arthroscopic

Aim

Reconstruct anterolateral bundle

Graft Options

A.  4 strand hamstring autograft

B.  Achilles Allograft

- bony block for femur (9 x 20 mm)

- tubularise tendon to fit through 9 or 10 mm tunnel

- don't cut tendon short

Vumedi Dr Bruce Levy Cadaveric video

Definition

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

Epidemiology

Age: 20 - 50

Sex: M > F

Types

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

Bristow

Concept

Non-anatomical bony block 

- transfer of coracoid process through subscapularis

- dynamic anteroinferior musculotendinous sling

- provides subscapularis tenodesis

- preventing lower portion from displacing proximally as arm abducted

- when shoulder in vulnerable position abduction and ER

Advantages

Improved cosmesis

Biomechanics

Able to achieve relatively high level of function after STJ fusion

- previously believed that isolated STJ fusion should not be performed

- believed that triple arthrodesis was operation of choice for hindfoot

- STJ fusion has superior result with less stress on AJ

Average loss of DF 30% / PF 10%

Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints

- imperative that fusion be positioned in ~ 5^o valgus 

Definition

Patients usually complain of subluxation rather than dislocation

- rarely requires reduction

Different entity to acute posterior dislocation usually

Epidemiology

Rare

Aetiology

1.  Ligamentous laxity > 50%

- commonly associated with MDI

- posterior only 20%

- posterior & inferior 20%

Definition

Instability in at least 2 planes

- postero-inferior

- antero-inferior

- antero-postero-inferior

Epidemiology

Recognised as a common problem 

- often misdiagnosed

Most patients athletic

Indications

Indications have narrowed

- due to success of shoulder arthroplasty

1. Chronic infections of GHJ

2. Stabilization in paralytic disorders

3. Post-traumatic brachial plexus palsy

4. Salvage of failed GHJ Arthroplasty

- may need bone graft procedures

5. Arthritic diseases unsuitable for arthroplasty / young patient

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis