We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit system. 9 patients un- derwent PCL reconstruction using our pressfit system. The surgical procedure is described in detail. Post-operatively, 5 patients were available for assessment and review. Four patients gave a final Lysholm score of 92 – 100%. Three patients gave a Hospital for Special Surgery (HSS) score of excellent, one fair and one poor. Two patients gave a re- duced Tegner activity score post-operatively while the other three gave a similar score post-operatively. Assessment using KT-1000 revealed four patients with a side-to-side difference of less than 3 mm (average side-to-side difference,1.87 mm), while one patient exhibited a side-to-side difference of 5.8 mm. We believe that our technique enhances tunnel healing through usage of a bone-plug fixation and provides a cheap alternative for graft fixation on the femoral side in PCL reconstruction.
Introduction: Degenerative disorder involving the acromioclavicular
joint (ACJ) is quite common especially in the elderly.
One of the surgical modalities of treatment of this disorder is the
Mumford Procedure. Arthroscopic approach is preferred due to
its reduced morbidity and faster post-operative recovery. One
method utilizes the anteromedial and Neviaser portals, which
allow direct and better visualization of the ACJ from the
subacromial space. However, the dangers that may arise from
incision and insertion of instruments through these portals are
not fully understood. This cadaveric study was carried out to
investigate the dangers that can arise from utilization of these
portals and which structures are at risk during this procedure.
Methods: Arthroscopic Mumford procedures were performed
on 5 cadaver shoulders by a single surgeon utilizing the
anteromedial and Neviaser portals. After marking each portals
with methylene blue, dissection of nearby structures were
carried out immediately after each procedure was completed.
Important structures (subclavian artery as well as brachial plexus
and its branches) were identified and the nearest measurements
were made from each portal edges to these structures. Results:
The anteromedial portal was noted to be closest to the
suprascapular nerve (SSN) at 2.91 cm, while the Neviaser portal
was noted to be closest also to the SSN at 1.60 cm. The
suprascapular nerve was the structure most at risk during the
Mumford procedure. The anteromedial portal was noted to be
the most risky portal to utilize compared to the Neviaser portal.
Conclusion: Extra precaution needs to be given to the
anteromedial portal while performing an arthroscopic distal
clavicle resection in view of the risk of injuring the
suprascapular nerve of the affected limb.
We present a case report of a 45-year-old Malay female prison officer with a diagnosis of lateral patellofemoral joint (PFJ) osteoarthritis (OA) in her right knee for whom conservative treatment failed. She was periodically followed up for the unresolving anterior right knee pain, and the patient was offered interpositional PFJ arthroplasty with the quadriceps tendon. A novel technique of interpositional PFJ arthroplasty using lateral inner section ipsilateral quadriceps tendon was applied. The approach and surgical technique were described in this case report. The aim of this study is to describe why this technique was chosen, step by step with images on how interpositional PFJ arthroplasty is done and its satisfactory outcome following a three-month follow up.
Recurrent shoulder dislocation is a common orthopedic condition, but bilateral involvement is rare and presents unique challenges in management. The Latarjet procedure is an effective surgical technique that addresses instability by creating a bony block on the anterior glenoid rim. This case highlights the successful management of bilateral recurrent shoulder dislocation using the bilateral shoulder open Latarjet procedure and emphasizes the importance of early intervention in such cases.
Discal cysts are a rare diagnosis involving the formation of an intraspinal extradural cyst. They are a diagnostic challenge as it is difficult to differentiate discal cysts from other causes of back pain, neurological deficit, and radiculopathy. Due to its rarity, there is a lack of research-based evidence on the optimal management of the discal cyst. This case report aims to increase awareness of this diagnosis and to highlight a possible treatment option for this condition.
Management of shoulder dislocation can be challenging especially when glenoid bone fracture is involved. Bony Bankart lesion can be managed either through an open surgery or, of late, using arthroscopic technique. Arthroscopic bony Bankart repair is technically difficult, requiring specialized instruments to penetrate the bone fragment within the detached labrum. This case report describes an alternative way of doing an arthroscopic reattachment of an acute bony Bankart lesion using traction sutures, an accessory anteromedial portal and utilization of knotless anchors. A 44-year-old male technician was climbing a ladder when he slipped and fell directly on his left shoulder. Imaging revealed bony Bankart fracture with presence of ipsilateral greater tuberosity (GT) fracture and a Hill-Sachs lesion. In a right lateral position, arthroscopic reduction of the bony fragment was performed utilizing a Fibrewire® (Arthrex, Inc., Naples, FL, USA) suture as traction apparatus while securing the upper and lower tissue enveloping the bony Bankart fragment. An accessory portal was made lower down anteriorly to de-rotate the fragment, holding it in place while securing two Pushlock® (Arthrex, Inc.) anchors to the native glenoid. We then performed GT fixation using two cannulated screws. Check radiographs revealed acceptable reduction of the Bankart fragment. With careful case selection, arthroscopic repair of acute bony Bankart lesions is possible using special arthroscopic reduction maneuver and fixation technique with subsequent good outcome.