arthroscopic

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

Aim

Reconstruct anterolateral bundle

Graft Options

A.  4 strand hamstring autograft

B.  Achilles Allograft

- bony block for femur (9 x 20 mm)

- tubularise tendon to fit through 9 or 10 mm tunnel

- don't cut tendon short

Vumedi Dr Bruce Levy Cadaveric video

Definition

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

Epidemiology

Age: 20 - 50

Sex: M > F

Types

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

Technique

Position

- beach chair / lateral

- water pump, adrenaline in bags

- block pre-op useful as easier to control BP

- often inject the SAD with combination of LA with A prior to scope

Posterior portal

- 2 cm inferior, 1 cm medial

- soft spot between IS and Tm

Enter subacromial space

- sweep to clear adhesion

- saline on pump at 30 - 40 - 50

Technique

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

Options

Arthroscopic

- intra-articular

- suprapectoral

Open

- suprapectoral

- subpectoral

A.  Arthroscopic Intra-articular

Concept

Advantages

Improved cosmesis

Biomechanics

Able to achieve relatively high level of function after STJ fusion

- previously believed that isolated STJ fusion should not be performed

- believed that triple arthrodesis was operation of choice for hindfoot

- STJ fusion has superior result with less stress on AJ

Average loss of DF 30% / PF 10%

Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints

- imperative that fusion be positioned in ~ 5^o valgus 

Indications

Indications have narrowed

- due to success of shoulder arthroplasty

1. Chronic infections of GHJ

2. Stabilization in paralytic disorders

3. Post-traumatic brachial plexus palsy

4. Salvage of failed GHJ Arthroplasty

- may need bone graft procedures

5. Arthritic diseases unsuitable for arthroplasty / young patient