JBJS Essential Surgical Techniques最新文献

{"title":"Proximal Scaphoid Pole Reconstruction Utilizing Ipsilateral Proximal Hamate Autograft.","authors":"J Terrence Jose Jerome","doi":"10.2106/JBJS.ST.25.00025","DOIUrl":"10.2106/JBJS.ST.25.00025","url":null,"abstract":"<p><strong>Background: </strong>Proximal pole scaphoid fractures complicated by nonunion and osteonecrosis present a challenging scenario with few good reconstructive options, especially when the proximal fragment is small or fragmented<sup>1-4</sup>. The use of an ipsilateral proximal hamate osteochondral autograft has emerged as a promising technique for reconstructing the proximal scaphoid pole, with the potential to restore carpal mechanics while avoiding the morbidity associated with free vascularized bone grafts or distant autograft sites.</p><p><strong>Description: </strong>The procedure involves replacing the diseased proximal scaphoid with a structurally matched osteochondral graft from the ipsilateral proximal hamate. After excising the necrotic or fragmented scaphoid pole, a size-matched graft-harvested with its attached volar capitohamate ligament-is rotated 180° on its longitudinal axis to replicate normal scaphoid anatomy. The defect is measured in 3 planes using the scapholunate joint (proximal) and viable distal scaphoid surface as boundaries. On the hamate, an osteotomy is marked 8 to 10 mm distal to its proximal tip, parallel to the articular surface. The volar capitohamate ligament is preserved to guide graft orientation and maintain stability. These measurements align with recent anatomic and biomechanical studies that have confirmed 6 to 10-mm grafts accurately reproduce scaphoid morphology without compromising carpal kinematics. The graft is then inserted into the defect and secured with rigid internal fixation (headless compression screws or Kirschner wires). Residual gaps may be filled with cancellous bone graft. Scapholunate interosseous ligament (SLIL) reconstruction is typically performed by suturing the hamate's volar capitohamate ligament to the dorsal SLIL remnant on the lunate with a 2-0 nonabsorbable suture. In patients with a partially intact SLIL, such as after failed fixation, the hamate graft alone may provide adequate stability, making formal reconstruction unnecessary. If intraoperative findings reveal dorsal scapholunate instability or an attenuated SLIL, reconstruction is indicated. Healthy, tensionable ligament remnants are repaired directly or reinforced with suture anchors. When dorsal fibers are deficient but volar remnants remain, the attached volar capitohamate ligament is used for reinforcement. For small defects, a micro-interference screw may be employed for fixation. Postoperatively, the wrist is immobilized in a cast. When radiographic evidence of union is observed, the cast is removed and the patient begins a structured hand therapy program.</p><p><strong>Alternatives: </strong>Alternatives include vascularized and nonvascularized bone grafts (e.g., iliac crest), a vascularized medial femoral trochlear osteochondral flap, costochondral rib graft, proximal row carpectomy, and wrist arthrodesis<sup>1,2</sup>. These may be limited by donor-site morbidity, complexity, or suboptimal restoration of wr","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertebral Body Tethering of Double Major Curvature via Mini-Open, Thoracoscopically-Assisted Thoracic and Thoracoabdominal Approaches.","authors":"Baron S Lonner, Mark Kurapatti, Sergei Dolgopolov, George Youssef, Olgerta Mucollari","doi":"10.2106/JBJS.ST.26.00004","DOIUrl":"10.2106/JBJS.ST.26.00004","url":null,"abstract":"<p><strong>Background: </strong>We describe key pearls and principles of a mini-open, thoracoscopically-assisted vertebral body tethering case for double-major scoliosis with 2 distinct anterior approaches: thoracic and thoracoabdominal.</p><p><strong>Description: </strong>The thoracic curve is addressed through a mini-thoracotomy combined with thoracoscopic portals utilizing single-lung ventilation to provide clear visualization. Key steps include precise fluoroscopic marking of vertebral levels, muscle-sparing entry between the ribs, controlled pleural entry and mobilization, and careful management of segmental vessels. Vertebral body screws are placed under direct and fluoroscopic guidance with strict adherence to orthogonal trajectories and avoidance of disc violation. Tether placement proceeds segment-by-segment, maximizing correction at the apex while maintaining appropriate laxity distally to prevent overcorrection. Major tethering principles include maintaining colinear screw alignment to prevent tether kinking and utilizing bicortical fixation when anatomy permits. These principles ensure uniform force transmission and minimize stress concentrations within the tether construct, optimizing tether durability. The lumbar curve is accessed through a thoracoabdominal exposure that includes mobilization of the diaphragm with cuffed detachment and blunt retroperitoneal dissection to safely identify the iliopsoas muscle and sympathetic chain. Double-screw constructs are used at most accessible lumbar levels, with priority given to the apical region to enhance durability under higher mechanical loads. Screws are positioned posteriorly within the vertebral body to help maintain lumbar lordosis and are inserted with a controlled trajectory to achieve bicortical fixation while avoiding a posterior cortical breach and maintaining a safe distance from the spinal canal. Two tethers are applied (first posterior, then anterior) to distribute corrective forces and reduce peak tether strain, balancing correction with load-sharing. Adherence to these principles optimizes lordosis preservation, construct longevity, and safe modulation during growth.</p><p><strong>Alternatives: </strong>The primary alternative treatment is posterior spinal fusion (PSF), the current standard surgical treatment for adolescent idiopathic scoliosis<sup>1</sup>. PSF generally provides greater and more predictable curve correction, particularly for thoracic-major curves, but sacrifices motion across the fused spinal segments.</p><p><strong>Rationale: </strong>This surgical technique is appropriately applied in skeletally immature patients with flexible double-major adolescent idiopathic scoliosis who are undergoing vertebral body tethering through combined thoracic and thoracoabdominal anterior approaches<sup>1-7</sup>. A representative scenario is a patient with a right thoracic and a left lumbar curve demonstrating ≥50% correction of both curves on preoperative bending radiograph","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-Suture Fixation for Acute Turf Toe Injuries.","authors":"Nicholas K Pappa, Christopher Haritos, Kyle S Ardavanis, Tobin Eckel, Kevin D Martin","doi":"10.2106/JBJS.ST.26.00003","DOIUrl":"10.2106/JBJS.ST.26.00003","url":null,"abstract":"<p><strong>Background: </strong>Turf toe is a hallux metatarsophalangeal joint (MTPJ) injury caused by hyperextension of the great toe with axial loading<sup>1,2</sup>. High-grade injuries may threaten return to sport and require surgery<sup>3,4</sup>. Here, we describe a capsular reconstruction of the great toe MTPJ with all-knotless suture anchors and suture tape augmentation for turf toe injuries, in isolation or in combination with a traumatic bunion, designed to reduce suture burden, minimize soft-tissue irritation, and facilitate recovery.</p><p><strong>Description: </strong>The procedure begins with the patient supine. A direct medial approach to the hallux MTPJ is performed. Both the medial base of the proximal phalanx and the medial eminence of the metatarsal head are drilled at isometric points, and augmentation with suture tape is then performed. Isometric drill holes are placed in the medial proximal phalanx base and metatarsal head for suture tape augmentation. A knotless suture anchor is placed approximately 3 mm proximal to the articular margin of the metatarsal head, repairing the medial capsule in a horizontal mattress fashion. An additional knotless anchor is placed at the plantar plate insertion, and the suture is passed through the tibial sesamoid sling and tensioned with the toe in 20° of plantar flexion. Suture tape is secured into the proximal phalanx with an interference screw, then passed through the deep capsule into the metatarsal head, followed by the placement of an additional interference screw into the metatarsal head. The anchor is inserted into the plantar-medial proximal phalanx at the flexor hallucis brevis insertion. The toe is flexed during tensioning, then adjusted per clinical examination and the sesamoid location beneath the metatarsal head. Knotless fixation permits incremental tensioning with intraoperative assessment of motion. Final tensioning is performed with the toe in neutral to correct deformity without overconstraint, preserving range of motion.</p><p><strong>Alternatives: </strong>Nonoperative alternatives include rest, ice, compression and elevation; anti-inflammatory drugs; activity modification; and brief immobilization<sup>5,6</sup>. Operative alternatives include primary capsuloligamentous complex repair with nonabsorbable sutures, plantar plate advancement with bone tunnels or suture anchors if primary repair is not feasible, and concomitant procedures such as sesamoidectomy and bunionectomy based on the injury pattern<sup>2,7,8</sup>.</p><p><strong>Rationale: </strong>This technique is intended for high-grade turf toe injuries with capsuloligamentous disruption, sesamoid complex insufficiency, and MTPJ instability. Nonoperative treatment may be appropriate in cases of low-grade injury; however, persistent pain, instability, or loss of push-off strength following nonoperative treatment would indicate a higher-grade injury. Compared with isolated repair or plantar plate advancement alone, th","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Suzuki Frame Fixation for the Treatment of Dorsal Proximal Interphalangeal Joint Fracture-Dislocation.","authors":"J Terrence Jose Jerome, Vijay Malshikare","doi":"10.2106/JBJS.ST.24.00039","DOIUrl":"10.2106/JBJS.ST.24.00039","url":null,"abstract":"<p><strong>Background: </strong>The proximal interphalangeal (PIP) joint is critical for hand function, contributing substantially to grasping and overall dexterity<sup>1-3</sup>. Injuries to this joint, often caused by axial loading, can lead to various fracture patterns and dislocations, resulting in long-term complications such as pain, stiffness, reduced range of motion, arthritis, and instability<sup>1,2</sup>. Traditional surgical approaches for unstable dorsal PIP joint fracture-dislocation include dorsal block pinning, open reduction and internal fixation (ORIF), hemi-hamate or hemi-capitate arthroplasty, and external fixation<sup>1-3</sup>. Although these methods can be effective, they may have limitations in certain situations. The Suzuki frame, a pins-and-rubber-band traction system, offers a dynamic external fixation option that allows for early controlled motion while maintaining fracture reduction. This technique has several advantages, including ligamentotaxis (the traction force helps to reduce fracture fragments and restore joint alignment), early mobilization (the dynamic nature of the frame allows for early active motion, minimizing joint stiffness), and simplicity (the technique is relatively straightforward and can be performed with readily available materials).</p><p><strong>Description: </strong>The modified Suzuki frame procedure for dorsal PIP joint fracture-dislocation involves administering local anesthesia and establishing a sterile field. Under fluoroscopic guidance, three 1.0-mm Kirschner wires are inserted: 1 through the center of rotation of the proximal phalangeal head, 1 through the center of rotation of the middle phalangeal head, and 1 (the \"translation pin\") in the middle phalanx distal to the fracture. The wires are then bent to create a frame with hooks, and the translation pin is secured to the proximal wire. Rubber bands are applied between the hooks to provide traction and maintain reduction. PIP joint congruency is confirmed through a full range of motion under fluoroscopy. Dressings and a splint are applied, allowing for limited immediate postoperative motion. Formal hand therapy begins 1 week postoperatively.</p><p><strong>Alternatives: </strong>Although nonsurgical treatment may be considered for stable, minimally displaced dorsal PIP joint fracture-dislocations, unstable injuries often necessitate operative intervention to restore joint congruity and stability. Several surgical techniques are available to treat these injuries, each with its own advantages and limitations. These techniques include dorsal block pinning, ORIF, hemi-hamate or hemi-capitate arthroplasty, and the use of modified external fixators with various external fixation constructs and pins to provide stability and allow for early controlled motion.</p><p><strong>Rationale: </strong>The modified Suzuki frame is a dynamic external fixator that addresses the limitations of other treatment options for dorsal PIP joint fracture-dislocati","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Supraspinatus Tendon Reconstruction Using Hybrid LARS-Fascia Lata Graft for Irreparable Posterosuperior Massive Rotator Cuff Tears.","authors":"Xiaoli Gou, Zhenyu Wang, Xueyan Zhao, Xuping Tian, Binghua Zhou","doi":"10.2106/JBJS.ST.25.00032","DOIUrl":"10.2106/JBJS.ST.25.00032","url":null,"abstract":"<p><strong>Background: </strong>Conventional techniques for repairing an irreparable posterosuperior massive rotator cuff tear (MRCT) typically fail<sup>1,2</sup>. The supraspinatus tendon reconstruction (STR) technique offers a systematic approach to achieve both anatomic restoration and functional recovery of the supraspinatus tendon<sup>1</sup>. The use of autografts for reconstruction is challenged by their limited availability, inadequate dimensions, and donor site morbidity. The Ligament Augmentation and Reconstruction System (LARS; MovMedix) is a synthetic ligament consisting of fibers made of polyethylene terephthalate that is used as an alternative to autograft; however, concerns remain regarding inadequate graft integration with bone<sup>3</sup>. In contrast, fascia lata autografts demonstrate enhanced interface healing with both the supraspinatus muscle and the bone at the footprint<sup>4-6</sup>. The present article describes a unique arthroscopic STR approach involving a hybrid LARS-fascia lata graft for irreparable posterosuperior MRCTs.</p><p><strong>Description: </strong>The patient is placed in the lateral decubitus position, with lateral traction applied to the operative arm. Following diagnostic arthroscopy and subacromial decompression, the dimensions of the rotator cuff defect are measured arthroscopically. The width of the LARS artificial ligament is matched to the defect size, and the length is determined by the distance from the greater tuberosity to the most medial aspect of the scapular spine. A 5-cm autogenous fascia lata graft is harvested from the ipsilateral proximal thigh (distal to a point 2 cm above the greater trochanter). The graft is then circumferentially wrapped around one end of the LARS ligament and sutured in a mattress suture pattern. Two absorbable anchors are placed on the medial line of the footprint. The anchors are sutured through the lateral end of the hybrid LARS-fascia lata graft. The guide pin is passed through the subacromial region from the lateral portal, running along the supraspinatus muscle to the most medial part of the spine of the scapula and penetrating the dorsal skin. The traction wire is pulled medially and fixed with use of a double-row anchor technique. A transverse incision approximately 3 cm in length is made at the most medial side of the scapular spine to expose the medial end of the patch and the spine of the scapula. A suture anchor is implanted at the most medial part of the scapular spine, and the fascia lata is sutured to maintain the graft under as much tension as possible<sup>7-9</sup>.</p><p><strong>Alternatives: </strong>Surgical alternatives for the treatment of irreparable posterosuperior MRCTs include partial repair, superior capsular reconstruction (SCR), tendon transfers (such as latissimus dorsi or pectoralis major transfer), and reverse shoulder arthroplasty.</p><p><strong>Rationale: </strong>Compared with SCR and its modified approaches such as the \"sandwich\" t","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Exposure of C1-C2 for Instrumentation and Fusion.","authors":"Sachin Borkar, Vivek Yadav, Rohit Bharti","doi":"10.2106/JBJS.ST.26.00001","DOIUrl":"10.2106/JBJS.ST.26.00001","url":null,"abstract":"<p><strong>Background: </strong>Posterior C1-C2 instrumentation and fusion is a well-established technique for the treatment of atlantoaxial instability. Safe posterior exposure is critically important because of the proximity of the vertebral artery, venous plexus, and C2 dorsal root ganglion. However, practical exposure nuances and safety pearls are often underemphasized.</p><p><strong>Description: </strong>The present video article demonstrates a stepwise approach for posterior exposure for C1-C2 instrumentation and fusion. Preoperative assessment includes dynamic flexion-extension radiographs to evaluate instability and reducibility, and computed tomography (CT) angiography to identify a high-riding vertebral artery or vascular anomalies. The patient is positioned prone with the head secured in a Mayfield clamp (or a horseshoe headrest). A midline posterior incision and subperiosteal dissection are performed to expose the posterior elements of C1 and C2. Key technical steps include careful management of the venous plexus, identification and preservation of the C2 dorsal root ganglion, exposure of the C1 lateral mass and C2 pars interarticularis, and controlled atlantoaxial joint mobilization to achieve reduction. Screws are placed in the C1 lateral mass and C2 pars interarticularis under fluoroscopic guidance, followed by rod placement, decortication, and bone grafting to achieve fusion.</p><p><strong>Alternatives: </strong>Nonoperative treatment options include cervical immobilization and pharmacologic intervention. Surgical alternatives include other posterior fixation techniques, wiring constructs, or anterior approaches in select cases.</p><p><strong>Rationale: </strong>Meticulous posterior exposure with attention to venous plexus control and ganglion preservation allows safe and reproducible C1-C2 instrumentation while minimizing the risk of neurovascular complications.</p><p><strong>Expected outcomes: </strong>Patients are counseled that posterior C1-C2 instrumentation and fusion is intended to provide stable fixation of the atlantoaxial complex, relieve pain related to instability, prevent progressive neurological compromise, and achieve a high rate of solid fusion. Previous studies have demonstrated reliable fusion, significant improvement in neck pain, and durable radiographic stability following posterior C1-C2 fixation with use of screw-rod constructs. Harms and Melcher<sup>2</sup> reported high rates of fusion with maintained alignment and low rates of hardware failure with use of posterior C1 lateral mass and C2 screw fixation. Goel and Laheri<sup>3</sup> similarly demonstrated effective stabilization and neurological improvement following posterior atlantoaxial fixation. Contemporary reviews have confirmed that modern posterior fixation techniques provide predictable clinical and radiographic outcomes with acceptable complication rates when meticulous surgical technique and appropriate preoperative planning are employed.</p><p><","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allograft-Prosthesis Composites for the Reconstruction of the Distal Femur After the Resection of a Bone Tumor in Childhood.","authors":"Khodamorad Jamshidi, Abolfazl Bagherifard, Amin Hamidzadah Khiavi, Alireza Mirzaei","doi":"10.2106/JBJS.ST.25.00012","DOIUrl":"10.2106/JBJS.ST.25.00012","url":null,"abstract":"<p><strong>Background: </strong>The tibial physis is responsible for about 30% of the growth in the limb<sup>1</sup>. Therefore, preservation of this growth potential in skeletally immature patients undergoing distal femoral tumor resection and reconstruction is important. Reconstruction with use of an expandable prosthesis has a high failure rate<sup>2,3</sup>. Osteoarticular allograft reconstruction of the distal femur allows for the preservation of the proximal tibial plateau; however, the small size of the child's tibial plateau relative to the femoral condyle of the allograft creates challenges in size matching<sup>2,4,5</sup>. To address this issue, resurfacing the osteoarticular allograft with the appropriate femoral component of a total knee prosthesis, referred to as allograft-prosthesis composite (APC) reconstruction, could be regarded as a viable alternative<sup>2,6</sup>.</p><p><strong>Description: </strong>An anterior longitudinal incision is made encompassing the biopsy tract, either medial or lateral to the midline, depending on the tumor mass. The roof of the adductor canal is opened to expose the femoral vein and artery for protection. The resection length is based on the length of medullary involvement as measured on magnetic resonance imaging (MRI), plus an additional 2-cm margin. The bone marrow from the proximal femur is sent for frozen-section analysis in order to ensure that an adequate margin has been achieved. Depending on the MRI findings, the capsule, collateral ligaments, and cruciate ligaments are incised, and the meniscus on the tibial plateau is preserved, with consideration given to achieving a negative margin. An appropriately sized osteoarticular allograft with the retained capsule and ligaments is obtained from a standard bone bank. The femoral component of the unconstrained total knee prosthesis is matched for size with the patient's tibial plateau and is fixed to the distal end of the osteoarticular allograft with use of bone cement. The resurfaced allograft is fixed to the host bone with a bridging plate. The ligaments and capsule of the allograft are sutured as closely as possible to their counterparts in the proximal tibia. Knee stability is evaluated at the end of the procedure. Two crossed pins are utilized to fix the knee in 15° flexion to prevent joint subluxation in cases of knee instability and are removed after 2 weeks.</p><p><strong>Alternatives: </strong>One alternative is reconstruction with use of an expandable prosthesis; however, high failure rates have been reported, including due to stem loosening, lengthening failure, and periprosthetic fracture<sup>3</sup>. Moreover, currently available expandable prostheses require a minimum resection length substantially longer than the actual tumor length, leading to unnecessary removal of healthy bone and loss of valuable bone stock in growing children<sup>2,3</sup>. Osteoarticular allograft presents challenges related to the small size of the tibial pl","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Anterior Approach to Hip Resurfacing Arthroplasty.","authors":"Addy S Brandstetter, Ilan Y Mitchnik, Ofir Vinograd, Noam Shohat","doi":"10.2106/JBJS.ST.25.00019","DOIUrl":"10.2106/JBJS.ST.25.00019","url":null,"abstract":"<p><strong>Background: </strong>Hip resurfacing arthroplasty remains an appealing option for young and active patients<sup>1</sup>, but its use has declined because of technical challenges, risks of femoral neck notching, and adverse reactions associated with metal<i>-</i>on<i>-</i>metal bearings, raising concerns regarding long-term implant survival<sup>2</sup>. Accurate preparation of the femoral head and acetabulum is critical for successful outcomes<sup>3</sup>. In the present video article, we describe a reproducible technique utilizing preoperative 3D computed tomography (CT)-based planning and patient-specific 3D-printed jigs to optimize femoral head preparation, in conjunction with a direct anterior approach that preserves tendon attachments and avoids muscle injury.</p><p><strong>Description: </strong>Through a standard anterolateral skin incision and fascial split, the tensor fasciae latae (TFL) is mobilized by blunt finger dissection up to the anterior superior iliac spine while maintaining its fascial origin. The superficial internervous plane is created between the TFL laterally and the sartorius medially. Dissection proceeds in the deep interval between the gluteus medius and rectus femoris, with care to preserve the ascending branches of the lateral circumflex femoral vessels. The approach continues to the hip joint capsule, which is sharply incised to allow femoral head dislocation. Femoral head preparation is guided by patient-specific 3D-printed jigs generated from preoperative CT scans. Each jig provides a reproducible entry point and trajectory for a Steinmann pin, ensuring central alignment and avoiding femoral neck notching. Sequential reaming, chamfer cuts, and trialing are performed. The acetabulum is exposed with 3 retractors (anterior and inferior Hohmann and posterior curved 2-pronged) and progressively reamed without fluoroscopy until congruent hemispherical coverage is achieved. A press-fit cup is implanted without cement, followed by cementation of the femoral component with use of a dry-field technique. Stability and leg length are reassessed, and closure is performed in layers with barbed absorbable sutures and a waterproof dressing. If intraoperative stability or leg length restoration is found to be unsatisfactory, adjustments are made prior to final implantation. This may include repositioning of the acetabular component, upsizing or adjusting the femoral component, or performing additional soft-tissue release to achieve proper balance. Cementation of the definitive implants and closure are only performed once stability and length are confirmed in all functional positions.</p><p><strong>Alternatives: </strong>Conventional resurfacing techniques rely on intraoperative fluoroscopy, mechanical alignment guides, or freehand pin placement for femoral head preparation. Compared with these methods, 3D-printed patient-specific jigs minimize intraoperative fluoroscopy, standardize pin trajectory, and reduce the risk of m","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allograft Reconstruction Technique for Chronic Pectoralis Major Tears.","authors":"Steve A Mora, Daniel Stokes, Rachel M Frank, Abdulaziz F Ahmed","doi":"10.2106/JBJS.ST.24.00043","DOIUrl":"10.2106/JBJS.ST.24.00043","url":null,"abstract":"<p><strong>Background: </strong>Allograft reconstruction is indicated for chronic pectoralis major tears because such tears will have fibrotic changes, retraction, and stiffness that prevent primary repair<sup>1-3</sup>. Various reconstruction techniques have been described, particularly in cases in which the myotendinous unit is degenerated. Autografts (such as hamstring tendons and bone-patellar tendon-bone grafts) and allografts (such as Achilles tendon, fascia lata, and dermal grafts) have both been utilized<sup>4,5</sup>. In the present video article, we describe a technique utilizing a doubled Achilles tendon allograft, which provides sufficient width to replicate the native sternal head insertion. A 3-point fixation construct is utilized to enhance graft-to-muscle interface strength.</p><p><strong>Description: </strong>An anterior axillary approach is utilized for cosmesis and optimal access. A 7 to 8-cm incision is made just lateral to the axillary fold, retracting the clavicular head laterally without exposing the deltopectoral interval. The sternal head is identified via MRI guidance and intraoperative cues, including fibrous \"guitar-string\" adhesions. Dissection remains anterior to the clavipectoral fascia to avoid neurovascular structures. The retracted muscle, typically fibrotic and shortened, is tagged with 3 high-tensile, nonabsorbable sutures. The Achilles allograft is folded to create upper and lower leaflets. Three rows of Krackow locking sutures are placed in the upper leaflet and 2 sutures in the lower leaflet. With use of a bent Hohmann retractor, the clavicular head is retracted laterally. The anatomic insertion site-posterior to the clavicular head and lateral to the bicipital groove-is prepared with use of a burr. Importantly, no osseous trough is created, minimizing fracture risk. Three 4.5-mm drill holes are made vertically. The folded Achilles allograft is secured to the humerus with use of unicortical suture buttons and a tension-slide maneuver. Sutures are tied through the graft for secondary fixation, first securing the graft to the bone without also securing to the torn muscle under tension. Attention then turns to the muscle-to-graft connection. The arm is adducted to neutral and internally rotated. The tagged sternal head is drawn between the Achilles leaflets and temporarily clamped. Proper tension allows 60° of abduction; if not, the muscle is repositioned more medially. Fixation is completed at 3 points. (1) Heavy sutures from the lower leaflet are passed posterior-to-anterior through the pectoralis and tied. (2) The tagging sutures from the pectoralis major are passed through the Krackow rows in the upper leaflet and tied, using rip-stops to reinforce fixation. (3) The uncut sutures from the lower leaflet are passed through the upper leaflet, closing the \"fish-mouth\" configuration. Excess graft is trimmed, and the leaflets are secured with use of a running 2-0 Vicryl (Ethicon) suture.</p><p><strong>Alternative","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 3","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biportal Endoscopic Posterior Cervical Foraminotomy.","authors":"Samuel K Cho, Matthew S Miyasaka, Daniel C Berman, Marlon Murasko, Junho Song, Tariq Issa","doi":"10.2106/JBJS.ST.25.00023","DOIUrl":"10.2106/JBJS.ST.25.00023","url":null,"abstract":"<p><strong>Background: </strong>Cervical spine pathologies causing nerve-root compression are treated with use of decompression through a variety of techniques. Although several operative management options exist, cervical foraminotomy may be indicated in patients with isolated, unilateral cervical radiculopathy. Biportal endoscopic cervical foraminotomy allows decompression with minimal soft-tissue disturbance and excellent visualization.</p><p><strong>Description: </strong>The procedure is performed with the patient in a prone position with routine neuromonitoring. Intraoperative fluoroscopy is utilized to identify the operative level, and 2 paramedian incisions are made for the portal sites at a 20° to 30° angle to the desired disc space. The working portal is utilized for surgical instruments, and the second portal serves as a viewing portal for the endoscope. Sequential dilators are utilized to establish the working portal, and a semi-tubular sheath of the desired length is placed. For the viewing portal, an endoscopic trocar is advanced through the fascia, and the camera is introduced. After endoscope insertion, surgical landmarks are identified, beginning with the interlaminar V point that marks the junction of adjacent laminae at the medial border of the facet joint. Once identified, overlying soft tissue is removed using radiofrequency ablation, and decompression of the nerve root can begin. We alternate between utilizing a high-speed diamond burr and a Kerrison rongeur to perform a laminoforaminotomy. Care is taken to minimize the facetectomy extent to <50% in order to reduce the risk of iatrogenic instability. The ligamentum flavum is preserved until the end in order to protect the dura from fluid pressure and surgical instruments. In the presence of disc herniation, disc fragments are removed through the working portal after gentle nerve root retraction. Once decompression of the neural foramen is completed to the lateral border of the pedicle, meticulous hemostasis is achieved using radiofrequency ablation, bone wax, and flowable thrombin-based hemostatic agents. Patients are typically discharged home on the same day.</p><p><strong>Alternatives: </strong>Patients can undergo cervical foraminotomy utilizing traditional open, microscopic tubular, or uniportal endoscopic techniques. Alternatively, patients may undergo anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA), according to surgeon preference and individual patient pathology.</p><p><strong>Rationale: </strong>Both open and minimally invasive cervical foraminotomy result in favorable clinical outcomes<sup>1,2</sup>. However, minimally invasive approaches are associated with earlier discharge, and reduced muscle damage and operative blood loss. Although tubular foraminotomy is a traditional minimally invasive option, endoscopic approaches offer distinct benefits. First, biportal endoscopy allows for greater maneuverability and visualization of the n","PeriodicalId":44676,"journal":{"name":"JBJS Essential Surgical Techniques","volume":"16 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13282034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}