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The Oblique Mattress Lasso-Loop Stitch for Arthroscopic Capsulolabral Repair.

ABSTRACT: Arthroscopic capsulolabral repair during shoulder stabilization surgery requires the use of suture anchors. Several arthroscopic suturing techniques for capsulolabral repair have been described, and each carries very specific advantages and disadvantages with regard to risk, patient satisfaction, and functional outcomes. The purpose of this report is to describe the oblique mattress lasso-loop stitch. This stitch (1) provides strong initial fixation of the labrum, (2) establishes labral height and allows for larger capsular plication if needed, (3) prevents the suture from cutting through the radial fibers of the glenoid labrum, (4) prevents knot migration to the articular side and loosening of the knot, and (5) requires fewer implants and preserves glenoid bone stock by increasing the amount of labrum and capsule that can be reattached to the glenoid with a single-loaded suture anchor.

SUBMITTER: Parnes N

PROVIDER: S-EPMC5123991 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Arthroscopic glenoid labral repair with an oblique mattress configuration.

Project description:There have been several arthroscopic techniques described in the literature regarding the passage of sutures for an arthroscopic glenoid labral repair. With simple suture passage when tying knots, there is a concern of internal knot impingement, especially in the posterosuperior labrum. On the other hand, with simple suture passage with knotless technology, there is a concern of leaving the anchor hole exposed in the glenohumeral joint space, especially with anchors that are degradable over time. Whereas a horizontal mattress configuration may address these 2 issues in most cases, there is the issue of tissue cut-through with the labral tissue fibers being in the same plane as the horizontal mattress sutures. The purpose of this report is to describe the oblique mattress configuration, which allows the passage of suture through multiple labral tissue planes, covers up the anchor holes with labral tissue, and maintains the knots away from the articular surface if knots are tied.

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Arthroscopic Subscapularis Tendon Repair Using the Lasso-Loop Technique Through Anterolateral Viewing Portal.

Project description:The subscapularis is the strongest muscle among the rotator cuff muscles, and it provides a coupled balanced force across the glenohumeral joint by resisting the infraspinatus in axial plane and the shearing force of deltoid in the coronal plane. It is important to repair subscapularis tears to maintain the coupled balanced force. Subscapularis tendon tears are difficult to diagnose and treat. Only a small portion of the subscapularis tendon is visualized during routine arthroscopy, as it is largely covered by the middle and inferior glenohumeral ligaments. Various repair techniques have been described in the literature. Here, we describe the anterolateral viewing portal for better visualization of subscapularis and our preferred technique, the lasso-loop technique, which provides better tissue grip and improved functional outcome.

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All-arthroscopic suprapectoral long head of biceps tendon tenodesis with interference screw-like tendon fixation after modified lasso-loop stitch tendon securing.

Project description:Arthroscopic suprapectoral techniques for tenodesis of the long head of the biceps tendon (LHB) are appropriate for the treatment of proximal biceps lesions. Several types of techniques and fixation devices have been described and evaluated in biomechanical studies regarding primary stability. In this technical note, we describe an all-arthroscopic suprapectoral technique using the 6.25-mm Bio-SwiveLock device (Arthrex, Naples, FL) for an interference screw-like bony fixation after having armed the tendon with a lasso-loop stitch. Both the interference screw fixation and securing of the lasso-loop tendon have been well described and approved in biomechanical tests concerning the primary stability. One advantage of this technique performed from the glenohumeral space, in addition to the strong and secure fixation with ingrowth of the tendon in a bony canal, is the avoidance of touching the soft tissue above the bicipital groove, which results in a smooth fitting of the tendon into its natural canal and therefore avoids mechanical irritation of the stump at the rotator interval. In conclusion, the all-arthroscopic suprapectoral LHB tenodesis performed from the glenohumeral space with the modified lasso-loop stitch for securing of the tendon and the 6.25-mm Bio-SwiveLock suture anchor for interference screw-like bony tendon fixation is an appropriate technique for the treatment of LHB-associated lesions.

| S-EPMC3678672 | biostudies-literature

Arthroscopic bankart repair: accessory posterior portal with slotted cannula for lowest capsulolabral access.

Project description:We present a novel technique for safe establishment of the accessory posterior portal using a slotted cannula. Arthroscopic Bankart repair is a common procedure. A variety of arthroscopic techniques have been described in the literature, commonly using the posterior portal for visualization and the anterior portal with a working cannula. The accessory posterior portal enables elegant access to the lower part of the capsulolabral junction, a firmer grasp and mobilization of the tissue, quick and easy tool exchange using a slotted cannula, and clearer suture placement because of the flat, direct working angle. The skin incision is made small without the need for an arthroscopic cannula, and the portal location is in a relatively safe zone. The use of the accessory posterior portal along with a slotted cannula shortens the duration of the operative procedure and improves safety and performance.

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Arthroscopic Repair of Rotator Cuff Tears Using a Suture Hook With Lasso Loop for Forward Suture Passing

Project description: Not available

| S-EPMC10907960 | biostudies-literature

Enhanced rehabilitation guidance after arthroscopic capsulolabral repair of the shoulder: a randomized controlled trial.

Project description:OBJECTIVE:To compare the effects of a 12-month home-based exercise program to usual care in patients after arthroscopic capsulolabral repair of the shoulder. DESIGN:Randomized controlled trial. SETTING:Outpatient physical and rehabilitation medicine clinic. SUBJECTS:Forty-five patients (mean age: 35?years; standard deviation (SD): 10?years) who underwent arthroscopic capsulolabral repair due to labral lesion were randomized into an exercise group (EG) or a control group (CG). INTERVENTION:The EG received a 12-month home-based additional exercise program with four physiotherapy follow-up visits, while the CG received standard postoperative exercise instructions. MAIN MEASURES:Self-reported shoulder disability was assessed with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and quality of life with the Short-Form (SF)-36 Health Survey. The function of the operated shoulder was evaluated with strength and range of motion measurements. RESULTS:No between-group differences were observed in any of the outcomes at the follow-up. Mean ASES score improved by 16 (95% confidence interval (CI): 10-23) points from the baseline 78 (SD: 17) in the EG and 13 (95% CI: 7-19) points from the baseline 79 (SD: 17) in the CG. Both groups achieved a significant improvement in the dimensions of Physical Functioning, Role-Physical, and Bodily Pain of the SF-36 and in every aspect of strength and range of motion measures. In EG, exercise adherence was moderate (52%) during the first six months and poor (22%) during the last six months. CONCLUSION:Home-based additional exercises with four outpatient follow-up visits did not improve outcome after arthroscopic capsular repair of the shoulder.

| S-EPMC7350199 | biostudies-literature

A Lasso-Loop Traction Technique for Arthroscopic Superior Capsular Reconstruction.

Project description:Irreparable rotator cuff tears (RCTs) cause shoulder pain and disfunction. Management of RCT patients has classically been difficult due to few treatment options. Since Mihata et al. in 2013 introduced the superior capsular reconstruction (SCR) technique as a treatment option, it has become widespread among surgeons, especially for young active patients in whom reverse shoulder arthroplasty is not recommended. With SCR, a reduced humeral head can be maintained and superior displacement is avoided, improving shoulder pain and restoring active shoulder motion. A variety of grafts may be used, but the surgery can be technically complicated. An arthroscopic lasso-loop traction technique for SCR is described here, which simplifies graft shoulder reduction by traction from the anteromedial and posteromedial portals.

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Arthroscopic Posterior Capsulolabral Reconstruction With Gracilis Allograft

Project description:Posterior shoulder instability is increasingly recognized and represents a complex continuum of pathology that can be challenging to diagnose and treat. Current surgical options involve posterior labral repair with or without capsular plication, as well as bony procedures, including glenoid bone grafting and glenoid osteotomy when indicated, often in the setting of revision. There is presently a dearth of surgical options to directly address the root cause of soft tissue failure, including a diminutive posterior labrum, chondrolabral retroversion, and thin or hyperelastic posterior capsule. This article presents a technique for arthroscopically augmenting the posterior capsulolabral complex in the setting of soft tissue insufficiency, laxity, or poor prognostic factors for failure. Secondarily, this technique provides a lower risk revision option for reconstruction in failed posterior instability without glenoid bone defect. Technique Video Video 1 This video depicts an arthroscopic technique for reconstructing the posterior labrum and augmenting the glenohumeral posterior capsule in the setting of recurrent instability. Patient is in beach chair position and right shoulder is viewed from the superior portal.

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The "Double Lasso-Loop" Technique Used for Arthroscopic Proximal Biceps Tenodesis.

Project description:Disorders of the long head biceps tendon are among the most challenging of shoulder problems to diagnose and manage. In this Technical Note, we introduce an arthroscopic technique for proximal biceps tenodesis high in the groove at the articular margin of the humeral head using a single anchor and 2 self-cinching loops followed by 5 alternating half-hitches to secure the construct. This method is simple and enables stable fixation of the biceps tendon.

| S-EPMC6475644 | biostudies-literature

Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study.

Project description:Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation.

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