RESUMEN
Suspensory cortical fixation is commonly used for distal biceps tendon repair and reconstruction with one of several commercially available devices. The single-incision approach typically used with these devices is believed to have a lower incidence of heterotopic ossification than the dual-incision technique, but the true incidence of heterotopic ossification is unknown. The role of chemotherapeutic or radiation prophylaxis is undefined. We have identified 4 cases of extensive heterotopic ossification after biceps fixation with a suspensory button and single-incision approach. Surgeons should be aware of this potential complication when using suspensory cortical buttons for distal biceps fixation.
Asunto(s)
Traumatismos del Brazo/cirugía , Osificación Heterotópica/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Traumatismos de los Tendones/cirugía , Tenodesis/métodos , Adulto , Humanos , Masculino , Persona de Mediana Edad , Osificación Heterotópica/etiología , Anclas para Sutura , Tenodesis/instrumentaciónRESUMEN
For select patients with persistent patellofemoral pain, the anteromedial tibial tubercle transfer (Fulkerson osteotomy) provides excellent clinical results. This procedure, indicated for patients with patellar malalignment, has become one of the most popular distal realignment procedures. One potential concern with this technique is the proximity of the posterior vascular structures during bicortical tibial drilling for screw placement. To address this concern, we measured the proximity of these structures in 7 consecutive fresh-frozen cadaveric knees. For each knee, barium was injected into the femoral artery, and anteroposterior (AP) radiographs were taken to document the location of the popliteal vessels. Next, the initial steps of the Fulkerson osteotomy were performed. Then, a lateral release and the tibial osteotomy were performed, the tubercle was advanced into position, and two 9/64-inch extralong drill bits were placed through the tubercle and the posterior tibial cortex. Repeat AP radiographs were obtained, and digital calipers were used to measure the distance from the drill bits to the popliteal vessels. The vascular structure closest to the exit point of the superior drill bit was the bifurcation of the popliteal artery (mean distance, 8.3 mm; SD, 9.3 mm; range, 0.0-21.3 mm), and in 2 knees this structure directly overlay the bifurcation on the AP radiograph; the vascular structure closest to the exit point of the inferior drill bit was the posterior tibial artery (mean distance, 9.0 mm; SD, 8.0 mm; range, 0.0-20.0 mm), and again in 2 knees the drill bit lay directly over the artery on the AP radiograph. Bicortical drilling for screw placement during the anteromedial tibial tubercle transfer procedure may come precariously close to the posterior vascular structures of the knee, so orthopedic surgeons must take extreme caution not to drill past the posterior cortex during this part of the operation.
Asunto(s)
Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Meniscos Tibiales/cirugía , Osteotomía/métodos , Tibia/cirugía , Angiografía/métodos , Cadáver , Humanos , Articulación de la Rodilla/irrigación sanguínea , Meniscos Tibiales/irrigación sanguínea , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/métodos , Osteotomía/efectos adversos , Medición de Riesgo , Sensibilidad y Especificidad , Tibia/irrigación sanguíneaRESUMEN
There are several devices currently available for all-inside meniscal repair. One of the newest of these devices, the FasT-Fix (Smith & Nephew, Endoscopic Division, Andover, MA), is attractive because it combines advantages of traditional inside-out meniscal repair with an all-inside technique. We chose to critically evaluate these devices in a cadaver model. FasT-Fix devices were inserted arthroscopically in 8 fresh-frozen cadaveric knees at 5 to 7 mm intervals. A total of 45 devices were placed (24 laterally, 21 medially), and the knees were subsequently dissected to determine the location of the inserted devices. Several potential pitfalls were identified during the evaluation. When using the depth penetration limiter that comes preset with the device (to a depth of 22 mm), superficial structures, including the iliotibial tract and even the skin, were at risk for penetration with the needle. The device could not effectively be inserted into the anterior meniscus or the extreme posterior horn. Other potential pitfalls seen during insertion of the FasT-Fix meniscal repair devices include suture tensioning issues (including failure of the suture during tightening), intra-articular deployment of the implants, premature deployment of both the first and second implants, difficulty in advancing the trigger for deployment of the second implant, and difficulty in placing vertical-mattress sutures. Although the FasT-Fix is already in clinical use, additional modifications would likely enhance meniscal repair using this device.
Asunto(s)
Artroscopios , Artroscopía , Meniscos Tibiales/cirugía , Artroscopía/efectos adversos , Cadáver , Diseño de Equipo , Análisis de Falla de Equipo , Humanos , Prótesis e Implantes , Técnicas de SuturaRESUMEN
This study evaluated the risk to the popliteal artery associated with the tibial inlay technique in posterior cruciate ligament (PCL) reconstruction. Barium was injected into the femoral arteries of eight fresh-frozen cadaveric knees and anteroposterior (AP) radiographs were obtained. Dissection of the fascia overlying the gastrocnemius muscle, identification of the interval between the medial head of the gastrocnemius and the semimembranosus, and lateral retraction of the medial head of the gastrocnemius (the Burks and Schaffer approach) was performed. Subsequently, a bicortical screw was placed from posterior to anterior through the tibia as is performed in the tibial inlay technique. A second AP radiograph was obtained. The distance from the center of the screw to the edge of the popliteal artery was measured using digital calipers. The closest any screw came to the popliteal artery was 18.1 mm, and the average distance was 21.1 mm (21.1 +/- 4.6 mm, range: 18.1-31.7 mm). When this distance was calculated as a percentage of the tibial plateau width, the smallest value was 19.2% (24% +/- 4.9%, range: 19.2%-35.1%). A posterior approach for a tibial inlay PCL reconstruction procedure appears safe with respect to the popliteal artery.