Meniscus-Side-Knot-tying Technique Instead of Capsular-Side-Knot-Tying in Arthroscopic Outside-In Meniscal Repair: A Small but Meaningful Modification
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PROVIDER: S-EPMC10907913 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:PurposeTo quantify an orthopaedic trainee's ability to tie arthroscopic knots before and after a short cadaveric-based arthroscopy training period using a commercially available knot-tying workstation.MethodsDuring a weeklong cadaveric arthroscopic training camp, 15 third- and fourth-year orthopaedic residents were evaluated using a commercially available benchtop knot-tying workstation. At the beginning of the week (baseline), each participant was asked to tie 3 knots of his or her choice backed up by 3 half-hitches using nonabsorbable suture. Successful knots fit the sizer and elongated less than 3 mm after application of a 15-lb load. Afterward, residents watched a video demonstrating a sample knot and were encouraged to practice over the ensuing days. At the end of the week (post-training), residents were asked to tie 3 knots. The time to completion and success of each knot were recorded. To compare baseline and post-training knot success, t tests and χ2 analysis were performed.ResultsDuring baseline testing, residents successfully tied 26.7% of their knots (12 of 45 knots) in 352 ± 116 seconds (mean ± standard deviation). During post-training testing, residents successfully tied 66.7% of knots (30 of 45 knots, P = .00014) in 294 ± 63 seconds (P = .023), showing significant improvement in the time and ability to tie arthroscopic knots.ConclusionsWith a short cadaveric-based training period, orthopaedic trainees showed a significant improvement in their ability to tie arthroscopic knots on a commercially available benchtop knot-tying workstation. Given the initial low percentage of successfully tied knots and the limited opportunities for trainees to improve, trainees should be encouraged to practice and improve their skills.Clinical relevanceWith training, residents can improve arthroscopic knot-tying abilities, which may allow them to successfully perform this critical task in the operating room.
| S-EPMC8220621 | biostudies-literature
Project description:Irreparable rotator cuff tears are a complicated problem, and current treatment options include nonoperative rehabilitation, debridement with or without a biceps tenotomy, tuberoplasty, partial rotator cuff repair, patch augmentation, biodegradable spacers, tendon transfer, and reverse shoulder arthroplasty. Arthroscopic superior capsular reconstruction is a more recent technique that is gaining popularity for use in irreparable rotator cuff tears. However, this surgery can be technically complicated. The purpose of this technique is to increase reproducibility and simplify a complicated procedure by addressing the current challenges of previous techniques.
| S-EPMC6112060 | biostudies-literature
Project description:Numerous studies have analyzed techniques for producing reliable and efficient arthroscopic knots. All aspects have been explored, from the biomechanics and strength to the ability to teach and replicate at all levels of training. This technique article describes an additional maneuver (X-grab) for efficiently marking the post side of the arthroscopic knot without having to do this separately outside of the joint. This is most useful for procedures such as rotator cuff repair and capsular repair or plication in hip arthroscopy in which the location of the knot (i.e., the post) is critical. The aim of this Technical Note is to describe the X-grab maneuver, which shortens this process to a single step, limiting the see-sawing of sutures and over-instrumentation of the joint seen with other techniques.
| S-EPMC9243617 | biostudies-literature
Project description:Arthroscopic partial medial meniscectomy is a very common orthopaedic procedure performed for symptomatic, irreparable meniscus tears. It is usually associated with a very good outcome and minimal complications. In some patients with tight medial compartment, the posterior horn of the medial meniscus can be difficult to visualize, and access in this area with instruments may be challenging. To increase the opening of the medial compartment, after valgus-extension stress position of the knee, different techniques of deep medial collateral ligament release have been described. The outside-in pie-crusting technique shown in this technical note has documented effectiveness and good outcomes with minimal or no morbidity.
| S-EPMC5040130 | biostudies-literature
Project description:Even though inside-out repair of meniscal tears is still the gold standard, the need for a posterior incision is a certain disadvantage of this approach. However, all-inside arthroscopic meniscal stacked suture repair can be performed for hypermobile lateral meniscus using all-inside devices and slotted canula. This technique is able not only to reduce surgical invasion but also preserve meniscal mobility, since sutures are placed on the peripheral area of the lateral meniscus. To successfully use the devices required for this procedure, surgeons must understand proper insertion techniques. The purpose of this Technical Note is to demonstrate this technique using FASTFIX 360.
| S-EPMC8322567 | biostudies-literature
Project description:A meniscal root tear can increase the tibiofemoral contact pressure to approximate that of total meniscectomy and eventually lead to degenerative change. An anatomic and stable meniscal root repair is essential in restoring the tibiofemoral contact pressure back to that of a normal knee. Suture anchor technique and pull-out suture technique are the 2 main arthroscopic root repair procedures with equivalent success; nonetheless, there remains a lack of an optimal technique with a biomechanical property matching that of the intact root. This article presents a technically simple, fast, and robust pull-out suture construct that incorporates 2 slip-knot locking loops at the meniscus-suture interface. This technique can be used for both medial and lateral posterior root repair, as well as concomitantly with cruciate ligament reconstruction.
| S-EPMC8821894 | biostudies-literature
Project description:The medial meniscus posterior root tears are a common problem in early elder patients. From a biomechanical study, the anatomical repair demonstrated a restored contact area and contact pressure than the nonanatomical repair. Nonanatomical repair of the medial meniscus posterior root resulted in decreased tibiofemoral contact area and increased contact pressure. Various surgical repair techniques were reported in the literature. However, there was no reported precise arthroscopic landmark to define the anatomical footprint of the posterior root attachment of the medial meniscus. We propose the "meniscal track", an arthroscopic landmark to guide the location of the anatomical footprint of the medial meniscus posterior root attachment.
| S-EPMC10323970 | biostudies-literature
Project description:MRI did not detect any abnormality in the medial meniscus besides high-intensity changes at the meniscofemoral portion of the deep medial collateral ligament. Although pure valgus stress test proved no medial joint widening at 0° and 30°, when an examiner applied knee valgus and tibial external rotation force, the patient experienced pain in the anteromedial knee joint that coincided with their refractory symptoms in individual specific activity. Arthroscopy investigation confirmed that the anterior to middle segment of the medial meniscus had excessively slid into the central direction by a probe-drawing manoeuvre; synchronous meniscal movement in the valgus and external rotation test was also observed. After arthroscopic meniscal suture to the lesion had suppressed the abnormal meniscal movement, the patients' refractory anteromedial symptoms disappeared immediately. From their common history of medial collateral injury and the high intensity at the deep medial collateral ligament, we assumed that chronic deep medial collateral ligament impairment sustained the hypermobility of the medial meniscus. Arthroscopic confirmation of hypermobility led to definitive treatment of a simple meniscal suture. Painful deep MCL injuries with hypermobile medial arthroscopic findings are not a rare phenomenon as previously assumed; however, surgeons often fail to recognize its latent clinical features.
| S-EPMC7289751 | biostudies-literature
Project description:Posterior shoulder instability is more prevalent than traditionally believed. Surgical repairs of posterior shoulder instability have overall good success rates. However, in elite overhead and throwing athletes, a low rate of return to the preinjury level of play after repair remains a challenge. The 2 goals of posterior shoulder stabilization surgery are secure fixation of the labrum to the glenoid and retensioning of the posterior capsulolabral complex. Recent studies have shown significant advantages of arthroscopic anatomic repair over open nonanatomic techniques. We report a combined double pulley-simple knot technique for arthroscopic fixation of posterior labral tears and capsular shift. The technique incorporates several advantages of this hybrid fixation method.
| S-EPMC4809746 | biostudies-literature
Project description:We report on a rotaxane-like architecture secured by the in situ tying of an overhand knot in the tris(2,6-pyridyldicarboxamide) region of the axle through complexation with a lanthanide ion (Lu3+ ). The increase in steric bulk caused by the knotting locks a crown ether onto the thread. Removal of the lutetium ion unties the knot, and when the axle binding site for the ring is deactivated, the macrocycle spontaneously dethreads. When the binding interaction is switched on again, the crown ether rethreads over the 10 nm length of the untangled strand. The overhand knot can be retied, relocking the threaded structure, by once again adding lutetium ions.
| S-EPMC6099318 | biostudies-literature