Percutaneous suturing of the ruptured Achilles tendon with endoscopic control

Introduction: A prospective study of modified percutaneous Achilles tendon repair performed between 1999 and 2005 under local infiltration anesthesia is presented; the study evaluated the results of percutaneous repair technique by visualization of the synovia under endoscopic control, followed by early functional postoperative treatment for surgical intervention of acute Achilles tendon ruptures. Patients: Sixty-two patients (58 males, 4 females, mean age 32) were treated by percutaneous suturing with modified Bunnel technique under endoscopic control within 10 days after acute total rupture. Physiotherapy was initiated immediately after the operation and patients were encouraged to weight-bearing ambulation with a walking brace-moon boot as tolerated. Full weight-bearing was allowed minimum after 3 weeks postoperatively without brace. Results: The procedure was tolerated in all patients. There were no significant ROM limitation was observed. Two patients experienced transient hypoesthesia in the region of sural nerve that spontaneously resolved in 6 months. Fifty-nine patients (95%) including professional athletes returned to their previous sportive activities, while 18 of them (29%) had some minor complaints. The interval from injury to return to regular work and rehabilitation training was 11.7 weeks (10-13 weeks). At the latest follow-up (mean: 46 months; range: 12-78 months), all the patients had satisfactory results with a mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score of 94.6. No re-ruptures, deep venous thrombosis or wound problems occurred. Conclusion: The proposed method offers a reasonable treatment option for acute total Achilles tendon rupture with a low number of complications. The rerupture rate and return to preinjury activities are comparable to open and percutaneous without endoscopic control procedures. © Springer-Verlag 2009

An alternative endoscopic portal for suprascapular nerve approach: an anatomic study

PubMedID: 24531360Methods: Open dissection (12 left shoulders) and arthroscopy (12 contralateral shoulders) of the suprascapular notch were performed. In left shoulders, the posterolateral prominence of the acromion, the T1 spinous process, and the suprascapular notch were marked (K-wires). Distances from the posterolateral prominence of the acromion to the suprascapular notch and to the T1 spinous process were measured, and the proportion of those distances (distance to the suprascapular notch/distance to the T1 spinous process) was calculated to indicate the portal’s location. In right shoulders, arthroscopy anatomically assessed that proportion’s reliability.Results: Median distances from the posterolateral prominence of the acromion to the T1 spinous process and to the suprascapular notch were 175.7 mm (average 180.4, SD 11.8 mm) and 72.3 mm (average 73.9, SD 4.9), respectively. The medians of the proportions of the defined distances were 40.9 % (range 40–42 %) and 41 % (range 39.3–42.1 %), respectively.Conclusion: Locating the portal at the lateral, 41 % of the distance between the posterolateral prominence of the acromion and the T1 spinous process was accurate and reproducible for suprascapular notch visualization. Clinically, this portal seems to eliminate perioperative morbidity by reducing excessive soft-tissue dissection with a shorter arthroscopic route and avoiding the ligamentous damage.Purpose: Arthroscopic approaches have been less preferred than open techniques for treating suprascapular nerve entrapment, possibly because current arthroscopic portals are based on distances to reference points, resulting in discrepancies from differing shoulder sizes. This study reports a portal placement based on proportions rather than absolute length. © 2014, Springer-Verlag Berlin Heidelberg

Meniscectomy

Meniscal injury is a common cause of knee pain and major cause of functional impairment of the knee at young athletic population. Although the menisci were thought to be a vestigial tissue and treated with disrespect as an unnecessary appendage for many years; today it is known that the menisci provide mechanical support, localized pressure distribution, and lubrication to the knee joint. Therefore, a shift toward meniscal preservation has led to the development of new surgical techniques in recent decades as removal of the meniscus constitutes a risk factor for osteoarthritis. Therefore, total meniscectomy has been replaced by arthroscopic partial meniscectomy rather than total meniscectomy. Treatment choice of a meniscal pathologies also depend on patient's age, health, lifestyle, sporting activity level, and request to undergo major surgery and also the location and type of meniscal tear. In this article, we provide a general perspective on evolution of surgical management especially better understanding on meniscectomy procedures in various types of meniscal tears. Copyright © 2010 by Lippincott Williams & Wilkins

Arthroscopic patellar instability surgery

Biomechanically, knee joint as a motion complex includes gliding, rolling, translation, and rotation during its extension to flexion. A significant incidence of knee pain and disability arises from patellofemoral disorders in elderly ages. Patellar instability is a subjective term that defines pain, blockage, and twisting clinically due to deterioration of static and dynamic knee extensor mechanism. An accurate diagnosis relies both on assessing soft tissues and bony tissues together and considering pelvic and spinal stabilizers with the knowledge of distal alignment reaches from L5 to S1 vertebrae. Under the title of patellar instability, arthroscopic medial plication technique and the importance of medial patellofemoral ligament in this approach will be discussed. © Springer-Verlag Berlin Heidelberg 2012

Endoscopy and percutaneous suturing in the achilles tendon ruptures

Achilles tendon ruptures commonly occur during sportive activities and there is a tendency of increasing in the incidence of ruptures because of “weekend warriors” who are over 30 years of age. These pathologies are the third most frequent major tendon ruptures after rotator cuff and quadriceps ruptures. Various modalities have been recommended as appropriate treatment options for Achilles tendon ruptures. Nevertheless, there is no consensus on the treatment method, and it is still determined by the surgeon and the patient. Open surgical repair of the Achilles tendon carries specific risks including adhesions between the tendon and the skin, infection, and particularly wound breakdown. Therefore, to avoid these complications the percutaneous repair technique has been described and has become popular. Endoscopy-assisted percutaneous suturing of the Achilles tendon under infiltration anesthesia proffers a rational alternative for the treatment of both athletic and non-athletic individuals. This technique resulted in a cosmetic wound appearance, endurable to early active mobilization and satisfactory clinical recovery without any severe complication. Furthermore, this procedure protects the paratenon and thus blood supplies of the tendon, and enhances biologic recovery. Also direct visualization and manipulation of the tendon ends provides a precise apposition of the ruptured tendon, thus diminishing the handicaps of the single percutaneous technique. In this chapter we described our Achilles tendon repair technique under local anesthesia without tourniquet and with cooperation of the patient, and the results of our clinical experiences under the lights of literature. © Springer-Verlag Berlin Heidelberg 2012