Subject(s)
Ambulatory Surgical Procedures/methods , Anterior Cruciate Ligament/surgery , Arthroscopy/methods , Endoscopy/methods , Adolescent , Adult , Ambulatory Surgical Procedures/economics , Clinical Protocols , Costs and Cost Analysis , Endoscopy/economics , Female , Humans , Male , Middle Aged , Patellar Ligament/transplantation , Postoperative Complications/etiology , Prospective Studies , Transplantation, Autologous/methodsABSTRACT
The ACL is a complex structure, and its replacement involves precise surgical technique, which relates directly to its function in constraining anterior tibial translation. Many techniques have been developed for reconstruction of the ACL. Here we have described our method of choice for arthroscopically assisted graft placement, which uses the middle-third patellar tendon autograft placed using a press-fit fixation technique. This technique was developed to avoid drawbacks encountered with fixation using an interference screw. Biomechanical testing has shown this technique to be similar in pull-out strength to fixation obtained with an interference screw, but without the associated technical difficulties. One other benefit of this technique, which is not readily apparent, and not one that we, as surgeons, would ever hope to take advantage of, is that should a revision ACL reconstruction be necessary in the future, there is no interference screw in the femur to remove.
Subject(s)
Anterior Cruciate Ligament/surgery , Endoscopy/methods , Patellar Ligament/transplantation , Arthroscopy , Femur/surgery , Humans , Postoperative Care , Tibia/surgery , Transplantation, Autologous/methodsSubject(s)
Anterior Cruciate Ligament/surgery , Arthroscopy/methods , Intraoperative Complications/etiology , Patellar Ligament/transplantation , Bone Transplantation , Endoscopy/methods , Humans , Intraoperative Complications/prevention & control , Transplantation, Autologous , Transplantation, HomologousABSTRACT
The superficial branch of the radial nerve was dissected using loupe magnification in 20 cadaver forearms. The nerve was found to arise between the tendons of the branchioradialis and extensor carpi radialis longus 8.6 cm proximal to the radial styloid, piercing the forearm fascia 6.0 cm from the radial styloid. An average of 5.8 branches crossed the wrist joint. Innervation to the dorsum of the digits was variable, with 45% of specimens innervating the radial 2 1/2 digits and 30% innervating the radial 3 1/2 digits. Sixteen specimens had branches directly overlying the typical transverse incision for De Quervain's release and 12 specimens had branches directly overlying the 3-4 wrist arthroscopy portal. An appreciation for the location of the superficial radial nerve in the forearm, the variation of its digital innervation, and the proximity of branches to commonly used surgical incisions is important when performing surgical procedures over the dorsum of the hand and wrist.
