OKOJ, Volume 6, No. 7

Techniques for Arthroscopic Subscapularis Repair

In this comprehensive series of surgical technique videos, Dr. Burkhart performs arthroscopic repair of three subscapularis tears: a small partial subscapularis tendon tear without subluxation of the biceps, a massive rotator cuff tear including the subscapularis tendon, and a complete retracted subscapularis tendon tear. Arthroscopic portal placement, interference screw placement, and stitch tying are illustrated in detail for each procedure. An arthroscopic video view of a normal subscapularis tendon is also provided for comparison.

    • Keywords:
    • Biceps tenotomy

    • posterior lever push

    • half-racking suture

    • strangulation stitch

    • locking Krackow whip stitch

    • traction stitch

    • Subspecialty:
    • Shoulder and Elbow

Outcomes of Single-Bundle Anterior Cruciate Ligament Reconstruction

Arthroscopically assisted single-bundle reconstruction of the anterior cruciate ligament (ACL) is a reproducible surgical procedure with a high success rate and greater than 90% patient satisfaction. Data on arthroscopically assisted single-bundle ACL reconstruction using the classic bone-patellar tendon-bone autograft, hamstring autograft, as well as allograft tissues indicate that the procedure reliably improves knee stability and patient function. Complications following ACL reconstruction using modern endoscopic techniques are generally mild and uncommon. Graft failure, when noted, occurs in 0% to 6% of patients; 15% to 25% of patients report mild patellofemoral discomfort and/or crepitus. Significant postoperative stiffness is rare, with absolute postoperative range-of-motion measurements averaging 0°to roughly 140°in more than 90% of patients.

    • Keywords:
    • ACL injury

    • anterior cruciate ligament injury

    • ACL tear

    • anterior cruciate ligament reconstruction

    • anterior cruciate ligament surgery

    • ACL surgery

    • single-incision technique

    • single-bundle anterior cruciate ligament reconstruction

    • single-bundle ACL reconstruction

    • bone-patellar tendon bone autograft

    • BPTB autograft

    • BPTB allograft

    • Achilles tendon autograft

    • hamstring tendon allograft

    • Subspecialty:
    • Sports Medicine

Treatment of Posterior Malleolus Fractures

Posterior malleolus fractures may occur in isolation or, more commonly, in association with bimalleolar or trimalleolar fracture patterns. These fractures result from posterior tibiofibular ligament avulsion, or bony impaction from the talus. Isolated posterior malleolus fractures have also been reported to occur in conjunction with spiral tibial shaft fractures. Posterior malleolus fractures may be identified on standard AP, mortise, and lateral radiographs of the ankle; however, CT allows for better assessment of displacement and the location of fracture lines. Generally, nondisplaced fractures with less than 25% involvement of the articular surface may be treated nonsurgically with short-term immobilization followed by range-of-motion exercise and gradual return to weight bearing. Surgical options include minimally-invasive, percutaneous fixation, although formal open reduction and internal fixation using a posteromedial, posterolateral, or combined approach is often necessary.

    • Keywords:
    • ankle fracture

    • broken ankle

    • malleolus fracture

    • bimalleolar fracture

    • trimalleolar fracture

    • posterior malleolar fracture

    • pronation-external rotation ankle fracture

    • supination-external rotation ankle fracture

    • syndesmotic injury

    • tibiotalar joint injury

    • posterior pilon fracture

    • tibial plafond fracture

    • Subspecialty:
    • Trauma

    • Foot and Ankle