Choon Key Lee

Arthroscopic Repair of Combined Bankart and SLAP Lesions: Operative Techniques and Clinical Results

Background To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. Methods From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. Results VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. Conclusions In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.

Arthroscopic double bundle ACL reconstruction using a bone patellar tendon bone—gracilis tendon composite autograft: a technical note

The authors devised an alternative arthroscopic double bundle ACL reconstruction technique using a bone patellar tendon bone (BPTB)–gracilis tendon composite autograft. One tibial and two femoral tunnels were used to reconstruct two bundles of anterior cruciate ligaments (ACL) [an anteromedial bundle (AM) and a post-erolateral bundle (PL)]. BTBB was fixed in the tunnels produced on the isometric points of the tibia and femur using the conventional technique. The gracilis tendon was then fixed in a PL tunnel produced using the outside-in technique. The authors consider that the devised technique based on a combination of autogenous bone patellar bone graft and gracilis tendon, can minimize tunnel widening post-operatively, allow easier revision should the reconstructed ACL fail, and also provides an alternative means of restoring rotation stability.

Arthroscopic all-inside repair of Palmer type 1B triangular fibrocartilage complex tears: a technical note

Arthroscopic repair of peripheral dorso-ulnar triangular fibrocartilage complex (TFCC) lesions is now a preferred method. Both outside-in and inside-out techniques are commonly performed for repairing Palmer type 1B TFCC tear. But these techniques have disadvantages of making an additional skin incision to tie knots subcutaneously over the capsule. We performed an arthroscopic all-inside repair technique of Palmer type 1B TFCC tears, which is a modified method of the outside-in technique using a spinal needle. This all-inside technique is as simple as previously described arthroscopic techniques and also has advantages of vertical mattress suture and no additional incision. We recommend this technique as a useful alternative to the others for repairing Palmer type 1B TFCC tear.

Displaced avulsion fracture of medial meniscus posterior horn through the intercondylar notch in the patient without combined ligamentous injuries

Avulsion fractures of the posterior horn of the medial meniscus are uncommon and must be differentiated from a loose body. The authors present a displaced avulsion fracture of the medial meniscus posterior horn through the intercondylar notch into the anteromedial compartment of the knee, which was treated by arthroscopic reduction and internal fixation using pull-out suture technique.

Treatment of persistent extraarticular infection using a temporary cement spacer on the tibia after ACL reconstruction

Postoperative infection after anterior cruciate ligament (ACL) reconstruction is an uncommon but serious complication. Although several treatments for intraarticular infection have been reported, no report has been recorded on the treatment of persistent extraarticular infections. The authors experienced reconstructed graft removal due to a refractory extraarticular infection on tibia. Early ACL reimplantation was performed using a temporary cement spacer containing antibiotics and a irradiated bone patellar tendon bone allograft.