Basics of hip arthroscopy: Step-by-step technique.

Hip arthroscopy is a surgical procedure that has a technically challenging nature, requiring advanced spatial skills and specialised instrumentation. The most common indication for hip arthroscopy is femoroacetabular impingement, which is increasing due to improved awareness and knowledge of the condition among healthcare professionals. Hip arthroscopy requires many different checkpoints from patient positioning to capsule closure to be successfully completed. Patient positioning is one of the keystones of hip arthroscopy and the probability of a surgeon achieving successful outcomes is significantly influenced by the establishment of optimal access points. The importance of the acetabular labrum and capsule has been better understood in recent years. There has been a noticeable preference towards prioritising acetabular labral repair over debridement or excision. Similarly, consistent with the literature, capsule closure restores naive hip biomechanics more successfully and improves functional outcomes following hip arthroscopy. Osteochondroplasty is a frequently employed therapeutic intervention; yet, attaining optimal osteochondroplasty outcomes might present challenges. The aim is, to restore the full perfect sphericity of the femoral head without attenuation of the head. The aim of this article is to highlight the knowledge accumulated from experiences based on previous hip arthroscopy surgeries as a solution for future troubleshooting steps. Level of Evidence: Level V.

Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review.

BACKGROUND: Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. METHODS: Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases "suprapectoral," "subpectoral," "tenodesis," and "long head of biceps tendon". Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. RESULTS: From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. DISCUSSION: Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area.Level of evidence: IV.

Treatment of Relapsed and Neglected Pes Equinovarus with Binary Arthrodesis and Hexapodal Spider Frame.

PURPOSE: The aim of this study was to assess the clinical and radiological outcomes of patients with recurrent or neglected pes equinovarus (PEV), who underwent talonavicular or calcaneocuboid arthrodesis with a hexapod spider frame. METHODS: The study included 18 patients; a total of 25 feet were treated with dual arthrodesis and a hexapod spider frame. The International Club Foot Study Group (ICFSG) scoring system and visual analog scale (VAS) were used to assess preoperative status and postoperative outcomes. All functional, morphological and radiologic evaluations during the follow-up were done as described by Kling et al. RESULTS: Patients were followed up for an average of 24.1 ± 11.8 months. The mean age of our cohort was 8.84 ± 2.83 years. The mean duration of correction was 3 weeks and the mean duration treatment length was 15.3 ± 1.9 weeks. Postoperative assessment revealed eight excellent, 13 good, and four poor outcomes, according to the ICFSG scoring system. There was a significant difference between preoperative and postoperative ICFSG scores, 12 feet showed an excellent outcome, 12 feet had good outcomes, and one foot was rated as a failure in the final assessment, based on the Kling criteria. There was also a significant difference between preoperative and postoperative VAS scores. CONCLUSION: Dual arthrodesis plus a hexapod spider frame is a valuable option for patients with recurrent or neglected PEV. It can be offered safely to avoid secondary recurrences and potential complications in cases of rigid feet as well as challenging cases that are resistant to soft tissue manipulation.

Prone-positioned knee arthroscopy for isolated retropatellar cartilage defects with gel-type autologous chondrocyte implantation.

OBJECTIVE: Treatment of isolated retropatellar cartilage defects using current gel-type regenerative methods requires settlement of the gel to the underlying subchondral bone under gravity; thus, prone positioned arthroscopy is used. INDICATIONS: Isolated retropatellar contained cartilage defect size >2.5 cm2. Age <40 years, epiphyseal closure, cartilage defect grade 3/4 (International Cartilage Repair Society). CONTRAINDICATIONS: Cartilage defects at medial or lateral femorotibial compartments, at the trochlea, with degenerative genesis, rheumatoid arthritis, local infection, patellar malalignment, patellofemoral dysplasia, knee instability, knee malalignment >3°, kissing lesions. SURGICAL TECHNIQUE: Two-stage procedure: At initial arthroscopy, chondrocytes were harvested. At the second stage, the patient was positioned prone and the leg with a thigh tourniquet was fixed in a leg holder. Removal of table extension below the knee and support of foot in sling to prevent knee hyperextension. Placement of 2 lateral portals. Lesion visualized and debrided, followed by aspiration of intra-articular fluid. A loop, placed posterior to the patellar ligament using a lasso, was used to suspend a weight to expand the patellofemoral space. The lesion was then dried using a sponge. NOVOCART® Inject (TETEC, Reutlingen, Germany) administered onto the defect. Gel was allowed to solidify for 15 min and operation was completed. POSTOPERATIVE MANAGEMENT: Knee locked in extension using a brace for 6 weeks. Continuous passive motion applied and incrementally increased until full range of motion (ROM) at week 6. Weight-bearing as tolerated was allowed with the knee in extension. Routine clinical follow-up after 3, 6 and 12 months. RESULTS: Mean age of the 5 patients was 23 ± 6 (range 14-30) years; mean follow-up time after surgery 28 ± 7 (range 20-40) months. All patients returned to full activity without residual knee ROM restriction. Clinical examination at the latest follow-up revealed a Kujala score of 90 ± 12 points and Lysholm score of 95 ± 5 points. MRI showed filled cartilage defects in all patients. Mocart score was 63 ± 7 points. Cartilage was inhomogeneous and hyperintense at the repaired site. Quantitative measurement of the patella mobility of the operated knee under a translating force of 10 N showed medial and lateral displacements of 21 ± 5 and 15 ± 2 mm and on the healthy side 22 ± 5 and 19 ± 3 mm, respectively.