Use Of Accessory Portal Research Articles

Comprehensive Arthroscopic Shoulder Stabilization in the Lateral Decubitus Position

Arthroscopic shoulder stabilization offers a safe and effective means for restoring glenohumeral mechanics in the setting of shoulder instability. Modern arthroscopic techniques have allowed improved access and efficiency when treating patients with shoulder instability. However, access to certain areas of the labrum and the creation of safe accessory portals can still prove difficult for the arthroscopic surgeon. Currently, there is debate as to the ideal patient position, portal location, equipment, and technique for addressing anterior–inferior labral pathology. The following article presents a safe and effective approach to accessing the labrum for treatment of shoulder instability in the lateral decubitus position. In addition, this paper highlights the use of accessory portals, including a percutaneous “7-o’clock” portal for suture anchor placement, along with multiple types of suture anchor and suture shuttling techniques.

Subtalar Joint Preparation Using 2 Portal Posterior Arthroscopic Technique vs Sinus Tarsi Open Approach: A Cadaveric Study

Category:Ankle, Arthroscopy, Basic Sciences/BiologicsIntroduction/Purpose:Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. Subtalar fusion can be done through open approach or arthroscopic technique. Arthroscopic technique is associated with rapid recovery; however, it requires adequate training and skill. Arthroscopic technique can be done through lateral or posterior portals. Sometimes it may be necessary to use accessory portal to open or distract the joint for adequate joint preparation. Use of accessory portal may result in injury to the neurovascular structure. Whatever the technique, one of the most important aspects of fusion is adequate preparation of the joint. Aim of our study is to compare the preparation of subtalar joint using sinus tarsi open approach and posterior subtalar scopy using 2 portal technique in cadaveric specimens.Methods:We used 20 below knee fresh-frozen cadaver legs for this cadaveric study. Subtalar joints of ten specimens were prepared through the lateral approach, while the remaining ten joints were prepared using sinus tarsi incisions. After the completion of preparation, all ankles were dissected open, photographic images of calcaneal and talar articular were taken. (Image)Surface areas of each articular facet and prepared area of the talus, distal tibia, and distal fibula were measured and analyzed.Results:Open technique results in better preparation of joint surface in calcaneus and overall. While open technique results in preparation of 92% joint surface (combined talus and calcaneus), arthroscopic technique results in in 80% of joint surface. Open technique results in better preparation of calcaneus (79vs 94%). The anterolateral corner of calcaneus was difficult to be reached using the scope and unprepared in most cases. There was no significant difference in the preparation of talar articular surface. (Table 1)Conclusion:Open sinus tarsi results in more joint preparation compared to 2 portal posterior arthroscopic technique. The less amount of joint preparation in arthroscopic technique is mostly due to less preparation of AL corner. Of calcaneus. When using posterior arthroscopic technique, it is advisable to use accessory portal to distract the joint to aid in adequate preparation.

Objectification of the effect of repeated hydrodilatation in combination with intensive rehabilitation in patients with frozen shoulder

Arthroscopic shoulder stabilization offers a safe and effective means for restoring glenohumeral mechanics in the setting of shoulder instability. Modern arthroscopic techniques have allowed improved access and efficiency when treating patients with shoulder instability. However, access to certain areas of the labrum and the creation of safe accessory portals can still prove difficult for the arthroscopic surgeon. Currently, there is debate as to the ideal patient position, portal location, equipment, and technique for addressing anterior–inferior labral pathology. The following article presents a safe and effective approach to accessing the labrum for treatment of shoulder instability in the lateral decubitus position. In addition, this paper highlights the use of accessory portals, including a percutaneous “7-o’clock” portal for suture anchor placement, along with multiple types of suture anchor and suture shuttling techniques.

Arthroscopic Repair of a Circumferential 360° Labral Tear

Injuries to the glenoid labrum can result in shoulder instability and pain. These lesions may occur anywhere around the glenoid labrum, and thus, the arthroscopist must be prepared to approach all aspects of the glenoid from multiple angles. The pan-labral or circumferential (360°) tear of the glenoid labrum presents a unique challenge to even the experienced arthroscopist. The extent of the lesion requires the use of accessory portals and percutaneous techniques to establish adequate visualization and to facilitate the proper trajectory for anchor placement. The pan-labral tear also demands intraoperative planning throughout the repair to ensure proper tensioning and alignment of the labrum and capsular tissue. The purposes of this article are to report a technique for repairing a pan-labral lesion and to emphasize the use of accessory portals and percutaneous techniques for complete access to the glenoid.

The Use of Accessory Portals in Bankart Repair With Posterior Extension in the Lateral Decubitus Position

The Bankart lesion, in which the anteroinferior labrum is detached from the glenoid, is the critical anatomic lesion in the majority of patients with anterior glenohumeral instability. Some patients with anterior glenohumeral instability will have Bankart lesions with posterior extension beyond the 6-o'clock position, and achieving anatomic labral repair in these cases can present a technical challenge. In our experience, the lateral decubitus position and use of accessory portals allow superior visualization of the inferior half of the glenohumeral joint for glenoid and labral preparation, anchor placement, and suture management. The use of double-loaded suture anchors at the inferior glenoid provides multiple points of fixation at this challenging location while limiting the number of anchors required. The purpose of this article is to present a simple and reproducible technique for arthroscopic repair of Bankart lesions with posterior extension, emphasizing the use of accessory 5-o'clock trans-subscapularis and 7-o'clock portals.

An Analysis of Technical Aspects of the Arthroscopic Bankart Procedure as Performed in the United States

The purpose of this study was to investigate the intersurgeon variation in technical aspects of performing an arthroscopic Bankart repair. A unique approach with experienced equipment representatives from 3 different arthroscopic companies was used. Experienced representatives were identified by DePuy Mitek, Smith & Nephew, and Arthrex and filled out questionnaires on how their surgeons performed arthroscopic Bankart procedures. This was performed in a blinded fashion with no knowledge of the identities of the specific surgeons or representatives by us. A video on different aspects of the procedure was observed by each representative before filling out the questionnaire to help standardize responses. Data were collected using REDCap (Research Electronic Data Capture). Data were analyzed as an infrequent observation with 0% to 30% of representatives reporting the observation; sometimes, 31% to 70% reporting the observation; and often, greater than 70% of representatives reporting. Seventy-six percent of representatives had 6 or more years of arthroscopic experience. Forty-three percent of representatives reported that their surgeons use 3 portals for the procedure often. Forty-four percent reported that viewing was performed exclusively from the posterior portal while the surgeon was performing the repair. Seventy-three percent reported that the Hill-Sachs lesion was observed often, and 61% reported that the posterior labrum was evaluated often before the repair. Only 25% of representatives reported that the Bankart lesion was extensively released and mobilized often. Thirty-three percent reported 3 anchors as being used often. Seventy-five percent reported biocomposite anchors as being used often. Single-loaded anchors were reported as being used often by 47%. Eighty-one percent reported that sutures were placed in a simple fashion. Eighty-three percent reported the use of any posterior sutures or anchors for additional plication as infrequent. There is significant variation in performance of the arthroscopic Bankart repair in the United States. Areas of concern include completeness of the diagnostic examination, the adequacy of capsulolabral mobilization, variation in the use of accessory portals, and inconsistent use of additional capsular or labral plication or fixation.

Easy and Safe All-Inside Suture Technique for Posterior Horn Tears of Lateral Meniscus Using Standard Anteromedial and Anterolateral Portals

The importance of the lateral meniscus in weight bearing, distribution of force, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication is well known. Surgeons currently agree on the importance of preserving the menisci. Different suture techniques have been standardized. These include outside-in, inside-out, and all-inside techniques. The all-inside technique can be used to repair lesions of the posterior horn of the lateral meniscus. However, this technique presents important disadvantages, such as the necessity for an accessory portal and a high risk of neurovascular damage. For these reasons, we have developed a technique in which a suture hook and a shuttle relay are used to pass the suture wire through the meniscal lesion of the posterior horn of the lateral meniscus with an all-inside technique, without the use of accessory portals and cannulas, with a standard 30° arthroscopic camera.

Humeral Avulsion of Glenohumeral Ligaments

Humeral avulsion of glenohumeral ligaments (HAGL) is an increasingly recognized cause of recurrent shoulder instability. HAGL lesions are the result of acute traumatic glenohumeral subluxation or dislocation. Anterior avulsion of the inferior glenohumeral ligament from the humeral neck is the more common lesion; however, posterior lesions are seen as well. Careful history and physical examination are critical in the diagnosis of HAGL lesions. MRI is the best imaging study for diagnosing these lesions. Injection of intra-articular contrast dye aids in visualization. Most HAGL lesions cause recurrent instability and require surgical repair. Arthroscopic repair with the use of accessory portals has yielded promising results. Excellent results have been achieved with open surgical management using a subscapularis incision. Mini-open techniques involve limited incision in the lower one half of the subscapularis.

The Value of Intercondylar Notch Visualization of the Posteromedial and Posterolateral Compartments During Knee Arthroscopy

Summary: The intercondylar notch views allow for visualization of the posteromedial and posterolateral compartments of the knee without the use of accessory portals. The purpose of this study was to prospectively evaluate whether these views are useful either diagnostically or therapeutically in the performance of knee arthroscopy. Two surgeons at one institution performed 150 consecutive knee arthroscopies. After arthroscopic examination of the knee using standard portals, a diagnosis and treatment decisions were made. Thereafter, visualization of the posteromedial and posterolateral compartments through the intercondylar notch was undertaken. Each view was performed initially with a 30° arthroscope and 3 questions were asked: (1) Did the view change the diagnosis or add additional information? (2) Did it change the surgical treatment? (3) Was it useful during performance of the procedure? The 70° arthroscope was then used and the same three questions were addressed. In 20.6% of the cases, the intercondylar notch views made a diagnostic and/or therapeutic difference, and the surgical procedure was changed in 11.3% based solely on this information. The views were 3 times as likely to make a difference in anterior cruciate ligament (ACL) reconstructions when compared with arthroscopy without ACL reconstruction (P < .01). The 70° arthroscope added nominal additional information. There were no significant complications. We advocate visualization of the posteromedial and posterolateral compartments through the intercondylar notch as a valuable part of routine knee arthroscopy.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 8 (November), 1999: pp 813–817