Arthroscopic Treatment of Chronic Tibial Spine Malunion
| Autor: | Jim C. Hsu, James C. Linhoff |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
Surgical resection 030222 orthopedics medicine.medical_specialty Surgical approach business.industry Anterior cruciate ligament medicine.medical_treatment education 030229 sport sciences musculoskeletal system medicine.disease Surgery Resection 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Technical Note medicine Internal fixation Orthopedics and Sports Medicine Malunion business Tibial spine |
| Zdroj: | Arthroscopy Techniques |
| ISSN: | 2212-6287 |
| Popis: | Reports of surgical resection and internal fixation for symptomatic tibial spine malunion are rare, and the reported techniques typically involve an open surgical approach. We present an all-arthroscopic technique of tibial spine malunion treatment, with selective arthroscopic bone resection below the tibial spine, preserving the anterior cruciate ligament attachment, followed by internal fixation of the tibial spine with a hybrid transtibial and suture–bridge construct using knotless anchors and tape sutures. Technique Video Video 1 Preoperative coronal and sagittal magnetic resonance images of the left knee demonstrate a bony prominence at the anterior notch, at the anterior cruciate ligament (ACL) attachment, consistent with tibial spine malunion. Coronal and sagittal magnetic resonance images of a normal left knee are provided for comparison. The patient is set up in the supine position for left knee arthroscopy. The tibial spine malunion is identified arthroscopically. Knee extension demonstrates impingement of the malunion bony prominence on distal femur. The bony prominence is debrided to define its medial and lateral borders. An osteotome is used to make 2 horizontal cuts spanning from the medial to the lateral borders, the top cut about 1 cm below the upper border, and the lower cut flush with the base of the prominence. The trajectory of the osteotome when making the top cut is oriented parallel to the top bony surface contour, so that as the cut continues the tibial spine top layer remains about 1 cm in thickness. The bone between the cuts is removed in small increments, alternating between osteotome and grasper/shaver, progressing with the cuts and removal carefully to maintain the integrity of the tibial spine layer. Once enough room is cleared, a bone-cutting shaver is introduced to deepen the bone contour downward, to recreate space for the tibial spine to be reduced downward, eliminating the bony prominence. Two tape sutures (FiberTape; Arthrex, Naples, FL) are folded in half and passed in opposite directions around the base of the ACL just above the tibial spine, and then the sutures are cinched to themselves by passing the free ends through the loop end (“luggage tag”), to capture the ACL and the bone. The tip of an ACL tibial guide is placed to reduce the tibial spine. A 2.4-mm guidewire is drilled through both tibia and tibial spine and removed, and then a suture passing wire (Nitinol Suture Passing Wire; Arthrex) is passed up the bone tunnel, to pull two limbs of the suture tapes, one from each tape, down and out of the leg. These suture limbs are secured to the tibial cortex using a knotless anchor such as the 4.75-mm SwiveLock (Arthrex). The low anterior tibial cortex distal to the tibial spine is debrided. An accessory transtendinous portal is made, entering above the tibial tubercle and through the patellar tendon. This portal is used to secure the remaining two limbs of the tape sutures under tension into the low anteromedial and anterolateral tibial cortex with 2 additional SwiveLock (Arthrex) anchors, providing an anterior-row fixation analogous to the lateral row in a double-row, transosseous-equivalent rotator cuff fixation. (ACL, anterior cruciate ligament.) |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|