Surgical Technique to Repair Musculotendinous Junction Tear of Supraspinatus Using Lateral-Row Anchors to Avoid Cut-Through.
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ABSTRACT:
SUBMITTER: Chernchujit B
PROVIDER: S-EPMC5368098 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Subscapularis is the most powerful muscle in the rotator cuff. A steep learning curve and constrained space anteriorly make the repair difficult. In massive tears of the rotator cuff, repair of the subscapularis initially makes the massive supraspinatus tear repairable. We present our technique to repair subscapularis and supraspinatus tear by double-row anchors in a knotless and tension-free manner. This technique can be done in partial or full-thickness tears of the upper subscapularis.
| S-EPMC5765822 | biostudies-other
Project description:Abductor tendon tears are an increasingly recognized clinical entity in patients with lateral thigh pain and weakness. These "rotator cuff tears of the hip" typically result from chronic, nontraumatic rupture of the anterior fibers of the gluteus medius. Although the abductor tendon typically tears from the osseous insertion, the case discussed here ruptured at the musculotendinous junction. This is the first report of this abductor tear subtype and its endoscopic repair.
| S-EPMC3716196 | biostudies-literature
Project description:This article aims to describe a modification of the arthroscopic suture bridge technique for repair of a massive (>3 cm) rotator cuff tear. The method uses 2 medial anchors and 2 lateral anchors for rotator cuff repair, as well as double-row biceps tenodesis. This operative modification may impart better tendon healing and fewer rupture complications than the traditional double-row repair techniques.
| S-EPMC7301334 | biostudies-literature
Project description:BackgroundThe aim of this paper is to present a novel bimanual double aspiration technique to avoid intraoperative giant tear slippage. The major problem of giant retinal tears (GRT) surgery is the mobility of the posterior flap (slippage), which has been classically solved by the use of intraoperative perfluorocarbon liquid (PFCL). However, avoiding slippage of the posterior flap can be a serious technical challenge when the PFCL is removed, especially when a GRT circumference is > 180°.MethodsConventional three-port 23-gauge pars plana vitrectomy (PPV) plus chandelier was performed in three patients with giant retinal tears (GRT), using the "bimanual double aspiration technique" with non-contact wide field viewing systems. All surgeries were performed by the same surgeon.ResultsNone of the three cases presented with a retinal slippage after the bimanual aspiration technique.DiscussionGRT are full thickness retinal tears that extend circumferentially more than 90° of the retina. Management of GRT is a challenge for the vitreoretinal surgeons because the higher risk of proliferative vitreoretinopathy (PVR), re-detachment and increased risk of retinal slippage; this last can occur intraoperative or postoperative. Retinal slippage is not uncommon but far under-reported and can lead to various complications such as hypotony, retinal folds, and may exacerbate PVR formation. We performed bimanual double aspiration technique to avoid intraoperative giant tear slippage. We believe that this maneuver may avoid slippage by drying the posterior edge of the GRT. There were no complications related with the technique, and no additional equipment was needed.ConclusionIn summary, "bimanual double aspiration technique", is a simple, effective, safe and economic maneuver that could be a good option to avoid intraoperative slippage in giant retinal detachment surgery, thus achieving the stabilization of the posterior retinal flap.
| S-EPMC8161621 | biostudies-literature
Project description:Many arthroscopy suture techniques have been described for small rotator cuff tears, but there is no consensus. The aim of this study is to describe a double-row knot technique, which we call a "trident point," for the superior and posterosuperior small cuff tear that is easily reproducible and has a fast learning curve. This knot takes into account the excess of tendon tissue on the foot print after a cuff suture, called a "dog-ear deformity." However clinical, ultrasound, and biomechanical evaluation with follow-up remains necessary to validate the sustainability of this arthroscopy technique.
| S-EPMC7953229 | biostudies-literature
Project description:Small symptomatic rotator cuff tears are a common problem seen by orthopaedic surgeons. Arthroscopic repair has been shown to have favorable outcomes for these lesions. There is as yet no consensus on the ideal technique for the arthroscopic repair of small rotator cuff tears. We present a single lateral row technique for the repair of such lesions, which we believe to be reproducible and effective, that achieves good approximation of the tear while reducing the chance of suture cutouts.
| S-EPMC7953233 | biostudies-literature
Project description:The posterior lateral meniscus root (PLMR) provides the circumferential tension required to stabilize the lateral meniscus. Thus, preservation of the PLMR is important to prevent an increase in tibiofemoral contact pressure, which could result in osteoarthritis. We describe an all-arthroscopic approach to the fixation of PLMR using suture anchors through associated posterolateral arthroscopic portals that result in a more favorable inclination of the anchors. Initially, the anatomical insertion site of the root on the tibial plateau is debrided, 1 to 2 anchors are placed through the posterolateral portals into the root's footprint area, and the meniscus is finally sutured from the posterolateral portals. Compression of the meniscus is achieved with bone contact. This technique achieves lateral meniscus root fixation, reducing the risk of subluxation of the meniscus and subsequent osteoarthritis.
| S-EPMC5797299 | biostudies-literature
Project description:Complete radial tears of the meniscus render the entirety of the meniscus functionally incompetent (known as an ameniscal state); therefore, attempts at repair are essential. Although various techniques have been described, repair failures continue to frequently occur, especially with the medial meniscus. Inside-out repair and anchoring of the preserved meniscus to both the capsule and tibia may offer the advantage of a more robust repair. The objective of this Technical Note is to describe a method of repair for complete radial tears of the medial meniscus using a combination of inside-out sutures and secondary reinforcement to the tibia using all-suture knotless anchors.
| S-EPMC7953262 | biostudies-literature
Project description:Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique. Technique Video Video 1 The arthroscopic view from the anterolateral portal shows a decreased volume of the lateral meniscus due to a previous surgical resection. The posterior lateral meniscus (LM) is pulled anteriorly over the center of the lateral compartment by probing. The posterior LM is repaired under the guidance of the ultrasound by having the assistant surgeon place the ultrasound probe, covered with a sterile sleeve, horizontally on the popliteal fossa to allow confirmation of the posterior portion of the LM and the popliteal artery. An all-inside suture device, the JuggerStitch, is introduced from an anterolateral portal, and the tip of the needle is observed in the ultrasound image. While penetrating the posterior LM, the direction of the needle is confirmed not to injure the neurovascular structures. The anchor of the JuggerStich is introduced at the posterior side of the LM and can be observed as a high echoic region. After introduction of two anchors, the sutures are pulled anteriorly through the anterolateral portal, and the knot is tightened. The ultrasound image shows that the two anchors are positioned on the capsule behind the posterior LM. The same procedures are then repeated. The location of the popliteal artery and the direction of the needle are confirmed by ultrasound every time. If the needle is directed toward the artery, it should be extracted and inserted again. A total of 4 sutures are performed to obtain stability of the LM under the assistance of ultrasound. The final arthroscopic examination shows the properly secured repair and the stabilized posterior LM by probing.
| S-EPMC9134676 | biostudies-literature
Project description:Arthroscopic rotator cuff repairs are mostly secured with suture anchors and often supplemented by footprint decortication. The objectives of this study were to characterize the strength of bone-tendon healing following anchor repair and assess the effect of channeling the supraspinatus (SSP) humeral footprint 1 week ahead of reattachment surgery.One hundred twelve rabbits underwent unilateral detachment of one SSP tendon and were randomly assigned to two groups: channeling the footprint at time of detachment and no channeling. One week later, reattachment was performed using an anchor. The repaired and contralateral shoulders were harvested at 0, 1, 2, or 4 weeks after repair and mechanically tested to failure. Outcome measures included load at failure, stiffness, and site of failure.Anchor fixation had a mean load at failure of 81?±?32 N and a stiffness of 27?±?9 N/mm immediately after repair compared to 166?±?47 N and 66?±?13 N/mm in the contralateral (both p?<?0.05). Mechanical recovery of the reattached SSP tendon was achieved after 4 weeks (221?±?73 N, 206?±?59 N, and 198?±?49 N in the channeling, no channeling, and contralateral groups, respectively, p?>?0.05). The dominant site of failure shifted from the footprint at 0/1 week to bone avulsion/mid-substance tear at 4 weeks (p < 0.05). There were no differences in outcomes between the channeling and no channeling groups.This study is the first of its kind to provide quantitative data on the mechanical properties of the enthesis following anchor repair in a rabbit model. Anchor repair led to rapid and complete restoration of SSP mechanical properties. Further evidence is needed before recommending channeling ahead of repair surgery.
| S-EPMC5870745 | biostudies-literature