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Video Journal of Sports Medicine
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  This is an Open Access Journal Open Access journal
ISSN (Online) 2635-0254
Published by Sage Publications Homepage  [1174 journals]
  • Arthroscopic Posterior Glenoid Augmentation With Distal Tibial Allograft

    • Authors: Robert S. Dean, Eric J. Dennis, LeeAnne F. Torres, Danielle E. Rider, Nicholas A. Trasolini, Max D. Gehrman, Brian R. Waterman
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Posterior glenohumeral instability is much less common than anterior instability, and there is a paucity of studies looking at glenoid bone loss as it relates to posterior instability. However, while the data are not as robust, posterior glenoid bone loss can lead to recurrent instability and failed soft tissue procedures. Arthroscopic posterior glenoid augmentation with distal tibial allograft (DTA) is a minimally invasive option to restore stability and preserve function.Indications:The primary indication for posterior glenoid augmentation is posterior instability with>20% to 25% posterior glenoid bone loss or recurrent posterior instability after prior stabilization procedure. In this case, the patient is a 21-year-old man with recurrent instability after 2 prior soft tissue stabilization procedures.Technique Description:The patient was positioned in lateral decubitus, and portals were established. Arthroscopic evaluation was performed to assess the labrum, biceps, rotator cuff, glenoid, and humeral head. Glenoid mobilization was performed, and an incision was made for introduction of the bone block. The glenoid was prepared, and a trial was used to guide preparation of the graft, which was harvested from the articular cartilage of the distal tibia. The graft was irrigated and bathed in platelet-rich plasma (PRP) and then introduced and positioned for maximal coverage of the defect. Screw fixation was performed with two 3.75-mm screws. The posterior capsule was reapproximated, and a layered closure was performed.Results:Previous studies have reported significant improvements in patient-reported outcomes, high rates of healing, and no cases of recurrent instability after DTA for anterior glenoid bone loss. Additional studies have reported few patients with recurrent instability and no instances of partial or non-union. Significant loss of range of motion has not been reported in the most recent case series. One previous study reported significantly improved patient-reported outcomes and near-complete osseous reabsorption with DTA after failed Latarjet procedure.Discussion/Conclusion:Arthroscopic posterior glenoid augmentation with DTA is a viable treatment option for patients with shoulder pain and instability with>20% to 25% posterior glenoid bone loss and/or following prior stabilization procedures.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-08-04T11:00:01Z
      DOI: 10.1177/26350254221086294
      Issue No: Vol. 2, No. 4 (2022)
       
  • Arthroscopic Repair of a “Floating” Posterior Inferior
           Glenohumeral Ligament

    • Authors: Justin J. Greiner, Joshua C. Setliff, Joshua D. Dworkin, Albert Lin
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Combined posterior glenoid labrum lesions with posterior humeral avulsion of the glenohumeral ligament, also known as the “floating” posterior inferior glenohumeral ligament (PIGL), occur infrequently. These combined lesions are frequently missed on magnetic resonance imaging in the workup of posterior shoulder instability. Correct identification of the “floating” PIGL lesion allows for appropriate preoperative planning and treatment to decrease the risk of recurrent posterior shoulder instability.Indications:A “floating” PIGL lesion is a cause of posterior shoulder instability and demonstrates increased translation when compared with isolated labral lesions. Surgical repair of an acute “floating” PIGL lesion with concomitant superior labral tear is described.Technique Description:The patient is placed in the lateral decubitus position. Standard posterior and anterior portals are created. In this case, a superior labral tear with anterior labral tear extension was also identified and repaired. The posterior labrum was repaired prior to the posterior humeral avulsion of the glenohumeral ligament (HAGL). The torn posterior labrum is mobilized and glenoid bony bed prepared. Short, 2.9-mm biocomposite knotless suture anchors loaded with suture tape are used for labral fixation. A 70° arthroscope is used to visualize the posterior HAGL from the anterior cannula and an additional posterior inferior portal established. The footprint of PIGL on the humerus is identified, debrided, and two 3.0-mm anchors loaded with suture placed. The sutures are passed through the capsule and PIGL and tied in a mattress pattern external to the capsule and ligament. The posterior portals are closed with nonabsorbable suture.Results:While few outcomes are described in the literature for the “floating” PIGL, the literature suggests good outcomes following surgical repair.Conclusion:The “floating” PIGL lesion is a rare cause of posterior shoulder instability. It is important to perform a thorough evaluation for concomitant pathology in patients with posterior shoulder instability as multiple structures can be injured. Arthroscopic repair of the posterior labrum and posterior humeral avulsion of the glenohumeral ligament can be performed to restore posterior stability to the shoulder in the setting of a “floating” PIGL.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-08-02T11:00:01Z
      DOI: 10.1177/26350254221097980
      Issue No: Vol. 2, No. 4 (2022)
       
  • Anatomic Repair of a Lateral Collateral Ligament and Anterolateral
           Capsular Complex Injury With Internal Brace Augmentation

    • Authors: Kyle Schoell, Aryan Haratian, Amir Fathi, Ioanna K. Bolia, Laith K. Hasan, Frank A. Petrigliano, Alexander E. Weber, George F. “Rick“ Hatch
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Lateral collateral ligament (LCL) injuries are implicated in varus instability of the knee. Often, these accompany other ligamentous injuries including anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) tears, and injury to the anterolateral capsular complex (ALCC). Use of internal brace augmentation with anatomic repair is an alternative to reconstruction to improve patient outcomes and facilitate early range of motion and weight bearing.Indications:We present a case of an anatomic repair of a LCL and an ALCC injury with internal brace augmentation.Technique Description:A curvilinear incision centered over the lateral epicondyle is used. The avulsed LCL and biceps tendon was exposed and a placed #5 FiberWire was placed into the distal LCL, biceps tendon, and the popliteofibular ligament. A split was made in the iliotibial (IT) band and a second #5 FiberWire was placed proximally in the LCL/biceps tendon for additional fixation. A tunnel was made in the fibular head and tibia using a 2.4-mm beath pin and the two #5 FiberWires were passed to the anteromedial tibia. The FiberWires were fixed to the tibia using a 14-mm attachable button system (ABS) manhole cover for suspensory fixation. Repair and internal bracing of the anterolateral capsular complex was accomplished with 2 interlocked TightRopes and a #2 FiberTape. This fixation method achieved repair by compressing the anterolateral capsular complex onto its tibial origin. The suture devices also served to augment the repair and were fixed proximally to the femur using another 14-mm ABS manhole cover. The FiberTape was fixed to the anterolateral tibia distally with a 4.5 mm SwiveLock. The TightRopes were passed through a tunnel to the anterolateral tibia and secured using an ABS Dog Bone. The construct was tensioned in near full extension and gapping was matched fluoroscopically to the contralateral knee.Results:Patient was cleared for full return to sports 9 months postoperatively. At the final follow up visit, the patient had excellent strength, stability, and 135° range of motion on the operative knee. Patient had returned to exercise at home but was unable to return to sports due to COVID-19 restrictions.Conclusion:Anatomic repair of the LCL and the ALCC with internal brace augmentation can serve as an effective alternative to reconstruction and demonstrates excellent patient outcomes regarding restoring stability, ROM, and return to preoperative sports.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-26T11:00:01Z
      DOI: 10.1177/26350254221093082
      Issue No: Vol. 2, No. 4 (2022)
       
  • Medial Patellofemoral Reconstruction With a Hamstring Allograft

    • Authors: Hailey P. Huddleston, Navya Dandu, Blake M. Bodendorfer, Adam B. Yanke
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Lateral patellar instability is common in young, active patients. Patients who fail conservative treatment may benefit from medial patellofemoral ligament (MPFL) reconstruction.Indications:Recurrent lateral patellar instability.Technique Description:Examination assesses patellar translation, eversion and range of instability. Diagnostic arthroscopy is performed for loose bodies, cartilage damage, trochlear dysplasia, and tracking. A longitudinal incision is made from superomedial to mid-body of the patella. The plane between the capsule and retinaculum is developed for palpation of the medial epicondyle and adductor tubercle. Electrocautery and rongeur are used to create a trough on the patella from centromedially to superomedially. Two suture anchors are placed at the proximal and distal trough. Fluoroscopy is utilized to identify Schöttle point with a perfect lateral radiograph. A 3-centimeter incision is made, and blunt dissection connects the 2 incisions in the developed plane. A guidepin is advanced at Schöttle point, and suture anchor sutures are shuttled through the plane, posterior to the guidepin. There should be loosening of tension with knee flexion. A semitendinosus allograft is whipstitched with terminal tapering. The whipstitched end is tunneled around the guidepin and brought back to the patella, so that both ends have an excess of 20 to 25 millimeters, and excess graft is trimmed from the free end prior to whipstitching. The doubled graft is sized. The midportion of the tendon is tagged and passed through both anchors. The graft is tensioned to the patellar trough and the graft ends are advanced through the developed plane. The femoral tunnel is reamed, and the graft is tensioned into the tunnel after nitinol wire placement with the knee in full extension. Isometry and lateral patellar translation are assessed, aiming for 1 quadrant with firm endpoint. The patella is proximalized and the tensioned graft is secured with an interference screw.Results:MPFL reconstruction is successful for the majority of patients, with 1.2% reporting instability, 3.6% apprehension, and 3.1% reoperation. Possible complications include patellar fracture, patellofemoral pain, and knee stiffness (loss of range of motion).Discussion/Conclusion:Lateral patellar instability is common, and MPFL reconstruction is typically successful for the majority of patients.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-21T11:00:01Z
      DOI: 10.1177/26350254221093080
      Issue No: Vol. 2, No. 4 (2022)
       
  • Easy Arthroscopic Transseptal Approach of the Knee

    • Authors: Lampros Gousopoulos, Graeme Hopper, Yoann Levy, Charles Grob, Thais Dutra Vieira, Bertrand Sonnery-Cottet
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:The arthroscopic approach to the posterior compartment of the knee is always challenging. This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury.Indications:Indications include arthroscopic posterior cruciate ligament (PCL) reconstruction, fixation of avulsion fractures of the tibial attachment of the PCL, arthroscopic posterolateral corner reconstruction, removal of loose bodies from the posterior compartment, PCL cyst removal, ramp repair, and arthroscopic arthrolysis of the posterior compartment.Technique Description:Using a posteromedial portal, a shaver is introduced with the tip in direct contact with the medial side of the septum facing anteriorly, away from the popliteal neurovascular bundle. The scope is then inserted into the posterolateral compartment to visualize the lateral side of the septum while the shaver remains in the posteromedial compartment. The septum is then released until the tip of the shaver is visible. The shaver is then removed and the scope can now be inserted from the posteromedial portal to the posterolateral compartment through the released septum.Results:The transseptal approach can be performed without any additional risk if the shaver remains centrally on the inferior aspect of the septum. Therefore, the risk of iatrogenic injury of the middle genicular artery is minimized. Likewise, with the knee flexed to 90°, there is no risk of damaging the popliteal neurovascular bundle. Having a precise knowledge of the anatomy of the posterior compartment of the knee minimizes any risks of the transseptal approach, avoiding any additional surgical time whilst facilitating the indicated operation.Conclusion:This easy arthroscopic transseptal approach allows safe access to the posterior compartment of the knee, avoiding any potential neurovascular injury.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-19T11:00:00Z
      DOI: 10.1177/26350254221087290
      Issue No: Vol. 2, No. 4 (2022)
       
  • Distal Biceps Tendon Repair Using a Unicortical Button

    • Authors: Gustavo Barrazueta, Hisham Awan, Gregory Cvetanovich
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Distal biceps tendon ruptures occur most commonly in the dominant arm of men in their 4th through 6th decades of life. These injuries lead to a 30% reduction in flexion strength and 40% reduction in supination strength. Numerous methods exist for fixation of the distal biceps tendon, including bicortical endobutton, transosseous tunnels, suture anchors, and interference screws. We review the technique for using a unicortical button fixation method.Indications:Indications for surgical fixation of the distal biceps tendon include complete tendon ruptures, where a loss of elbow flexion and forearm supination strength of 30% and 40%, respectively, is not desired and partial tendon ruptures that have failed nonoperative treatment. Typically, nonoperative treatment of partial tendon ruptures is tried for a minimum of 3 months.Technique Description:We present the technique of repairing a distal biceps tendon rupture using a unicortical button. A 1-incision technique is utilized through a transverse incision approximately 3-4 cm distal to the elbow flexion crease. Onlay fixation of the distal biceps tendon to the radial tuberosity is achieved with a unicortical, or intramedullary, button. The postoperative protocol varies with surgeon but is similar to other fixation techniques.Results:Outcomes for primary repair of the distal biceps tendon are promising in the literature with both patient-reported outcomes and objective data showing good to excellent results. Bicortical button fixation has traditionally shown to be stiffer with a higher load to failure than other fixation techniques, including suture anchors, transosseous tunnels, and interference screws. The unicortical button has been shown to be statistically equivalent to the bicortical button, with similar cyclic loading and load to failure values.Discussion/Conclusion:The unicortical button technique for distal biceps repairs has the benefit of using a small footprint in the radial tuberosity, potentially decreasing the risk of heterotopic ossification, providing a safer avenue of obtaining anatomic placement and trajectory of repair, and decreasing the risk of posterior interosseous nerve injury. The unicortical button has been shown to have a similar strength profile to the bicortical button, which is higher than all other fixation techniques previously described in the literature.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-14T11:00:00Z
      DOI: 10.1177/26350254221096489
      Issue No: Vol. 2, No. 4 (2022)
       
  • Arthroscopic Treatment of Anterior Shoulder Instability Using Suture
           Anchors With Pre-Tied Knots in the Beach Chair Position

    • Authors: Cameron G. Thomson, Ramsey S. Sabbagh, Nihar S. Shah, Jorge H. Figueras, Brian M. Grawe
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Arthroscopic Bankart repair is routinely performed for treatment of anterior shoulder instability. Although an overall successful procedure, arthroscopic free-hand knot tying can be challenging and inconsistent, even for experienced surgeons. Knotless anchors, on the other hand, pose challenges in developing consistent good loop security prior to implantation, and, in the absence of a secure loop tissue tension on the glenoid face, might be inadequate. As an alternative, suture anchors with pre-tied knots offer the strength and security of knots without the need to perform complex and unreliable free-handed ties. Furthermore, loop security is consistent, reliable, and effective with each anchor.Indications:Patients with anterior labral tears and minimal bone loss are candidates for arthroscopic Bankart repair. The goal of surgery is to restore a robust tissue profile and statically keep the humeral head well-seated within the glenohumeral joint space.Technique Description:We demonstrate how to perform Bankart repair using suture anchors with pre-tied knots. The torn labrum is first mobilized and elevated, and suture anchors are placed along the glenoid rim from inferior to superior, treating the torn tissue as “rungs of a ladder.” The pre-tied sliding knot secures the restored labrum, along with glenohumeral ligaments and capsule, as necessary, using only a limited number of incrementally tensioned half hitch knots.Results:Of the 30 patients treated for anterior shoulder instability using this technique, the majority met the minimal clinically important improvement in the American Shoulder and Elbow Surgeons Shoulder Score, Western Ontario Shoulder Instability Index, and Marx activity scale by 2 years. Two patients reported experiencing subsequent minor subluxation events that improved following short courses of physical therapy, and no patients sustained subsequent frank dislocations.Discussion/Conclusion:Using suture anchors with pre-tied knots for arthroscopic Bankart repair allows for fast, easy, and consistently dependable reconstruction of the labrum and leads to reliable clinical outcomes.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-12T11:00:06Z
      DOI: 10.1177/26350254221089356
      Issue No: Vol. 2, No. 4 (2022)
       
  • “Scopen” Scope to Open Hamstring Repair

    • Authors: Lakshmanan Sivasundaram, Mario Hevesi, Morgan W. Rice, Katlynn M. Paul, Michael J. Salata, Richard C. Mather, Jorge Chahla, Shane J. Nho
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:Hamstring injuries at the musculotendinous junction are relatively common. However, injuries to the proximal hamstring account for just 12% of hamstring injuries. Surgical repair of these injuries including both open and endoscopic techniques are becoming increasingly more common.Indications:Surgical intervention is generally reserved for cases with 2 or more torn tendons and at least 2 centimeters of retraction.Technique Description:The combined open and endoscopic technique utilizes direct posterior and posterolateral portals. After visualizing the posterior femoral cutaneous (PFCN) and sciatic nerves (SN), the proximal hamstring tear is identified, and the shaver is used to remove any surrounding adhesions and aid in clearing any hematoma. The ischial tuberosity is prepared using a shaver, radiofrequency ablation, and a 5.5 mm, round arthroscopic burr. Two, 4.5 mm, doubled-loaded anchors are placed into the ischium. The incision for the open portion of the case is created by incising the skin between the direct posterior and posterolateral portals. A dissection is continued down to the gluteal fascia, and the gluteal fascia is incised in line with the surgical incision. The gluteus maximus is retracted then the hamstring stump is secured with a stay suture and brought outside the surgical incision for inspection. The double-loaded sutures are passed in a running locking technique. The other suture limbs are then passed through the central aspect of the tendon and tensioned to reduce the proximal hamstring onto the prepared tuberosity.Results:Significant postoperative improvements in patient-reported outcomes have been reported for open and endoscopic repairs in isolation, but to date there are no outcomes studies on the combined “Scopen” technique. Postoperative complications may include numbness or neuropraxia, re-rupture, infection, and deep vein thrombosis (DVT).Discussion:The endoscopic portion allows an improved view and preservation of the SN and PFCN, as well as a detailed view of the ischial tuberosity for decortication and anchor placement in comparison with a purely open approach. In comparison with a purely endoscopic approach, this combined approach can be used in patients with retraction>4 cm, and can also be utilized for chronic, retracted tears as well.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-07T11:00:00Z
      DOI: 10.1177/26350254221089355
      Issue No: Vol. 2, No. 4 (2022)
       
  • Non-Operative Management of Symptomatic Hallux Limitus: A Novel Approach
           of Foot Core Stabilization and Extracorporeal Shockwave Therapy

    • Authors: Tom Reilly, Lindsay Wasserman, Adam S. Tenforde
      Abstract: Video Journal of Sports Medicine, Volume 2, Issue 4, July-August 2022.
      Background:This video presents assessment and management of hallux limitus using intrinsic foot strengthening and joint mobilization techniques with combination of extracorporeal shockwave therapy (ESWT).Indications:Clinical history includes pain with walking, running, jumping, or loaded plantarflexion localized to the first metatarsophalangeal (MTP) joint. Indications for our treatment approach of hallux limitus include pain localized to the first MTP joint, corresponding lack of active range of motion/passive range of motion, and reduced foot/ankle strength often with joint space narrowing on imaging.Technique Description:Our program uses the principle of foot core exercises that enhance intrinsic muscles of the foot to assist in medial longitudinal arch stabilization and hallux strengthening. Progression of these exercises can be done in weight-bearing and impact activities specific to patient goals. In addition to these foot intrinsic exercises, calf raises should be incorporated to strengthen the gastroc-soleus complex to both improve plantar foot strength and facilitate extension of the first MTP joint. Manual therapy techniques reduce the rigidity of the first MTP joint and restore appropriate medial-lateral and plantar-dorsal balance. With severe limitations in mobility or pain limitations, ESWT can be incorporated to treat the joint and surrounding soft tissue restrictions.Results:Increased first MTP extension is observed. Reduced symptoms of first MTP joint pain with activity allow patients to return to walking and other physical activities with improved comfort. Complications are rare. Pain over the first MTP joint is expected during ESWT. Rarely, irritation of the plantar components of the first MTP joint, including the tibial and fibular sesamoid bones, may occur.Discussion/Conclusion:Non-surgical management of hallux limitus may improve using the described technique of intrinsic foot strengthening with focus on stabilization of the medial longitudinal arch and strategies of improved mobility of the first MTP joint. Adding ESWT may address joint limitations and facilitate gains in exercise and mobility.
      Citation: Video Journal of Sports Medicine
      PubDate: 2022-07-05T11:00:12Z
      DOI: 10.1177/26350254221089354
      Issue No: Vol. 2, No. 4 (2022)
       
 
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