Editorial Commentary: Suture Button Fixation for the Latarjet Procedure Is Superior to Screw Fixation.

An increasing body of evidence suggests that suture button fixation is comparable with screw fixation in Latarjet and potentially associated with reduced graft resorption. Suture button fixation may facilitate performing the Latarjet procedure, particularly when done in an arthroscopic manner. The use of suture button fixation technique theoretically facilitates improved positioning of the graft on the glenoid, as it frees the surgeon from the potential of the soft-tissue envelope to impact positioning of the graft, which can occur with screw-based guides. The bone graft can be shuttled into an optimal position and then tensioned with relative ease in comparison with screw-based techniques. Suture button fixation results in lower complication rates compared with screw fixation; almost one third of the screw fixation complications are hardware-related, and screw fixation results in a high rate of hardware removal. Moreover, the arthroscopic Latarjet suture button literature is published by experienced surgeons. Arthroscopic Latarjet has a significant learning curve, reducing the translatability of studies that report superior findings with any one technique. The generalizability of results reminds us that evidence-based medicine should be practiced through the lens of not only patient preferences, but also through an honest appraisal of a surgeon's own ability.

Anchorless Acromioclavicular and Coracoclavicular Ligament Repair Using a Graft-Passing Instrument to Pass Suture Under the Coracoid.

Acromioclavicular joint separation is a common shoulder injury. Grade I and II separation may be treated nonoperatively, whereas higher grades tend to require surgical intervention. Various repair techniques have been described in the literature, with no consensus on the gold standard. This Technical Note describes our use of a graft-passing instrument to pass suture under the coracoid during an anatomic reconstruction of both the acromioclavicular and coracoclavicular ligaments. Although this approach is technically challenging, it avoids coracoid drilling and requires smaller-diameter clavicle and acromion drilling. Furthermore, using suture instead of graft material increases the cost-effectiveness of the procedure.

Evaluation of Osteochondral Allograft Transplant Using In-Office Needle Arthroscopy.

In-office needle arthroscopy (IONA) has been available in various iterations for decades. Studies have described it as comparable if not superior to magnetic resonance imaging for identifying intra-articular pathology with associated cost savings per patient. A new IONA system has been brought to market with a modernized user interface and disposable handpieces offering the opportunity to address intra-articular pathology. This article outlines the use of this IONA system for the postoperative evaluation of an osteochondral allograft transplant.

Single-Portal, Single-Anchor Repair of a Superior Third Subscapularis Tear Using a Self-Punching Knotless Soft Suture Anchor.

Numerous techniques exist for arthroscopic subscapularis repair with varying degrees of complexity based on tear morphology, all of which have established satisfactory outcomes in function and patient satisfaction. Arthroscopic subscapularis repair can require several working portals and suture anchors, increasing both technical complexity and operative time. This Technical Note describes an arthroscopic repair of a superior one-third subscapularis tear using a self-punching knotless soft suture anchor through a single anterior working portal. Thus, we offer a unique approach to arthroscopic repair of superior one-third subscapularis tears that is time-saving, reproducible, and highly efficient while minimizing iatrogenic damage and postoperative complications.

Arthroscopic Single Portal, Single Anchor Knotless Subscapularis Repair with Concomitant Tenodesis of the Long Head of the Biceps Tendon.

Anterior shoulder pathology involving the subscapularis is often associated with the biceps tendon because both anatomic structures intersect the lesser tuberosity. Standard procedures for such pathology often involve simultaneous subscapularis repairs and biceps tenodesis. Single anterior portal subscapularis repairs have been emerging in the past 5 years because of cost-effectiveness and efficiency. Biceps tenodesis is a common procedure performed both open and arthroscopically. This technique takes advantage of the close relation between the long head of the biceps tendon and subscapularis tendon to restore the functional length-tension relation and preserve function through fixation using a single portal and a single knotless suture anchor.

Stemless Total Shoulder Arthroplasty With Orthobiologic Augmentation.

Total shoulder arthroplasty (TSA) has evolved over the years and is used for a variety of indications, with arthritis being the most common. Stemless TSA is a unique bone-preserving design that can eliminate rotational malalignment. Additionally, recent literature has found utility in the use of biological mesh and a platelet-rich plasma injection to improve healing. The purpose of this article is to outline the process of TSA using a stemless system and how to incorporate the use of amnion matrix and platelet-rich plasma into the surgical technique.

Mini-Open Subpectoral Biceps Tenodesis Using a Suture Anchor with Bone-Bridge Backup.

Pathology of the long head of the biceps tendon is a known cause of anterior shoulder pain. Current surgical management options include tenotomy and tenodesis. Tenodesis can be performed arthroscopically or as an open procedure. Arthroscopic tenodesis typically uses a suprapectoral attachment, which may fail to address tendon pathology in the bicipital groove. Open tenodesis carries iatrogenic risk to neurovascular structures and a fracture risk while drilling, as well as the morbidity of an open procedure. This technique paper describes a mini-open subpectoral approach using a suture anchor and bone bridge backup for dual fixation. Use of a suture anchor instead of an interference screw reduces drill hole diameter reducing the risk of iatrogenic humeral fracture. Dual fixation provides a robust repair which may be of use for athletic patients desiring an accelerated recovery.

Tibial Plateau With Arthroscopic Reduction-Internal Fixation.

Arthroscopic-assisted internal fixation is an ideal technique for visualizing chondral reduction during tibial open reduction-internal fixation. Typically, open reduction-internal fixation is performed using radiographic and Fluoroscan imaging (Hologic, Bedford, MA) for reduction of subchondral bone. However, reduction without visualization does not ensure chondral surface reduction. This Technical Note and supplemental video describe an arthroscopic-assisted technique involving the tibial plateau that gives complete visualization as tamping occurs to restore the cartilage surface of the subchondral bone and elevate the fracture.

Arthroscopic Harvesting of Autologous Bone Graft for Use as a Mesenchymal Stem Cell Carrier in Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) tears are detrimental to knee stability and normal function. Although the standard of treatment is an ACL reconstruction, technical improvements are sought to enhance clinical outcomes due to the appreciable failure rate. The use of autologous biologic substances as carriers of stem cells are desirable because of their multipotent properties. Traditionally, the collection of autologous bone grafts is through an open incision of the iliac crest, which causes substantial morbidity to the patient. This Technical Note describes an arthroscopic, minimally invasive collection method of autologous tibial and femoral bone graft to use in backfilling the tunnels during an ACL reconstruction to improve graft incorporation and clinical outcomes.

Inside-Out Bucket-Handle Meniscus Repair With a Single-Handed Self-Advancing Zone-Specific Meniscus Repair Device.

Meniscus tears are among the most common knee injuries in the general population and often are treated arthroscopically with a meniscus repair. Of the various meniscus repair techniques available, the inside-out meniscus tear is considered the gold standard due to its versatility and good clinical outcomes. The purpose of this Technical Note and accompanying video is to describe an inside-out bucket-handle meniscus repair using a single handed, self-advancing meniscus repair device with an interchangeable zone-specific multicannula system to decrease the technical difficulty and operative time of the repair.

Transtibial Pull-Out Repair of Converted Radial Tear Adjacent to Medial Meniscus Root.

Radial tears increase tibiofemoral contact pressure and disrupt the ability of the meniscus to withstand hoop stress, leading to earlier-onset osteoarthritis. Repair of radial tears is problematic because they have a lower healing rate and lack a single gold standard technique. However, when a radial tear is proximal to the root, there is an opportunity to convert it into a root tear. This is ideal because root tears fixed through a transtibial tunnel technique have improved clinical outcomes and reduced rates of osteoarthritis. This Technical Note and accompanying video describe a method for repairing a radial tear near the meniscus root by converting a radial tear to a root tear followed by a pull-out root repair through a transtibial tunnel. This method restores the meniscus root, allowing it to withstand hoop stress. Our technique uses a disposable root repair kit that includes a FlipCutter, a Knee Scorpion Suture Passer, a 4.75-mm SwiveLock anchor tap, a SutureLasso, a PassPort Cannula, 0 FiberLink sutures, and TigerLink sutures.

Arthroscopic Double-Pulley Remplissage Using a 2-Portal Technique for Hill-Sachs Lesions in Recurrent Anterior Shoulder Instability.

Hill-Sachs lesions of the humeral head are associated with recurrent anterior shoulder instability. Arthroscopic double-pulley remplissage has emerged as the leading alternative to the open Latarjet procedure to address recurrent shoulder instability with comparable recurrence rates and favorable complication rates. This Technical Note describes our adaptation of the double-pulley remplissage technique by using 2 portals, with the anterior portal used as the viewing portal and suture passage through the posterior portal. This technique eliminates the need for a lateral percutaneous portal, consequently minimizing operative time and postoperative morbidity. Furthermore, using the anterior portal as the viewing portal allows for direct visualization of the reduction of the infraspinatus into the Hill-Sachs defect. The drawback of this technique is that there is no view of the subacromial space during knot tying.

Stem Cell-Infused Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) tears are unfortunate but common injuries in the athletic population. The standard of care for ACL tears is a surgical intervention to reconstruct the ACL to restore knee functionality as well as quality of life. In recent years, bone marrow aspirate concentrate (BMAC) has seen increasing use in various orthopaedic settings. This increase can be attributed to the potential beneficial qualities that mesenchymal stem cells, progenitor cells, and growth factors, all of which are present in BMAC, can provide. In this technical note and accompanying video, we describe an anatomic allograft ACL reconstruction infused with BMAC to utilize BMAC's potential benefits.

Acromioclavicular Joint Repair Using a Suture Cerclage Tensioning System.

Injuries to the acromioclavicular (AC) joint are common among adults in their twenties and account for 8% of all joint dislocations. Although there are numerous operative approaches to treating AC joint separations, a gold standard does not exist because of lack of conclusive evidence supporting the use of 1 standard technique. In this Technical Note and accompanying video, we describe an anatomic AC joint repair using a suture cerclage tensioning system to accurately control the reduction and improve the precision and outcomes of the repair.

Prenatal intrapericardial teratomas: diagnosis and management.

We present a 21-week gestation fetus, who upon routine investigation was noted to have a left-sided pleural effusion. The pregnancy was terminated, and at autopsy, a diagnosis of intrapericardial teratoma was confirmed. Primary cardiac tumors in infants and children are rare, and intrapericardial teratomas are even more so. In this brief case report, we review intrapericardial teratomas and present pertinent diagnostic and management options.

Hypertrophic cardiomyopathy presenting as restrictive cardiomyopathy: a case complicated by biventricular apical aneurysms and papillary fibroelastoma.

This report describes a 45-year-old male patient with nonobstructive hypertrophic cardiomyopathy, biventricular apical aneurysms, and papillary fibroelastoma. Histology revealed muscle fiber disarray, interstitial fibrosis, and mural vessel changes. The wall of the aneurysms showed fat infiltration, and loss and replacement of muscle fibers with fibrous tissues. A review of the literature suggests that this case is the first reported experience with the three pathologies occurring in combination.