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Intraoperative and Postoperative Issues With Arthroscopic Rotator Cuff Repair

Introduction Rotator cuff pathology is commonly encountered in an orthopedic practice and can result in significant pain and dysfunction. The prevalence of rotator cuff tears in the general population is reported to be between 9.7% and 62%, and increases with age. Varkey et al. reported 397,116 Medicare patients underwent rotator cuff repair between 2005 and 2012. REFERENCE: Varkey et al JSES 2016 . The majority…

Preoperative Issues With Rotator Cuff Surgery

Introduction Approximately 18 million Americans report shoulder pain each year, of which a large percentage are attributable to rotator cuff pathology. Tears of the rotator cuff tendon are common in the general population, and are associated with shoulder pain, dysfunction, and a detrimental effect on patient quality of life. Rotator cuff tears occur in up to 50% of individual older than 65 years of age, and…

Multidirectional Instability

Introduction Definition The term multidirectional instability (MDI) was first described by Neer and Foster in their preliminary report in 1980, when they reported the results of open inferior capsular shift as a treatment for this condition. A few years later, they defined MDI as symptomatic subluxations or dislocations of the glenohumeral joint in three directions. On the basis of these studies, they concluded that patients with…

Posterior Instability

Introduction Posterior shoulder instability represents an array of disorders, ranging all the way from symptomatic subluxation (symptomatic, excessive translation of the humeral head on the glenoid) to multiple frank dislocation events. Posterior shoulder instability events are primarily subluxation events in nature, with complete dislocations comprising only 3% to 8%. , Posterior dislocations are significantly less common than anterior, with the percentage of posterior events accounting for…

Intraoperative and Postoperative Issues With the Latarjet Procedure

Introduction When Bankart originally described anterior glenohumeral instability, he described the labral tear as the essential lesion which was present in over 90% of cases. More recently, however, we have recognized the increasing role of bony anatomy in shoulder stability. Defects, such as glenoid bone loss or a Hill–Sachs lesion of the humeral head, can significantly compromise stability and may compromise the results of labral repair…

Anterior Instability: Intraoperative and Postoperative Issues With Arthroscopic Repair

Introduction Anterior glenohumeral instability is a common problem encountered by the orthopedic surgeon, particularly in young active patients. Young male contact-sport athletes with anterior shoulder instability who do not undergo surgical stabilization have particularly high rates of going on to develop recurrent anterior instability, with recurrence rates approaching 90%. , The critical lesion in over 90% of anterior glenohumeral instability cases is the Bankart lesion, in…

Anterior Instability: Preoperative Issues

Background Traumatic instability of the shoulder joint is generally associated with a Bankart lesion, in which the anteroinferior glenoid labrum and inferior glenohumeral ligament (IGHL) detach from the glenoid. , Although open or arthroscopic surgery is the standard treatment approach for shoulder instability, there are several preoperative complications that directly influence patient outcome and surgical success. The most pertinent include the presence of glenoid bone loss,…

Knee Osteotomies

Introduction Osteotomies around the knee play a pivotal role in the treatment and prevention of osteoarthritis. They are also used as concomitant procedures to other joint preservation techniques, such as meniscal transplantation and articular cartilage restoration, and in the treatment of ligamentous instability. As such, realignment procedures in both the proximal tibia, distal femur, and tibial tubercle are regularly performed using a variety of techniques, all…

Patellar Instability

Introduction Patellar instability is a common cause of knee dysfunction in adolescents and young adults, with primary patellar dislocations occurring at an incidence of 42 per 100,000 person-years. Management after first-time dislocation can include conservative measures such as nonsteroidal antiinflammatory drugs, bracing, and physical therapy. In cases of recurrent patellar instability, surgical stabilization may be indicated. Determining the appropriate surgical procedure requires the assessment of soft…

Cartilage Surgery in the Juvenile

Background Focal articular cartilage lesions or defects are common in arthroscopic surgery of the knee. Chondral defects may occur as a result of overt trauma, but can also occur because of a de novo process such as osteochondritis dissecans (OCD). Although it is thought that OCD affects the subchondral bone, these lesions can become unstable and thus involve overlying cartilaginous changes. Epidemiologic data on articular cartilage…

Cartilage Surgery in the Adult

Introduction Chondral injuries are becoming an increasingly recognized cause of pain and disability in the knee. , When patients with focal symptomatic chondral defects fail nonoperative management, surgical intervention is offered. There are many options for surgical treatment of symptomatic cartilage defects, and these options can be separated into palliative, reparative, restorative, and reconstructive procedures. Palliative procedures include lesion debridement and loose body removal. Reparative procedures…

Multiple Ligament Injury

Introduction Multiligament injuries can pose challenging scenarios in terms of treatment protocols because of the complex nature of the injury mechanisms and potential complications that may occur. A knee dislocation is defined as an episode where at least two of the four major ligaments of the knee, being the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and/or the fibular/lateral collateral ligament…

Lateral Collateral Ligament

Introduction Research regarding the posterolateral corner (PLC) of the knee has significantly improved our understanding of the anatomy and biomechanics it encompasses, yielding vital information regarding the three major stabilizing structures of the PLC: the fibular (lateral) collateral ligament (FCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL) (shown in Fig. 18.1 ). This greater understanding has allowed for a substantial advancement in the treatment…

Medial Collateral Ligament

Introduction The medial collateral ligament (MCL) is one of the most frequently injured ligaments of the knee. Earlier studies tended to focus primarily on injury to the MCL; however, recent anatomical and biomechanical work has outlined the importance of the posterior oblique ligament (POL) and the posterior medial capsule (PMC). Although a majority of MCL injuries occur in isolation, complete ruptures are frequently associated with injuries…

Preoperative, Intraoperative, and Postoperative Complications With Posterior Cruciate Ligament

Introduction Posterior cruciate ligament (PCL) injuries are most commonly encountered in the setting of multiligamentous knee injuries. Isolated injuries of the PCL are relatively less common by comparison. A prospective analysis by Fanelli found the rate of PCL injury among acute knee injuries in 222 patients to be 38%, with just 3.5% representing isolated injuries. The most common associated ligamentous injuries included PCL with posterolateral corner…

Complications in Pediatric Anterior Cruciate Ligament Surgery: Transphyseal in Skeletally Immature Patients

Introduction Although once thought to be uncommon, anterior cruciate ligament (ACL) injuries are increasingly recognized in the pediatric and adolescent athletic population. In total, 12% to 36% of children and adolescents presenting with a hemarthrosis after a knee injury have evidence of an ACL injury on magnetic resonance imaging (MRI). Studies have demonstrated that the incidence of pediatric ACL tears has increased at a significantly higher…

Complications in Pediatric Anterior Cruciate Ligament Surgery: All-Epiphyseal Technique

Introduction The all-epiphyseal anterior cruciate ligament (ACL) reconstruction techniques are efficacious alternatives to traditional ACL reconstruction (ACLR) techniques in skeletally immature patients. Current trends in pediatric orthopedics show the growing popularity of the all-epiphyseal ACLR. In a survey study of 71 members of Pediatric Research in Sports Medicine, 33% of pediatric orthopedic surgeons recommended an all-epiphyseal ACLR technique in a hypothetical 8-year-old patient with a complete…

Complications in Pediatric Anterior Cruciate Ligament Surgery: The Iliotibial Band Technique

Introduction The incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients increases continuously. This increase is partially because of the developed awareness of the condition and seeking of medical treatment, but also owing to an actual increase of ACL injuries in children, because of greater year-round participation in organized sports at a younger age and early sports specialization. , As a consequence, the number…

General Considerations and Complications for Pediatric Anterior Cruciate Ligament Reconstruction

Introduction Although once considered rare among skeletally immature patients, anterior cruciate ligament (ACL) injuries have increased in frequency among children and adolescents over recent years. , The observed increase in the incidence of ACL injuries may be related to any combination of a rise in youth sports participation, single-sport specialization, increased training time and intensity, and enhanced recognition of ACL tears with improved diagnostic modalities. In…

Complications in Anterior Cruciate Ligament Revision Reconstruction

Introduction With approximately 200,000 anterior cruciate ligament (ACL) tears per year, primary anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopedic procedures performed, and accounts for $1 billion to $2 billion dollars in healthcare per year. ACL tears frequently result from sports-related injuries, especially those activities with noncontact pivoting or cutting motions, and many of the patients are younger and expect a full…