Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Suprascapular nerve entrapment can cause disabling shoulder pain. Suprascapular nerve release is often performed for compression neuropathy and to release pressure on the nerve associated with arthroscopic labral repair. This report describes a novel all-arthroscopic technique for decompression of the suprascapular nerve at the suprascapular notch or spinoglenoid notch through a subacromial approach. ⋯ The medial border of the conoid ligament is identified and followed to its coracoid attachment. The supraspinatus muscle is retracted with a blunt trocar placed through an accessory Neviaser portal. The transverse scapular ligament, which courses inferior to the suprascapular artery, is sectioned with arthroscopic scissors, and the suprascapular nerve is decompressed.
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Arthroscopic decompression of the suprascapular nerve by transection of the transverse scapular ligament has only recently been described. Arthroscopic decompression of a bony suprascapular notch foramen has not been previously reported. This article presents a case report and outlines an arthroscopic technique to safely decompress a bony suprascapular notch. ⋯ The smooth cannula serves nicely to sweep and retract the suprascapular artery and associated fibrofatty tissue from the field of view while allowing instrumentation and visualization of the suprascapular notch. The course of the suprascapular nerve and morphology of the notch is confirmed. A Kerrison punch rongeur, routinely used in spine surgery, is introduced through the superomedial portal and a notchplasty is performed safely, allowing decompression of the suprascapular nerve.
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To perform a controlled laboratory study to evaluate the effect of bupivacaine and morphine on chondrocytes and synovium in a coculture model of diarthrodial joints. ⋯ Intra-articular bupivacaine infusion is an effective analgesic strategy and is frequently used in both office and outpatient surgical settings. This study provides evidence that the continued usage of postoperative bupivacaine continuous infusion pumps may have a detrimental effect on chondrocytes. Morphine has been shown to be an effective intra-articular analgesic, and its anti-inflammatory role seen in this study makes it a potential alternative to bupivacaine.
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Comparative Study
Anterior cruciate ligament reconstruction: autogenous quadriceps tendon-bone compared with bone-patellar tendon-bone grafts at 2-year follow-up.
The purpose of this study was to evaluate and compare postoperative anterior knee pain, knee stability, and functional scores of an autogenous bone-patellar tendon-bone (BPTB) graft and a quadriceps tendon-bone (QTB) graft. ⋯ A QTB graft attached with the EndoPearl device (Linvatec, Largo, FL) appears to be an effective alternative for single-bundle ACL reconstruction. When followed with an accelerated rehabilitation program, reconstruction with a QTB graft provided knee stability comparable to a BPTB graft but with less kneeling pain than a BPTB graft.
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Clinical Trial
Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears.
The purpose of our study was to evaluate the outcome of massive rotator cuff tears repaired by use of an arthroscopic biceps augmentation technique, interpositioning the tenotomized biceps tendon to bridge the gap between the torn edges of the cuff tendon. ⋯ An arthroscopic augmentation technique using the tenotomized biceps tendon was effective in achieving fewer structural failures, equivalent clinical outcomes, and significant improvement in muscle strength in comparison traditional arthroscopic repairs by avoiding undue tension in cases with massive rotator cuff tear.