Techniques in Orthopaedics最新文献

{"title":"A Novel Technique for Medial Patellofemoral Ligament Reconstruction Using Vertical Patellar Tunnels and Use of a Single Implant. Technical Note","authors":"D. Edwards, Juan Pablo Casas-Cordero, J. Alonso, Daniel Cerda, F. Cornejo, Gerardo Zelaya","doi":"10.1097/BTO.0000000000000614","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000614","url":null,"abstract":"P atellar instability is a common pathology with an estimated incidence in the general population of 5.8 cases per 100,000, increasing to 29 cases per 100,000 in younger groups (10 to 17 y). This condition presents a rate of recurrence after the first dislocation episode of 15% to 44% and over 50% after the second episode. It also presents a high persistence of mechanical symptoms after the first episode of dislocation, where 50% of patients not resuming their previous physical activity are described and up to 70% suffer some degree of functional limitation.1 This pathology has a multifactorial etiology, with anatomic and biomechanical aspects involved, within which a patellar malalignment, genu valgus, patella alta, and increased patellar tilt can be found, in addition to predictors of redislocation such as the presence of trochlear dysplasia. The medial patellofemoral ligament (MPFL) is deemed as 1 of the main stabilizing structures of the patella, mainly in the first 30 degrees of flexion, which is frequently injured in cases of patellar instability, up to 94% in some series.2 Reconstruction of the MPFL can be performed alone or in combination with a tibial tubercle osteotomy, usually carried out with a tibial tuberosity-trochlear groove measurement > 20 mm. Our group generally performs an isolated reconstruction of the MPFL, reserving the distal realignment only for those cases with clinical lateral patellar chondrosis, as recommended by Elizabeth Arendt.3 Regarding MPFL reconstruction, we present a technique that to the best of our knowledge, has not been published, with which we have had good preliminary clinical results with a low rate of redislocation (3 cases in 86 operated knees) and improvement in Kujala scores (37 to 79 in our series). ANATOMY","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83409145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Extensor Digiti Quinty (EDQ) Opponensplasty—Revisited","authors":"J. Dengler, Carrie L. Roth Bettlach, Margot Riggi, A. Moore","doi":"10.1097/BTO.0000000000000613","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000613","url":null,"abstract":"Introduction: The extensor digiti quinty (EDQ) opponensplasty, although previously described, is not widely used by hand surgeons. This tendon transfer was used selectively in cases of combined median-ulnar nerve palsies at our center over the last 4 years, with the primary goal to preserve the extensor indices proprius (EIP) for pinch plasty. We present our technique and the series of 8 patients that underwent EDQ opponensplasty here. Materials and Methods: A retrospective chart review identified patients with combined median-ulnar nerve palsies that underwent EDQ opponensplasty between 2015 and 2019 at our institution by a single surgeon. Primary outcome measures collected were pinch, grip, disabilities of the arm, shoulder, and hand (DASH) scores, thumb position, palmar abduction angle, and thumb span. Secondary outcomes included donor site morbidity and complications. Results: Eight patients (9 hands) ages 21 to 53 underwent EDQ opponensplasty, with an average follow-up of 8 months. Postoperative pinch and grip on the affected side improved from preoperative values. All 9 transfers were functional with the thumb positioned in the palmar plane of the hand. Palmar abduction ranged from 45 to 70 degrees. Motor reeducation was achieved without any difficulty in all patients. No patients had evidence of donor site morbidity. Discussion: The EDQ opponensplasty is satisfactory in achieving thumb opposition in the setting of combined median-ulnar neuropathy, without evidence of donor site morbidity. The EDQ is expendable, has adequate length, an optimal line of pull, minimal donor site morbidity, and leaves the extensor indices proprius available for pinch plasty.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate Weight-Bearing Following Biplanar Plating of Periprosthetic Femoral Fractures","authors":"Rachel A. Thomas, Tommy Pan, M. Garner","doi":"10.1097/BTO.0000000000000612","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000612","url":null,"abstract":"Purpose: Femoral fractures in geriatric patients have a high 1-year mortality rate. Early mobilization without restrictions and full weight-bearing in elderly periprosthetic femoral fractures may improve mortality, morbidity, and accelerate functional recovery. The purpose of this study was to evaluate periprosthetic femoral fractures treated with biplanar plating and early ambulation. Materials and Methods: We conducted a retrospective study of periprosthetic femoral fractures treated with biplanar plating and immediate weight-bearing over a 4-year period. All patients were treated with anatomic reduction and primary bone healing, with biplanar fixation through a single, lateral-based incision. The primary outcome was radiographic union. Secondary outcomes were preinjury level and postinjury level of functional independence and need for revision surgery. Results: Seven patients met the inclusion criteria. The average age was 79.7 (range, 63 to 88) years. The average follow-up period was 18 months. Bony union occurred in all patients after the index procedure, with no revision surgeries documented. Five patients (71%) returned to preoperative ambulatory status, and all patients returned to their preoperative living environment. Conclusion: Our study supports the possibility of immediate weight-bearing in geriatric periprosthetic femur fractures treated with anatomic reduction and biplanar plating through a single lateral-based incision, although additional studies are needed.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72726589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Technique for Routine Clinical Measurement of Postoperative Total Knee Extension","authors":"M. Hungerford, P. Neubauer, Jordan Ochs, M. Jackson, A. Boner","doi":"10.1097/BTO.0000000000000611","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000611","url":null,"abstract":"Introduction: We propose a novel clinical technique to easily obtain a radiographic measurement for terminal passive knee extension based upon a weight-bearing lateral radiograph. Materials and Methods: Lateral radiographs were obtained with the patient in the standing position. The leg was positioned with slight hip flexion and full passive extension of the knee by instructing the patient to bear partial weight through their heel, with simultaneous use of a wooden wedge to dorsiflex the foot to neutral and to aid in balance. A Terminal extension was measured radiographically with digital imaging software. Fifty postoperative knee radiographs were used in assessing inter-observer and intra-observer reliability. Results: Inter-observer reliability yielded an Intraclass Correlation Coefficient of 0.973. The correlation coefficient for intra-observer reliability was 0.980. Conclusion: With the use of weight-bearing extension radiographs and our measurement technique, we present a method that can easily be applied across any setting in total knee arthroplasty to obtain accurate, objective data on patient knee extension.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82034849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Shelf Osteotomy With Proximal Femoral Reconstruction After Oncologic Resection","authors":"Joanne Y. Zhou, Cara H. Lai, S. Pun, Ann E. Richey, Holly B. Leshikar, R. Avedian, R. Steffner","doi":"10.1097/BTO.0000000000000610","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000610","url":null,"abstract":"Introduction: Oncologic proximal femoral resection and reconstruction in skeletally immature children remains a formidable task due to the risk of developing hip instability with patient growth or interval leg lengthening through the prosthesis. Shelf pelvic osteotomy increases femoral head coverage and containment, and favorable long-term results have been reported in the setting of developmental dysplasia of the hip and Perthes disease. We present a technique of combining shelf osteotomy with expandable proximal femoral endoprosthesis reconstruction in pediatric limb-sparing surgery. Materials and Methods: Four surgeons at 2 centers from 2012 to 2020 performed proximal femoral reconstruction with shelf osteotomy. Data were collected retrospectively on operative technique, radiographic measurements, and complications including dislocation, subluxation, implant loosening, pain, function, and radiographic outcomes. Results: Five patients were included in the study. The mean follow-up was 49 months (range: 17 to 104 mo). The mean lateral center edge angle status postproximal femoral resection and reconstruction shelf osteotomy was 56.1 degrees (±30.5). There were no reported incidences of subluxations, dislocations, periprosthetic fractures, or soft tissue complications. The 3 patients with the longest follow-up at 3, 5, and 8 years tolerated serial lengthening of the endoprosthesis totaling 1 cm, 7.25 cm, and 9 cm, respectively, and demonstrated earlier triradiate cartilage closure in the operative side compared with the nonoperative side. All patients have returned to independent ambulation. Discussion: Combining proximal femoral reconstruction with shelf osteotomy in limb salvage pediatric orthopedic oncology may help to improve hip stability with serial lengthening and patient growth.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74892912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic Tibialis Anterior Tendinopathy Necessitating Tendon Debridement With Adjunctive Autograft Fixation: A Unique Case","authors":"T. Sanchez, Turner Sankey, S. Young, C. Willis, A. Wilson, Whitt M Harrelson, Ashish B. Shah","doi":"10.1097/bto.0000000000000606","DOIUrl":"https://doi.org/10.1097/bto.0000000000000606","url":null,"abstract":"T ibialis anterior tendinopathy (TAT) is a painful, debilitating injury commonly caused by inflammation of the tibialis anterior (TA) tendon or degeneration of its tendon sheath.1 Tibialis anterior rupture is classically caused by an acute eccentric contraction in the setting of preexisting tendinosis, and patients often recall immediate pain, swelling, loss of function in ankle dorsiflexion causing chronic equinus, and the presence of foot drop or “steppage gait.”1 Others are unaware because of the recruitment of the long toe extensors.1 If a diagnosis of TA tendon rupture is uncertain after history and physical exam, imaging studies such as an magnetic resonance imaging or ultrasound will help confirm. Nonoperative treatment options include ankle foot orthoses and tendo-achilles stretching. However, most patients benefit from surgery to restore active dorsiflexion and physical function. Options for reconstructing the TA tendon include primary repair, tendon transfers, or reconstruction with graft.1 Primary repair can be done with a primary end-to-end repair or a sliding anterior tibial tendon graft (utilized for deficits 2 to 4 cm in length).2,3 Tendon transfers are used when the deficit is larger than 4 cm.1 Techniques utilized include transfer of the extensor hallucis longus (EHL), extensor digitorum longus (EDL), posterior tibial, peroneus brevis, or allograft tendon. EHL tendon transfer is the most common transfer option reported in literature. In cases where tendon transfer is not available or insufficient, a free tendon autograft or allograft can be used. Techniques reported include harvesting the peroneus tertius, semitendinosus, gracilis, plantaris, or Achilles tendon.3,4 TA tendon rupture is an uncommon pathology, and the literature does not provide conclusive evidence for the best operative intervention. Huh and colleagues utilized allograft for an end-to-end interposition of the ruptured TA tendon with distal fixation in the medial cuneiform through a bone tunnel. Our study utilized plantaris autograft as an overlay on an end-to-end TA anastomosis without any additional fixation. Drawbacks associated with the plantaris tendon autograft have historically centered around the need for an extra incision and access to the superficial posterior compartment of the lower leg. The author’s proposed technique involves the convenient utilization of a plantaris tendon autograft for the anterior tibial tendon repair after the recommended gastrocnemius recession. Gastrocnemius recession is recommended to alleviate the associated chronic equinus positioning of the ankle associated with TAT or rupture and allows for easy access to the plantaris tendon. This procedure is hypothesized to have lower complication rates with equal patient outcomes.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80212611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Capsular Repair Using a Knotless Barbed Suture With a Mini-direct Lateral Approach for Total Hip Arthroplasty: A Technique Note and Feasibility Study","authors":"N. Kobayashi, Y. Yukizawa, S. Takagawa, Hideki Honda, Kensuke Kameda, Y. Inaba","doi":"10.1097/BTO.0000000000000609","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000609","url":null,"abstract":"Introduction: How the hip joint capsule is processed during total hip arthroplasty (THA) and whether a capsular repair is needed, are important factors determining the success of the procedure. In this surgical technique report, we present a detailed technical discussion of the pearls and pitfalls of complete capsular repair using knotless barbed sutures for a mini-direct lateral approach THA. Materials and Methods: A total of 45 consecutive cases that underwent a mini-direct lateral approach for THA with a complete capsular repair were included. A historical control group of 169 cases with partial capsulectomy without repair were also reviewed. This technique is based on a modified mini-incision direct lateral approach. A T-shaped capsulotomy was performed. The margin to be seamed at the femoral side of the capsular ligament must be preserved. A knotless barbed suture was applied for repairing the capsular ligament and gluteus minimus. Results: In 42 cases (93.3%), a complete capsular repair was achieved successfully. The average operative time was 106±20 minutes. The average intraoperative bleeding was 369±241 mL. There was no major complication both intra and postoperatively. Conclusion: Complete capsular repair through a mini-direct lateral approach was feasible by using a knotless barbed suture. Preserving the margin used to seam the femoral side of the capsular ligament is a key requirement for reattachment of the capsule. In addition, a continuous knotless barbed suture facilitates gradual plication of the capsule without a cheese cut.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87795941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic Posterolateral Corner Reconstruction With Single Graft Tibial Socket Fixation","authors":"B. Swift, M. Alzahrani, Jeffrey M Potter, M. Pickell","doi":"10.1097/BTO.0000000000000607","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000607","url":null,"abstract":"Introduction: The posterolateral corner (PLC) is comprised of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Injuries to the PLC are associated with significant morbidity and functional limitation, most frequently manifested through a varus thrust gait. In the previous 2 decades, advances have been made in understanding the importance of the PLC and as a result, many techniques have been developed to address its reconstruction. Material and Methods: The Laprade technique is a previously described anatomic reconstruction of the PLC. We propose some modifications to this technique, which involve dissection of the posterolateral tibia to allow direct protection of the popliteal neurovascular bundle while establishing tibial fixation. A single hamstring graft is utilized for the reconstruction, is routed through the fibular tunnel and subsequently secured with the use of a dual-expanding tenodesis anchor, placed in a tibial socket removing the need for a tibial tunnel. Conclusion: The present study describes a novel anatomic technique that allows for improved protection of neurovascular structures, better control of graft tensioning and tunnel management, and the judicious use of a single tendon autograft while maintaining the described benefits of the anatomic Laprade technique.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84617847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Suture Fixation Technique for Tibial Spine Avulsion Injuries","authors":"Samantha Tayne, Tram L Tran, N. Vij, J. Vaughn, Gehron P. Treme, H. Menzer","doi":"10.1097/BTO.0000000000000605","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000605","url":null,"abstract":"Introduction: Tibial spine fractures typically occur in skeletally immature patients between 8 and 14 years of age. Surgical treatment is generally pursued for displaced fractures that cannot be reduced with closed manipulation. Recent biomechanical evidence favors suture fixation over screw fixation. Current suture-only techniques largely revolve around double-crossed suture configuration and lack a description regarding a form of secondary fixation. The purpose of this manuscript is to describe 2 additions to the existing suture-only techniques for pediatric tibial spine avulsion injuries. Materials and Methods (Surgical Technique): Our technique involves a U-pattern and an X-pattern suture configuration for the primary fixation. Secondary fixation is achieved with an extra-articular knotless anchor. Results: This technical write-up describes a suture fixation technique for pediatric tibial spine injuries. Discussion: There has been a shift in the literature toward suture fixation over screw fixation in cartilaginous and comminuted tibial spine avulsion injuries. In this article, we describe an arthroscopic suture fixation technique. The proposed benefits include better anatomic reduction of the fracture and improved force dissipation. Suture fixation is not without complications, namely residual laxity, which can be minimized through the use of a self-tension/continuous compression suture.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90003840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Reconstruction Using Long Tibial Autograft After Resection of Giant Aneurysmal Bone Cyst","authors":"Mohammed S Alisi, Freih O Abu Hassan, Mohammad N Alswerki, A. Abdulelah, M. Alshrouf","doi":"10.1097/BTO.0000000000000608","DOIUrl":"https://doi.org/10.1097/BTO.0000000000000608","url":null,"abstract":"Introduction: Management of giant aneurysmal bone cyst in skeletally immature patients is challenging. The huge size can be destructive and can lead to significant deformity, disability, and limb-length discrepancy. Hence, reconstruction is warranted as a treatment option. Materials and Methods: Here, we present a case of giant aneurysmal bone cyst in the distal femur of a 9 year old obese child. After complete resection, we reconstructed the large distal femur defect by a 15 cm long-tibia autograft of the same limb. Fixation was done using hybrid (monoplanar and circular) external fixation. Detailed surgical techniques and several clinical and technical challenges have been discussed. Results: After 13 years of follow-up, the distal femur is well formed with preservation of the articular surface, and the site of the tibia autograft is completely regenerated. Conclusion: The tibia can be used as an autograft for the reconstruction of large-sized defects in skeletally immature patients.","PeriodicalId":45336,"journal":{"name":"Techniques in Orthopaedics","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76117121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}