Knee bursitis

una publicación de Victor Ravens.

http://www.ncbi.nlm.nih.gov/pubmed/24140143
http://www.arthroscopyjournal.org/article/S0749-8063(13)00925-0/abstract

Arthroscopy. 2013 Dec;29(12):1932-40. doi: 10.1016/j.arthro.2013.08.023. Epub 2013 Oct 18.

Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression.

Hapa O, Bedi A, Gursan O, Akar MS, Güvencer M, Havitçioğlu H, Larson CM.

Author information

Abstract

PURPOSE:

The purposes of this study were to define the anatomy of the anterior inferior iliac spine (AIIS) and its relation to the footprint of the rectus femoris tendon and to evaluate on the clinical outcomes after AIIS/subspine decompression.

METHODS:

The rectus origin was dissected and detached in 11 male cadaveric hips with a mean age of 54.3 ± 14.3 years (range, 33 to 74 years). The proximal-distal and medial-lateral extent of the footprint and its relation to the AIIS and acetabular rim were evaluated, with the 12-o'clock position defined as directly lateral at the insertion of the indirect head of the rectus tendon and the 1- to 6-o'clock positions defined as anterior acetabular positions. To assess the safety and efficacy of subspine decompression for AIIS deformity, clinical correlation of a series of 163 AIIS decompressions (mean age, 27.8 years; age range, 14 to 52 years) performed from January 2011 to January 2012 was completed, and outcome scores, strength deficits, and ruptures were assessed by manual muscle testing and postoperative radiographs. All patients presented with symptomatic FAI with proximal femoral and/or acetabular deformity and type 2 (131 hips) or type 3 (32 hips) AIIS morphology as defined by Hetsroni et al.

RESULTS:

The mean proximal-distal and medial-lateral distances for the rectus origin footprint were 2.2 ± 0.1 cm (range, 2.1 to 2.4 cm) and 1.6 ± 0.3 cm (range, 1.2 to 2.3 cm), respectively. There was a characteristic bare area at the anteromedial AIIS. On the clock face, the lateral margin (1-o'clock to 1:30 position) and medial margin (2-o'clock to 2:30 position) of the AIIS and the indirect head of the rectus (12 o'clock) were consistent for all specimens. In the clinical series, 163 AIIS decompressions were performed for symptomatic subspine impingement. The mean modified Harris Hip Score was 63.1 points (range, 21 to 90 points) preoperatively compared with 85.3 points (range, 37 to 100 points) at a mean follow-up of 11.1 ± 4.1 months (range, 6 to 24 months) (P < .01). Short Form 12 scores improved significantly from a mean of 70.4 (range, 34 to 93) preoperatively to a mean of 81.3 (range, 31 to 99) postoperatively (P < .01). The mean pain score on a visual analog scale also improved significantly from a mean of 4.9 (range, 0.1 to 8.6) preoperatively to a mean of 1.9 (range, 0 to 7.8) postoperatively (P < .01). The mean alpha angle improved from 61.5° (range, 35° to 90°) preoperatively to 49° (range, 35° to 63°) postoperatively on anteroposterior radiographs and from 71° (range, 45° to 90°) preoperatively to 44.3° (range, 37° to 60°) postoperatively on lateral radiographs. No short- or long-term hip flexion deficits or rectus femoris avulsions were noted with up to 2 years' follow-up.

CONCLUSIONS:

The origin of the rectus femoris tendon is broad on the AIIS and protective against direct head detachment with subspine decompression. This broad origin and consistent bare area anteromedially on the AIIS can be readily used by surgeons to perform a safe AIIS resection in cases of symptomatic impingement. Arthroscopic subspine decompression in addition to osteoplasty for symptomatic cam- and/or pincer-type FAI deformities can reliably improve outcome scores without significant hip flexion deficits or AIIS/rectus femoris avulsions.

CLINICAL RELEVANCE:

The direct head of the rectus tendon has a broad insertion on the AIIS, and an area devoid of tendon provides a "safe zone" for subspine decompression in cases of symptomatic AIIS impingement.

Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

New Study: The Use of PRP in Ligament and Meniscal Healing

http://www.ncbi.nlm.nih.gov/pubmed/24212368
New Study: The Use of PRP in Ligament and Meniscal Healing
by TOBI Faculty, Jason Dragoo MD

Steven SampsonFounder, President at The Orthohealing CenterContribuidor principal

Platelet Rich Plasma has quickly emerged as a wide spread treatment for acute and chronic musculoskeletal disorders, such as tendinopathies and arthritis. However, a recent study out of Sports Medicine Arthroscopy, summarizes an emerging trend amongst PRP researchers: the application of PRP for meniscus and ligament healing.

Recent clinical studies support the potential benefit of PRP in Anterior Cruciate Ligament allograft maturation, while some animal studies suggest PRP effects on primary ACL repair. However, no randomized controlled trials have yet to exhibit benefits in PRP for ACL tendon allograft-tunnel integration.
The use of Platelet Rich Plasma for meniscus repair is much less documented in comparison to ligaments. This review article found only two studies which documented the application of PRP for meniscal healing. The compilation of studies incorporating PRP in ligament and meniscus treatment provided promising evidence for Platelet Rich Plasma application in primary ACL repair in skeletally immature patients, ACL graft maturation, and repair of meniscal tears in avascular zones. This area of PRP research is vastly unexplored and reveals much potential for future advancement in PRP treatment options.

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/24212368

Meet Dr. Dragoo and field leaders publishing the latest research at The Orthobiologic Institute (TOBI) 5th Annual PRP & Regenerative Medicine Symposium with Cadaver Lab, June 6-7, 2014 in Las Vegas. www.prpseminar.com

The Use of PRP in Ligament and Meniscal Healing. ncbi.nlm.nih.gov

PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

Sports Med Arthrosc. 2013 Dec;21(4):206-12. doi: 10.1097/JSA.0000000000000005.

The use of PRP in ligament and meniscal healing.

Braun HJ, Wasterlain AS, Dragoo JL.

Author information

Abstract

Platelet-rich plasma (PRP) has become a popular treatment for acute and chronic soft tissue injuries. Although the majority of research has focused on its use in tendinopathy, PRP may have potential in meniscus and ligament healing. Some level II studies support a possible benefit for anterior cruciate ligament (ACL) allograft maturation, and preliminary animal studies point to a potential role for PRP in primary ACL repair. However, randomized controlled trials have not demonstrated a benefit of PRP for ACL tendon allograft-tunnel integration. To date, 2 studies document the use of PRP for meniscal applications, but this field is largely unexplored. With respect to ligament and meniscal applications, the current literature suggests PRP may be promising for primary ACL repair in skeletally immature patients, ACL graft maturation, and repair of meniscal tears in the avascular zone.

PMID:

 

24212368

 

[PubMed - in process]

Operaron a Juan Falcón y Hugo Soto del Zamora FC y seran bajas por 40 días

http://www.balonazos.com/ve/index.php/2013-08-19-19-49-54/noticias/9327-operaron-a-juan-falcon-y-hugo-soto-del-zamora-fc-y-seran-bajas-por-40-dias

Publicado el Miércoles, 18 Diciembre 2013 18:14 | Escrito por Redacción Balonazos.com @Balonazos

El atacante nacional Juan Falcón y el defensor colombiano Hugo Soto, ambos del Zamora FC, fueron operados tras sufrir molestias antiguas que los aquejaban partido a partido. El Doctor titular del conjunto zamorano, Rafael Viloria, explicó la situación en primera instancia del central colombiano Hugo Soto “Soto fue intervenido en su rodilla derecha, tras una lesión meniscal, se decidió realizar una artroscopia de rodilla. Que fue dirigida por mi persona en la Centro Clínico Varyna, en un tiempo de una hora, sin ninguna irregularidad y que ahora le permitió regresar a Cartagena- Colombia donde llevará acabo una parte de su recuperación”.

Por otro lado el goleador de la “furia llanera” Juan Falcón, también fue intervenido de su tobillo izquierdo, en lo que el mismo declaró como “una operación planificada”. Al respecto, Viloria soltó que “Juan tuvo que recibir una Artroscopia de Tobillo, para suturar una lesión osteocondral. La operación fue llevada a cabo en el Centro Clínico Mérida por el Doctor Antonio Torres un cirujano especializado en lesiones de pie y tobillo. Gracias a Dios todo ocurrió sin ninguna complicación y desde hoy mismo (miércoles) podrá reintegrarse con el grupo acá en Barinas para iniciar su rehabilitación”.

Al respecto de la recuperación de ambos jugadores, el especialista del actual monarca del fútbol venezolano, comentó que “son cirugías bastante sencillas, por lo que ambos jugadores sólo deberán cuidarse y tomar las medidas necesarias para llevar la recuperación lo más pronto posible. Estimamos que en un tiempo estipulado de unos 30 a 40 días ambos podrán volver a las canchas”.

Fuente Prensa Zamora FC

- See more at: http://www.balonazos.com/ve/index.php/2013-08-19-19-49-54/noticias/9327-operaron-a-juan-falcon-y-hugo-soto-del-zamora-fc-y-seran-bajas-por-40-dias#sthash.RhzbAApw.dpuf

Proyecto Articúlate para estudiar la adherencia terapéutica en la artrosis

una publicación de Victor Ravens.

http://drpinal.com/cientificos/wrist-suturing-all-inside-technique/

A TECHNIQUE FOR ARTHROSCOPIC ALL-INSIDE SUTURING IN THE WRIST

F. Del Piñal; F.J. García Bernal, L. Cagigal, A. Studer, J. Regalado and C. Thams

J. Hand Surg Eur Vol OnlineFirst published on February 11, 2010 as doi: 10.1177/1753193409361014. The Journal of Hand Surgery (2010) 0: 0: 1–5.

ABSTRACT (full text pdf. below)

A technique for arthroscopic all-inside suturing in the wrist

A technique for arthroscopic all-inside suturing in the wrist is presented. The procedure allows placement of the knot inside the joint without additional incisions. We have applied it in cases of dorsal, foveal and coronal tears of the triangular fibrocartilage. No special instrument is required apart from a Tuohy needle.

- See more at: http://drpinal.com/cientificos/wrist-suturing-all-inside-technique/#sthash.srcDLvQs.dpuf

#Artroscopia Permite tratar las lesiones de la rodilla sin tener que abrir la articulación, te lo explicamos en detalle

FUENTE:
http://www.cun.es/recursos-multimedia/infografico/artroscopia-rodilla?utm_source=twitter&utm_medium=tuit&utm_term=artroscopia&utm_campaign=13112012_tw_infco_artroscopia_rodilla

12.11.2012 Cirugía Ortopédica y Traumatología

Artroscopia de rodilla

Técnica quirúrgica para acceder al interior de la rodilla a través de unos pequeños orificios. Mediante una lente de pequeño calibre se observa el interior de la articulación y se tratan diversas lesiones sin necesidad de abrirla.

Conozca qué es la artroscopia de rodilla [PDF, 10.27 MB]

 http://www.cun.es/contenido_alt/1271264

En cifras
1 millón de artroscopias de todas las articulaciones se realizan al año en España.
50% menos de riesgo de infección respecto a la cirugía abierta.
3 de cada 10.000 habitantes sufren una rotura de ligamento cruzado anterior cada año.
50% de las lesiones de ligamento cruzado se acompañan de lesiones de menisco.

Artroscopia de rodilla

Técnica quirúrgica para acceder al interior de la rodilla a través de unos pequeños orificios. Mediante una lente de pequeño calibre se observa el interior de la articulación y se tratan diversas lesiones sin necesidad de abrirla.
LESIONES DE LIGAMENTO CRUZADO ANTERIOR
Es una de las lesiones que más se trata mediante artroscopia por ser un procedimiento menos invasivo que el tradicional.
Cartílago articular
Fémur
El ligamento cruzado anterior una la tibia con el fémur, dando estabilidad a la rodilla.
Su rotura se produce cuando la tibia y el peroné se desplazan en direcciones opuestas. Provoca imposibilidad para doblar la rodilla.
Peroné
Menisco
Ligamento lateral
PROCEDIMIENTO TRADICIONAL
Amplia lesión en la rodilla, recuperación dolorosa.
Incisión y cicatriz: Una de entre 7 y 10 cm
Ingreso tras la intervención: De 2 a 7 días
Recuperación de 2 a 7 días
Diagnóstico y valoración: No se valoran u operan otras lesiones en el momento de la operación.
ARTROSCOPIA DE RODILLA
Procedimiento mínimamente invasivo.
Incisión y cicatriz: Tres de entre 6 mm y 1 cm
Una de entre 3 y 4 cm
Ingreso tras la intervención: Entre varias horas y dos días
Recuperación: 6 meses
Diagnóstico y valoración: Se valora íntegramente la rodilla en el mismo procedimiento, y se tratan todas las lesiones que puedieran existir.

INTERVENCIÓN

POSICIÓN DEL PACIENTE
Paciente tumbado, con la rodilla doblada y sujeta por un soporte
DURACIÓN
1 hora
ANESTESIA
El tipo de anestesia elegido depende de las características del paciente (sexo, edad...)
Raquídea: Consciente. Se duerme el cuerpo del pecho a las piernas.
General: El paciente está completamente dormido.
EQUIPO MÉDICO
Cirujano
Cirujano ayudante
Instrumentalista
Anestesista
ARTROSCOPIO
Consta de una cámara y una fuente de luz que da una imagen de la zona operada. El cirujano ve la zona a través de un monitor.
1 Por el interior del tubo hay un haz de fibra óptica por el que se transmite luz que ilumina la articulación.
2 Unas lentes de aumento en la punta recogen la imagen, que viaja hacia el otro extremo del tubo.
3 La minicámara registra la imagen, que se proyecta en un monitor para que el equipo médico pueda verla.
IRRIGACIÓN
Se introduce solución salina en la rodilla para dar espacio y visibilidad al cirujano.
Cartílago articular
Fémur
Ligamento cruzado posterior
Meniscos
Tibia
Incisión de 3-4 cm para introducir el injerto con el que se reconstruye el ligamento.
INSTRUMENTAL
Por una de las incisiones se introduce el instrumental para eliminar el tejido dañado.
RECUPERACIÓN
Semanas
Operación
El paciente es dado de alta el día de la intervención o al día siguiente
En los siguientes días llevará un vendaje compresivo.
Recuperación de la movilidad
El paciente realiza los ejercicios recomendados con el objetivo de recuperar gradualmente la movilidad, disminuir el dolor y la inflamación.
Fortalecimiento
En esta segunda fase, los ejercicios buscan fortalecer la rodilla y
completar la movilidad, libre de dolor. Se recupera fuerza muscular y estabilidad.
Fortalecimiento avanzado
El paciente sigue con los ejercicios. Se mantiene el grado de movilidad y se aumenta la fuerza muscular.
EJERCICIOS
Deben realizarse a diario durante las 15 primeras semanas.
Vuelta a la actividad normal. Podrá realizar deportes con cambio de dirección a partir de los seis meses.

OTRAS LESIONES TRATADAS MEDIANTE ARTROSCOPIA

LESIONES DE MENISCO
Al deteriorarse la articulación pierde estabilidad y el cartílago se desgasta más.
LESIONES DEL CARTÍLAGO ARTICULAR
Su desgaste produce rozamiento entre el fémur y la tibia al mover la rodilla
SINOVITIS CRÓNICA
El cartílago que envuelve la articulación se inflama y produce dolor.
RIGIDEZ DE RODILLA
La rodilla se bloquea y no se puede doblar.
FRACTURAS
Algunos casos de fracturas intraarticulares se tratan con artroscopia.
BURSITIS
Los sacos sinoviales que rodean la rodilla producen líqudo o se inflaman.
CUERPOS LIBRES INTRAARTICULARES
Fragmentos de cartílago dañado que se encuentran entre las articulaciones.

http://www.clinorthop.org/journal/11999/0/0/2905_10.1007_s11999-013-2905-y/0/article.html

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Julie E. Adams MD
Symposium: Thumb Carpometacarpal Arthritis
Online First ™ - March , 2013

Abstract on SpringerLink | Full article HTML | Full article PDF

Download Citation

Abstract

Background

Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation.

Questions/purposes

A systematic review was performed to determine the influence of (1) interposition material (manufactured, biological, or none); and (2) patient-related factors (including metacarpophalangeal joint hyperextension, ligamentous laxity, and severity of arthritis) on pain, functional scores, and postoperative complications unique to each approach.

Methods

A systematic review of the English language literature regarding thumb basilar joint arthritis and arthroscopic partial trapeziectomy or débridement was performed. Those procedures including ligament reconstruction or stabilization were excluded.

Results

Biological materials and no interposition were both associated with satisfactory improvement and low rates of complications; complication rates with synthetic materials were higher. Eaton Stages I to III were treated successfully with this technique. The effect of scaphotrapeziotrapezoid (STT) changes was variably described across series. In most series, metacarpophalangeal hyperextension did not seem to have an adverse effect on outcomes, although these patients were excluded in some series.

Conclusions

Arthroscopic débridement with or without interposition can be used for treatment of Eaton Stages I to III CMC osteoarthritis with satisfactory outcomes. Some series suggest satisfactory outcomes in the setting of STT changes and metacarpophalangeal hyperextension.

La artroscopia es ideal para descartar lesiones

una publicación de Victor Ravens.

Luis Fernando Prato "Manejo integral en la rehabilitación del paciente con reconstrucción del ligamento cruzado anterior..."

 http://vimeo.com/76872179

Luis Fernando Prato "Manejo integral en la rehabilitación del paciente con reconstrucción del ligamento cruzado anterior..."

Luis Fernando Prato "Manejo integral en la rehabilitación del paciente con reconstrucción del ligamento cruzado anterior..." from Col·legi Fisioterapeutes on Vimeo.

A TECHNIQUE FOR ARTHROSCOPIC ALL-INSIDE SUTURING IN THE WRIST

una publicación de Victor Ravens.

http://www.ncbi.nlm.nih.gov/pubmed/24169146

Arthroscopy. 2013 Dec;29(12):1911-21. doi: 10.1016/j.arthro.2013.08.032. Epub 2013 Oct 26.

Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade Fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure.

Mori D, Funakoshi N, Yamashita F.

Source

Kyoto Shimogamo Hospital, Kyoto, Japan. Electronic address: altair.0421@gmail.com.

Abstract

PURPOSE:

This study aimed to compare the arthroscopic patch graft procedure and partial repair for irreparable large or massive rotator cuff tears (RCTs) in shoulders with low-grade fatty degeneration of the infraspinatus (stage 1 or 2 according to Goutallier et al.) in terms of the functional and structural outcomes.

METHODS:

This study included 24 patients who underwent the patch graft procedure (group A) and 24 patients who underwent partial repair (group B) for irreparable large or massive RCTs. Clinical outcomes were evaluated at a mean of 35.5 months postoperatively in group A and 35.7 months in group B.

RESULTS:

The clinical findings were significantly improved at the final follow-up in both groups (P < .001). A significant difference was found between groups A and B in terms of postoperative Constant and American Shoulder and Elbow Surgeons scores (P = .001 and P = .021, respectively). There was a significant difference in the retear rate for the infraspinatus tendon (ISP) between the 2 groups (2 patients [8.3%] in group A v 10 patients [41.7%] in group B, P = .015). At the final follow-up, there was a significant difference in the affected side-versus-unaffected side muscle strength ratios for abduction and external rotation between group A and group B (P < .001 for both). Shoulders with retears of the ISP showed significantly inferior clinical outcomes compared with those without retears (P < .001).

CONCLUSIONS:

In arthroscopic surgery for irreparable large or massive RCTs with low-grade fatty degeneration of the infraspinatus, the patch graft procedure showed an 8.3% retear rate for the repaired ISP with both improved clinical scores and recovery of muscle strength, whereas the partial repair had a retear rate of 41.7% (P = .015).

LEVEL OF EVIDENCE:

Level Ш, retrospective comparative study.

Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Avances en la cirugía artroscópica: indicaciones y resultados

http://www.ncbi.nlm.nih.gov/pubmed/17278923

Curr Opin Rheumatol. 2007 Mar;19(2):106-10.

Advances in arthroscopic surgery: indications and outcomes.

Katz JN, Gomoll AH.

Source

Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. jnkatz@partners.org

Abstract

PURPOSE OF REVIEW:

To examine recent trends in the use of arthroscopic surgical techniques to address musculoskeletal problems. The review is particularly timely given the rapidly expanding range of indications for diagnostic and therapeutic arthroscopic procedures involving virtually every peripheral joint.

RECENT FINDINGS:

We focus on arthroscopic approaches to problems of the hip, wrist, elbow and ankle. Hip arthroscopy is permitting novel, minimally invasive approaches to the management of femoral acetabular impingement, labral tears, loose bodies and chondral lesions. Wrist arthroscopy has provided novel approaches to ligament tears, synovitis and fractures. Ankle arthroscopy has been especially helpful with soft tissue impingement syndromes, synovitis and fracture. Elbow arthroscopy has been especially helpful in the management of synovitis and osteoarthritis due to osteophytosis. Complications of arthroscopic procedures occur very rarely. Virtually all the literature on arthroscopy outcomes comes from small uncontrolled studies.

SUMMARY:

Arthroscopy provides a safe alternative to arthrotomy in the management of a wide range of clinical problems. The generally weak designs of studies performed to date compromises the strength of recommendations that can be made about the role of these procedures in clinical practice.

Más de 250 traumatólogos debaten los últimos avances en artroscopia de rodilla./ 2013

http://www.portalesmedicos.com/medicina/noticias/13272/1/Mas-de-250-traumatologos-debaten-los-ultimos-avances-en-artroscopia-de-rodilla-/Page1.html


Más de 250 traumatólogos debaten los últimos 

avances en artroscopia de rodilla. 

 
Ricardo Cuéllar: “La artroscopia, como medio de tratamiento, constituye un avance consolidado en la patología de rodilla”.


- Expertos de toda España se reúnen los días 23 y 24 de febrero en la capital guipuzcoana con motivo del II Curso de Cirugía Artroscópica básica y el III Curso de Cirugía Artroscópica Avanzada de Rodilla

- El encuentro se organiza con el patrocinio científico del Hospital Universitario Donostia. Policlínica Gipuzkoa será la sede de las sesiones quirúrgicas

- El Curso versará sobre tres tipos de lesiones: menisco, cartílago y ligamentos cruzados. Se realizarán cirugías en espécimen de cadáver; ello permitirá mostrar el abordaje de lesiones por otro lado más difíciles de encontrar


Donostia-San Sebastián, febrero de 2012.- Más de 250 traumatólogos de toda España se darán cita a partir de hoy, días 23 y 24 de febrero en el Auditorio del Parque Tecnológico de San Sebastián, para debatir sobre los últimos avances de la técnica artroscópica de rodilla así como abordar tres tipos de lesiones: las meniscales, las de cartílago y las de los ligamentos cruzados. 

El II Curso de Cirugía Artroscópica básica y el III Curso de Cirugía Artroscópica Avanzada de Rodilla los organiza el Departamento de Cirugía Ortopédica y Traumatología del Hospital Universitario Donostia, presidido por el traumatólogo Ricardo Cuéllar junto con su Jefe del Servicio, Jaime Usabiaga. Policlínica Gipuzkoa, copatrocinador de los cursos, será sede de las sesiones quirúrgicas. 

Durante las jornadas, como novedad, se realizarán cirugías en espécimen de cadáver, “para poder presentar los diferentes tipos de técnicas quirúrgicas que no siempre son fáciles de encontrar en pacientes reales en las fechas requeridas. En ellos, se abordarán tres clases de lesiones: las meniscales, las del cartílago y las de los ligamentos cruzados”, detalla el traumatólogo Ricardo Cuéllar, uno de los mas conocidos especialistas en el tratamiento de estas patologías. 

Según explica Ricardo Cuéllar, la artroscopia “es una vía para realizar una cirugía de forma menos agresiva y, actualmente, para el tratamiento de muchas patologías de rodilla, nadie se plantea realizar cirugía abierta. Se puede considerar como un avance consolidado”. 

Entre las técnicas referidas al tratamiento de la patología meniscal, “se hará una demostración de sutura meniscal, implante de menisco artificial y trasplante meniscal -colocación del menisco obtenido de banco de tejidos a partir de donante-, técnicas que pocos equipos realizan en España y que los asistentes tendrán ocasión de presenciar durante los cursos. 

Las mesas de debate, en las que intervendrán numerosos especialistas, se centrarán en otros dos puntos de discusión: el avance en el tratamiento de las lesiones del cartílago y del ligamento cruzado. Cuéllar explica que “en el primer caso, se abordarán las técnicas para implante de condrocitos. Éstos son células capaces de recuperar la destrucción de una zona del cartílago siempre que se trate de una lesión única, localizada. En el segundo apartado, se discutirá sobre la óptima reconstrucción del ligamento cruzado, bien con un solo paquete de fibras o reconstruyendo los dos. También se presentaran novedosos resultados de la técnica de reconstrucción del ligamento cruzado guiada por navegador”. 

Desde los quirófanos de Policlinica Gipuzkoa se retransmitirán dos cirugías en directo sobre reconstrucción de ligamentos cruzados, a cargo de los traumatólogos José Achalandabaso y Joan Carles Monllau y de reconstrucción de una lesión combinada de ligamento cruzado y menisco, por parte de los traumatólogos Eduardo Sánchez-Alepuz y Miguel Ruiz-Ibán. 

Las sesiones se complementarán con la realización de diferentes talleres dirigidos al aprendizaje de intervenciones concretas y con prácticas de técnica quirúrgica en modernos equipos de simulación.

http://www.portalesmedicos.com/medicina/noticias/13272/1/Mas-de-250-traumatologos-debaten-los-ultimos-avances-en-artroscopia-de-rodilla-/Page1.html

http://www.sanjuandedios-oh.es/?q=node/825

Especialistas de todo el país exponen los avances en Artroscopia

11/03/2013 - 22:15

General

El Hospital San Juan de Dios del Aljarafe ha celebrado un curso eminentemente práctico en el que se han dado cita traumatólogos y cirujanos ortopédicos de todo el país. Durante este curso, denominado ‘Nuevas tendencias en artroscopia y rodilla’ se han realizado cuatro intervenciones de última generación relacionadas con problemas de inestabilidad de rodilla, lesiones del cartílago articular, dos de las principales causas de la artrosis de la rodilla, o el síndrome de dolor femoropatelar (SDFP) que se presenta como una de las más patologías frecuentes de esta articulación.


La artrosis de rodilla en sus fases finales puede provocar la necesidad de sustituir la articulación por una artificial (prótesis de rodilla). Varios estudios han demostrado que el tratamiento eficaz y en tiempo de estos problemas puede reducir la necesidad de reemplazo protésico de rodilla en uno de cada tres casos.
El tratamiento de estas lesiones mediante artroscopia, que es una técnica mínimamente invasiva, permite un postoperatorio menos doloroso, con menos días de hospitalización y una recuperación más rápida.
Las lesiones del cartílago articular de rodilla son fácilmente diagnosticables durante la artroscopia de rodilla, si bien las opciones de tratamiento son en ocasiones limitadas. Dado el limitado potencial regenerativo del cartílago articular, el acceso a material cuya estructura, composición, propiedades mecánicas y durabilidad sean similares al tejido original, ha incentivado el desarrollo de métodos de cultivo en laboratorio. El Servicio Andaluz de Salud ofrece en su catálogo de servicios el tratamiento mediante implante de condrocitos cultivados autólogos realizado en el Centro Regional de Transfusión Sanguínea y en el Hospital Virgen de la Victoria de Málaga.  El objetivo del curso es dar a conocer esta técnica entre los cirujanos ortopédicos andaluces, para evitar el riesgo de un tratamiento menos adecuado de los pacientes afectados por esta dolencia.
En cuanto a la reconstrucción de ligamento cruzado anterior es una intervención que se ha extendido  en los últimos diez años a la mayoría de centros hospitalarios andaluces. Desde sus inicios en los años 80 hasta la actualidad, la técnica ha evolucionado en algunos aspectos.  En este curso se ha realizado una actualización práctica de la técnica en su versión más avanzada con la oportunidad de intercambiar impresiones con los cirujanos referentes de la misma.
Por último, la denervación patelar es una técnica paliativa adecuada para el alivio sintomático del dolor de la cara anterior de la rodilla. Para que sea eficaz, es necesario que la técnica quirúrgica se adapte lo más posible a la descripción original de la misma. En este sentido el curso ha contado con la presencia del doctor Vega García autor de la misma.

FUENTE:
http://www.arthroscopytechniques.org/article/S2212-6287(13)00030-3/fulltext

The Posterolateral Portal: Optimizing Anchor Placement and Labral Repair at the Inferior Glenoid

• Gregory L. Cvetanovich, M.D.
, 
• Frank McCormick, M.D.
, 
• Brandon J. Erickson, M.D.
, 
• Anil K. Gupta, M.D.
, 
• Geoff D. Abrams, M.D.
, 
• Joshua D. Harris, M.D.
, 
• Anthony A. Romeo, M.D.
, 
• Bernard R. Bach, M.D.
, 
• Matthew T. Provencher, M.D.

Received 16 December 2012; accepted 15 February 2013. published online 03 June 2013.

Videos (1):

Video 1. 
A narrated overview of the use of the posterolateral portal in arthroscopic capsulolabral repair of the inferior glenoid, focusing on how this portal improves suture shuttling and anchor placement.

Download This Video (20 MB)

Article Outline

• Abstract
• Surgical Technique
  • Patient Setup
  • Initial Portal Placement and Diagnostic Arthroscopy
  • Labral Preparation
  • Posterolateral Portal
  • Anchor Placement
  • Labral Repair
• Discussion
• Supplementary data
• References
• Copyright

Abstract 

The Bankart lesion is considered the critical lesion in anterior shoulder instability, in which the anteroinferior glenoid labrum separates from the glenoid rim. Technical advances in arthroscopy have ushered in a shift from open to arthroscopic Bankart repair. When one is performing an arthroscopic Bankart repair, proper portal placement is critical for success in labral preparation and anchor placement. Frequently, standard anterior portals are insufficient for inferior glenoid anchor placement and suture shuttling. The posterolateral portal—located 4 cm lateral to the posterolateral corner of the acromion—simplifies and improves anchor placement, trajectory, and anatomic capsulolabral repair of the inferior glenoid. We present our preferred technique for capsulolabral repair of the inferior glenoid.

 

Anterior glenohumeral dislocation is commonly associated with a Bankart lesion, in which the anteroinferior glenoid labrum separates from the glenoid rim. Technical advances in arthroscopy have ushered in a shift from open to arthroscopic Bankart repair. Arthroscopic Bankart repair outcomes now parallel those of open Bankart repairs. When one is performing an arthroscopic Bankart repair, proper portal placement is critical for success in labral preparation and anchor placement. Moreover, recurrent instability is anterior and inferior. Therefore it is critical to anatomically reduce the anterior-band of the inferior glenohumeral ligament. Frequently, standard portals are insufficient for optimal repair, and therefore authors have used various accessory portals.1

In our experience with arthroscopic Bankart repair, the 7-o'clock posterolateral portal provides optimal access to the inferior glenoid. Labral suture passage, knot tying in the anteroinferior quadrant, and placement of suture anchors at the inferior glenoid are all improved with this approach. We present our preferred technique for arthroscopic Bankart repair, emphasizing the use of the 7-o'clock posterolateral portal. Video 1 shows a narrated review of the surgical technique.

Back to Article Outline

Surgical Technique 

Patient Setup 

We prefer an interscalene block followed by general anesthesia. The patient is placed in the lateral decubitus position because we find that this provides the best possible access to and visualization of the entire capsulolabral complex. The operative extremity is examined with the patient under anesthesia to confirm the pattern of instability and to refine the operative plan, including estimating the correct amount of capsular plication. Subsequently, the patient's operative arm is prepared and draped in standard sterile fashion and suspended by gentle traction in slight abduction and forward flexion. A marking pen is used to outline the acromion, distal clavicle, and coracoid process and to mark the portal sites. The posterolateral portal is marked 4 cm off of the posterolateral acromion (Fig 1). One may trace the trajectory of the posterior clavicle laterally as confirmation of the appropriate position.

• 
  • View Large Image 
  • Download to PowerPoint

• Fig 1. 

  For arthroscopic inferior labral repair with the posterolateral portal, the patient is positioned in the lateral decubitus position. We use a posterior portal (3) 2 cm inferior to the posterolateral corner of the acromion and an anterosuperior portal (1) in the rotator interval just anterior to the biceps. The posterolateral portal (2) is created by an inside-out technique with an 18-gauge spinal needle, located approximately 4 cm lateral to the posterolateral corner of the acromion (following the trajectory of the posterior border of the clavicle laterally). The arthroscope is in the anterosuperior portal for optimal visualization.

Initial Portal Placement and Diagnostic Arthroscopy 

A posterior viewing portal is created approximately 2 cm inferior to the posterolateral corner of the acromion, and a 30° arthroscope is inserted. An anterosuperior portal is then created proximal in the rotator interval, just anterior to the biceps, by use of 18-gauge spinal needle localization, and a 7-mm cannula is placed. A diagnostic arthroscopy of the glenohumeral joint is performed to identify the Bankart lesion and identify concomitant injury to other structures including the remainder of the capsulolabral complex, long head of the biceps tendon, rotator cuff, humeral head Hill-Sachs lesion, and glenoid bone stock.

Labral Preparation 

After a Bankart lesion is confirmed, the arthroscope is transferred to the anterosuperior portal for optimal viewing of the anteroinferior glenoid (Fig 2A). Proper labral preparation is critical to successful arthroscopic Bankart repair. Under arthroscopic visualization from the anterosuperior portal, a tissue liberator, from the anteroinferior working portal, is used to peel the labrum from the glenoid at the labrum-bone interface until subscapularis muscle fibers are visualized. This confirms adequate mobilization, because the capsulolabral complex often self-reduces to its native footprint after this maneuver. Next, a tissue rasp or burr is used to create punctate glenoid bleeding.

• 
  • View Large Image 
  • Download to PowerPoint

• Fig 2. 

  (A) Placing the arthroscope in the anterosuperior portal provides optimal visualization of inferior capsulolabral pathology, indicated by an asterisk. (B) The posterolateral portal provides an excellent trajectory for inferior glenoid anchor placement, with drilling for anchor placement in a trajectory that is nearly perpendicular to the floor. (C) After anchor placement in the inferior glenoid through the posterolateral portal, we retain sutures in the posterolateral portal and place the cannula in the posterior portal for improved suture management during capsulolabral repair. (D) We insert the Spectrum through the posterior portal to grasp the capsule anterior to the anchor, avoiding the axillary nerve and enhancing plication of the capsular pouch. One must use a right Spectrum in a right shoulder and vice versa. (E) Sutures are tied with a sliding knot followed by alternating half-hitches, with the knot away from the articular surface.

Posterolateral Portal 

Using 18-gauge spinal needle localization, we then create a posterolateral portal percutaneously for anchor placement (Table 1). This portal is located approximately 4 cm lateral to the posterolateral corner of the acromion (following the trajectory of the posterior border of the clavicle laterally). We create this portal by an inside-out technique with an 18-gauge spinal needle. The spinal needle trajectory is nearly perpendicular to the floor, generally aimed at the coracoid, and hugging the humeral head.

Table 1. Pearls of Posterolateral Portal Placement

1. Use an inside-out technique with an 18-gauge spinal needle to localize the portal trajectory.

2. The spinal needle trajectory should be nearly perpendicular to the floor, generally aimed at the coracoid, and hugging the humeral head.

3. The incision should be approximately 4 cm lateral to the posterolateral corner of the acromion.

4. Confirm the location by following the trajectory of the posterior border of the clavicle laterally.

5. Use a percutaneous trocar for anchor drilling into the glenoid; if desired, a cannula can be used as a working portal.

Anchor Placement 

Closely following the trajectory of the spinal needle, a blunt trocar is passed through the teres minor, passing through the capsule under direct visualization, and is placed at the inferior glenoid. We prefer to gently mallet the trocar into the glenoid as we optimize the trajectory. This minimizes the risk for movement with drilling and the potential for skiving across the glenoid cartilage. The posterolateral portal enables the trocar to be placed 1 to 2 mm from the glenoid rim, minimizing drilling into the articular surface (Fig 2B). Next, the assistant drills and places the anchor (Bio-Fastak; Arthrex, Naples, FL) percutaneously through the posterolateral portal. The sutures are gently pulled to ensure capture before removal of the trocar. The sutures are retained in the posterolateral portal to facilitate suture management (Fig 2C).

Labral Repair 

After the anchor is successfully placed, we cannulate the posterior portal using a switching stick to enable suture passage and knot tying. This approach enables the Spectrum (ConMed Linvatec, Largo, FL) to grasp the anterior capsule anterior to the anchor, thus avoiding the axillary nerve and bringing the labrum back to the inferior glenoid (Fig 2D). On the basis of our experience, this angle enhances plication of the capsular pouch. A key point is that the surgeon uses the Spectrum with the opposite angle to that needed anteriorly. For example, we use a right Spectrum in a right shoulder. Moreover, one can titrate the amount of plication based on the laxity identified clinically or during the examination with the patient under anesthesia. Alternatively, once the anchor is placed, we may approach the labral repair anteriorly from the anteroinferior portal.

The sutures are shuttled by use of a simple hoop suture configuration, because this best allows the appropriate tensioning and bumper re-creation at the inferior glenoid. The suture is secured with a sliding knot, followed by alternating half-hitches (Fig 2E). The knot should be away from the articular surface. We recommend that at least 3 suture anchors be used between the 3- and 6-o'clock position for arthroscopic Bankart repair so as to achieve re-creation of the glenoid labrum and desired capsular plication. Additional anchors are placed along the anterior glenoid approximately 5 to 7 mm apart by use of the anteroinferior working portal.

Back to Article Outline

Discussion 

Because of technical advances in arthroscopic instability repair, arthroscopic Bankart repair is becoming more commonly performed, with outcomes approaching those of the gold standard, open repair. Standard arthroscopic portals provide insufficient visualization and instrumentation access to the inferior glenoid. Our approach to arthroscopic Bankart repair uses the posterolateral portal, which has been previously described.2 In our experience, the advantages of the posterolateral portal are enhanced ability to place anchors in the inferior glenoid at an improved trajectory, improved anteroinferior knot tying, facilitation of anteroinferior labral repair, and anatomic reduction of the inferior glenohumeral ligament (Table 2).

Table 2. Benefits and Limitations of Posterolateral Portal

Benefits	Limitations
Enhanced ability to place anchors in inferior glenoid at improved trajectory for anchor placement	Distance of 35 mm from axillary nerve
Facilitation of anteroinferior labral repair
Anatomic reduction of inferior glenohumeral ligament

In 2002 Davidson and Rivenburgh3 first described the 7-o'clock posterolateral portal in cadaveric shoulders as a way to obtain improved working access to the inferior glenoid. This portal was found to enter the glenohumeral joint through the teres minor tendon at a safe distance from the suprascapular nerve and artery (28 ± 2 mm) and from the axillary nerve and posterior circumflex humeral artery (39 ± 4 mm).3 Difelice et al.4 found in a cadaveric study that a similarly placed posterolateral portal had a distance of 34 ± 5 mm from the axillary nerve and 29 ± 3 mm from the suprascapular nerve. These studies also found that arm position did not change the distance from the portal to the neurovascular structures.3, 4The reported uses of the posterolateral portal include arthroscopic management of humeral avulsion of the glenohumeral ligament,5 posterior instability,6 and Bankart lesions.7

Back to Article Outline

Supplementary data 

download video

Video 1. A narrated overview of the use of the posterolateral portal in arthroscopic capsulolabral repair of the inferior glenoid, focusing on how this portal improves suture shuttling and anchor placement.

Back to Article Outline

References 

1. Seroyer ST, Nho SJ, Provencher MT, Romeo AA. Four-quadrant approach to capsulolabral repair: An arthroscopic road map to the glenoid. Arthroscopy. 2010;26:555–562
   • View In Article
   • Abstract
   • Full Text
   •  Full-Text PDF (1669 KB) 
   • CrossRef
2. Nord KD, Brady PC, Yazdani RS, Burkhart SS. The anatomy and function of the low posterolateral portal in addressing posterior labral pathology. Arthroscopy. 2007;23:999–1005
   • View In Article
   • Abstract
   • Full Text
   •  Full-Text PDF (501 KB) 
   • CrossRef
3. Davidson PA, Rivenburgh DW. The 7-o'clock posteroinferior portal for shoulder arthroscopy. Am J Sports Med. 2002;30:693–696
   • View In Article
   • MEDLINE
4. Difelice GS, Williams RJ, Cohen MS, Warren RF. The accessory posterior portal for shoulder arthroscopy: Description of technique and cadaveric study. Arthroscopy. 2001;17:888–891
   • View In Article
   • Abstract
   • Full Text
   •  Full-Text PDF (146 KB) 
   • CrossRef
5. Parameswaran AD, Provencher MT, Bach BR, Verma N, Romeo AA. Humeral avulsion of the glenohumeral ligament: Injury pattern and arthroscopic repair techniques. Orthopedics. 2008;31:773–779
   • View In Article
   • CrossRef
6. Bradley JP, Tejwani SG. Arthroscopic management of posterior instability. Orthop Clin North Am. 2010;41:339–356
   • View In Article
   • Abstract
   • Full Text
   •  Full-Text PDF (1292 KB) 
   • CrossRef
7. Baker CL, Romeo AA. Combined arthroscopic repair of a type IV SLAP tear and Bankart lesion. Arthroscopy. 2009;25:1045–1050
   • View In Article
   • Abstract
   • Full Text
   •  Full-Text PDF (902 KB) 
   • CrossRef

 The authors report that they have no conflicts of interest in the authorship and publication of this article. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.

PII: S2212-6287(13)00030-3

doi:10.1016/j.eats.2013.02.011

© 2013 Arthroscopy Association of North America. All rights reserved.