Arthroscopy of the acromioclavicular joint.

For many years the Mumford procedure or open resection of the distal clavicle has been the procedure of choice for the treatment of recalcitrant acromioclavicular joint pain. With advancement in shoulder arthroscopy and bursoscopy, arthroscopic resection of the distal clavicle can reproduce similar excellent results, avoiding some of the risks of the open procedure, including joint instability and muscle weakness. The arthroscopist can select from two approaches, a direct or superior approach or the indirect or subacromial approach. Both approaches are effective if the resection is performed in a systematic fashion and the amount of resection measured post-operatively. The authors have attempted to describe the pertinent anatomy of the acromioclavicular joint, clinical indications, and surgical technique for arthroscopic resection of the distal clavicle.

Risk factors for arthroscopic popliteal artery laceration.

A case report is presented in which a patient with well-documented pigmented villonodular synovitis sustained a disruption of the popliteal artery without evidence of penetration of the posterior capsule. The patient had had several extensive open synovectomies in the prior 20 years. These included popliteal space exposure and dissection. At the time of open arterial repair, multiple nodules of pigmented scar were noted densely binding the popliteal artery to the surrounding muscle and fascial tissues. The arthroscopist should be aware that distension and instrumentation of the knee joint in such patients should be performed with extreme care to avoid arterial disruption.