Recognition and Differentiation of Baker Lesions in Lateral Epicondylitis During Arthroscopic Debridement.

Recognition of lateral capsular disruptions (Baker lesions) that are commonly identified during arthroscopic lateral epicondylitis release is important because understanding that these lesions exist-and the variation of their arthroscopic appearance-is important. In addition, identifying Baker lesions serves as evidence supporting lateral epicondylitis as the cause of symptoms. The purposes of this article are to describe the classification system and to arthroscopically show examples of each lesion type, as well as to describe our technique for arthroscopic lateral epicondylitis release.

Arthroscopic Recognition and Treatment Options for Biceps Subluxation.

Instability of the long head of the biceps tendon is a common pathologic condition that may be difficult to identify using history, physical examination, advanced diagnostic imaging, and even arthroscopic diagnostic inspection. The goal of this technical article is to showcase important anatomic features, intra-articular arthroscopic assessment, and commonly associated pathologies that should raise concern for biceps instability. Techniques to address concurrent biceps and subscapularis lesions are also described.

Arthroscopic Mobilization Techniques for Retracted Immobile Rotator Cuff Tears.

The treatment of massive, retracted rotator cuff tears remains a significant challenge to orthopaedic surgeons. While debridement and partial repair has been described as a viable option, surgeons seeking to perform a complete repair often must employ advanced mobilization techniques to lateralize retracted immobile rotator cuff tissue. Tears that appear irreparable often may be effectively mobilized with elements of capsular release, anterior interval slide, or posterior interval slide.

Use of a Mechanical Forearm Holder During Elbow Arthroscopy in Lateral Decubitus Position.

Proper patient positioning is a key consideration when performing elbow arthroscopy. The lateral decubitus position for arthroscopic management of a variety of elbow disorders has recently gained popularity among elbow surgeons. There are several advantages of the lateral decubitus position.

Preoperative Computed Tomography Scan in Distal Radius Fractures and the Effect on Preoperative Planning.

Purpose: It is unclear whether computed tomography (CT) scans alter the surgical plan when ordered before surgery for fixation of intra-articular distal radius fractures (DRFs). The purpose of this study was to determine whether a preoperative CT scan alters the planned approach (PA) or planned fixation strategy (PFS) for open reduction internal fixation of intra-articular DRFs.

Methods: Radiology records were retrospectively reviewed by one trauma surgeon and two hand surgeons for 33 intra-articular DRFs that met the inclusion criteria and previously underwent open reduction internal fixation.

Improved perioperative narcotic usage patterns in patients undergoing robotic-assisted compared to manual total hip arthroplasty.

Background: Robot-assisted total hip arthroplasty (RA-THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA (mTHA), but optimal dosage for peri-RA-THA and mTHA pain relief remains unclear. This study aimed to compare pain control with opioids between patients undergoing direct anterior approach THA with the use of a novel, fluoroscopic-assisted RA-THA system compared to opioid consumption associated with fluoroscopic-assisted, manual technique.

Methods: Retrospective cohort analysis was performed on a consecutive series of patients who received mTHA and fluoroscopy-based RA-THA.

Arthroscopic Techniques to Recognize and Quantify Subtle Medial and Lateral Elbow Instability.

The diagnosis and treatment of elbow instability can be challenging for surgeons. Although history, physical examination, radiographs, and advanced imaging such as stress ultrasound scanning and magnetic resonance imaging are helpful, diagnostic arthroscopy is a valuable tool in the armamentarium of an elbow surgeon. Elbow arthroscopy is not only a diagnostic tool but also has the added therapeutic benefits that are not available with other diagnostic modalities.

"Double Row Rip-Stop" Arthroscopic Repair Technique for Acute, Retracted Rotator Cuff Tears.

Acute, retracted rotator cuff tendon tears are important to recognize and can present unique technical challenges to repair. Various arthroscopic techniques and suture configurations have been proposed for repair of acute tears with aims to maximize the repair footprint and optimize tendon fixation. The double row rip-stop configuration was designed and has been used for rotator cuff repair due to its potential advantages related to suture pullout, footprint reapproximation and load sharing.

Techniques and Tips to Arthroscopically Remove Prominent and Loose Shoulder Joint Hardware.

The number of arthroscopic shoulder operations has continued to steadily increase in recent years, with a projection of over 500,000 rotator cuff operations in 2023. Although the incidence of anchor pullout, hardware failure, and aberrant hardware placement is relatively low, this increased volume of shoulder operations has inevitably resulted in a consequent increase in the number of patients who experience such hardware complications. These hardware issues can cause significant pain, limit shoulder function, and cause permanent damage to the shoulder articular cartilage.

Manipulation Under Anesthesia and/or Lysis of Adhesions After Anterior Cruciate Ligament Reconstruction in Female Basketball Players: Does Race Play a Role?

Background: Arthrofibrosis can limit function and return to sport after anterior cruciate ligament (ACL) reconstruction. Previously reported risk factors for developing arthrofibrosis after ACL reconstruction include female sex, age <18 years, time from injury to surgery <28 days, concomitant meniscal repair, prolonged immobilization, and genetic factors. There is a lack of evidence regarding whether race plays a significant role.

Medialized Rip-Stop Convergence Technique for Retracted Rotator Cuff Tears.

Attempts to restore the anatomical footprint during rotator cuff repair for retracted, relatively immobile tears can be difficult. In some cases, it can lead to excessive tension of the repair. Previous studies have noted improved clinical outcomes when repair tension is not excessive, and medialization of the anatomical footprint has been suggested as a technique that can help surgeons repair large, retracted tears without excessive tension and achieve improved clinical outcomes.

Limited Arthroscopic Deltoid Fasciectomy Increases Subacromial Visualization and Characterization of Rotator Cuff Tears.

Adequate arthroscopic visualization in the subacromial space is a necessity to appropriately characterize rotator cuff tears and to subsequently develop a suture construct that best reduces the cuff tear with the least tissue tension possible for optimal healing. The purpose of this article and corresponding video is to demonstrate a technique for carrying out a limited deltoid fasciectomy, resulting in enhanced visualization of the rotator cuff through the lateral viewing portal.

Augmentation of Massive Rotator Cuff Repairs Using Biceps Transposition Without Tenotomy Improves Clinical and Patient-Reported Outcomes: The Biological Superior Capsular Reconstruction Technique.

Purpose: To evaluate the outcomes of a consecutive series of patients after transposition of the biceps without tenotomy (biological superior capsular reconstruction [bio-SCR] technique) to augment massive rotator cuff repairs.

Methods: Thirty massive rotator cuff tears repaired and augmented using the bio-SCR technique between June 2018 and July 2021 were identified and retrospectively reviewed. American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale pain scores, supraspinatus and infraspinatus strength, and range of motion were collected preoperatively and postoperatively.

Image-Free Robotic-Assisted Total Knee Arthroplasty Results in Quicker Recovery but Equivalent One-Year Outcomes Compared to Conventional Total Knee Arthroplasty.

Background: Few studies have addressed whether robotic-assisted total knee arthroplasty (RA-TKA) significantly impacts functional outcomes. This study was conducted to determine whether image-free RA-TKA improves function compared to conventional total knee arthroplasty (C-TKA), performed without the utilization of robotics or navigation, using the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) as measures of meaningful clinical improvement.

Methods: A multicenter propensity score-matched retrospective study was conducted of RA-TKA using an image-free robotic system and C-TKA cases at an average follow-up of 14 months (range, 12 months to 20 months).

Arthroscopic Techniques to Stabilize Glenoid Bony Bankart Fragments.

A bony Bankart lesion is an avulsion of the labroligamentous complex associated with an anterior glenoid rim fracture. Bony Bankart lesions can be seen in up to 70% of traumatic shoulder dislocations. With such a high prevalence, the development of an optimal repair technique is important.

Arthroscopic Identification and Management of Hourglass Biceps.

The hourglass biceps is a condition in which the intra-articular portion of the biceps tendon becomes inflamed and hypertrophies relative to the remaining tendon. This condition can be seen in association with rotator cuff and labral pathology and may lead to anterior shoulder pain. Diagnosis requires careful visualization and inspection of the biceps tendon during shoulder arthroscopy, as the presentation may be subtle.

Arthroscopic Management Strategies for Glenohumeral Articular Cartilage Lesions and Defects.

Glenoid articular cartilage lesions are a source of shoulder pain and can occur in the setting of glenohumeral instability and degenerative shoulder disease. Glenolabral articular disruption lesions have been reported to be associated with worse outcomes after arthroscopic repair of labral tears. There are relatively few published studies evaluating outcomes after surgical treatment of glenoid articular lesions; however, it is generally accepted that management should consist of restoring the glenoid articular surface, minimizing exposed articular defect, and re-establishing capsulolabral integrity to achieve stability.

"Triple-Fix" Arthroscopic Biceps Tenodesis: Indications and Technique.

Pathology of the long head of the bicep tendon is a common cause of anterior shoulder pain and frequently is treated surgically using either tenodesis or tenotomy. Tenodesis often is the preferred technique for younger, more active patients and laborers, especially when cosmesis and preservation of function are clinical priorities. However, the security of the tenodesis varies with fixation methods and techniques, and failure of the tenodesis can have both cosmetic and symptomatic consequences.

The Arthroscopic "Bellows" Sign Identifies Hidden Rotator Cuff Tears.

The intraoperative recognition of rotator cuff tears continues to be a challenge in some cases, despite clinical suspicion, a physical examination suggesting a rotator cuff tear, and detection on preoperative imaging studies. Intraoperative identification can be elusive in partial tears including intratendinous tears and obscured full-thickness tears. The purpose of this Technical Note, and the associated technique video, is to discuss a visual sign for the detection of various rotator cuff tear pathologies.

Arthroscopically Assisted Humeral Head Decompression for Avascular Necrosis: Lateral Cortical Perforation Technique.

Avascular necrosis (AVN) of the humeral head is debilitating condition that, when left untreated, can progress to humeral head collapse and end-stage arthritis of the glenohumeral joint. Core decompression is widely regarded as a first-line surgical treatment for early-stage AVN, and when performed on the appropriate patient, core decompression is an effective treatment for improving symptoms and preventing progression and humeral head collapse. This article discusses operative indications and presents a relatively simple and effective arthroscopic method for core decompression of humeral head avascular necrosis.

Improved accuracy and fewer outliers with a novel CT-free robotic THA system in matched-pair analysis with manual THA.

Accurate component orientation and restoration of hip biomechanics remains a continuing challenge in total hip arthroplasty (THA). The goal of this study was to analyze the accuracy/reproducibility of a novel CT-free and pin-less robotic-assisted THA (RA-THA) platform compared to manual THA (mTHA). This matched-pair cadaveric study compared this RA-THA system to mTHA (n = 33/arm), both using the assistance of fluoroscopic imaging, in a group of 14 high-volume arthroplasty surgeons.

"Ninja Technique" for Percutaneous Completion of Partial-Thickness, Articular-Sided Rotator Cuff Tears.

Rotator cuff tears are a common source of shoulder pain and dysfunction. Owing to the multifaceted nature of these injuries, various viable methodologies exist for their surgical and nonsurgical management. Among surgically managed patients, those with PASTA (partial articular supraspinatus tendon avulsion) lesions require careful consideration of technique.

Combined Intra-articular and Extra-articular Visualization for Repair of a Complete Subscapularis Tear: The "Blended View" Technique.

Repair of subscapularis tendon tears can be a challenging task, even for an experienced arthroscopist. The complexity results not only from the difficulty in identifying these tears accurately but also because establishing orientation for visualization and repair of this often distorted anatomy can be difficult. Even after a subscapularis tear is identified and mobilized, restoration of the footprint can prove demanding due to the limited view of the subscapularis tendon's lesser tuberosity insertion site, especially from the traditional posterior portal.