Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon : a case report

Achilles tendon rupture is a common trauma requiring surgical management. For chronic Achilles tendon rupture in particular, reconstructive surgery is desirable and several methods have been described. Here we present a case of chronic Achilles tendon rupture reconstructed using the semitendinosus tendon because of the difficulty in pulling down the proximal stump to reach the distal stump and due to an insufficient margin for hooking a suture to the distal stump. Postoperatively, the patient had a fully functional tendon and resumed his normal activities of daily living. Using this surgical technique, we expect favorable outcomes in cases of Achilles tendon rupture

Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

The minimally invasive percutaneous endoscopic discectomy (PED) as the postero-lateral approach with the local anesthesia was started in the late 20th century. The procedure only requires 8 mm of skin incision ; thus, it is the least invasive disc surgery presently. The surgery related complications were reviewed in the initial 100 cases from the single surgeon (K.S., first author). Two cases showed exiting nerve irritation, and complained of leg paresthetic pain for 6 to 12 weeks after the surgery (2.0%). The symptoms got better with medicines. One showed post-surgical epidural hematoma, and required surgical removal of the mass (1.0%). Two cases complained neck pain during surgery (2.0%). Surgeons would be aware of the specific complications for the postero-lateral approach of PED procedure

Optimizing baseplate position in reverse total shoulder arthroplasty in small-sized Japanese females : technical notes and literature review

The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the humeral stem and required encircling wiring. In our experience, the short term clinical results of RTSA were excellent, but a new prosthesis that is designed to fit the short stature of Asians with smaller glenoid and humerus should be considered

Efficacy of hip arthroscopy in the diagnosis and treatment of synovial osteochondromatosis : a case report and literature review

Here we report a rare case of synovial osteochondromatosis of the hip and provide a brief review of the literature. A 37-year-old woman was referred to our department with a 3-year history of right hip pain. At initial consultation, she complained of pain upon standing and when sitting down, occasional pain at rest and nocturnal pain in the right hip, and worsening of the pain at premenstruum. The range of motion of the affected hip was totally limited by pain. Plain radiography revealed a slightly calcified (or ossified) lesion at the acetabular fossa of the right hip. Computed tomography showed clusters of loose bodies filling the acetabular fossa. Synovial osteochondromatosis was suspected and she underwent hip arthroscopic surgery. Complete resection was performed using the lateral and anterior portals. Postoperatively, her symptoms disappeared entirely and she was discharged 4 days after surgery. The patient regained full range of motion of the right hip and follow-up CT revealed no remaining loose bodies in the right hip. Hip arthroscopy is considered to be effective for the diagnosis and treatment of synovial osteochondromatosis of the hip and is minimally invasive

State of the Art : Elbow Arthroscopy : Review of the Literature and Application for Osteochondritis Dissecans of the Capitellum

Elbow arthroscopy has become a safe and effective treatment option for a number of elbow disorders. The most rewarding and successful indication is the removal of loose bodies. Loose bodies are often a result of osteochondritis dissecans (OCD) of the　capitellum, and arthroscopy in this case is useful for performing debridement, thereby eliminating the need for a more extensive open procedure associated with complications. In this review, we describe our arthroscopic technique for OCD of the capitellum. We usually conduct arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30°and 70°. The 70°arthroscope provides a greater operative field than the 30°arthroscope. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Loose bodies are commonly found in the radial fossa, coronoid fossa, and in the olecranon fossa. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The most significant complication in arthroplasty is neurovascular injury. However, we have never experienced this devastating complication, which can be avoided by paying careful attention to detail

The state of the art in arthroscopic hip surgery

Hip arthroscopy is among the most rapidly evolving arthroscopic techniques in the last decade and offers the benefits of being both a minimally invasive procedure and an excellent diagnostic tool. Improvements in instrumentation and surgical skills have advanced our ability to accurately diagnose and treat various conditions of the hip joint, and hip arthroscopy has elucidated several pathologies that cause disabling symptoms. Many of these conditions were previously unrecognized and left untreated. The indications for hip arthroscopy include the management of early osteoarthritis, synovial disorders (e.g., synovial osteochondromatosis), labral tears, chondral lesions, and femoroacetabular impingement (FAI), which is increasingly recognized as a disorder that can lead to the development of early cartilage and labral injury. A better understanding of hip arthroscopy, including the anatomy, improved surgical techniques, indications, and complications of the procedure, is essential for its success. This review article discusses the state of the art of arthroscopic hip surgery

Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome : A Case Report

Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive

State of the Art : Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia

Minimally invasive percutaneous endoscopic discectomy (PED) with a transforaminal approach under local anesthesia was started in the late 20th century. As the procedure requires a skin incision of only 8mm, it is the least invasive disc surgery procedure at present, and owing to advances in instruments and optics, the use of this technique has gradually spread. In Japan, Dr. Dezawa from Teikyo University Mizonokuchi Hospital introduced this technique in 2003. Thanks to his efforts, the number of surgeons who can perform PED has increased, although the number of active PED surgeons is still only around 20. The first author (K.S.) started PED in 2010. In this review article, we explain the state-of-the-art PED transforaminal technique for minimally invasive disc surgery and present three successful cases

Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery : A technical note

The pedicle screw (PS) system is widely used for spinal reconstruction. Recently, screw insertion using the cortical bone trajectory (CBT) technique has been reported to provide increased holding strength of the vertebra, even in an osteoporotic spine. CBT is also beneficial due to its low invasiveness. We have been performing hybrid reconstruction with CBT at the cranial level and PS at the caudal level based on the concept of minimal invasiveness. We applied this hybrid technique to 6 cases of degenerative spondylolisthesis. Surgery was completed with a small skin incision of around 5-6 cm, which is shorter than that of the conventional PS procedure. The mean percent slippage before surgery was 19.8%, and this was reduced to 3.9% after surgery and almost maintained 3 months after surgery. Furthermore, no major surgical complications were observed. Here, we introduce the minimally invasive hybrid technique of CBT-PS. Surgeons should be aware of the procedure as an option for minimally invasive lumbar spine reconstructive surgery

State of the art : Intraoperative neuromonitoring in spinal deformity surgery

Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques, including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery