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Arthroscopy Techniques
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    • Cover Image - Arthroscopy Techniques, Volume 12, Issue 2
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    • Knee

      • ACL
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  • Technical Note
    Open Access

    Fresh Femoral Osteochondral Allograft Transplantation Using a Single-Plug Technique for Large Osteochondral Defects of the Knee

    Arthroscopy Techniques
    Vol. 12Issue 2e223–e232Published online: January 18, 2023
    • Yi Ling Chua
    • Don Thong Siang Koh
    • Kong Hwee Lee
    Cited in Scopus: 0
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    Osteochondral allograft (OCA) transplantation has been used to treat a wide spectrum of cartilage deficiencies in the knee, including spontaneous necrosis of the knee. Studies reporting outcomes after OCA transplantation have shown reliable improvement in pain and return to activities of daily living. We describe a single-plug, press-fit technique for OCA transplantation with concomitant high tibial osteotomy to treat femoral condyle chondral defects in a varus knee. Pearls and pitfalls of this technique are presented; attention should be paid to correction of concomitant joint pathology and malalignment to facilitate osseointegration and survivorship of the allograft plug into host bone.
    Fresh Femoral Osteochondral Allograft Transplantation Using a Single-Plug Technique for Large Osteochondral Defects of the Knee
  • Technical Note
    Open Access

    Flexion Contracture in Knee Osteoarthritis Can Be Fully Eliminated by Hybrid Closed Wedge High Tibial Osteotomy Using a Reduction-Insertion-Compression Handle

    Arthroscopy Techniques
    Vol. 12Issue 2e247–e253Published online: January 18, 2023
    • Ryuichi Nakamura
    • Masaki Amemiya
    • Fumiyoshi Kawashima
    • Akira Okano
    Cited in Scopus: 1
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    In conventional closed-wedge high tibial osteotomy (CWHTO) with preservation of the medial hinge, flexion contracture cannot be improved because of the two-dimensional correction. Conversely, in hybrid CWHTO, for which the name is derived from a hybrid of the lateral closing and medial opening, the medial cortex is intentionally disrupted. The medial hinge disruption enables three-dimensional correction, which helps eliminate flexion contracture by decreasing posterior tibial slope (PTS). The fine adjustment of the anterior closing distance and thigh-compression technique further facilitates PTS control.
    Flexion Contracture in Knee Osteoarthritis Can Be Fully Eliminated by Hybrid Closed Wedge High Tibial Osteotomy Using a Reduction-Insertion-Compression Handle
  • Technical Note
    Open Access

    Augmentation of Patellar Tendon Repair With Autologous Semitendinosus Graft—Porto Technique

    Arthroscopy Techniques
    Vol. 6Issue 6e2271–e2276Published online: November 27, 2017
    • João Espregueira-Mendes
    • Renato Andrade
    • M.J.S. Fredrick Michael
    • André Sarmento
    • Nuno Sevivas
    • Rui Rocha
    • and others
    Cited in Scopus: 9
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    Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone.
    Augmentation of Patellar Tendon Repair With Autologous Semitendinosus Graft—Porto Technique
  • Technical Note
    Open Access

    Modified Elmslie-Trillat Procedure for Distal Realignment of Patella Tendon

    Arthroscopy Techniques
    Vol. 6Issue 6e2277–e2282Published online: November 27, 2017
    • Ricardo Bastos Filho
    • Alberto Monteiro
    • Renato Andrade
    • M.J.S. Fredrick Michael
    • Nuno Sevivas
    • Bruno Pereira
    • and others
    Cited in Scopus: 0
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    • Video
    Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable.
    Modified Elmslie-Trillat Procedure for Distal Realignment of Patella Tendon
  • Technical Note
    Open Access

    Open-Wedge Valgus High Tibial Osteotomy Technique With Inverted L-Shaped Configuration

    Arthroscopy Techniques
    Vol. 6Issue 6e2161–e2167Published online: November 13, 2017
    • Juan C. Monllau
    • Juan I. Erquicia
    • Federico Ibañez
    • Maximiliano Ibañez
    • Pablo E. Gelber
    • Angel Masferrer-Pino
    • and others
    Cited in Scopus: 5
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    • Video
    High tibial osteotomy (HTO) is a useful alternative in the treatment of symptomatic varus malalignment. However, among its drawbacks is the tendency to decrease patellar height and increase the posterior tibial slope. The increased tibial slope increases anterior cruciate ligament tension and may compromise its function. On the other hand, patella baja often causes anterior knee pain and, over time, may favor degeneration of the patellofemoral joint. The aim of this study is to describe a technical modification of the standard open-wedge HTO.
    Open-Wedge Valgus High Tibial Osteotomy Technique With Inverted L-Shaped Configuration
  • Technical Note
    Open Access

    Opening Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction or Revision

    Arthroscopy Techniques
    Vol. 6Issue 5e1735–e1741Published online: October 2, 2017
    • Davide Edoardo Bonasia
    • Federico Dettoni
    • Anna Palazzolo
    • Roberto Rossi
    Cited in Scopus: 10
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    High tibial osteotomy (HTO) is a valid treatment option for young active patients with medial tibiofemoral osteoarthrosis (OA) and varus deformity. Sometimes medial OA is combined with symptomatic anterior cruciate ligament (ACL) deficiency. Although isolated HTO (with possible delayed ACL reconstruction) might be indicated in the older population, young active patients may require combined HTO and ACL reconstruction. In addition, an abnormally increased tibial slope may predispose to ACL reconstruction failure and should be addressed for a successful ACL revision.
    Opening Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction or Revision
  • Technical Note
    Open Access

    Opening Wedge High Tibial Osteotomy Using Combined Computed Tomography-Based and Image-Free Navigation System

    Arthroscopy Techniques
    Vol. 6Issue 4e1145–e1151Published online: July 31, 2017
    • Yasushi Akamatsu
    • Hideo Kobayashi
    • Yoshihiro Kusayama
    • Ken Kumagai
    • Tomoyuki Saito
    Cited in Scopus: 4
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    • Video
    For opening wedge high tibial osteotomy (OWHTO), it is recommended that the osteotomy line is parallel to the medial tibial posterior slope (TPS) in the sagittal view and that the alignments are simultaneously controlled in the coronal and sagittal views. Here combined computed tomography (CT)-based and image-free navigation systems were used for intraoperative reference during OWHTO. Using the CT-based navigation, 2 entry points for insertion of Kirschner wires were preoperatively set up and an accurate osteotomy plane was intraoperatively duplicated.
    Opening Wedge High Tibial Osteotomy Using Combined Computed Tomography-Based and Image-Free Navigation System
  • Technical Note
    Open Access

    Joint Preservation Surgery for Medial Compartment Osteoarthritis

    Arthroscopy Techniques
    Vol. 6Issue 3e717–e728Published online: June 5, 2017
    • Deepak Goyal
    • Anjali Goyal
    • Nobuo Adachi
    Cited in Scopus: 2
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    • Video
    Single compartment osteoarthritis is a commonly encountered condition in the middle-aged population, with the medial compartment being the most commonly involved compartment. Medial compartment osteoarthritis becomes seriously disabling for these active patients, with a very few definitive solutions. These patients quickly stop responding to the conservative methods such as lifestyle modification, drugs, physiotherapy, and rehab programs. Less invasive procedures such as intra-articular injections or joint debridement also do not give a long-lasting relief.
    Joint Preservation Surgery for Medial Compartment Osteoarthritis
  • Technical Note
    Open Access

    Medial Closing-Wedge Distal Femoral Osteotomy for Genu Valgum With Lateral Compartment Disease

    Arthroscopy Techniques
    Vol. 5Issue 6e1357–e1366Published online: November 28, 2016
    • James D. Wylie
    • Travis G. Maak
    Cited in Scopus: 12
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    • Video
    Lateral compartment disease combined with valgus alignment can lead to progressive knee joint degeneration. In the symptomatic patient with isolated lateral compartment disease, a varus-producing distal femoral osteotomy can unload the diseased lateral compartment. This osteotomy may be combined with other cartilage or meniscal restorative techniques to optimize knee joint preservation and pain relief. The osteotomy can be performed with a medial closing-wedge or lateral opening-wedge technique.
    Medial Closing-Wedge Distal Femoral Osteotomy for Genu Valgum With Lateral Compartment Disease
  • Technical Note
    Open Access

    Autologous Osteophyte Grafting for Open-Wedge High Tibial Osteotomy

    Arthroscopy Techniques
    Vol. 5Issue 5e989–e995Published online: September 5, 2016
    • Takenori Akiyama
    • Ken Okazaki
    • Taro Mawatari
    • Satoshi Ikemura
    • Shunsuke Nakamura
    Cited in Scopus: 20
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    Osteophytes are physiological bony outgrowths that develop at the margins of the articular surfaces during the progression of osteoarthritis; they are associated with active endochondral bone formation processes and expressions of various growth factors. We believe they could be a source of bone grafts as a result of a potentially strong osteoinductive effect. Moreover, osteophytes can be easily harvested by arthroscopy in patients undergoing open-wedge high tibial osteotomy (OW-HTO) for medial unicompartmental knee osteoarthritis.
    Autologous Osteophyte Grafting for Open-Wedge High Tibial Osteotomy
  • Technical Note
    Open Access

    Medial Opening Wedge Proximal Tibial Osteotomy

    Arthroscopy Techniques
    Vol. 5Issue 4e919–e928Published online: August 22, 2016
    • Jorge Chahla
    • Chase S. Dean
    • Justin J. Mitchell
    • Gilbert Moatshe
    • Raphael Serra Cruz
    • Robert F. LaPrade
    Cited in Scopus: 28
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    Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency.
    Medial Opening Wedge Proximal Tibial Osteotomy
  • Technical Note
    Open Access

    Opening-Wedge Proximal Tibial Osteotomy

    Arthroscopy Techniques
    Vol. 5Issue 4e769–e774Published online: July 18, 2016
    • Michael O'Malley
    • Patrick J. Reardon
    • Ayoosh Pareek
    • Aaron Krych
    • Michael J. Stuart
    Cited in Scopus: 3
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    • Video
    Varus knee malalignment caused by medial compartment arthritis results in progressive asymmetric wear of the tibiofemoral joint. This wear can cause progressively painful gonarthrosis. Surgical methods to address varus knee malalignment include lateral closing-wedge proximal tibial osteotomy, medial opening-wedge osteotomy, and arthroplasty. Medial opening-wedge proximal tibial osteotomy is an effective procedure for restoring proper coronal alignment and reducing knee pain. In this technical note, we present a reproducible technique for proximal tibial osteotomy.
    Opening-Wedge Proximal Tibial Osteotomy
  • Technical Note
    Open Access

    Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy

    Arthroscopy Techniques
    Vol. 5Issue 3e531–e540Published online: May 23, 2016
    • Chase S. Dean
    • Jorge Chahla
    • Samuel G. Moulton
    • Marco Nitri
    • Raphael Serra Cruz
    • Robert F. LaPrade
    Cited in Scopus: 10
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    Proximal tibial anterolateral opening-wedge osteotomies have been reported to achieve successful biplanar lower-extremity realignment. Indications for a proximal tibial anterolateral osteotomy include symptomatic genu recurvatum with genu valgus alignment, usually in patients with a flat sagittal-plane tibial slope. The biplanar approach is able to simultaneously address both components of a patient's malalignment with a single procedure. The correction amount is verified with spacers and intraoperative imaging, while correction of the patient's heel height is simultaneously measured.
    Anterolateral Biplanar Proximal Tibial Opening-Wedge Osteotomy
  • Technical Note
    Open Access

    Open-Wedge High Tibial Osteotomy Using a Protective Cutting System: Technical Advancement for the Accuracy of the Osteotomy and Avoiding Intraoperative Complications

    Arthroscopy Techniques
    Vol. 5Issue 1e7–e10Published online: January 4, 2016
    • Yong Seuk Lee
    • Myung Chul Lee
    • Seo Goo Kang
    • Ashraf Elazab
    • Won Seok Oh
    Cited in Scopus: 16
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    • Video
    Open-wedge high tibial osteotomy for medial unicompartmental arthritis of the knee joint is a successful treatment option but is associated with potential intraoperative complications such as tibial plateau fracture, dislocation of the osteotomy hinge, under- or over-correction of the posterior slope, and neurovascular injury. Therefore we devised a protective cutting system and describe our method for the prevention of these complications. The potential advantages of this system are protection of the posterior neurovascular structures using a curved protector, bone cutting along the natural tibial slope using a superior surface aligning with the natural tibial slope, and complete 1-plane sawing of the posterior wall before the lateral hinge.
    Open-Wedge High Tibial Osteotomy Using a Protective Cutting System: Technical Advancement for the Accuracy of the Osteotomy and Avoiding Intraoperative Complications
  • Technical Note
    Open Access

    Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate

    Arthroscopy Techniques
    Vol. 4Issue 6e687–e695Published online: November 17, 2015
    • Luís Eduardo Passarelli Tírico
    • Marco Kawamura Demange
    • Marcelo Batista Bonadio
    • Camilo Partezani Helito
    • Riccardo Gomes Gobbi
    • José Ricardo Pécora
    Cited in Scopus: 6
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    Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market.
    Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate
  • Technical Note
    Open Access

    Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique

    Arthroscopy Techniques
    Vol. 4Issue 5e601–e607Published online: October 26, 2015
    • Jonathan A. Godin
    • Vasili Karas
    • Julia D. Visgauss
    • William E. Garrett
    Cited in Scopus: 10
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    Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft.
    Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique
  • Technical Note
    Open Access

    A Novel Closed-Wedge High Tibial Osteotomy Procedure to Treat Osteoarthritis of the Knee: Hybrid Technique and Rehabilitation Measures

    Arthroscopy Techniques
    Vol. 3Issue 4e431–e437Published online: July 7, 2014
    • Ryohei Takeuchi
    • Hiroyuki Ishikawa
    • Yasuyuki Miyasaka
    • Yohei Sasaki
    • Takashi Kuniya
    • So Tsukahara
    Cited in Scopus: 43
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    High tibial valgus osteotomy (HTO) is an established treatment for medial-compartment osteoarthritis of the knee. We have combined medial open and lateral closed-wedge HTO (hybrid closed-wedge HTO) to overcome the limitations of traditional closed-wedge HTO. Our new hybrid procedure has the following advantages: (1) the bone block removed is smaller in size; (2) the procedure yields optimal geometric characteristics for bone healing; (3) there is no step-off at the lateral osteotomy site; (4) the lateral cortex of the proximal and distal fragments is attached firmly by the oblique osteotomy; and (5) early full weight-bearing walking is possible.
    A Novel Closed-Wedge High Tibial Osteotomy Procedure to Treat Osteoarthritis of the Knee: Hybrid Technique and Rehabilitation Measures
  • Technical Note
    Open Access

    Arthroscopic and Computer-Assisted High Tibial Osteotomy Using Standard Total Knee Arthroplasty Navigation Software

    Arthroscopy Techniques
    Vol. 2Issue 2e161–e166Published online: May 6, 2013
    • Stephen R. Thompson
    • Nazar Zabtia
    • Bradley Weening
    • Paul Zalzal
    Cited in Scopus: 4
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    Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer.
    Arthroscopic and Computer-Assisted High Tibial Osteotomy Using Standard Total Knee Arthroplasty Navigation Software
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