Flying Swan Arthroscopic Labral Repair using a Tensioned Suture Bridge Construct
|
|
- Claude McDaniel
- 8 years ago
- Views:
Transcription
1 SHOULDER TECHNIQUE GUIDE Flying Swan Arthroscopic Labral Repair using a Tensioned Suture Bridge Construct Andrew L. Wallace, MFSEM PhD FRCS FRACS Susan Alexander, MSc PhD FRCS KNEE HIP SHOULDER EXTREMITIES
2 2 SHOULDER TECHNIQUE GUIDE
3 As described by: Andrew L. Wallace, MFSEM PhD FRCS FRACS Fortius Clinic, London and Susan Alexander, MSc PhD FRCS Royal Orthopaedic Hospital, Stanmore, London SHOULDER TECHNIQUE GUIDE
4 INTRODUCTION Arthroscopic anterior labral repair is a well-established procedure and has been shown to be superior to non-operative treatment, especially for young male patients with traumatic instability of the shoulder 1. Although the Bankart lesion (detachment of the labrum from the anterior glenoid margin) is regarded as the essential lesion of instability, and is evident in the vast majority of cases 2, it is recognized that there is a spectrum of other pathological lesions of the soft tissues of the shoulder, including superior labral tears (SLAP lesions), humeral avulsion of the glenohumeral ligaments (HAGL lesions) and the anterior labroligamentous periosteal sleeve avulsion (ALPSA lesions) 2, 3. In the ALPSA lesion, the entire capsulolabral complex becomes detached from its insertion and heals more medially on the anterior aspect of the glenoid neck, exposing the underlying bone 4. Recently, studies have revealed that the presence of an ALPSA lesion is more common in younger patients (<25 years) and is associated with a higher frequency of preoperative dislocation episodes and a higher rate of recurrence following arthroscopic surgery 5,6. Although the aetiology of ALPSA lesions is not yet clear, the high recurrence rate after surgery may reflect the relative lack of a periosteal hinge along the glenoid neck. In simple terms, when a Bankart lesion is reattached with suture anchors along the anterior glenoid margin, the intact periosteum serves to provide a wide footprint of contact between the soft tissue and bone for biological healing to occur (Figure 1). However during mobilisation of an ALPSA lesion, it is evident that the periosteal hinge is usually absent, or collapsed and deficient. As a result, labral repair with suture anchors is dependent on rim fixation over a narrower and smaller surface area adjacent to the articular margin (Figure 2). The reduction in surface area for healing of soft tissue to bone may, in part, explain the higher recurrence rates after patients return to competitive sport. Figure 1 Figure 2 Double-row suture anchor repair (similar in concept to contemporary arthroscopic methods of rotator cuff repair) has been proposed as a possible solution to improve the footprint of healing along the glenoid neck 7, but may be difficult to achieve within the confined space of the glenohumeral joint. We have developed a novel technique, deploying the BIORAPTOR Knotless Suture Anchor that facilitates a tensioned suture bridge between anchors that improves fixation of the labrum and contact of tissue to bone and may address this problem. 4 SHOULDER TECHNIQUE GUIDE
5 SURGICAL TECHNIQUE PATIENT PREPARATION AND PORTAL PLACEMENT The surgeon can easily use the Flying Swan technique in both the beach chair and lateral decubitus positions. Place the patient on the operating table in a beach chair position with the arm draped freely. Assess translation of the glenohumeral joint in different positions of arm abduction and rotation to determine the degree and direction of instability and the presence of an engaging Hill-Sachs lesion. Insert the arthroscope into the glenohumeral joint via a standard posterior viewing portal. Create an anterior working portal over the superior edge of the subscapularis tendon as laterally as possible. Insert an 8.5 mm x 72 mm CLEAR-TRAC COMPLETE cannula and introduce a probe to assess the integrity of the labrum. Inspect the entire joint thoroughly to exclude associated superior or posterior labral lesions, HAGL lesions, chondral defects or cuff tears. Relative contraindications to this technique include an inverted pear sign, indicative of inferior glenoid bone deficiency, and a Hill-Sachs lesion that engages with the anterior glenoid rim upon abduction of the arm 8. STEP 1 STEP 2 PREPARATION OF THE TISSUE Create an additional antero-superior working portal superiorly in the rotator interval and insert a 7 mm x 72 mm CLEAR-TRAC COMPLETE cannula. Using a sharp periosteal elevator, mobilise the entire capsulolabral complex medially from the base of the glenoid neck. Take care to adequately release all capsular adhesions so the fibres of the underlying subscapularis muscle can be visualised. Next, abrade the bony surface of the exposed anterior glenoid neck to a bleeding surface using a soft tissue shaver or a bony burr, such as the Smith & Nephew DYONICS SYNOVATOR PLATINUM 4.5 mm Blade. DRILLING Insert a BIORAPTOR Knotless 2.9 mm flat-tipped drill bit through the Crown Tip drill guide via the anterior portal. Drill holes 3 mm onto the glenoid face at 1, 3 and 5 o clock. SHOULDER TECHNIQUE GUIDE
6 STEP 3 STEP 4 SUTURE-PASSING Insert the ACCU-PASS 45 Left Curve (for a Left Shoulder) or Right Curve (for a Right Shoulder) Suture Shuttle down the inferior cannula and through the labrum and capsule at the 5 o clock position. Advance the monofilament suture loop into the joint space. Use a grasper to retrieve the monofilament suture loop through the superior cannula. Remove the ACCU-PASS suture shuttle, leaving the monofilament suture tails exiting from the inferior cannula. Pass one end of an ULTRABRAID suture through the monofilament suture loop and shuttle the ULTRABRAID suture through the labrum by pulling on the tail ends of the monofilament suture loop through the inferior cannula. Retrieve the other limb of the ULTRABRAID suture through the inferior cannula using a suture manipulator, so that both suture limbs exit the inferior cannula. LOADING THE BIORAPTOR KNOTLESS ANCHOR Load the two free ends of the ULTRABRAID suture into the eyelet of the BIORAPTOR Knotless suture anchor. This anchor, fabricated from poly ether ether ketone PEEK-OPTIMA, is designed to lock the sutures in the eyelet by deployment of a small screw located in the body of the anchor. This allows the surgeon to set the desired tension on the repair, independent of anchor depth. While holding the anchor handle, push the suture threader tab forward to release the suture threader loop. Thread the free ends of the suture through the suturethreading loop. Remove the suture threader tab from the shaft of the insertion device, and pull to feed the sutures through the anchor eyelet. Note: the green retention suture is used to prevent disengagement of the anchor prior to deployment within the bone. 6 SHOULDER TECHNIQUE GUIDE
7 STEP 5 STEP 6 INSERTING THE ANCHOR Advance the loaded suture anchor into the inferior cannula. Without tensioning the sutures at this stage, advance the anchor to the prepared bone site. Orient the anchor such that the free limb sutures entering the anchor are facing the articular cartilage. Ensure that the sutures are not twisted around the anchor. Note: Ensure that the anchor is aligned with the drilled hole to achieve proper implantation. LOCKING SUTURE & COMPLETING 5 O CLOCK ANCHOR DEPLOYMENT Establish and maintain axial alignment of the suture anchor with the prepared insertion site. Place the tip of the anchor into the prepared hole. Use a mallet to tap the inserter handle until the laser mark is flush with the cortical bone. This places the suture anchor approximately 2 3 mm below the bone surface. Unhook both ends of the green retention suture from the cleats on the inserter handle. Pull one end to remove the retention suture from the handle and discard. The retention suture must be removed prior to applying tension. Once satisfactory tensioning of the suture limbs is achieved, maintain this tension by hooking the sutures into the cleats on the inserter handle. Turn the torque limiting knob clockwise, engaging the screw and clamping the sutures in the apex of the anchor. Several clicks should be heard, confirming that the suture is locked. Unhook the suture limbs from the cleats on the inserter handle. Turn the torque limiting knob a quarter turn anticlockwise and use a mallet to disengage the inserter from the anchor. SHOULDER TECHNIQUE GUIDE
8 STEP 7 STEP 8 CUTTING 1 STRAND OF ULTRABRAID & PREPARING 1 O CLOCK POSITION Cut only one of the blue suture limbs using the Smith & Nephew Flush Suture Cutter, retrieve the remaining blue suture limb and temporarily park it in the superior portal. Repeat Steps 3 to 6 with an ULTRABRAID COBRAID-blue or COBRAID-black (striped suture), in order to deploy a second BIORAPTOR Knotless suture anchor at the 1 o clock position. PASSING SUTURES BACK THROUGH LABRUM AT 1 AND 5 O CLOCK Using an ACCU-PASS Crescent suture shuttle, penetrate the repaired labrum, immediately adjacent and superior to the 5 o clock anchor. Shuttle the monofilament loop through the labrum and retrieve from the superior portal using a suture manipulator. Reinsert the suture manipulator through the superior portal and correctly identify and retrieve the remaining blue suture limb from the 5 o clock anchor. Outside the joint, pass the blue ULTRABRAID through the monofilament loop and shuttle through the labrum by pulling on the tails of the monofilament loop, via the inferior cannula. Repeat this process for the COBRAID suture from the 1 o clock anchor. 8 SHOULDER TECHNIQUE GUIDE
9 STEP 9 STEP 10 PASSING 1 & 5 O CLOCK SUTURES BACK THROUGH LABRUM AT 3 O CLOCK POSITION Use the ACCU-PASS Crescent to penetrate the capsule medial to the labrum opposite the 3 o clock anchor. Reverse the monofilament suture loop so that the tails are exiting the tip of the ACCU-PASS Crescent. Retrieve the tails of the monofilament loop through the superior cannula. LOADING THE 2 ULTRABRAID SUTURES INTO THE 3 O CLOCK BIORAPTOR KNOTLESS Pass the two sutures through the eyelet of the third BIORAPTOR Knotless anchor, as in STEP 4. Insert the BIORAPTOR Knotless anchor into the 3 o clock drill hole. Outside the joint, pass the blue and striped suture limbs through the monofilament loop and shuttle through the labrum by pulling on the monofilament tails exiting the superior cannula, so that the ULTRABRAID suture tails are passing from the capsular to the glenoid side of the labrum. Using a suture maniputor, the blue and striped suture limbs are then retrieved back through the inferior portal. SHOULDER TECHNIQUE GUIDE
10 STEP 11 When viewed from the posterior portal a good bumper of labral tissue should be evident and when the arm is moved into 30 abduction, additional external rotation results in reconstitution of the hammock effect of the inferior glenohumeral ligament. TENSION REPAIR AND LOCK 3 O CLOCK BIORAPTOR KNOTLESS Tension the suture limbs from the 1 and 5 o clock anchors by traction on the suture ends. Once satisfactory tensioning of the resulting suture bridge is completed, turn the torque limiting knob on the end of the insertion device clockwise to engage the internal screw and lock the sutures in the anchor eyelet. The insertion device is removed and the suture ends are cut flush with the labrum, completing the repair. When viewed from the inferior portal the tensioned suture bridge between the anchor sites can be clearly visualised, the two limbs of the repair being reminiscent of a swan in flight. 10 SHOULDER TECHNIQUE GUIDE
11 ORDERING INFORMATION To order the instruments used in this technique guide, contact an authorised Smith & Nephew representative. Prior to performing this technique, consult the Instructions for Use documentation provided with individual components including indications, contraindications, warnings, cautions, and instructions. Reference # Description Reference # Description Suture Anchors BIORAPTOR Knotless Suture Anchor (Shoulder) Suture ULTRABRAID II, #2 Blue Suture 38 (box of 10) ULTRABRAID #2 COBRAID suture, 38, single pack, sterile (box of 10) ACCU-PASS monofilament, size #1, single pack, sterile (box of 10) ACCU-PASS Suture Shuttles º, left, sterile º, right, sterile Crescent, sterile º, upbend, sterile Straight, sterile º, upbend, sterile Disposable Burrs, Disposable Blades, Disposable Cannula, and Reusable Obturators mm DYONICS PLATINUM SYNOVATOR mm DYONICS PLATINUM SYNOVATOR mm shielded burr, box of 6, sterile mm x 72 mm Threaded Cannula, with disposable obturator, green, box of 10, sterile CLEAR-TRAC COMPLETE Threaded Cannula, 8.5 mm x 90 mm, with disposable obturator, box of 10, sterile mm x 72 mm Threaded Cannula, with disposable obturator, grey, box of 10, sterile CLEAR-TRAC COMPLETE Reusable Obturator, 8.5 mm x 72 mm, (4.3 mm cannulation) CLEAR-TRAC COMPLETE Reusable Obturator, 8.5 mm x 72 mm, (1.5 mm cannulation) CLEAR-TRAC FLEXIBLE Threaded Cannula, 8.0 mm x 72 mm, with disposable obturator, box of 10, sterile CLEAR-TRAC COMPLETE Reusable Obturator, 8.0 mm x 72 mm, (4.3 mm Cannulation) 3801 Switching Stick, 4.3 mm, not cannulated (13 long) ELITE PREMIUM II Shoulder Arthroscopy System ELITE PREMIUM Suture Loop Vertical Grasper, blue handle ELITE PREMIUM Combination Grasper, red handle ELITE PREMIUM Alligator Locking Grasper, green handle ARTHRO-PIERCE Instrument, straight ARTHRO-PIERCE Instrument, 45º right ARTHRO-PIERCE Instrument, 45º left ARTHRO-PIERCE Instrument, 35º up ELITE PASS PREMIUM Suture Shuttle with Ratchet Flush suture cutter ELITE PREMIUM Hook Knife ELITE PREMIUM Bankart Rasp ELITE PREMIUM Knife Rasp mm tapered awl ELITE PREMIUM Crochet Hook ELITE Calibrated Probe ELITE PREMIUM Full Loop Knot Manipulator, silver handle (qty 2) ARTHRO-PIERCE Instrument, curved left, Inline handle ARTHRO-PIERCE Instrument, curved right, Inline handle Shoulder arthroscopy sterilization tray and lid SHOULDER TECHNIQUE GUIDE
12 References 1. Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder: a randomized, double-blind trial. Robinson CM, Jenkins PJ, White TO, Ker A, Will E. J Bone Joint Surg Am : Prevalence comparison of accompanying lesions between primary and recurrent anterior dislocation in the shoulder. Kim D-S, Yoon Y-S, Yi CH. Am J Sports Med : A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Yiannakopoulos CK, Mataragas E, Antonogiannakis E. Arthroscopy : The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder. Neviaser TJ. Arthroscopy : Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion. Ozbaydar M, Elhassan B, Diller D, Massimini D, Higgins LD, Warner JJP. Arthroscopy : Anterior labroligamentous periosteal sleeve avulsion lesion in arthroscopic capsulolabral repair for anterior shoulder instability. Lee BG, Cho NS, Rhee YG. Knee Surg Sports Traumatol Arthrosc : Evaluation of glenoid capsulolabral complex insertional anatomy and restoration with singe- and double-row capsulolabral repairs. Ahmad CS, Galano GJ, Vorys GC, Covey AS, Gardner TR, Levine WN. J Shoulder Elbow Surg : Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Burkhart SS, De Beer JF. Arthroscopy : CAUTION: U.S. Federal law restricts these devices to sale by or on the order of a physician. Endoscopy Smith & Nephew, Inc. Andover, MA USA Fax U.S. Customer Service Courtesy of Smith & Nephew, Inc., Endoscopy Division Trademark of Smith & Nephew, registered U.S. Patent & Trademark Office Smith & Nephew, Inc. All rights reserved. 06/
Arthroscopic Shoulder Instability Repair Using the SUTUREFIX ULTRA Suture Anchor and SUTUREFIX ULTRA Instrumentation System
*smith&nephew SHOULDER TECHNIQUE GUIDE Arthroscopic Shoulder Instability Repair Using the SUTUREFIX ULTRA Suture Anchor and SUTUREFIX ULTRA Instrumentation System KNEE HIP SHOULDER EXTREMITIES Arthroscopic
More informationBankart Repair using the Smith & Nephew BIORAPTOR 2.9 Suture Anchor
Shoulder Series Technique Guide *smith&nephew BIORAPTOR 2.9 Suture Anchor Bankart Repair using the Smith & Nephew BIORAPTOR 2.9 Suture Anchor Gary M. Gartsman, M.D. Introduction Arthroscopic studies of
More informationKnotilus TM. Anchor Instability Repair. Technique Guide
Knotilus TM Anchor Instability Repair Technique Guide Instability Repair Using the Knotilus TM Anchor Introduction While the shoulder has more mobility than any other joint in the body, it is also the
More informationShoulder Restoration System
Shoulder Restoration System PopLok Knotless Suture Anchor Simple, Secure, Versatile all-peek knotless anchor system for rotator cuff and instability repairs CO M M I T T ED TO I N N OVATI O N SURGICAL
More informationAchilles Tendon Repair, Operative Technique
*smith&nephew ANKLE TECHNIQUE GUIDE Achilles Tendon Repair, Operative Technique Prepared in Consultation with: C. Niek van Dijk, MD, PhD KNEE HIP SHOULDER EXTREMITIES Achilles Tendon Repair, Operative
More informationthe revo / mini-revo shoulder fixation system s u r g i c a l t e c h n i q u e
the revo / mini-revo shoulder fixation system s u r g i c a l t e c h n i q u e REVO The following techniques are described by Stephen J. Snyder, M.D., Van Nuys, CA. Arthroscopic repair of the rotator
More informationArthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh
Arthroscopic Shoulder Procedures David C. Neuschwander MD Allegheny Health Network Orthopedic Associates of Pittsburgh Shoulder Instability Anterior Instability Posterior Instability Glenohumeral Joint
More informationSecond Look Arthroscopy Following Arthroscopic Shoulder Anterior Instability Reconstruction
Second Look Arthroscopy Following Arthroscopic Shoulder Anterior Instability Reconstruction Emmanuel Antonogiannakis, Christos K. Yiannakopoulos, George Babalis, Dimitrios Kostopoulos, Gerasimos Gialas,
More informationCombined lesions of the glenoid labrum include labral
9(1):10 14, 2008 Ó 2008 Lippincott Williams & Wilkins, Philadelphia T E C H N I Q U E Arthroscopic Repair of Combined Labral Lesions MAJ Brett D. Owens, MD, Bradley J. Nelson, MD, and COL Thomas M. DeBerardino,
More informationPortal Placement for Shoulder Arthroscopy: Basic to Advanced William B. Stetson, MD
Portal Placement for Shoulder Arthroscopy: Basic to Advanced William B. Stetson, MD 1. Cannulas Smooth Ribbed Lipped Partial Threaded Fully Threaded Flexible 5.75 mm, 6 mm, 7 mm & 8.25 mm x 7cm or 9 cm
More informationShoulder Dyslexia: The Alphabet Soup. Alison Nguyen 4/13/06
Shoulder Dyslexia: The Alphabet Soup Alison Nguyen 4/13/06 Mystery Cases Case 1 Case 2 Case 3 Case 4 Shoulder Dyslexia: The Alphabet Soup Shoulder dyslexia: addressing the endless alphabet soup Ant-inf
More informationThe rapid evolution of arthroscopic shoulder surgery
Technical Note Arthroscopic Repair of SLAP Lesions With a Bioknotless Suture Anchor Edward Yian, M.D., Conrad Wang, M.D., Peter J. Millett, M.D., and Jon J. P. Warner, M.D. Abstract: The diagnosis and
More informationSHOULDER INSTABILITY IN PATIENTS WITH EDS
EDNF 2012 CONFERENCE LIVING WITH EDS SHOULDER INSTABILITY IN PATIENTS WITH EDS Keith Kenter, MD Associate Professor Sports Medicine & Shoulder Reconstruction Director, Orthopaedic Residency Program Department
More informationStabilization of Acute Acromioclavicular Joint Dislocations using Dog Bone Button Technology Surgical Technique
Stabilization of Acute Acromioclavicular Joint Dislocations using Dog Bone Button Technology Surgical Technique AC Repair - Dog Bone Button Stabilization of Acute Acromioclavicular Joint Dislocations using
More informationThe Treatment of Traumatic Recurrent Anterior Shoulder Instability with Arthroscopic Bankart Repair
J Med Sci 22;22(2):63-68 http://jms.ndmctsgh.edu.tw/22263.pdf Copyright 22 JMS Hsing-Ning Yu, et al. The Treatment of Traumatic Recurrent Anterior Shoulder Instability with Arthroscopic Bankart Repair
More informationFAST-FIX 360 Meniscal Repair System
FAST-FIX 360 Meniscal Repair System FAST-FIX 360 Meniscal Repair System All-Inside Meniscal Repair Knee Series Technique Guide as described by: Charles H. Brown, Jr., MD Nicholas Sgaglione, MD All-Inside
More informationHip Arthroscopy Product Guide
Hip Arthroscopy Product Guide Tissue Preserving Hip Solutions Recent advances in the knowledge of and treatment of femoroacetabular impingement have led to the development of minimally invasive techniques
More informationTOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears
Labral Tears The shoulder is your body s most flexible joint. It is designed to let the arm move in almost any direction. But this flexibility has a price, making the joint prone to injury. The shoulder
More informationShoulder Instability. Fig 1: Intact labrum and biceps tendon
Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone
More informationArthroscopic Shoulder Stabilization With Suture Anchors: Technique, Technology, and Pitfalls
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 390, pp. 17 30 2001 Lippincott Williams & Wilkins, Inc. Arthroscopic Shoulder Stabilization With Suture Anchors: Technique, Technology, and Pitfalls Brian
More informationSHOULDER INSTABILITY. E. Edward Khalfayan, MD
SHOULDER INSTABILITY E. Edward Khalfayan, MD Instability of the shoulder can occur from a single injury or as the result of repetitive activity such as overhead sports. Dislocations of the shoulder are
More informationLabral Repair. Surgical Protocol by Ronald Glousman, M.D. and Nicholas Sgaglione, M.D.
Labral Repair Surgical Protocol by Ronald Glousman, M.D. and Nicholas Sgaglione, M.D. It s small. It s strong. And it's all suture. The JuggerKnot Soft Anchor represents the next generation of suture anchor
More informationThe Material Difference. Options for Rotator Cuff Repair, Labral Repair and Suture Management
The Material Difference Options for Rotator Cuff Repair, Labral Repair and Suture Management The Material Difference Biomet Sports Medicine recognizes the benefit of material options. Many times surgeons
More informationThe Trans-Rotator Cuff Approach to SLAP Lesions: Technical Aspects for Repair and a Clinical Follow-up of 31 Patients at a Minimum of 2 Years
The Trans-Rotator Cuff Approach to SLAP Lesions: Technical Aspects for Repair and a Clinical Follow-up of 31 Patients at a Minimum of 2 Years Stephen J. O Brien, M.D., Answorth A. Allen, M.D., Struan H.
More informationAnatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL)
Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL) Mark Glazebrook James Stone Masato Takao Stephane Guillo Introduction Ankle stabilization is required when a patient
More informationA Simplified Approach to Common Shoulder Problems
A Simplified Approach to Common Shoulder Problems Objectives: Understand the basic categories of common shoulder problems. Understand the common patient symptoms. Understand the basic exam findings. Understand
More informationArthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results
Original Article Clinics in Orthopedic Surgery 2010;2:39-46 doi:10.4055/cios.2010.2.1.39 Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results Hyung Lae Cho,
More informationAnterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy
Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsule reconstruction is a surgical procedure utilized for anterior
More informationThe information contained in this document is intended for healthcare professionals only.
The information contained in this document is intended for healthcare professionals only. Dall-Miles Cabling System Dall-Miles Recon and Trauma Cable System Trochanteric Reattachment Using the Trochanteric
More informationAll Suture Anchor. with IntelliBraid Technology
All Suture Anchor with IntelliBraid Technology Introduction Searching For a Better Option The ICONIX family of anchors symbolize the next generation of suture anchor technology. The all suture based system
More informationLabral Repair. Surgical Protocol by Ronald Glousman, M.D. and Nicholas Sgaglione, M.D.
Labral Repair Surgical Protocol by Ronald Glousman, M.D. and Nicholas Sgaglione, M.D. It s small. It s strong. And it's all suture. The JuggerKnot Soft Anchor represents the next generation of suture anchor
More informationTechnique Guide. VersiTomic. Michael A. Rauh, MD. Anterior Cruciate Ligament Reconstruction
Technique Guide VersiTomic Anterior Cruciate Ligament Reconstruction Michael A. Rauh, MD The opinions expressed are those of Dr. Rauh and are not necessarily those of Stryker VersiTomic Anterior Cruciate
More informationArthroscopic Management of Anterior Instability: Pearls, Pitfalls, and Lessons Learned
Arthroscopic Management of Anterior Instability: Pearls, Pitfalls, and Lessons Learned Matthew T. Provencher, MD a,b, *, Neil Ghodadra, MD c, Anthony A. Romeo, MD d,e KEYWORDS Anterior shoulder instability
More informationAredundant or insufficient posterior capsule has
Original Article With Video Illustration Kim s Lesion: An Incomplete and Concealed Avulsion of the Posteroinferior Labrum in Posterior or Multidirectional Posteroinferior Instability of the Shoulder Seung-Ho
More information5/7/2009 SHOULDER) CONDITIONS OF THE SHOULDER NOW IT TIME TO TEST YOU ICD-9 SKILLS: PLEASE APPEND THE APPROPRIATE DIAGNOSIS CODE FOR EACH:
SHOULDER CONDITIONS OF THE SHOULDER AND THEIR TREATMENT Presented by Kevin Solinsky, CPC,CPC-I,CEDC, CEMC The is a major joint and plays a large part in daily life, particularly for athletes and those
More informationRotator Cuff Tears in Football
Disclosures Rotator Cuff Tears in Football Roger Ostrander, MD Consultant: Mitek Consultant: On-Q Research Support: Arthrex Research Support: Breg Research Support: Arthrosurface 2 Anatomy 4 major muscles:
More informationThe aim of surgical treatment for anterior posttraumatic. Arthroscopic Treatment of Anterior Shoulder Instability Using Knotless Suture Anchors
Arthroscopic Treatment of Anterior Shoulder Instability Using Knotless Suture Anchors Raffaele Garofalo, M.D., Andrea Mocci, M.D., Biagio Moretti, M.D., Eugenio Callari, M.D., Giovanni Di Giacomo, M.D.,
More informationHow To Use A Phoenix Retrograde Femoral Nail
Phoenix Retrograde Femoral Nail System Featuring CoreLock Technology Surgical Technique Contents Introduction... Page 1 Indications... Page 2 Design Features... Page 3 Surgical Technique... Page 6 Product
More informationDouble Bone Plug Meniscus Reconstruction Surgical Technique
Double Bone Plug Meniscus Reconstruction Surgical Technique Double Bone Plug Meniscus Low Profile Reamer 2-0 FiberWire Meniscus Repair Needles Collared Pin & Coring Reamer Set RetroConstruction Drill Guide
More informationAnterior shoulder instability has been reported to
Systematic Review With Video Illustration Arthroscopic Stabilization for First-Time Versus Recurrent Shoulder Instability Robert C. Grumet, M.D., Bernard R. Bach Jr, M.D., and CDR Matthew T. Provencher,
More informationV-TEK IVP System 2.7 System 4.0
V-TEK IVP System Ankle 2.7 Fix System 4.0 Surgical Technique Surgical Technique Titanium osteosynthesis system for tibio-talar and tibio-talo-calcaneal fusion SECTION 1 Ankle Fix System 4.0 Titanium osteosynthesis
More informationABSTRACT. Conrad Wang, MD is a Resident in the Harvard Combined Orthopaedic Residency Program
SUPERIOR LABRAL TEARS OF THE SHOULDER: SURGICAL REPAIR USING A BIORESORBABLE KNOTLESS SUTURE ANCHOR CONRAD WANG, MD, EDWARD YIAN MD, PETER J. MILLETT MD, MSC., JON J.P. WARNER, MD HARVARD SHOULDER SERVICE,
More informationn sports medicine update
Section Editor: Darren L. Johnson, MD Complications ssociated With rthroscopic Labral Repair Implants: Case Series Jerrod J. Felder, MD; Michael P. Elliott, DO; Scott D. Mair, MD bstract: rthroscopic labral
More informationThe reported incidence of Bankart lesions 1 with
Technical Note Overlap Arthroscopic Bankart Repair: Reconstruction to the Glenoid Rim Basim A. Fleega, M.D. Abstract: A new arthroscopic approach for traumatic instability has been developed with which
More informationSurgical Technique. Struan H Coleman MD, PhD
Surgical Technique Guide Struan H Coleman MD, PhD the Author Struan H. Coleman MD, PhD, specializes in Sports Medicine at Hospital for Special Surgery where he treats orthopedic conditions of the shoulder,
More informationRehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair
Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on
More informationTechnical Note. The Arthroscopic Latarjet Procedure for the Treatment of Anterior Shoulder Instability
Technical Note The Arthroscopic Latarjet Procedure for the Treatment of Anterior Shoulder Instability Laurent Lafosse, M.D., Etienne Lejeune, M.D., Antoine Bouchard, M.D., Carlos Kakuda, M.D., Reuben Gobezie,
More information1 of 6 1/22/2015 10:06 AM
1 of 6 1/22/2015 10:06 AM 2 of 6 1/22/2015 10:06 AM This cross-section view of the shoulder socket shows a typical SLAP tear. Injuries to the superior labrum can be caused by acute trauma or by repetitive
More informationWith advances made in arthroscopic surgery, more
Suture Capsulorrhaphy Versus Capsulolabral Advancement for Shoulder Instability Andrew D. Kersten, M.D., Meredith Fabing, D.O., Scott Ensminger, B.S., Constantine K. Demetropoulos, Ph.D., Ross Cooper,
More informationLateral Ankle Instability Repair using TWINFIX Ti 3.5 mm Suture Anchors
*smith&nephew ANKLE TECHNIQUE GUIDE Lateral Ankle Instability Repair using TWINFIX Ti 3.5 mm Suture Anchors Prepared in Consultation with: James Calder, MD KNEE HIP SHOULDER EXTREMITIES Lateral Ankle Instability
More informationHow To Fix A Radial Head Plate
Mayo Clinic CoNGRUENT RADIAL HEAD PLATE Since 1988 Acumed has been designing solutions to the demanding situations facing orthopedic surgeons, hospitals and their patients. Our strategy has been to know
More informationEvolution of arthroscopic shoulder stabilization: do we still need open techniques?
Surgical Procedures Evolution of arthroscopic shoulder stabilization: do we still need open techniques? Page 1 of 6 S Sedeek*, E Gerard, H Andrew Abstract Introduction Traumatic anterior instability of
More informationRehabilitation Guidelines for Arthroscopic Capsular Shift
Rehabilitation Guidelines for Arthroscopic Capsular Shift The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular
More informationShoulder Arthroscopy
Copyright 2011 American Academy of Orthopaedic Surgeons Shoulder Arthroscopy Arthroscopy is a procedure that orthopaedic surgeons use to inspect, diagnose, and repair problems inside a joint. The word
More informationHip Arthroscopy Principles and Application J.W. Thomas Byrd, M.D.
Hip Series Technique Guide Hip Arthroscopy Principles and Application J.W. Thomas Byrd, M.D. As described by: J.W. Thomas Byrd, M.D. Southern Sports Medicine and Orthopaedic Center Nashville, TN Introduction
More informationSports Medicine Instruments. shoulder small joint hip knee. Our Strengths Become. Your Solutions
Sports Medicine Instruments shoulder small joint hip knee Our Strengths Become Your Solutions Standard Arthroscopy Handle Infinite Pressure Lock Handle Symmetry Medical Inc. is recognized as a full-service
More informationACL Reconstruction with Bone-Tendon-Bone Transplants Using the ENDOBUTTON CL BTB Fixation System
Knee Series Technique Guide ACL Reconstruction with Bone-Tendon-Bone Transplants Using the ENDOBUTTON CL BTB Fixation System Stuart Fromm, M.D. As described by: Stuart Fromm, M.D. Black Hills Orthopedic
More informationFoot and Ankle Technique Guide Proximal Inter-Phalangeal (PIP) Fusion
Surgical Technique Foot and Ankle Technique Guide Proximal Inter-Phalangeal (PIP) Fusion Prepared in consultation with: Phinit Phisitkul, MD Department of Orthopedics and Rehabilitation University of Iowa
More informationReimbursements for. Getting Reimbursed for Shoulder Scopes. Even the most common procedures can challenge the most experienced coders.
Cristina Bentin, CCS-P, CPC-H, CMA Getting Reimbursed for Shoulder Scopes Even the most common procedures can challenge the most experienced coders. Reimbursements for orthopedic surgeries under the Medicare
More informationDr. Benjamin Hewitt. Shoulder Stabilisation
Please contactmethroughthegoldcoasthospitaswityouhaveanyproblemsafteryoursurgery. Dr. Benjamin Hewitt Orthopaedic Surgeon Shoulder Stabilisation The shoulder is the most flexible joint in the body, allowing
More informationRehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair
Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a
More informationZimmer Periarticular Proximal Tibial Locking Plate
Zimmer Periarticular Proximal Tibial Locking Plate Surgical Technique The Science of the Landscape Zimmer Periarticular Proximal Tibial Locking Plate 1 Table of Contents Introduction 2 Locking Screw Technology
More informationMRI shoulder: troubleshooting the cuff and instability. Phil Hughes Plymouth
MRI shoulder: troubleshooting the cuff and instability Phil Hughes Plymouth Shoulder Pathways Pain (subacromial/cuff) Stiffness (Frozen shoulder/oa) Weakness (Query cuff tear) Instability General Practice
More informationTechnique Guide. Orthopaedic Cable System. Cerclage solutions for general surgery.
Technique Guide Orthopaedic Cable System. Cerclage solutions for general surgery. Table of Contents Introduction The Orthopaedic Cable System 2 Indications 4 Contraindications 4 Surgical Technique Cerclage
More informationRehabilitation Guidelines For SLAP Lesion Repair
Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular surface of
More informationARTHROSCOPIC CAPSULAR PLICATION AND CAPSULAR SPLIT/SHIFT TECHNIQUES FOR MULTIDIRECTIONAL INSTABILITY
ARTHROSCOPIC CAPSULAR PLICATION AND CAPSULAR SPLIT/SHIFT TECHNIQUES FOR MULTIDIRECTIONAL INSTABILITY Joseph C. Tauro, MD Assistant Clinical Professor of Orthopaedic Surgery New Jersey Medical School Newark,
More informationThermal Capsulorrhaphy as a Treatment of Joint Instability. Original Policy Date
MP 7.01.65 Thermal Capsulorrhaphy as a Treatment of Joint Instability Medical Policy Section Surgery Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date Reviewed with literature search/12/2013
More informationInternal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation
Internal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation Lee D Kaplan, MD J Towers, MD PJ McMahon, MD CH Harner,, MD RW Rodosky,, MD Thrower s shoulder
More information10/16/2012. Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines
Orthopaedic Management of Shoulder Pathology Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines Opening Statements IBJI Began fall 2007 9000 Waukegan Rd, Morton Grove 900 Rand
More informationShoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke
Shoulder Injuries Dr Simon Locke Why Bother? Are shoulder and upper limb injuries common? Some anatomy What, where, what sports? How do they happen? Treatment, advances? QAS Injury Prevalence Screening
More informationMalleolar fractures Anna Ekman, Lena Brauer
Malleolar fractures Anna Ekman, Lena Brauer How to use this handout? The left column is the information as given during the lecture. The column at the right gives you space to make personal notes. Learning
More informationOrthopedic Foot Instruments. Dedicated instruments for reconstructive foot surgery.
Orthopedic Foot Instruments. Dedicated instruments for reconstructive foot surgery. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by
More informationAnteromedial ACL Reconstruction Surgical Technique for Soft Tissue Grafts
Anteromedial ACL Reconstruction Surgical Technique for Soft Tissue Grafts Advancing ACL Reconstruction with implant absorption and ossification of the Implant site 2,3,5 The MILAGRO BR Interference Screw
More informationLinvatec Has Taken Absorbable Technology to a New Level
2003 JUNE EDITION LINVATEC L EAST INVASIVE TECHNOLOGIES LINVATEC SPECIALISES IN HALL SURGICAL POWER EQUIPMENT Small and Large bone orthopaedics Otolaryngology ARTHROSCOPY Shaver systems Manual instruments
More informationTechnique Guide. Screw Removal Set. Instruments for removing Synthes screws.
Technique Guide Screw Removal Set. Instruments for removing Synthes screws. Table of Contents Introduction Screw Removal Set 2 Surgical Technique Preoperative Planning and Preparation 6 Removal of Intact
More informationArthroscopic Management of Superior Labral Anterior and Posterior (SLAP) and Associated Lesions: Clinical Features and Functional Outcome
44 Original Article Arthroscopic Management of Superior Labral Anterior and Posterior (SLAP) and Associated Lesions: Clinical Features and Functional Outcome Mui Hong Lim, 1 MBBS, MRCS (Edin), MMed (Orth),
More informationMs. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist
WHAT DOES THE ROTATOR CUFF DO? WHAT DOES THE ROTATOR CUFF DO? WHO GETS ROTATOR CUFF TEARS? HOW DO I CLINICALLY DIAGNOSE A CUFF TEAR? WHO NEEDS AN MRI? DOES EVERY CUFF TEAR NEED TO BE FIXED? WHAT DOES ROTATOR
More informationMinimally Invasive Hip Replacement through the Direct Lateral Approach
Surgical Technique INNOVATIONS IN MINIMALLY INVASIVE JOINT SURGERY Minimally Invasive Hip Replacement through the Direct Lateral Approach *smith&nephew Introduction Prosthetic replacement of the hip joint
More informationACCORD Cable System. Surgical technique completed in conjunction with: Robert Barrack, MD St. Louis, Missouri. Paul Di Cesare, MD New York, New York
Surgical Technique Innovations in Hip Surgery 2 ACCORD Cable System Surgical technique completed in conjunction with: Robert Barrack, MD St. Louis, Missouri Paul Di Cesare, MD New York, New York Fares
More informationTitanium Wire with Barb and Needle. For canthal tendon procedures.
Titanium Wire with Barb and Needle. For canthal tendon procedures. Technique Guide Instruments and implants approved by the AO Foundation Table of Contents Introduction Titanium Wire with Barb and Needle
More informationPosterior Referencing. Surgical Technique
Posterior Referencing Surgical Technique Posterior Referencing Surgical Technique INTRO Introduction Instrumentation Successful total knee arthroplasty depends in part on re-establishment of normal lower
More informationRehabilitation Protocol: SLAP Superior Labral Lesion Anterior to Posterior
Rehabilitation Protocol: SLAP Superior Labral Lesion Anterior to Posterior Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650 Lahey Outpatient Center, Lexington
More informationUpper extremity Failed shoulder stabilization surgery: what to do?
S P E C I A L F O C U S Upper extremity Failed shoulder stabilization surgery: what to do? Neil Ghodadra a, Robert Grumet a, Lance LeClere b and LCDR Matthew T. Provencher, MD MC USN b ABSTRACT Despite
More informationACL plastik, erfarenheter av. tidig kirurgisk behandling. tidig kirurgisk behandling 6/12/2013
in sports Per Renström, MD, PhD Professor emeritus,,, Sweden Member ATP and ITF Sports Science and Medical Committees Physician Swedish Football Association Presentation at the IOC Advanced team physician
More informationArthroscopic Subscapularis Repair
CHPTER 18 rthroscopic Subscapularis Repair mmar nbari, MD nthony. Romeo, MD n all-arthroscopic repair of the subscapularis tendon has seen significant interest in the past 10 years. s we refine our knowledge
More informationLevel V Evidence. Minor Shoulder Instability. Alessandro Castagna, M.D., Ulf Nordenson, M.D., Raffaele Garofalo, M.D., and Jon Karlsson, M.D., Ph.D.
Level V Evidence Minor Shoulder Instability Alessandro Castagna, M.D., Ulf Nordenson, M.D., Raffaele Garofalo, M.D., and Jon Karlsson, M.D., Ph.D. Abstract: The wide spectrum of shoulder instability is
More informationShoulder Update: Instability, Labrum, and Biceps. Brett M. Cascio, MD www.casciosportsmed.com
Shoulder Update: Instability, Labrum, and Biceps Brett M. Cascio, MD www.casciosportsmed.com Disclosures Topics Instability Anterior Posterior MDI SLAP Biceps Shoulder Resurfacing Instability GH joint
More information9/7/14. I do not have a financial relationship with any orthopedic manufacturing organization
I do not have a financial relationship with any orthopedic manufacturing organization Timothy M. Geib, MD Oklahoma Sports & Orthopedic Institute September 27, 2014 Despite what you may have heard, I am
More informationArthroscopic Labral Repair (SLAP)
Arthroscopic Labral Repair (SLAP) Brett Sanders, MD Center For Sports Medicine and Orthopaedic 2415 McCallie Ave. Chattanooga, TN (423) 624-2696 Anatomy The shoulder joint involves three bones: the scapula
More informationBONE PRESERVATION STEM
TRI-LOCK BONE PRESERVATION STEM Featuring GRIPTION Technology SURGICAL TECHNIQUE IMPLANT GEOMETRY Extending the TRI-LOCK Stem heritage The original TRI-LOCK Stem was introduced in 1981. This implant was
More informationZimmer Small Fragment Universal Locking System. Surgical Technique
Zimmer Small Fragment Universal Locking System Surgical Technique Zimmer Small Fragment Universal Locking System 1 Zimmer Small Fragment Universal Locking System Surgical Technique Table of Contents Introduction
More informationClassic shoulder impingement as described by. Anterior Internal Impingement: An Arthroscopic Observation. Original Article With Video Illustration
Original Article With Video Illustration Anterior Internal Impingement: An Arthroscopic Observation Steven Struhl, M.D. Purpose: The source of pain in patients with a stable shoulder and clinical signs
More informationOpen and Endoscopic Forehead Lift. Plastic Surgery. For All Brow and Forehead Lift Procedures. Revolutionizing. Soft-Tissue Fixation
Plastic Surgery Open and Endoscopic Forehead Lift For All Brow and Forehead Lift Procedures Revolutionizing Soft-Tissue Fixation DESIGNED FOR SIMPLICITY AND PREDICTABILITY The versatile design can be applied
More informationCAPPAGH NATIONAL ORTHOPAEDIC HOSPITAL, FINGLAS, DUBLIN 11. The Sisters of Mercy. Rotator Cuff Repair
1.0 Policy Statement... 2 2.0 Purpose... 2 3.0 Scope... 2 4.0 Health & Safety... 2 5.0 Responsibilities... 2 6.0 Definitions and Abbreviations... 3 7.0 Guideline... 3 7.1 Pre-Operative... 3 7.2 Post-Operative...
More informationNCB Distal Femur System. Surgical Technique
NCB Distal Femur System Surgical Technique NCB Distal Femur System Surgical Technique 3 Surgical Technique NCB Distal Femur System Table of Contents Introduction 4 Indications 8 Preoperative Planning
More informationPosterior Shoulder Stability
Diagnosis and Arthroscopic Management of Posterior Shoulder Instability Adam Blair Yanke, MD; Geoffrey S. Van Thiel, MD, MBA; Lance E. LeClere, MD; Daniel J. Solomon, MD; Bernard R. Bach, Jr, MD; Matthew
More informationTHE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder
THE SHOULDER Shoulder Pain 1. Fractures 2. Sports injuries 3. Instability/Dislocations 4. Rotator Cuff Disease and Tears 5. Arthritis Fractures The shoulder is made up of three primary bones, the clavicle,
More informationMini Medical School _ Focus on Orthopaedics
from The Cleveland Clinic Mini Medical School _ Focus on Orthopaedics Arthritis of the Shoulder: Treatment Options Joseph P. Iannotti MD, PhD Professor and Chairman, Department of Orthopaedic Surgery The
More informationSLAP repair. An information guide for patients. Delivering the best in care. UHB is a no smoking Trust
SLAP repair An information guide for patients Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
More informationARTHROSCOPIC STAPLING FOR DETACHED SUPERIOR GLENOID LABRUM
ARTHROSCOPIC STAPLING FOR DETACHED SUPERIOR GLENOID LABRUM MINORU YONEDA, ATSUSHI HIROOKA, SUSUMU SAITO, TOMIO YAMAMOTO, TAKAHIRO OCHI, KONSEI SHINO From the Osaka Kohseinenkin Hospital and Sumitomo Hospital,
More information