Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

En este objeto de Información se mostrarán, según el régimen pensional de prima media, los requisitos para las diferentes modalidades de acceso a la pensión como lo son por vejez, invalidez y para los sobrevivientes del afiliado.1.0Acceso a Interne

Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft

Improved Limb Positioning and Hip Access During Hip Arthroscopy With Articulated Traction Device

Surgeons use hip arthroscopy to address intra-articular pathology of the hip. To access the central compartment, traction must be applied to the leg. Various types of equipment and techniques have been used, but many have limitations. Improved ability to assess the offending pathology is achieved with improved ability to move the hip joint in space during surgery. Dynamic assessment of femoroacetabular impingement allows the surgeon to gauge the adequacy of resection. We describe the use of an articulated traction device that allows complete surgeon control over the leg position, as well as the freedom to place the leg in virtually any position with ease, unencumbered by the mechanics of a standard traction table. This device provides the surgeon with an improved ability to dynamically assess the hip and removes some of the responsibility of the operating room staff for intraoperative leg positioning

Endoscopic Sciatic Neurolysis

Despite remaining a controversial diagnosis, piriformis syndrome continues to affect patients' quality of life with pain, sitting discomfort, and exercise intolerance. Open sciatic neurolysis has been noted by the senior author to often only bring temporary relief of the symptoms, with the recurrence presumably due to postoperative scar tissue. Minimally invasive techniques used to decompress the nerve have met with mixed results. This article describes a step-by-step surgical technique designed to maximize patient safety, as well as surgeon orientation, and achieve a thorough neurolysis. Preoperative findings suggestive of piriformis syndrome are described and include retro-trochanteric pain, sciatica-like leg pain, and paresthesias, as well as a positive response to computed tomography–guided injection of dilute ropivacaine hydrochloride and 40 mg of triamcinolone. The operation is performed with the patient in the lateral decubitus position through 2 portals 6 to 8 cm apart, allowing for good triangulation. Dissection is undertaken with a combination of radiofrequency and a laparoscopic peanut, with the assistance of a vascular sling to control the sciatic nerve. Encouraging results have been achieved, and with increasing interest in this procedure, a step-by-step technical description with an accompanying video may prove useful for other experienced hip arthroscopists. Pearls and pitfalls are discussed

Inside Out: A Novel Labral Repair and Advancement Technique

Labral tears are a significant cause of hip pain and are currently the most common indication for hip arthroscopy. Compared with labral debridement, labral repair has significantly better outcomes in terms of both daily activities and athletic pursuits in the setting of femoral acetabular impingement. The techniques described in the literature all use anchor placement on the capsular aspect of the acetabular rim, which can be difficult especially anteriorly, where the rim is very thin, and has the potential for significant complications. Anchor breakage, anchor slippage into the surrounding (capsular side) soft tissue, and penetration of the cartilage surface are among the most common complications. We describe an intra-articular anchor placement technique for labral repair from inside out. This technique, because of the location of the anchor and direction of suture pull, can assist in labral advancement in cases in which the native labrum fails to create a seal because of its location away from the femoral head

Case Reports: Ipsilateral Shoulder and Elbow Arthroplasty Using Custom Interlocking Prostheses

Ipsilateral shoulder and elbow arthritis is not an uncommon problem seen in patients of upper extremity surgeons. If arthroplasty is required in both joints, there is a significant risk of periprosthetic fracture resulting from the stress riser occurring between the implants. We report the placement of custom interlocking shoulder and elbow prostheses in a patient with rheumatoid arthritis. The elbow prosthesis with an uncemented humeral component was placed followed 18 months later by a custom-designed shoulder prosthesis. An internal strut between the two prostheses was created. Seven years postoperatively, the patient was asymptomatic with no radiographic signs of impending failure

Aequorin mutants with increased thermostability

Bioluminescent labels can be especially useful for in vivo and live animal studies due to the negligible bioluminescence background in cells and most animals, and the non-toxicity of bioluminescent reporter systems. Significant thermal stability of bioluminescent labels is essential, however, due to the longitudinal nature and physiological temperature conditions of many bioluminescent based studies. To improve the thermostability of the bioluminescent protein aequorin we employed random and rational mutagenesis strategies to create two thermostable double mutants, S32T/E156V and M36I/E146K, and a particularly thermostable quadruple mutant, S32T/E156V/Q168R/L170I. The double aequorin mutants, S32T/E156V and M36I/E146K, retained 4 and 2.75 times more of their initial bioluminescence activity than wild type aequorin during thermostability studies at 37 °C. Moreover, the quadruple aequorin mutant, S32T/E156V/Q168R/L170I, exhibited more thermostability at a variety of temperatures than either double mutant alone, producing the most thermostable aequorin mutant identified thus far