minimally invasive option that can provide symptom relief. However, if patients continue to experience significant symptom burden, it is reasonable to discuss surgical options for ulnar nerve decompression.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-07-31T05:45:41Z DOI: 10.1177/26350254241244405 Issue No:Vol. 4, No. 4 (2024)
Authors:Chukwuma T. Iwuoha, Luke V. Tollefson, Joey Larson, Nicholas I. Kennedy, Robert F. LaPrade Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:The fabella is a sesamoid bone that is a normal anatomic variant yet a rare cause of pathology in the posterolateral portion of the knee. The fabella can cause chronic knee pain in patients with knee osteoarthritis and athletes at all levels and in rare cases can cause neuropathy. Initially, treatment for a painful fabella includes conservative measures, with surgical intervention after conservative treatments have failed. This technique describes our arthroscopic-assisted fabella removal technique with a concomitant medial meniscus revision repair.Indications:The goal of treatment is to relieve pain and numbness. Conservative measures (i.e., nonsteroidal anti-inflammatory drugs [NSAIDs], range of motion exercises, heel cord stretching, etc.) are the initial step in treatment. Patients are treated surgically after conservative measures have failed. The surgical approach involves an open incision, arthroscopy, or a combination.Technique Description:With the patient in the supine position, a physical examination is performed under anesthesia to compare to validate clinical findings. An open lateral knee approach helps to locate the fabella which is grasped with an Alice clap. An arthroscopy is performed, and viewing posterolaterally will confirm that the fabella is within the grips of the Alice clamp. After repair of the meniscus, the surgical bed is repositioned to identify the fabella properly. Excision of the fabella is performed sharply from the lateral gastrocnemius tendon, and palpation is demonstrated to ensure complete removal. Caution is essential to avoid complications including damage to nearby anatomic structures, such as the lateral gastrocnemius tendon, and incomplete fabella removal.Results:A clinical study by Dekker et al reported that 80% of patients were able to return to full activities and postoperative patient-reported outcomes improved from preoperative to postoperative. Fabella excision is recommended for patients with fabella pain who do not respond to conservative treatment.Discussion:We describe a technique for removing the fabella with arthroscopic assistance. Patients who have not responded appropriately to conservative treatment for a painful fabella should consider surgical intervention. With the early initiation of rehabilitation, patients will have an increased likelihood of decreased pain, resolution of symptoms, and reduced knee stiffness.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-07-30T10:00:02Z DOI: 10.1177/26350254241237806 Issue No:Vol. 4, No. 4 (2024)
Authors:Ehab M. Nazzal, Fritz Steuer, Liane Miller, Sophia McMahon, Matthew Como, Zachary J. Herman, Jonathan F. Dalton, Rajiv Reddy, Matthew F. Gong, Albert Lin Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Arthroscopic remplissage is an effective adjunct for anterior shoulder stabilization in patients with large engaging Hill-Sachs lesions (HSLs) and without significant glenoid bone loss or on-track HSLs with high risk of recurrence.Indications:The arthroscopic remplissage shown was performed in a patient with a high-risk profile for recurrence (age Citation: Video Journal of Sports Medicine PubDate: 2024-07-26T10:00:01Z DOI: 10.1177/26350254241237535 Issue No:Vol. 4, No. 4 (2024)
Authors:Nicholas W. Tully, Mark A. Glover, Jelle P. van der List, Benjamin S. Albertson, Brian R. Waterman Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Acromioclavicular (AC) joint separations occur most often in young male patients, commonly in athletes. Initially described by Jones et al. in 2001, reconstruction with semitendinosus allograft via cerclage has been increasingly adopted in recent times, though this not been as well described in video journals.Indications:Operative management of AC joint separation is classically indicated in Rockwood grade IV or higher AC joint injuries and controversial for grade III separations. One such treatment is AC joint reconstruction with semitendinosus allograft as described in this 37-year-old male patient, with a grade IIIB AC joint separation.Technique Description:A 6-cm incision was created overlying the clavicle. No distal clavicle excision was performed, but coracoclavicular (CC) scar tissue was elevated with medial and lateral windows about the coracoid. A passing suture was placed around the coracoid, and holes were drilled in the clavicle at 17% and 31% of the total clavicle length, consistent with ratios described by Rios et al; 5-mm tunnels were created corresponding to the trapezial and conoid limbs of the CC ligaments and tapped to 5.5 mm. A semitendinosus allograft was passed and fixed with two 5.5 × 15 mm polyetheretherketone (PEEK) screws after primary fixation with a FiberTape cerclage looped around the coracoid and clavicle independently with use of a tensiometer for maximal tightening. A FiberTak was used to fix the additional graft limb at the acromion to stabilize the AC joint and reinforced on itself with 0 vicryl. The patient was placed in a sling and assigned physical therapy (PT) focusing on limiting shoulder abduction and forward flexion for the first 6 weeks.Results:At 6 months postoperation, the patient continues to progress from PT, with low pain and near full range of motion. Although PT protocols vary widely, a full recovery is expected by 6 months, with the patient able to return to work, lifting no greater than 50 pounds.Discussion/Conclusion:This study describes the treatment of an acute grade IV AC joint separation in a 37-year-old male patient. Further adoption of AC joint reconstruction utilizing a semitendinosus allograft via cerclage continues to be a viable option for patients requiring operative management.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-07-24T10:00:01Z DOI: 10.1177/26350254241235673 Issue No:Vol. 4, No. 4 (2024)
Authors:Benjamin Lurie, George F. Hatch Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Patellar instability with symptomatic cartilage lesions in young patients is a challenging problem to treat. The use of osteotomies to correct malalignment and fresh osteochondral allograft transplantation (OCA) to address cartilage lesions and patellofemoral dysplasia is a viable treatment option for carefully selected patients.Indications:The patient is a 22-year-old woman with medial patellar instability caused by iatrogenic distal femoral external rotation and uncontained grade IV patellofemoral lesions. The patient was indicated for OCA because the lesions were too large for an osteochondral autograft transfer system (OATS) and were uncontained and not amenable to autologous chondrocyte implantation. Bipolar OCA also addresses the patient’s patellofemoral dysplasia by restoring a more morphologically normal patellofemoral joint. The external rotation and mild varus deformity are corrected with a biplanar distal femoral osteotomy. Correction of malalignment is necessary prior to OCA transplantation to avoid abnormal graft loading and thereby decrease the risk of graft failure.Technique Description:(1) Diagnostic arthroscopy and fluoroscopic examination under anesthesia. (2) Lateral closing wedge de-rotational distal femoral osteotomy. (3) Bipolar OCA with tibial tubercle osteotomy and removal of hardware.Results:In this case, the patient had significant improvement in her symptoms and had full knee range of motion with a normal gait at 3 months after surgery. Depending on a patient’s preoperative function and the specific pathology, full recovery can take considerably longer. A successful outcome is considered return to activities of daily living without significant pain. Return to higher level athletic activities is significantly more unpredictable. Graft survival of bipolar patellofemoral OCA is variable, and the literature is limited by the small number of procedures performed, but published series range from 60% to 85% at 5 years.Discussion/Conclusion:A successful outcome in these unique, complex cases depends on good patient selection, preoperative planning, and surgical execution. Patellar instability can be reliably treated when the predisposing anatomical factors are appropriately corrected. Bipolar OCA can provide significant improvement in pain and function, but continues to have the highest rate of graft failure compared with other sites within the knee, and should be considered a salvage operation for patients with significant limitations in activities of daily living.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-07-22T10:00:01Z DOI: 10.1177/26350254241234677 Issue No:Vol. 4, No. 4 (2024)
Authors:Amar S. Vadhera, Kevin C. Parvaresh, Hasani W. Swindell, Jonathan S. Lee, Adam B. Yanke, Nikhil N. Verma, Brian J. Cole, Jorge Chahla Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Chondral injuries in the knee are commonly discovered during knee arthroscopy procedures. Due to the poor restoration potential and avascular nature of cartilage, large defects are commonly treated with such surgical procedures. Treatment utilizing an osteochondral allograft (OCA) transplant for symptomatic focal cartilage defects in the patellofemoral joint has demonstrated strong, lasting clinical and radiographic outcomes.Indications:Active and otherwise healthy patients are indicated for surgery when presenting with significant joint-line pain and a large focal chondral defect verified on advanced imaging after an extensive course of nonoperative management.Technique Description:Beginning with diagnostic arthroscopy to confirm the large defect of the medial femoral condyle, we proceeded with OCA transplantation. A small medial peripatellar arthrotomy is performed. The fat pad is removed for visualization and retractors are placed both medially and laterally to appropriately visualize the defect. The defect is then sized according to the appropriate sizing guide. The guide is then placed perpendicular to the defect, and a central guide pin is drilled. A scoring reamer is used to carefully cut the size of the defect followed by a central reamer to prepare the defect. Any debris is removed, and the incision is thoroughly irrigated. The defect is then carefully measured in all four quadrants to match the donor. Any underlying bone is impacted for a stable base. A drill is then used for appropriate marrow venting underneath the defect. The corresponding donor site is selected and reamed with continuous irrigation to prevent thermal necrosis. The plug is removed and carefully measured to match the recipient site. The plug is thoroughly irrigated with pulse lavage to remove marrow elements. The graft is carefully inserted with gentle manual pressure until it is seated perfectly flush with the surrounding cartilage.Results:Clinical research has demonstrated good-to-excellent long-term survivorship of OCA transplantation. Long-term return to sport rates for recreational and competitive athletes are upward of 75%.Discussion/Conclusion:As surgical techniques continue to develop, surgeons should consider utilizing OCA transplants to treat large chondral defects in the patellofemoral joint.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-07-19T10:00:01Z DOI: 10.1177/26350254241237808 Issue No:Vol. 4, No. 4 (2024)
Authors:Brian Forsythe, Vahram Gamsarian, Harsh H. Patel, Elyse Berlinberg, Alec Warrier, Haseeb Goheer, Vikranth Mirle, Lashmanan Sivasundaram, Christopher M. Brusalis Abstract: Video Journal of Sports Medicine, Volume 4, Issue 4, May 2024. Background:Management of long head of the biceps tendon (LHBT) pathology is accomplished through a biceps tenotomy or tenodesis. While both modalities provide beneficial outcomes, a biceps tenodesis may confer improved cosmesis, functional outcomes, and decreased muscle cramping postoperatively. Many procedural considerations are undertaken prior to a tenodesis, such as the surgical approach and fixation device. While similar clinical outcomes are achieved between an open subpectoral and arthroscopic suprapectoral biceps tenodesis (ASPBT) with interference screw (IS) fixation, the latter technique offers a minimally invasive modality.Indications:The primary indications for an ASPBT include superior labrum anterior posterior (SLAP) tears, LHBT tears, biceps instability, bicipital tunnel disease, biceps pulley lesions, and biceps tenosynovitis. Contraindications to the arthroscopic approach include a distal lesion of the biceps tendon below the pectoralis major tendon (PMT). The IS may be used to create a biomechanically stiffer construct.Technique Description:With the arthroscope in the lateral portal, the distal aspect of the bicipital groove proximal to the superior border of the PMT is identified and opened. The LHBT is subsequently mobilized and released. An anterosuperolateral portal is localized with a spinal needle positioned perpendicular to the bicipital tunnel, 1.5 cm proximal to the superior border of the PMT. The biceps is then removed ex vivo and whip-stitches are sewn beginning 1 cm proximal to the myotendinous junction of the LHBT. After firmly associating the LHBT with the tip of the IS, a guidewire is placed 1.5 cm superior to the superior border of the PMT, perpendicular to the humerus, and a reamer is used to prepare a 6-, 7-, or 8-mm diameter socket. The tendon is inserted through the accessory portal into the tunnel, followed by screw fixation. Suture tails are tied with 5 alternating half hitches, each secured via an arthroscopic knot pusher.Results:ASPBT with IS fixation provides significant pain relief, improves range of motion (ROM), and enhances quality of life.Discussion:ASPBT with IS fixation provides significant improvements in patient-reported and functional outcomes and thus can be an acceptable treatment for LHBT pathology.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-07-17T10:00:10Z DOI: 10.1177/26350254241230972 Issue No:Vol. 4, No. 4 (2024)
Authors:Stephen Marcaccio, Rafael Buerba, Justin Arner, James Bradley Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Massive rotator cuff tears, defined as those that involved 2 or more tendons or where the length of the greatest diameter is greater than 5 cm, present a unique surgical challenge as there can be significant scarring, retraction, and poor tissue quality. Furthermore, healing of these tears is less reliable. This video presents our technique for anatomic, double row repair of a massive reparable rotator cuff tear.Indications:Indications for operative intervention include acute traumatic tears, as well as patients with pain and weakness who have failed to respond to conservative management, including physical therapy with confirmed large full thickness rotator cuff tear on advanced imaging. Of note, findings such as glenohumeral osteoarthritis, advanced muscle atrophy (Goutalier III/IV), superior migration of the humeral head>7 mm, and tears larger than 40 mm in length and width are concerning for irreparable tears, and may represent contraindications to surgical repair.Technique Description:The patient is placed in the lateral decubitus position. After diagnostic arthroscopy is performed, a subacromial bursectomy is performed. A radiofrequency probe and arthroscopic shaver are used to perform releases in the subacromial space as well as superior to the glenoid. Preparation of the footprint of the humeral head is then performed to create a good healing surface. The rotator cuff is grasped to confirm tension free mobilization. The medial row anchors are then placed. Once placed, the sutures are incorporated into 2 lateral row anchors in sequential fashion. Subacromial decompression is then performed.Results:Reduced pain and improved shoulder function are the goals of treatment, with sling immobilization lasting for roughly 6 weeks postoperatively prior to initiating strengthening and range of motion protocols.Discussion/Conclusion:Arthroscopic double row repair produces an anatomic and stable reduction of reparable massive rotator cuff tears for patients that have failed conservative management.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-26T10:00:03Z DOI: 10.1177/26350254241229101 Issue No:Vol. 4, No. 3 (2024)
Authors:Stephen Marcaccio, Brian Godshaw, Justin Arner, James Bradley Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:While rotator cuff repair has generally produced good to excellent outcomes, re-tear rates remain variable, with rates ranging from 20% to 50%. The ideal rotator cuff repair includes 3 main components: restoration of the humeral footprint contact area, appropriate compression of the tendon to the humeral footprint, and minimal motion at the bone-tendon interface until bone-tendon healing is completed. This video takes a well-established knotless double-row technique for rotator cuff repair and augments it with a modification to promote additional compression of the medial row tendon to the humeral footprint.Indications:This compression SpeedBridge technique is indicated for repair of T-type rotator cuff tears involving the supraspinatus and infraspinatus tendons in patients that have failed conservative management, including physical therapy, activity modification, and corticosteroid injections. This technique can also be applied to U-shaped or L-shaped tears by removing the initial step, which involves side-to-side repair of the “T” portion of the T-type tear. Of note, findings such as advanced muscle atrophy (Goutalier III/IV) and advanced glenohumeral arthritis are concerning for irreparable tears and may be contraindications for surgical repair.Technique Description:With the patient in the lateral decubitus position, a diagnostic arthroscopy is performed, the rotator cuff tear is debrided, and the footprint prepared. Two side-to-side stitches are placed to repair the “T” portion of the tear. The medial row anchors are then sequentially placed, and the pre-loaded sutures are passed through the tendon in 4 sequential locations in specific fashion. After placement of looped sutures in the anterior and posterior rotator cables, the passed sutures are then incorporated into the lateral row anchors. The medial row compression is provided by shuttling previously placed compression stitches through the knotless mechanism in the medial row anchors and terminally tensioned.Results:This technique provides additional medial row compression to an already-established knotless double-row rotator cuff repair technique to facilitate improved bone-tendon healing and construct strength.Discussion/Conclusion:The compression SpeedBridge technique is a unique method to apply additional medial row compression to a double-row rotator cuff repair.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-20T10:00:00Z DOI: 10.1177/26350254241229100 Issue No:Vol. 4, No. 3 (2024)
Authors:Stephen Marcaccio, Robin Dunn, Justin Arner, James Bradley Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:When evaluating a patient with a failed anterior cruciate ligament (ACL) reconstruction, a detailed history and physical examination is paramount. The position and size of original femoral and tibial tunnels are critical in the surgical decision-making in the setting of revision ACL reconstruction. This video presents a case of stage I revision ACL reconstruction with the use of allograft bone dowels due to increased size and poor position of original fixation tunnels.Indications:Indications for staging revision ACL reconstruction include significant tunnel osteolysis or dilation (>14 mm), or any situation in which the previous bone tunnels will interfere with anatomic graft placement and fixation.Technique Description:The patient is placed in the supine position with a standard setup for knee arthroscopy, including lateral thigh post and foot stop for maintained knee flexion at 90°. After diagnostic arthroscopy, the ACL graft remnant is debrided. The femoral tunnel is then debrided and re-cannulated, followed by reaming with cannulated reamers until adequate cortical chatter is achieved, ensuring the presence of a bleeding rim of bone throughout the tunnel to confirm that the correct diameter reamer has been reached. The appropriately sized bone dowel is inserted along the guide pin until fully seated and flush with lateral wall of the notch. This process is then repeated for the tibial tunnel, accessing the tunnel from the previous incision along the medial tibia.Results:This video presents a technique to achieve adequate bone grafting of previously used tunnels that are not suitable for single-stage revision ACL reconstruction. Patients undergo second-stage revision ACL reconstruction at roughly 4 to 6 months following stage I, when bone graft has fully incorporated on radiographs.Discussion/Conclusion:Stage I revision ACL reconstruction with tunnel grafting using allograft bone dowels is a minimally invasive method of grafting previously used fixation tunnels to allow for anatomic second-stage graft placement and fixation.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-18T10:00:17Z DOI: 10.1177/26350254241229099 Issue No:Vol. 4, No. 3 (2024)
Authors:Anna Bartsch, Ran Atzmon, Kinsley Pierre, Monica S. Vel, Seth L. Sherman Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Tibial tubercle osteotomy (TTO) can realign the patellofemoral joint and reduce patellofemoral contact stress. Anteriorization can reduce compressive patellofemoral loads and medialization shifts the pulling direction on the patella, thereby lowering the load on the lateral compartments.Indications:Patellofemoral instability, patellofemoral malalignment, and distal and lateral chondral defects.Technique Description:The Multi-Directional Tibial Tubercle Transfer System (MD3T) uses a generic 3-dimensional cutting template to create 2 compound wedges that are individually transposed and adjusted to achieve multiplanar correction. For isolated tibial tubercle anteriorization, the primary wedge is solely used and the proximal bone defect is filled with autograft taken from the distal part of the wedge and synthetic bone graft substitution. For tibial tubercle medialization, the primary and secondary wedges are transposed, filling each other's respective spaces. Through the transposition of the primary and secondary wedges, partial filling of the defect with the patient's own bone is achieved, reducing the bone defect. For combined anteromedialization, both of these techniques are merged.Results:During walking fatigue test and chair rising test in a cadaveric simulated 42-day healing period, no loosening or cracking occurred. Clinical study results on this technique are pending.Conclusion:The MD3T system achieves with its wedge technique a precise and reproducible multiplanar correction in TTO.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-13T10:00:13Z DOI: 10.1177/26350254241227439 Issue No:Vol. 4, No. 3 (2024)
Authors:Kyle T. Deivert, Jelle P. van der List, Nicholas A. Trasolini, Brian R. Waterman Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:True confirmed posterior shoulder dislocations are relatively uncommon injuries, with an estimated incidence of 1.1 per 100,000 individuals and are initially missed in up to 50% to 80% of cases. There are several treatment options for this injury presentation. In this case, we will focus on reconstruction with osteochondral allograft.Indications:If the cartilage cannot be fixed due to comminution or the cartilage is not viable due to chronicity or impact, osteochondral allograft might be a treatment option. This technique is typically considered for defects involving greater than 35% to 40% of the humeral head.Technique Description:The anterior defect on the humeral head was exposed on the cadaver specimen. Circular bone plugs were obtained from a distal femur specimen for grafting. Graft sites were prepared with a 15 reamer with an orthogonal approach to avoid oblique entry for a stacked bone plug configuration. Bone plug grafts were placed in the defect via press-fit fixation. The subscapularis is repaired to the lesser tubercle following the reconstruction.Results:Various studies reported improvement in pain, shoulder range of motion, and patient-reported outcome scores. A small percentage of patients developed allograft necrosis. Patients who received autografts had lower rates of osteoarthritis than patients who received allograft. Rehab protocol can last up to 12 months and begins with restricted range of motions and slowly advancing to isometric movements and gradually increasing range of motion and strengthening.Discussion/Conclusion:Outcomes described in previous studies are limited due to the low incidence of these injuries and small sample size. Missing the initial posterior dislocation as this is often correlated with inferior outcomes when treated in chronic setting. There is a risk of damage to humeral articular cartilage during osteochondral tissue harvesting so care must be taken during tissue harvest. Older, lower-demand patients have been reported to do well with nonoperative treatment, even in the case of a chronic dislocation, so careful discussion with the patient is needed to not perform surgery in a reasonably functioning non-painful shoulder.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-11T10:00:22Z DOI: 10.1177/26350254241226724 Issue No:Vol. 4, No. 3 (2024)
Authors:Rohan R. Patel, Joshua S. Green, Jay Moran, Estevao Santos, Michael J. Medvecky Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Injuries to the medial structures of the knee are common in multi-ligamentous knee injuries (MLKIs), which account for 0.02% of orthopedic injuries each year. The most common medial structure involved is the superficial medial collateral ligament (sMCL) with possible additional injury to the posterior oblique ligament (POL) and deep medial collateral ligament (dMCL). There has been little evidence for the superior management of these structures regarding the use of repair or reconstruction to reproduce overall knee function. Although reconstruction may provide more valgus stability postoperatively, the use of sMCL repair over reconstruction may be superior at reestablishing native anatomic alignment and kinematic relationships of the knee while also preserving proprioception and providing similar valgus stability.Indications:Surgical repair of medial structures is typically indicated for third-degree injuries, bony avulsions, tibial plateau fracture, intra-articular entrapment of the end of the ligament (Stener-type lesions), or anteromedial stability. They are particularly indicated in the elite athlete who presents with excessive valgus laxity due to valgus knee loading, external rotation, or combined force vectors.Technique Description:This surgical technique video demonstrates an open, medial-sided femoral and tibial approach to repair proximal and distal medial knee structures in the setting of MLKIs using case examples of a Stener lesion and a combined sMCL, POL, and medial patellofemoral ligament tears.Results:Repair of sMCL injuries has been reported to show favorable healing, knee stability, and function.Discussion/Conclusion:The use of fixation of the sMCL to its anatomical attachment points offers similar valgus stability and improved functional and patient-reported outcomes when compared with sMCL reconstruction.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-06T10:00:01Z DOI: 10.1177/26350254241226723 Issue No:Vol. 4, No. 3 (2024)
Authors:Juan Cassinelli, Philippe Delsol, Clémentine Rieussec, Johannes Barth Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Voluntary posterior shoulder instability is a rare condition, with a prevalence of 0.5% to 2.6% in young adults, in which the patient is able to provoke a dislocation or subluxation through voluntary activation of the muscles. Studies have shown results that highlight the importance of abnormal cortical activation in this population and suggest physiotherapeutic treatment as first line.Indications:Currently, there are a wide range of options of physiotherapeutic treatment for this condition, such as muscle reinforcement, scapulohumeral coordination, and/or muscle activation with electrodes, all with acceptable results. Simple, low-cost neuromotor rehabilitation is based on the simplicity of a different approach. We believe that with distal-proximal neuromotor rehabilitation we can improve a physiological muscle function.Technique Description:The goal of the pencil exercise is to stimulate the cerebral cortex by making circular movements with a pen between the fingers, bridging abnormal voluntary stimulation and activation of the shoulder muscles, allowing the patient to focus, by the view, only on hand movements.Results:In this case, we have achieved the bypass of the abnormal voluntary stimulation and activation of the shoulder muscles and improve the patient's physiological shoulder function with the implementation of the pencil exercise.Conclusion:This technique may be an effective option for the treatment of voluntary posterior shoulder dislocation because it is based on the stimulation of the cerebral cortex and not on traditional physiotherapeutic or surgical interventions. It is important to note that more research is needed to validate the results of this technique and determine its long-term efficacy.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-06-04T10:00:01Z DOI: 10.1177/26350254241237538 Issue No:Vol. 4, No. 3 (2024)
Authors:Johannes Barth, Julien Berhouet, David Gallinet, Maxime Antoni, Franck Dordain, Nicolas Bonnevialle, Jacques Guery, François Gadea, Adrien Jacquot, Christophe Charousset Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Considering the long head of biceps (LHB) management, important cultural differences exist among the surgeons around the world, especially when repairing small isolated distal supraspinatus tears under arthroscopy. In the perspective of an international survey to analyze our practice regarding biceps management in small rotator cuff tears, the aim is to collect all the possible LHB abnormalities according to literature review, before considering that the LHB could be normal or pathologic.Indications:The SFA (Société Francophone d’Arthroscopie) behind its research biceps group summarized these abnormalities in a description analysis called the “biceps box” concept, which was validated with a strong inter-rater reliability. The aim is to present the description analysis using a common language with short video records for each abnormality described to reproduce “intraoperatively” the different possible scenarios the surgeon has to encounter during arthroscopic evaluation.Technique Description:The description of the “biceps box” concept classifies lesions of the LHB, with so-called intrinsic lesions, for which the LHB should be considered pathological: partial rupture or delamination, fissuring, lateral or medial instability or subluxation, hypertrophy with an hourglass figure; and so-called extrinsic lesions, for which the LHB should be considered healthy: damage to the pulley without bicipital instability, exposure of the articular portion of the biceps by rupture of the supraspinatus tendon, inflammation of the superficial surface of the tendon, presence of type 1 or 2 superior labral anterior to posterior (SLAP) lesions, or a chondral print.Results:We present the 10 possible scenarios with video records according to our description analysis.Discussion/Conclusion:The LHB could be considered as a pain generator in certain situations which are still not completely clear. The indication of biceps tenotomy or tenodesis depends on the interpretation of the surgeon of these abnormalities as a pathologic or a normal condition. The next step is to use these videos in an international survey to assess cultural differences regarding the management and eventually find a consensus regarding treatment options for each abnormality.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-29T10:00:10Z DOI: 10.1177/26350254231222030 Issue No:Vol. 4, No. 3 (2024)
Authors:Luke V. Tollefson, Nicholas I. Kennedy, Robert F. LaPrade Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Anterior cruciate ligament reconstructions (ACLRs) are performed to restore knee biomechanics, increase knee stability, and slow the progression of osteoarthritis. After ACLRs, many patients still have residual anterolateral instability which is a risk factor for ACL graft failure. An anterolateral ligament reconstruction (ALLR) attempts to restore the native function of the anterolateral complex to augment the ACL. Performing an ALLR with an ACLR has been reported to reduce symptoms of instability and improve clinical outcomes.Indications:While no definitive indication for an ALLR has been set, current considerations include high posterior tibial slope>12°, revision ACLR, high-grade pivot shift, skeletally immature patients, hyperlaxity, and patients in high-level sports.Technique Description:The preoperative assessment includes a thorough physical examination with special attention paid to rotational laxity assessed via the pivot-shift examination. Imaging should include standard radiographic series (anteroposterior, posteroanterior flexion, lateral, and sunrise views), long-leg mechanical axis views to assess coronal plane alignment and standing lateral ACL stress radiographs to assess sagittal alignment and objective instability. The iliotibial band ALLR graft is harvested first. An 8-cm long by 1-cm wide strip of the inferior iliotibial band is harvested in a standard fashion, leaving the distal aspect attached to Gerdy’s tubercle. An anchor is placed centered upon the native ALL distal tibial insertion. The native ALL femoral origin is identified at 4.7 mm posterior and proximal to the fibular collateral ligament, and a second suture anchor is placed at this point. Final fixation is performed after the final fixation of the ACLR graft.Results:A study by Pioger et al reported that patients with ACLR and ALLR had significantly less reoperation rate than patients with isolated ACLR, 8.9% versus 20.5% respectively. Lee et al found that a revision ACLR in combination with an ALLR was effective in reducing rotational laxity, which was assessed by the pivot-shift test.Discussion:We describe a technique for a new anatomic ALLR using the iliotibial band that attempts to restore the native ALL anatomy. This surgical technique effectively restores rotational laxity and improves knee stability.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-23T10:00:30Z DOI: 10.1177/26350254231225476 Issue No:Vol. 4, No. 3 (2024)
Authors:Patrick Szukics, Jose Robaina, Jonas W. Ravich, Luis A. Vargas, Gautam Yagnik Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Medial meniscal root repairs are devastating injuries that can cause long-term knee problems if not properly addressed. Some common issues when addressing these injuries surgically include the “bungee-cord” effect seen with implants that sit too far from the tibial plateau surface and loss of tension on the sutures after cycling of the knee after the repair. This video will discuss the presentation of a patient with a medial meniscal root repair treated with a novel technique to counteract these aforementioned issues.Indications:Based on the patient’s medial meniscal root tear and minimal arthritis seen on radiograph, he was indicated for a meniscal root repair to prevent meniscal extrusion and reinforce normal meniscal hoop stresses to limit progression of his arthritis.Technique Description:This technique uses a novel re-tensionable all-suture anchor through a transtibial tunnel with 2 repair sutures through the meniscal root that sits just below the tibial plateau, allowing the surgeon the ability to re-tension the implant after cycling the knee.Results:Arthroscopic repair of the medial meniscal root allowed the patient to return to his previous level of activity.Discussion/Conclusion:In this case, arthroscopic medial meniscal root repair can yield good results in patients to get them back to their previous level of activity while minimizing the chance of rapid arthritic progression that is typically seen with nonoperative management of these injuries.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-21T10:00:09Z DOI: 10.1177/26350254231221568 Issue No:Vol. 4, No. 3 (2024)
Authors:Tebourbi Anis, Triki Rami, Nefiss Mouadh, Mohamed Amine Gharbi, Bouzidi Ramzi Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Failure rate of meniscal repair can reach 25%. Multiple techniques have been used to increase meniscal healing, notably biological augmentation techniques. One of them is fibrin clot–augmented meniscal repair, which will be described in this video.Indications:This technique is indicated mainly for the lesions with a high failure rate. This includes large, horizontal, and radial tears and even for meniscal cysts, especially in a stable knee. This technique can also be used in revision meniscal suture when failure is no longer an option.Surgical Technique:Fibrin clot is prepared from sterile peripheral venous blood from the patient. A plastic syringe is used to stir the blood in a sterile glass container. The fibrin clot is then formed and washed rigorously with saline solution. Rolling the fibrin clot which is fixed to the syringe allows to give the fibrillar aspect of the clot. The formed fibrin clot is now solid enough to be manipulated and can be fixed to a vicryl suture thread allowing it to enter the knee and be fixed inside the meniscal lesion. The clot is wrapped inside the meniscal lesion with inside-out or outside-in suture technique.Results:We used this technique for multiple types of lesions, like bucket handle meniscal tear, horizontal meniscal cleavage, parrot beak tear, and even in lesions within white-white zone. The postoperative protocol is the same as standard inside-out meniscal repair. This technique has been used in the literature with promising results.Conclusion:The fibrin clot–augmented meniscal repair is a demanding but promising technique. We need further follow-up to confirm its effectiveness.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-16T10:00:15Z DOI: 10.1177/26350254231220953 Issue No:Vol. 4, No. 3 (2024)
Authors:Christopher M. Brusalis, John T. Streepy, Tyler Williams, Sydney Garelick, Grant E. Garrigues Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Calcific tendinitis is a common source of shoulder pain and represents pathologic deposition of calcium hydroxyapatite within rotator cuff tendon tissue, most commonly the supraspinatus tendon.Indications:Arthroscopic decompression of calcific tendinitis with possible rotator cuff repair is indicated in patients with persistent, debilitating symptoms of pain and/or dysfunction who are recalcitrant to nonoperative treatments, including corticosteroid administration, ultrasound-guided needle barbotage, and/or extracorporeal shockwave therapy.Technique Description:With the patient in a beach chair position, a standard diagnostic shoulder arthroscopy is performed to evaluate for concomitant pathologies. Within the subacromial space, a thorough bursectomy is performed and the area of calcium deposition is localized with a spinal needle. A scalpel may be used to create a small incision through the rotator cuff tendon in line with its fibers to promote egress of calcific debris. Surrounding tissue and loose debris are removed with an arthroscopic shaver. Following decompression, the rotator cuff repair is inspected, and if a bursal-sided or full-thickness tear is identified, an arthroscopic repair is performed with a construct individualized to the specific tear pattern.Results:Surgical treatment conferred greater functional improvement and comparable pain reduction to nonoperative treatments in a systematic review comprised of 27 randomized trials. While the addition of a rotator cuff repair remains controversial, combined excision of calcific tendinitis with concomitant rotator cuff repair led to greater functional outcomes and pain reduction at 2-year minimum follow-up compared with isolated decompression.Conclusion:Calcific tendinitis within the shoulder may be treated successfully with arthroscopic decompression and subsequent repair of a residual rotator cuff defect, followed by a graduated physical rehabilitation program.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-14T10:05:13Z DOI: 10.1177/26350254231220952 Issue No:Vol. 4, No. 3 (2024)
Authors:Elizabeth Bond, Kevin A. Wu, Baker Mills, Ryan O’Donnell, Grant Cochran, Brian C. Lau Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Anterior cruciate ligament (ACL) repair has historically had poor outcomes and fell out of favor in the 1980s with the majority of surgeons opting to do an ACL reconstruction instead due to the high failure rate. The Bridge-Enhanced ACL Restoration or BEAR technique utilizes a de-cellularized, bovine-derived, type I collagen implant to aid in the ACL repair. The device is implanted to augment the healing of the ACL.Indications:The BEAR technique is indicated to augment ACL repair in cases of complete rupture where there is a residual tibial stump of sufficient length and good tissue quality.Results:In our experience to date, patients undergoing an ACL repair with BEAR recover range of motion quickly and have less quadriceps atrophy and less postoperative swelling than those undergoing ACL reconstruction requiring autograft harvest. We will continue to follow up our patient cohort to assess for re-rupture rate as they return to sport.Conclusion:The BEAR technique is a promising development that enables ACL repair as an alternative option to reconstruction. This article describes our approach including tips and tricks to successfully perform this procedure.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form. Citation: Video Journal of Sports Medicine PubDate: 2024-05-09T10:00:21Z DOI: 10.1177/26350254231218749 Issue No:Vol. 4, No. 3 (2024)
Authors:Nicholas Newcomb, William Curtis, Christopher Kurnik, Matthew Wharton, Gehron Treme, Christopher Shultz Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Tibial avulsion of the posterior cruciate ligament (PCL) often requires operative fixation, which frequently results in successful outcomes if identified acutely. Open or arthroscopic techniques are most commonly used.Indications:Primary surgical indications for open fixation include acute tibial avulsion of the PCL. Secondary indications include grade 2 to grade 3 posterior drawer test and radiographic posterior subluxation of the tibia. Ideally, the joint space and articular cartilage should be well preserved.Technique Description:In the simplified approach initially described by Burks and Schaffer, the patient is placed prone, and an inverted L-shaped incision is made over the posteromedial corner of the knee. A plane is developed between the medial head of the gastrocnemius and the semimembranosus down to the knee joint capsule. The gastrocnemius is retracted laterally to protect neurovascular structures and a vertical capsulotomy is performed. The tibial attachment of the PCL is reduced and held with K (Kirschner) wires and then fixated with screw and washer.Results:Six months post operation, our patient achieved full active and passive range of motion with a stable posterior drawer test. He returned to work without difficulty. Multiple studies have shown success with open PCL fixation and decreased rates of arthrofibrosis when compared with arthroscopic approach. In this case, the patient did not develop arthrofibrosis.Discussion/Conclusion:PCL tibial avulsions can be safely treated with an open approach. Contrary to other ligaments that favor reconstruction over repair, PCL avulsions may be better treated with early repair, so it is important to avoid delay in intervention. The most common complication in both open and arthroscopic approaches is arthrofibrosis, which is less common in the open approach. Early range of motion is encouraged to prevent arthrofibrosis.Patient Consent Disclosure Statement:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-07T10:00:26Z DOI: 10.1177/26350254231212930 Issue No:Vol. 4, No. 3 (2024)
Authors:Jack Dirnberger, Morgan D. Homan, Nicholas I. Kennedy, Robert F. LaPrade Abstract: Video Journal of Sports Medicine, Volume 4, Issue 3, May 2024. Background:Symptomatic genu recurvatum is defined as greater than 5° of knee hyperextension and can be caused by osseous deformity, soft tissue laxity, or a combination. Common symptoms include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee. In instances where the genu recurvatum is caused by reverse tibial slope, literature supports the use of anterior opening-wedge proximal tibial osteotomy (OW PTO) to treat genu recurvatum by increasing tibial slope. Correction of anterior slope to a more anatomic, posterior orientation allows any stressed ligaments to return to their normal tension and restores the native biomechanics of the knee.Indications:The primary indication for OW PTO is genu recurvatum that is nonresponsive to physical therapy or genu recurvatum with concurrent ligamentous injury. The heel-height test provides an objective assessment for the identification and measurement of knee hyperextension.Technique Description:2 guide pins are placed parallel to the tibial plateau, engaging the posterior cortex. A small micro sagittal saw is used to cut the anterior cortex. Osteotomes are used to complete the osteotomy, preserving a posterior hinge. An opening spreader device is placed and opened slowly while keeping the posterior cortex intact. The new slope is maintained by use of an opening wedge osteotomy plate and screws. Allograft bone graft is packed thoroughly into the osteotomy site. Fluoroscopy is used throughout the case to assess appropriate orientation and depth of the osteotomy, as well as the final opening width.Results:A review of 5 studies demonstrated adequate reduction in hyperextension, with a mean knee hyperextension ranging from 17° to 32° preoperatively and 0° to 7° postoperatively. Patients had significantly improved postoperative clinical outcomes compared with the preoperative state.Discussion/Conclusion:Anterior OW PTO has been shown to be a safe method of accurately correcting tibial plateau slope for the treatment of genu recurvatum. Patients can expect correction of knee hyperextension, restoration of anatomic posterior tibial slope, decreased posterior tibial translation, and increased subjective outcome scores.Patient Consent Disclosure Statement:The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Citation: Video Journal of Sports Medicine PubDate: 2024-05-01T10:00:27Z DOI: 10.1177/26350254231213392 Issue No:Vol. 4, No. 3 (2024)
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