While superior capsule reconstruction demonstrates effectiveness in motion recovery, the lower trapezius transfer proves superior in generating external rotation and abduction force. The purpose of this article was to describe a simple and reliable technique for combining both strategies during one surgical procedure, thereby maximizing functional recovery through the restoration of both motion and strength.

The acetabular labrum is indispensable for the healthy function of the hip joint, directly influencing its congruity, stability, and the generation of a negative pressure suction seal. The combined effects of overuse injuries, past developmental problems, and unsuccessful initial labral repairs can ultimately lead to labral insufficiency, demanding a labral reconstruction procedure for effective management. selleck Despite the diversity of graft options in hip labral reconstruction, there is currently no accepted gold standard method. The optimal graft's design should closely replicate the native labrum's geometry, internal structure, mechanical properties, and resistance to degradation. bio-inspired materials An arthroscopic labral reconstruction technique utilizing fresh meniscal allograft tissue has been developed in response to this.

Anterior shoulder discomfort is frequently linked to the long head of the biceps tendon, which can be concurrently involved with other shoulder pathologies like subacromial impingement, rotator cuff tears, and labral tears. Using all-suture knotless anchor fixation, a mini-open onlay biceps tenodesis technique is discussed in this technical note. Not only is this technique easily reproducible and efficient, but it also uniquely offers a consistent length-tension relationship. This minimizes the risk of peri-implant reactions and fractures without compromising the strength of fixation.

While intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are not unheard of, they are notably rare, and their symptomatic presentation is rarer still. Symptomatic presentations, nonetheless, pose a real challenge to the orthopaedic field, as there is no consensus on the most suitable intervention. Arthroscopic resection of the entire posterolateral bundle of the ACL, in a figure-of-four configuration, is described in this Technical Note as the surgical solution for an ACL ganglion cyst unresponsive to prior conservative methods.

Anterior instability's return after a Latarjet procedure, coupled with ongoing glenoid bone loss, can be attributed to the coracoid bone block's resorption, relocation, or incorrect placement. Autografts, such as iliac crest and distal clavicle bone transfers, and allografts, including distal tibia allografts, provide multiple avenues for managing anterior glenoid bone loss. This study highlights the utility of the coracoid process remnant as a potential treatment approach in cases of persistent glenoid bone loss after Latarjet failure. Inside the glenohumeral joint, through the rotator interval, the remnant coracoid autograft is harvested, transferred, and fixed using cortical buttons. A crucial aspect of this arthroscopic procedure is the use of glenoid and coracoid drilling guides for precise graft positioning, enhancing reproducibility and safety. This is complemented by a suture tensioning device, which facilitates intraoperative graft compression and facilitates proper bone graft healing.

The literature consistently demonstrates a substantial reduction in failure rates following anterior cruciate ligament (ACL) reconstruction when supplemented with extra-articular reinforcement techniques, such as those utilizing the anterolateral ligament (ALL) or iliotibial band tenodesis (ITBT) employing the modified Lemaire method. The ALL technique, while associated with a progressive decrease in ACL reconstruction failure rates, nonetheless carries a risk of graft rupture in certain cases. Subsequent revisions of these cases call for a broader selection of techniques, a continuous challenge for the surgical team, notably when the lateral approach presents difficulties, heightened by the distorted lateral anatomy due to previous reconstruction, the presence of existing tunnels, and the presence of fixation components. For the secure and stable fixation of the graft, a method using a single tunnel for the passage of both the anterior cruciate ligament (ACL) and iliotibial band (ITBT) grafts is presented. This results in a single fixation point. Through this method, a less expensive surgical procedure was executed, minimizing the risk of lateral condyle fracture and tunnel confluence. Revision procedures following unsuccessful combined anterior cruciate ligament (ACL) and anterior lateral ligament (ALL) reconstruction are recommended for implementation using this technique.

Hip arthroscopy, recognized as the standard treatment for femoroacetabular impingement syndrome and labral tears in both adults and adolescents, commonly involves a central compartment approach guided by fluoroscopy and maintained continuous distraction. In order to effectively perform a periportal capsulotomy, a necessary condition is the application of traction for improved visibility and instrument manipulation. Immune magnetic sphere These maneuvers are executed to safeguard the femoral head cartilage from any scuffing damage. When performing hip distraction on adolescents, practitioners must exercise extreme caution; improper force application can result in iatrogenic neurovascular damage, avascular necrosis, and potential lacerations to the genitals and foot/ankle. A worldwide network of experienced surgeons has created an extracapsular hip surgery approach involving precise and smaller capsulotomies, with a demonstrably low complication rate. The hip's approach, characterized by heightened security and simplicity, has garnered attention among adolescents. The initial capsulotomy reduces the need for distraction, making the subsequent procedures easier. During hip entry, this technique allows for the viewing of the cam morphology without any distracting maneuver. For pediatric and adolescent patients with femoral acetabular impingement syndrome and labral tears, an extracapsular approach is a considered a treatment option.

Extra-articular ligaments in the knee, elbow, and ankle joints are repaired and reconstructed using ultra-high molecular weight polyethylene sutures. Recent years have witnessed a rise in the utilization of these sutures in suture augmentation procedures, specifically for reconstructing the anterior cruciate ligament, an intra-articular structure. In the Technical Notes, though various surgical techniques are described, every documented reconstruction has been limited to a single bundle, with no report of its implementation in double-bundle reconstruction. The procedure for anatomical double-bundle anterior cruciate ligament reconstruction, coupled with the suture augmentation technique, is extensively detailed in this technical note.

A retrogradely inserted intramedullary nail is a surgical implant for tibiotalocalcaneal arthrodesis, offering critical mechanical strength and compression at the fusion site, with a concomitant reduction in soft tissue impact. Yet, certain instances of fusion failure lead to the excessive burdening of the implant, ultimately causing the implant to falter. Implant breakage is a probable consequence of excessive stress concentrated at the subtalar joint. Extracting the proximal segment of the broken tibiotalocalcaneal nail proves difficult. Numerous surgical strategies have been reported for the removal of the fractured tibiotalocalcaneal nail. This article details a surgical procedure for the removal of a broken tibiotalocalcaneal nail, using a pre-formed Steinmann pin to remove the proximal fragment. A key benefit is its minimally invasive approach, eliminating the need for specialized tools to extract the nail.

New research on the anterolateral ligament (ALL) of the knee reveals a growing understanding of its impact on knee stability. In spite of many cadaveric, biomechanical, and clinical studies, disagreement persists about the anatomical traits, the biomechanical function, and, remarkably, the very essence of the ALL. The surgical dissection of the ALL in human fetal lower limbs, illustrated with video, is detailed in this article, along with a description of the anatomical and histological features of the ALL during fetal development. Histologic analysis of dissected fetal knees revealed the clear presence of ALL, characterized by well-organized, dense collagenous tissue fibers alongside elongated fibroblasts, indicative of a ligament.

Anterior glenoid bony Bankart lesions stem from traumatic glenohumeral instability, potentially leading to recurrent instability if surgical stabilization is not implemented. While anatomically restoring large bony fragments yields excellent stability and functional results, the techniques required for this restoration are frequently either fragile or overly intricate. This technique guide elucidates a repair method for the glenoid articular surface, built upon tried and true biomechanical principles, resulting in a reliable, anatomically correct outcome. Standard anterior labral repair instrumentation and implants make this technique readily adaptable in the majority of bony Bankart settings.

A significant number of shoulder joint diseases exhibit a constellation of problems encompassing the long head biceps tendon (LHBT). Due to biceps pathology, shoulder pain is frequently experienced, and this pain is effectively managed through tenodesis. Diverse approaches exist for biceps tenodesis, encompassing varied fixation methods and placements. Employing a 2-suture anchor, this article describes an all-arthroscopic approach to suprapectoral biceps tenodesis. The biceps tendon repair using the Double 360 Lasso Loop technique involved only one puncture, minimizing damage and reducing the risk of suture slippage and failure.

A complete distal biceps tendon tear is typically managed with direct repair, yet chronic, mid-substance, or musculotendinous tears frequently present as difficult cases for surgical intervention. Although direct repair efforts are to be considered, in instances of significant retraction or tendon deficiency, a reconstructive procedure could be indicated. This paper demonstrates a distal biceps reconstruction method using an allograft with a Pulvertaft weave via a standard anterior incision, employing a similar approach to primary repair, and supplemented by a smaller, proximal incision for tendon retrieval.