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Arthroscopic Latarjet Stabilization of the Shoulder With Capsulolabral Repair
We describe a technical modification of the arthroscopic Latarjet procedure that includes repair of the anterior capsule at the conclusion of the operation. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Mesh Plates for Scapula Fixation
We present our experience managing these complex cases, and how the use of the mesh plates facilitated the procedure. No complications were recorded and at final follow-up patients regained satisfactory shoulder function. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Improving Medial Footprint Coverage in Double-Row Cuff Repair Using FiberTape
FiberTape has been designed to provide increased tissue cut-through resistance to prevent cuff repair failure. We hypothesize that this increased friction results in the FiberTape dragging the tendon laterally and adversely affecting tendon-footprint contact. Our aim was to compare our standard FiberTape repairs with a modified technique. In 5 cadavers, supraspinatus repairs using our standard technique was compared with a modification where the tendon was cinched down. The FiberTape tendon interface on the bursal side was marked and length of redundant FiberTape that was pulled through from the undersurface of the repair ...
Source: Techniques in Shoulder and Elbow Surgery - August 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Revision of a Failed Latarjet Procedure Using an Open Tricortical Iliac Crest Autograft Technique
Treatment of recurrent pain and instability after coracoid transfer procedure is a complex problem. This paper and accompanying video (Supplemental Digital Content 1, http://links.lww.com/TSES/A19 ) describe the surgical technique for revision of a failed Bristow-Latarjet procedure using a tricortical iliac crest autograft. The case presented here is a 32-year-old male with painful anterior subluxations after a Latarjet procedure because of coracoid graft pseudarthrosis. Surgical technique and result of the case are presented. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - August 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

How to Perform a Distal Clavicle Resection During Rotator Cuff Repair Surgery: Do Not Forget the Top of the Shoulder
Arthrosis of the acromioclavicular (AC) joint is a well-described source of shoulder pain. When nonoperative treatments fail, AC joint surgical resection arthroplasty, often called a Mumford procedure or distal clavicle excision or resection, may be offered. Most studies comparing open distal clavicle excision and arthroscopic techniques have demonstrated arthroscopic techniques to be less painful and afford an earlier return to activity. Two different arthroscopic AC joint resection surgical techniques, including a superior direct approach and an indirect “trans-bursal” subacromial technique, are described in detail. ...
Source: Techniques in Shoulder and Elbow Surgery - May 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Tips and Technical Pearls for Performing an Arthroscopic Acromioplasty in a Reproducible and Accurate Manner
The role of acromioplasty for treatment of shoulder pathology remains controversial. Recent level I data have questioned the efficacy of performing an acromioplasty either in isolation for the treatment of shoulder impingement or in conjunction with repair of a full-thickness rotator cuff tear. Currently, an acromioplasty is perhaps best indicated for an encroaching acromial morphology with clear arthroscopic evidence of associated bursal-sided rotator cuff injury. Arthroscopic acromioplasty can be technically optimized through an understanding of arthroscopic anatomy. Poor surgical technique resulting in uneven resection,...
Source: Techniques in Shoulder and Elbow Surgery - May 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Determining Center of Rotation and Scapular Notching in Reverse Total Shoulder Arthroplasty: A Reliability Study
This study emphasizes the need for further refinement of methods of radiographic digital analysis of shoulders undergoing RTSA. Level of Evidence: Level IV—retrospective diagnostic study. See Instructions for Authors for a complete description of levels of evidence (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - May 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Lesser Tuberosity Osteotomy Versus Soft-Tissue Subscapularis Release in Shoulder Arthroplasty: A Systematic Review
Shoulder arthroplasty procedures continued to increase in prevalence, and controversy still remains about the optimal method to manage the subscapularis. Our study reviewed the available literature clinically comparing subscapularis approaches. A systematic review was conducted using MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials. All clinical trials were identified, and trials comparing at least 2 different subscapularis approaches were examined. Six clinical trials were identified comparing lesser tuberosity osteotomy, subscapularis tenotomy, and peel. Two were randomized-controlled trials comparing ...
Source: Techniques in Shoulder and Elbow Surgery - May 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Rotator Cuff Augmentation Using Semitendinosus Tendon Autograft
The ideal surgical management of retracted rotator cuff tears has not been defined. Retraction of the tendon can make repair to the anatomic footprint on the humerus impossible. Various techniques have been described to address this problem, including medial repair, allograft and xenograft augmentation, but the results of these procedures have been mixed. The authors describe a hamstring tendon autograft reconstruction to augment the retracted rotator cuff tendons, allowing repair to the anatomic footprint of the humerus. Using this technique the length of the grafted muscle-tendon unit can be restored. The expense and pot...
Source: Techniques in Shoulder and Elbow Surgery - May 5, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Subscapularis Repair After Shoulder Arthroplasty
We present a case of a standard anatomic total shoulder arthroplasty subscapularis repair with a specific suture configuration and a metallic button. In this technique, both Krackow and Mason-Allen suture techniques are utilized to approximate the tendon down to the bone. The patient described recovered quickly after the surgery, and he has demonstrated excellent results. These results are similar to those seen by the senior author while utilizing this technique, and after transitioning to this technique, postoperative subscapularis failures have been infrequently appreciated. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Is Acromioplasty of Benefit for Rotator Cuff Repair?
Acromioplasty has traditionally been an integral component of the surgical procedure of a rotator cuff repair. The extrinsic theory suggests detrimental acromial morphology can initiate rotator cuff dysfunction and tearing. Acromioplasty is performed to modify existing acromial architecture to remove mechanical impingement. Acromioplasty has become one of the most frequently performed procedures in orthopedic surgery, featuring significant increase in incidence over recent decades. Several prospective randomized control trials with similar randomization design have now been published, which directly compare individuals rec...
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Arthroscopic Decompression and Bone Grafting of Proximal Humeral Intraosseous Ganglion: A Novel Technique
We present a novel, arthroscopic technique to treat intraosseous ganglion lesions of the proximal humerus. Using an arthroscopic approach, these lesions can be visualized, decompressed and curettage, with the ability to evaluate the extent of pathologic tissue remaining. This approach also allows for identification and treatment of additional glenohumeral pathology. Furthermore, we present a novel, completely arthroscopic technique of bone grafting and compaction to fill the resultant void. (Source: Techniques in Shoulder and Elbow Surgery)
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

The Anconeus-Triceps Lateral Flap Approach: New Surgical Exposure for Total Elbow Arthroplasty
Over the past 2 decades, the indications for total elbow arthroplasty have increased for acute and chronic pathologies. One complication following total elbow arthroplasty that is well recognized but is poorly described in the literature is the insufficiency of the extensor mechanism. During the last 3 years we have been using a modified triceps approach for total elbow arthroplasty using the anconeus-triceps lateral flap approach. This new approach preserves the proper triceps tendon medial insertion, and the lateral triceps, maintaining the continuity with the anconeus muscle as a flap single unit, is released and reflec...
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Finding the Canal: A Novel Technique for Identifying and Instrumenting Ulnar Canals During Total Elbow Arthroplasty
Instrumentation of the ulnar canal during primary or revision total elbow arthroplasty can be difficult in cases of deformity, a problem aggravated when utilizing a triceps-on approach. The proximal geometry is complex and may be violated if attention is not paid to the proper orientation of the canal leading to stress risers, fracture, and early implant failure. To avoid these complications, it is necessary to accurately identify the intramedullary canal in a reliable way to avoid eccentric reaming and violation of the ulnar cortex. We recently utilized a novel technique to identify the appropriate entry site for the prep...
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research

Extended Olecranon Osteotomy for Revision Total Elbow Arthroplasty: Surgical Technique and Case Report
Widening surgical indications for total elbow arthroplasty have resulted in increasing rates of implantation over the past several years. The need for advanced surgical techniques in the event of revision surgical treatment has become more apparent with time. Extraction of the ulnar component can be particularly challenging if well-fixed. The extended olecranon osteotomy for exposure of the ulnar intramedullary canal, cement mantle, and component was developed to address these concerns. Cadaveric dissection, implantation, osteotomy, and extraction of a total elbow arthroplasty were performed using an extended olecranon ost...
Source: Techniques in Shoulder and Elbow Surgery - February 10, 2015 Category: Orthopaedics Tags: Techniques Source Type: research