Numerical Simulation of Single and Double Bundle Reconstruction on Knee while Walking

This research studies behavior of ligament reconstruction on knee while walking using the integration of dynamics motion analysis and finite element analysis. The purpose is to calculate stress and strain distribution on single and double bundle reconstruction while walking. First, ligament reconstruction is tested to obtain mechanical properties, which are used for finite element analysis. Next, 3D CAD model and finite element model are constructed. Dynamics motion analysis of femur and tibia while walking is introduced. The degrees of hip and knee motion with respect to time are resulted of dynamics analysis and set as load for finite element analysis. The stress and strain on knee’s ligament reconstruction while walking are calculated by finite element method. The maximum stress and strain occur on a top of ligament while extend leg are 33.86 MPa and 0.153 mm/mm, respectively, for single hamstring bundle. The maximum stress is 43.82 MPa and maximum strain is 0.188 mm/mm for double hamstring bundles. The advantage is to understand the biomechanics of the knee ligament reconstruction while walking. This research result can help patients who have tear problem of an Anterior Cruciate Ligaments (ACL) or stroke rehabilitation and be developed for further research about force and behaviors of the other ligament and muscle in body

The Supine Position for Shoulder Arthroscopy

Shoulder arthroscopy is traditionally performed with the patient in either the beach chair position or the lateral decubitus position. Each position has its advantages and disadvantages. The main topics for consideration include ease of surgery, view into the surgical field, risks to the patient, and economics of the setup. In the lateral decubitus position, it is inconvenient to work through the anterior portal and it is difficult to convert to an open procedure. In the beach chair position, it is difficult to manage the airway and cerebral oxygenation and the patient's head and the beach chair frame obstruct the insertion of a scope into the superior and posterior portals. This technical note presents the supine position for shoulder arthroscopic surgery. The supine position does not have the disadvantages of the traditional positions. In addition, it is comparatively easy to set up and comfortable for the patient

Surgical Technique for Arthroscopy-Assisted Anatomical Reconstruction of Acromioclavicular and Coracoclavicular Ligaments Using Autologous Hamstring Graft in Chronic Acromioclavicular Joint Dislocations

Injuries to the acromioclavicular (AC) joint are becoming common with contact sports and bike accidents. It is well known that in AC dislocations, the first structure to fail is the AC capsule followed by the trapezoid and conoid ligaments. The function of these ligaments must be restored to restore the anatomy and physiology of the AC joint to get the best results. Until now, no technique has emerged as the gold standard for restoration of the AC joint anatomy and function. In our technique, the stress is on recreating the anatomy to make it more individualized based on individual variations. This Technical Note describes a procedure to reconstruct the coracoclavicular ligaments and AC joint by an arthroscopy-assisted technique. Arthroscopy helps to diagnose additional intra-articular pathologies that can be treated simultaneously, and better preparation of the undersurface of the coracoid helps in bone-to-graft healing. Our approach is more individualized as clavicle tunneling is done according to the size of the coracoid base instead of a fixed distance. Vertical stability is provided by coracoclavicular ligament reconstruction, horizontal stability is provided by AC ligament reconstruction, and the articular disc is recreated by soft-tissue graft interposition, thus restoring the complete anatomy

Both Posterior Root Lateral-Medial Meniscus Tears With Anterior Cruciate Ligament Rupture: The Step-by-Step Systematic Arthroscopic Repair Technique

The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner

All-Arthroscopic Long Head of the Biceps Transfer: An Optional Technique for Soft-Tissue Biceps Tenodesis

Proximal tendinopathy of the long head of the biceps (LHB) is a common shoulder problem that requires surgical intervention, especially in patients with concomitant rotator cuff tears. The comparative results of biceps tenotomy and biceps tenodesis are still doubtful; both techniques show good to excellent results in terms of postoperative pain and functional outcomes. The described technique—all-arthroscopic LHB transfer—is an optional biceps tenodesis technique using all-arthroscopic soft-tissue tenodesis and arthroscopic suturing of the LHB to the short head of the biceps and coracoacromial ligament combined with release of the LHB from the bicipital groove

Arthroscopic All-Inside Medial Meniscus Extrusion Reduction

Medial meniscus extrusion is commonly seen in patients who have medial meniscus posterior root tear. Extruded meniscus results in faster progression of knee arthrosis. Thus, it is important to reduce the extrusion as well as treat the cause of extrusion. This Technical Note describes an all-inside arthroscopic technique to reduce the meniscus extrusion. An additional medial portal has to be made along with the standard anteromedial and anterolateral portals. A double-loaded suture anchor is used to secure the extrusion of the meniscus in its native position. Thus, making a transosseous tibial tunnel is not required. It is easy to perform and is an efficient technique

A Surgical Technique for Posterolateral Placement of Interference Screw Accurately in Tibial Tunnel in Single-Bundle Anterior Cruciate Ligament Reconstruction

Anatomic orientation of the graft in anatomic anterior cruciate ligament reconstruction is the key to improved knee stability, restoration of normal knee kinematics, and the prevention of long-term joint degeneration. The graft position and orientation in the joint depend on the position of the tibial and femoral tunnels. Graft displacement in the tibial tunnel due to the position of the interference screw when the screw has proximal fixation also has an effect on the orientation of the graft. We have developed a technique for adjusting guidewire placement for the interference screw posterolaterally in the tibial tunnel in anatomic single-bundle anterior cruciate ligament reconstruction. This technique helps to push the graft medially and anteriorly in the tibial tunnel, avoids impingement of the graft with the lateral femoral condyle, and helps to maintain the orientation of the graft in a more anatomic way

Osteochondritis Dissecans of the Knee: Arthroscopic Suture Anchor Fixation

Osteochondritis dissecans (OCD) is a subchondral bone abnormality, in which subchondral bone and the overlying articular cartilage detach from the bony bed. Multiple techniques for OCD fixation have been described, including metallic, bioabsorbable implants and biological fixation. We describe a surgical technique for OCD lesions including bony bed preparation with curettage and microfracture, anatomic reduction, and fixation using a suture anchor to provide stability and healing of the lesion

Morphological classification of acromial spur: correlation between Rockwood tilt view and arthroscopic finding

Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. Methods: We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rockwood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. Results: The keel spur (33.9%) was the most common finding followed by the heel spur (27.8%). The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively.) These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. Conclusion: The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur