https://www.vumedi.com/video/arthroscopic-double-row-subscapularis-repa…
Technique
- extra-articular
Portals
- posterior portal very lateral so can see anterior aspect subacromial space
- port of Wilminton at anterolateral acromion to access SSC
- anterior portal in normal position, slightly more lateral so becomes working portal
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
Pigmented Villo-Nodular Synovitis
- benign inflammatory process that arises in synovial tissues
- contains significant amounts of hemosiderin
Age: 20 - 50
Sex: M > F
A. Diffuse
- throughout joint synovium
- more difficult to treat / excise fully
Position
- beach chair / lateral
- water pump, adrenaline in bags
- block pre-op useful as easier to control BP
- often inject the SAD with combination of LA with A prior to scope
Posterior portal
- 2 cm inferior, 1 cm medial
- soft spot between IS and Tm
Enter subacromial space
- sweep to clear adhesion
- saline on pump at 30 - 40 - 50
1. Establish portals
A. Posterior portal for viewing
B. Anterior portal
- need to keep low and away from biceps, otherwise difficult to get around biceps
- for suture passage, if in combination with bankart repair often use AI portal instead of AS
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
Arthroscopic
- intra-articular
- suprapectoral
Open
- suprapectoral
- subpectoral
Concept
Improved cosmesis
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 ~ 5o valgus
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