Vikram K Kandhari, Bibhas DasGupta, Deepak N Bhatia
Volume 2 | Issue 1 | Jan – Apr 2017 | Page 20 – 28
Author: Vikram K Kandhari [1], Bibhas DasGupta [1], Deepak N Bhatia [1].
[1] Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra,
[2] Sportsmed Mumbai, Parel, Mumbai, Maharashtra, India
Address of Correspondence
Dr. Deepak N Bhatia,
Department of Orthopaedic Surgery, Seth GS Medical College, and King Edward VII Memorial Hospital,
Parel, Mumbai – 400 012, Maharashtra, India.
E-mail: shoulderclinic@gmail.com
Abstract
Significant bone defects of glenohumeral joint play an important role in the management of shoulder instability. Bony instability is an important cause of failed soft-tissue repair and recurrent episodes of shoulder dislocations. Bony instability can also be associated with labral (superior and posterior) tears, humeral avulsion of glenohumeral ligament lesions, or rotator cuff tears. Computed tomography (CT) scan with three-dimensional reconstruction is essential for quantification of glenohumeral bone loss. Magnetic resonance imaging (MRI) is reliable for quantification of bone loss, and in addition, demonstrates the soft tissue pathology. Surface area based methods of quantifying glenoid bone loss are more accurate than width based methods. Certain factors important in managing patients with anterior glenohumeral instability include patients’ age, level of sports participation, involvement with contact sports, time of presentation (acute or chronic), and type of bony defect (bony Bankart or attritional bone loss). Soft-tissue reconstruction procedures (labroplasty and remplissage) are usually used in managing patients with nonsignificant bone loss. Patients having significant bone defects of glenoid (>25%) and humerus (off-track/engaging Hill-Sachs lesions) are candidates for open bone grafting of glenohumeral bone defects. Coracoid transfer(Latarjet procedure), either mini-open or arthroscopic gives good functional results and decreases chances of recurrence. Associated lesions should be addressed concomitantly to improve the functional outcome in patients with bony instability of the shoulder. This review presents an evidence-based comprehensive diagnostic and treatment options for patients with bony glenoid deficiency in anterior shoulder instability.
Keywords: Shoulder instability, Hill-Sachs lesion,Labroplasty, Latarjet procedure,Remplissage, Glenoid bone loss, Bony Bankart.
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| How to Cite this article:. Kandhari VK, DasGupta B, Bhatia DN. Current Trends in Management of Glenoid Bone Loss in Anterior Shoulder Instability. Asian Journal of Arthroscopy Jan – April 2017;1(2):20-28. |
Medial Patellofemoral Ligament Reconstruction- State of the Art
Benjamin F Sandberg, Marc A Tompkins
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 17-23
Author: Benjamin F Sandberg [1], Marc A Tompkins [1,2]
[1] The Orthopaedic Speciality Clinic, Wrangler Paranjpe Road, Pune
[2] Head, Translational Medicine & Research, SRM University, Kattankulathur, Tamil Nadu
Address of Correspondence
Dr. Sachin Ramchandra Tapasvi,
The Orthopaedic Speciality Clinic, Wrangler Paranjpe Road, Pune
Email: stapasvi@gmail.com
Abstract
The management of recurrent patellar instability has undergone progressive changes over the past few decades with improved optimal and predictable outcomes for the patients. Open surgical realignment procedures with bony osteotomies either proximal or distal to the Patella, designed to correct the imbalance of the extensor mechanism such that the patella tracks smoothly over the trochlea were commonly advocated. These procedures aimed to restore normal chondral loading of the patellofemoral joint and modify or delay progression of arthritic changes at an early age. With enhanced knowledge on the biomechanics of the anatomical structures providing medial and lateral restraints around the knee, the role of the Medial Patello-Femoral Ligament has been shown to be a vital one. This has refined the surgical options available to minimally invasive arthroscopic approaches with satisfying calculable results. This review article outlines the evolution of the surgical management of patellar instability and the prominent role of the MPFL reconstruction in achieving it. The biomechanics, surgical principles, anatomic landmarks, types of grafts and fixation methods, along with the senior surgeon’s preferred surgical technique are described in detail.
Keywords: Recurrent patellar instability, Medial Patello-Femoral Ligament, reconstruction.
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49. Hohn E, Pandya NK. Does the utilization of allograft tissue in medial patellofemoral ligament reconstruction in pediatric and adolescent patients restore patellar stability? ClinOrthop Related Res 2016;475:1563-9.
50. vonEngelhardt LV, Fuchs T, Weskamp P, Jerosch J. Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension. Knee Surg Sports TraumatolArthrosc 2017;???:???.
51. Joyner PW, Bruce J, Roth TS, Mills FB 4th, Winnier S, Hess R, et al. Biomechanical tensile strength analysis for medial patellofemoral ligament reconstruction. Knee 2017;24:965-76.
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The Role of Imaging in the Evaluation of Patellar Instability
Benjamin F Sandberg, Marc A Tompkins
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 10-16
Author: Benjamin F Sandberg [1], Marc A Tompkins [1,2]
[1] Department of, TRIAOrthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431,
[2] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454
Address of Correspondence
Dr. Bradley J Nelson,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200,Minneapolis, MN 55454.
E-mail: ???
Abstract
Patellar instability is a complex problem that requires a thorough evaluation and work up. A critical part of this work up is appropriate imaging. This article reviews key imaging techniques and important imaging findings in patellar instability patients. This includes the evaluation of patella alta, trochlear dysplasia, lateral patellar tilt, extensor mechanism alignment, valgus alignment, rotational alignment, and soft tissue injury. Effective management for patellar instability relies on a comprehensive approach where any of these elements are evaluated when necessary.
Keywords: Patellofemoral Instability, Patellar Instability, Patellar Dislocation, Imaging.
References
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26. Saggin PR, Dejour D, Meyer X, Tavernier T. Computed Tomography and Arthro-CT Scan in Patellofemoral Disorders. In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis. Berlin: Springer-Verlag; 2010. p. 73-8.
27. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy 2007;23:542-53.
28. Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP. The contribution of different femur segments to overall femoral torsion. Am J Sports Med 2016;44:1796-800.
29. Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: Injury patterns and assessment of risk factors. Radiographics 2010;30:961-81.
30. Tompkins MA, Rohr SR, Agel J, Arendt EA. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: An MRI-based study. Knee Surg Sports Traumatol Arthrosc 2018;26:677-84..
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First-time Lateral Patellar Dislocation: Evaluation and Management
Jarred K Holt, Bradley J Nelson
Volume 3 | Issue 1 | Jan – Apr 2018 | Page 3-9
Author: Jarred K Holt [1], Bradley J Nelson [1,2]
[1] Department of, TRIAOrthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431,
[2] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454
Address of Correspondence
Dr. Bradley J Nelson,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200,Minneapolis, MN 55454.
E-mail: ???
Abstract
Lateral patellar dislocation is a common injury affecting a young, athletically active population. These injuries occur as a direct trauma to the knee or as a result of a twisting mechanism on a planted foot. They are typically accompanied by an audible “pop,” acute pain, and substantial swelling. The nature of the injury results in a variety of bony and soft tissue disruptions including medial patellofemoral ligament tears and osteochondral lesions of the femoral trochlea and inferomedial patella. In the acute setting, initial treatment is directed toward obtaining a concentric reduction, though oftentimes, this has already occurred spontaneously following the injury. Further, management decisions are based on a multitude of factors including concomitant injuries and patient anatomic considerations. Historically, the first-time patella dislocations were treated conservatively; however, more recent literature supports operative care in an effort to prevent recurrent instability events. Given an overall lack of compelling evidence to support either treatment option, it is felt that a thorough risk assessment and shared decision-making model should be employed to guide care of the first-time patella dislocation.
Key words: lateral patellar dislocation, evaluation, surgical management
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Wrist Arthroscopy– Setup, Indications and Complications
Satish Mane, Marwan Hardan, Anup Bansode, Abhijeet L Wahegaonkar
Volume 2 | Issue 2 | Sep-Dec 2017 |
Author: Satish Mane [1], Marwan Hardan [1], Anup Bansode [2],
Abhijeet L Wahegaonkar [1]
[1] Department of Upper Extremity, Hand and Microvascular Reconstructive
Surgery, Sancheti Institute for Orthopedics and Rehabilitation, Pune,
Maharashtra, India,
[2] Department of Hand Surgery, Jehangir Hospital, Pune, Maharashtra, India.
Address of Correspondence
Dr. Satish Mane,
Department of Upper Extremity, Hand and Microvascular Reconstructive Surgery,
Sancheti Institute for Orthopedics and Rehabilitation, Pune, Maharashtra, India.
E-mail: drsatishmane@gmail.com
Abstract
Wrist Arthroscopy, a minimally invasive, outpatient procedure, is a valuable tool in the diagnosis and treatment of most disorders of the wrist. In this article Arthroscopy set up, equipments are described, and operative indications and complications are discussed. Anatomy of Portal is described in details. Portals allow direct visualization of articular surfaces of radio-carpal and mid-carpal joints, triangular fibrocartilage, interosseous and extrinsic ligaments. It offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue.
Keywords: Wrist arthroscopy, indications, portals, complications.
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Chronic Instability of the Distal Radioulnar Joint: Diagnosis and Management
Abhijeet L Wahegaonkar, Steve Rocha
Volume 2 | Issue 2 | Sep – Dec 2017 | Page 2-7
Author: Abhijeet L Wahegaonkar [1], Steve Rocha [1]
[1] Department of Orthopaedics, Upper Extremity, Hand and Microvascular Reconstructive Surgery Service, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
Address of Correspondence
Dr. Abhijeet L. Wahegaonkar
Department of Orthopaedics, Upper Extremity, Hand and
Microvascular Reconstructive Surgery Service, Sancheti Institute
for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email: abhiwahe@gmail.com
Abstract
Chronic Instability of the distal radioulnar joint is not uncommon but often misdiagnosed and mistreated. This review focusses on chronic wrist instability and provides an insight into this uncommon disorder.
Keywords: Distal Radioulnar Joint.
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Wrist Symposium in Asian Journal of Arthroscopy
Abhijeet Wahegaonkar, Sachin Tapasvi
Volume 2 | Issue 2 | Sep – Dec 2017 | Page 1
Author: Abhijeet Wahegaonkar [1], Sachin Tapasvi [2]
[1] Department of Orthopaedics, Upper Extremity, Hand and Microvascular Reconstructive Surgery Service, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
[2] Orthopaedic Speciality Clinic, Pune Mahatrahtra.
Address of Correspondence
Dr. Abhijeet L. Wahegaonkar
Department of Orthopaedics, Upper Extremity, Hand and Microvascular Reconstructive Surgery Service, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
Email: abhiwahe@gmail.com
Wrist Symposium in Asian Journal of Arthroscopy
It is perhaps for the first time that a special issue dedicated to wrist arthroscopy is being published in the Asia-Pacific region.
The advent of wrist arthroscopy has facilitated the diagnosis; improved the understanding of the etiopathogenesis and helped in the development of new therapies for several wrist injuries and pathologies with promising results. Therapeutic wrist arthroscopy has been established as the “Gold Standard” in the management of TFCC injuries and the indications are ever evolving, with contributions from brilliant authors and clinicians from around the world.
Arthroscopy of the wrist was once primarily performed for diagnostic applications. With rapid development of this art and science, the indications have expanded to reparative and reconstructive procedures.
This issue of the Asian Journal of Arthroscopy exposes just the tip of the iceberg of the exciting times ahead in the field of wrist surgery. I sincerely hope that the readers will gain some insight into the most commonly performed arthroscopic procedures such as ganglion excision, TFCC repair and scapholunate ligament repair. This is like a sensitization of what is a potentially “complicated” area even for experienced arthroscopists with the intention to drive away a lot of mental blocks towards wrist arthroscopy. The realm of possibility is ever expanding for anyone who wishes to explore this field.
I am grateful to the authors, each a master of wrist arthroscopy, for taking time off their busy practice and schedule to contribute to advancing science and knowledge.
I would like to take this opportunity to thank the Editors of the Asian Journal of Arthroscopy for entrusting me with the responsibility of compiling this special issue on Wrist Arthroscopy. I do hope our efforts satiates the readers’ appetite for information and knowledge.
Happy reading!
Dr. Abhijeet L. Wahegaonkar | Dr Sachin Tapasvi
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Rehabilitation Postsurgical Stabilization for Shoulder Instability
Shyam Sundar, David V Rajan
Volume 2 | Issue 1 | Jan – Apr 2017 | Page 40 – 48
Author: Shyam Sundar [1], David V Rajan [1].
[1] Ortho OneOrthopaedic Speciality Centre, Coimbatore, Tamil Nadu, India
Address of Correspondence
Dr. Shyam Sundar,
MS Orthopaedics, Ortho One Orthopaedic Speciality Centre, Coimbatore – 641 005, Tamil Nadu, India.
Email: drshyam.msortho@gmail.com
Abstract
The shoulder joint is a polyaxial joint with the advantage of increased mobility at the cost of stability. The incidence of subluxation/dislocation is on the increase considering the fact that children are more actively involved in sporting activities at a very young age. This has necessitated the orthopedic surgeons to identify those at risk of injuries as well as to treat those with injuries to restore normality without compromising the function. Over the recent past, surgical management for shoulder instability has evolved to a more precise level giving importance to the minutest details in respecting and repairing the injured structures. As a result of which the patient’s recovery and functional outcome has been better than how it was earlier. Nonetheless, the success of surgery depends not only on the surgeon or the patient factors but also in the implementation of a tailored rehabilitation protocol focusing on getting the patient back to normalcy at the earliest with minimal discomfort. The aim of this article is to kindle the various aspects of an ideal rehabilitation following surgical stabilization of shoulder instability and to guide in the optimizing treatment protocol.
Keywords: Shoulder instability, Rehabilitation, Proprioception, Kinetic chain.
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Biomechanics and Management of HAGL Lesions in Anterior Instability
Desmond J Bokor, Yuval Arama
Volume 2 | Issue 1 | Jan – Apr 2017 | Page 36 -39
Author: Desmond J Bokor [1], Yuval Arama [1].
[1] Department of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
Address of Correspondence
Dr. Desmond Bokor,
Suite 303, 2 Technology Place,Macquarie University. NSW. 2019, Sydney,Australia.
E-mail:desbok@iinet.net.au
Abstract
Humeral avulsion of the glenohumeral ligament is an uncommon but important cause for recurrent anterior instability of the shoulder. It is usually associated with high energy trauma in a slightly older male population with a hyperabduction/axial load mechanism. Associated damage can include avulsion of the glenoid labrum, rotator cuff tears, and bony damage. Diagnosis requires a high index of clinical suspicion, and MR arthrography performed 4-6 weeks post injury is the most reliable investigation. Care should be taken with MRI performed in the first week, as many of the lesions seen at this time will heal. Surgical repair is recommended for recurrent instability or if the patient requirements need them to have a stable shoulder. Repair can be performed using arthroscopic, minopen or full open techniques. Care should be taken when placing sutures through the capsule because of the proximity of the axillary nerve to the inferior capsular edge. Biomechanically, the capsule should be repaired to the medial humeral neck just below the chondral margin. Surgical outcomes are satisfactory in most series reported.
Keywords: Anterior instability, humeral avulsion of the glenohumeral ligament
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(Abstract) (Full Text HTML) (Download PDF)
Arthroscopic Stabilisation Techniques for Anterior Shoulder Instability
Shiraz Michael Bhatty, Jonathan Herald
Volume 2 | Issue 1 | Jan – Apr 2017 | Page 29 -35
Author: Shiraz Michael Bhatty [1], Jonathan Herald [1].
[1] Fellow, Orthoclinic, Sydney
Address of Correspondence
Dr. Shiraz Michael Bhatty, Fellow, Orthoclinic, Sydney.
Email: shirazbhatty@gmail.com
Abstract
Traumatic anteroinferior dislocation of shoulder in young patients often results in recurrent instability and can be a challenging problem to solve surgically. Treatment of anterior shoulder instability continues to evolve. Arthroscopic shoulder stabilization has become a preferred method of treatment for shoulder instability because reported success rates are parallel to those of open stabilization techniques. This is due to continuing advancement in techniques, instrumentation, improved understanding of the associated pathoanatomy and proper patient selection. In addition to the typical capsulolabral disruptionsseen following a primary dislocation, patients with recurrent instability often have coexistent osseous injury to the humeral head and glenoid. Important considerations during arthroscopy include identifying all pathology, adequate mobilization of the capsulolabral sleeve, retensioning of glenohumeral sleeve and secure anatomic fixation. With advancements in technique and more accurate diagnoses, these outcomes will continue to rise, and patients will more reliably be able to return to prior functioning levels.
Keywords: disclocation of shoulder, pathoanatomy, capsulolabral sleeve.
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Current Trends in Management of Glenoid Bone Loss in Anterior Shoulder Instability
Vikram K Kandhari, Bibhas DasGupta, Deepak N Bhatia
Volume 2 | Issue 1 | Jan – Apr 2017 | Page 20 – 28
Author: Vikram K Kandhari [1], Bibhas DasGupta [1], Deepak N Bhatia [1].
[1] Department of Orthopaedic Surgery, Seth GS Medical College, King Edward VII Memorial Hospital, Parel, Mumbai, Maharashtra,
[2] Sportsmed Mumbai, Parel, Mumbai, Maharashtra, India
Address of Correspondence
Dr. Deepak N Bhatia,
Department of Orthopaedic Surgery, Seth GS Medical College, and King Edward VII Memorial Hospital,
Parel, Mumbai – 400 012, Maharashtra, India.
E-mail: shoulderclinic@gmail.com
Abstract
Significant bone defects of glenohumeral joint play an important role in the management of shoulder instability. Bony instability is an important cause of failed soft-tissue repair and recurrent episodes of shoulder dislocations. Bony instability can also be associated with labral (superior and posterior) tears, humeral avulsion of glenohumeral ligament lesions, or rotator cuff tears. Computed tomography (CT) scan with three-dimensional reconstruction is essential for quantification of glenohumeral bone loss. Magnetic resonance imaging (MRI) is reliable for quantification of bone loss, and in addition, demonstrates the soft tissue pathology. Surface area based methods of quantifying glenoid bone loss are more accurate than width based methods. Certain factors important in managing patients with anterior glenohumeral instability include patients’ age, level of sports participation, involvement with contact sports, time of presentation (acute or chronic), and type of bony defect (bony Bankart or attritional bone loss). Soft-tissue reconstruction procedures (labroplasty and remplissage) are usually used in managing patients with nonsignificant bone loss. Patients having significant bone defects of glenoid (>25%) and humerus (off-track/engaging Hill-Sachs lesions) are candidates for open bone grafting of glenohumeral bone defects. Coracoid transfer(Latarjet procedure), either mini-open or arthroscopic gives good functional results and decreases chances of recurrence. Associated lesions should be addressed concomitantly to improve the functional outcome in patients with bony instability of the shoulder. This review presents an evidence-based comprehensive diagnostic and treatment options for patients with bony glenoid deficiency in anterior shoulder instability.
Keywords: Shoulder instability, Hill-Sachs lesion,Labroplasty, Latarjet procedure,Remplissage, Glenoid bone loss, Bony Bankart.
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