Operative v Nonoperative
Levy et al Arthroscopy 2009
- systematic Review
- improved outcomes with operative management
https://pubmed.ncbi.nlm.nih.gov/19341932/
Vicenti et al. Injury 2019
- systematic review
- two studies compare operative v nonoperative
Middle age men
Steroids / Growth Hormone
Usually occurs in gym
Bench Press
Significant bruising in the acute phase
In chronic setting, ask patient to adduct against hip / resistance
Case 1: Acute Presentation
https://www.vumedi.com/video/arthroscopic-double-row-subscapularis-repa…
Technique
- extra-articular
Portals
- posterior portal very lateral so can see anterior aspect subacromial space
- port of Wilminton at anterolateral acromion to access SSC
- anterior portal in normal position, slightly more lateral so becomes working portal
- reported higher incidence with immediate reconstruction in acute phase
- reduced by settling inflammation / effusion and obtaining FROM
- always best to delay if not professional athlete
- problematic if patient has locked bucket handle mensical tear
Bottoni et al Am J Sports Med 2008
- RCT of early (average 9 days) v late reconstruction (average 85 days)
1. Establish portals
A. Posterior portal for viewing
B. Anterior portal
- need to keep low and away from biceps, otherwise difficult to get around biceps
- for suture passage, if in combination with bankart repair often use AI portal instead of AS
Improved cosmesis
1. Seebacher's 3 layers of the medial knee
Layer 1
- sartorius and sartorius fascia
Layer 2
- superficial MCL
- posterior oblique ligament
- semimembranosus
Layer 3
- deep MCL (meniscofemoral and meniscotibial ligament)
- posteromedial capsule
2. MCL
Superficial MCL