Arthroscopic Trans-Portal Deep Medial Collateral Ligament Pie-Crusting Release

Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space

Arthroscopic Labrum Reconstruction in the Hip Using the Indirect Head of Rectus Femoris as a Local Graft: Surgical Technique

The importance of the acetabular labrum has been well documented for the health and function of the hip joint. Labral reconstruction has proven effective but often requires the use of a cadaveric allograft or auto graft from the fascia lata or gracilis. The indirect head of the rectus femoris is in close proximity with the anterior superior acetabulum, which is the most common site of labral tears. Using the indirect head of the rectus femoris as a local graft minimizes surgical invasiveness by mitigating the need to harvest the graft from a different location, in case of an autograft, and by minimizing donor site morbidity and damage to local tissues. The graft is harvested and fixed to the acetabular rim through the same arthroscopic portals. Hip labral reconstruction using the reflected head of the rectus femoris tendon is a minimally invasive surgical procedure that restores stability to the hip joint, is applicable in all patients undergoing hip labral reconstruction, and offers decreased tissue morbidity compared with other grafting techniques

Arthroscopy of the Nondistractable Hip: A Novel Extracapsular Approach

Adequate traction to achieve hip joint distraction is essential for avoiding iatrogenic injury to the joint during hip arthroscopy. An inability to distract the joint is a relative contraindication for hip arthroscopy. This report describes a novel technique involving an extracapsular approach to gain safe access to a hip joint that fails a trial of traction during positioning for hip arthroscopy. The anterolateral portal is established under fluoroscopic guidance. The arthroscope is positioned on the lateral rim of the acetabulum. A shaver, introduced through a modified anterior portal, is used to facilitate capsular exposure. An arthroscopic capsular incision is made proximal to the lateral acetabular rim and extended anteriorly with a radiofrequency probe. Osteoplasty of the anterolateral acetabular rim is carried out with a burr while protecting the labrum. Distraction of the hip is then possible, allowing safe central-compartment access and subsequent chondrolabral procedures