Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. The brachial plexus and axillary vessels lie medial and inferior to the coracoid. The beach chair position facilitates achieving these two objectives. Probes, disposable cannulas, and other operative tools are similar to those used for knee arthroscopy.
Key Points Areas of cartilage destabilization are often part of a delaminated chondrolabral complex. We report the technique of limited chondral debridement with labral repair and microfracture through the delaminated but attached cartilage Tables 1 and 2. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. Fig 2.
Enthusiasm for minimally invasive shoulder surgery has fostered many studies on arthroscopic shoulder anatomy. The operating room table is positioned such that the torso is approximately 70 to 80 0 from horizontal. Galatz, and Ken Yamaguchi A firm grasp of shoulder anatomy is requisite to ensure the best possible outcome and to avoid complications of arthroscopic shoulder surgery.
The posterolateral comer of the acromion is often the easiest landmark to feel, because the overlying posterior deltoid is thin. Fig 1. This "releases" the superior tendon of the subscapularis, allowing the surgeon to effectively place the anterior working portal more inferiorly, fulfilling the first criterion. The posterolateral approach caused less vascular damage than the anterolateral approach.
Second, traction is rarely necessary during beach chair positioning. Abduction of the shoulder decreases both these distances. Preoperative axial T1 magnetic resonance arthrogram using a 1. An alternative to the use of a beanbag for the beach chair position is use of the "OR Direct" or similar positioning table. The medial border arrow of the scapula should be freely accessible after the beanbag has been evacuated.
Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. A camera sheath with an inflow portal is used. The adduction distraction maneuver.
However, recent insights into the pathomechanics of shoulder instability, especially regarding bipolar bony lesions, have renewed our interest in the arthroscopic treatment of Hill-Sachs lesions and the role of soft-tissue interventions after bone block procedures. The beach chair position facilitates achieving these two objectives. The humerus is then gradually externally rotated from its neutral position, and the responses of the anterior band of the inferior glenohumeral ligament and the axillary pouch are observed. These three points approximate an equilateral triangle. At the level 13 of the glenoid equator, the arthroscope is then advanced anterior to the labrum and into the anterior capsular pouch. Probes, disposable cannulas, and other operative tools are similar to those used for knee arthroscopy.
However, data on the utility of these tests are more limited in the shoulder, with worse diagnostic performance compared with the evaluation of hip and knee PJI because of the low virulence of the commonly cultured shoulder organisms, such as Cutibacterium acnes. Previously described techniques. The mean age of the patients was The posterior portal with inflow and camera sheath. No patients developed severe glenohumeral arthritis Samilson 4. An articulated forearm-positioning device McConnell Universal Positioner, Greenville, TX may be utilized with the beach chair position, and the base should be attached before the patient is prepared and draped.
The rotator cuff is inspected from anterior to posterior. The appropriate borders for draping are the neck medially and 3 to 4 cm distal to the axilla inferiorly. Prophylactic use of metoprolol immediately after the block is obtained has also been shown to be effective in preventing this phenomenon. An emphasis is placed on appreciating normal anatomy and its variants as distinguished from true pathology of the shoulder. A recent systematic review on diagnostic accuracy for SI joint pain concluded that more reliable criteria are strongly positive responses to diagnostic injection and a physical examination in which 3 or more provocative maneuvers are positive.
With the arm adducted, the rod is directed as laterally as possible. Marcel, M. In a normal hip, there is a contiguous transition from articular cartilage to labrum without gapping; however, in patients with femoroacetabular impingementeassociated labral tears, the labrum most often remains partially attached to the acetabular rim, whereas the articular cartilage separates from the labrum and potentially delaminates from the subchondral bone, constituting a Seldes type I lesion. Arthroscopic labral base repair in the hip: Clinical results of a described technique.
Removing the shoulder support from the operative shoulder allows adequate shoulder exposure. B demonstrating the entrance of the needle in rotator interval when placed using an "outside in" percutaneous technique. Vessel density in the 5- to mm depth around the lateral talar dome was higher in the anterior and medial side.
Third, conversion to an open surgical procedure from the beach chair position is seamless, avoiding the need to either reposition or redrape the patient. B Arthroscopic view the acromion. Onset of symptoms has been generally reported to occur between 30 and min after regional blockade.