John M. Tokish, M.D ., an orthopedic surgeon at Mayo Clinic's campus in Arizona, initiates diagnostic arthroscopy to assess pathology and then obtains preoperative imaging. Dr. Tokish prepares the glenoid surface for graft placement, creating a flush surface to receive the graft. He prefers a tibial allograft and soaks the graft with platelet-rich plasma. He places a Latarjet guide until the flange sits flush on the glenoid. He then places Kirschner wires and overdrills to create tunnels for fixation. Through these tunnels, he places an arthroscopic router that can prepare the surface of the bone. To offset the patient's bone loss, he places 8 to 12 millimeters of graft arthroscopically and can visualize an exact match to the glenoid surface. The graft is secured without metal implants and with greatly decreased risk of neurovascular complications.
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This is a description of the arthroscopic technique for distal tibial telegraphed bone augmentation with suture, anchor fixation for anterior shoulder instability here are relevant disclosures. A diagnostic arthroscopy is performed to thoroughly assess the patient's pathology. Preoperative imaging is correlated with inter operative visualization to focus on the area of bone loss capsule, er and aggressive labor liberation is performed and the entire glide surfaces prepared for graft placement by debridement down to viable bone with an emphasis on creating a flush surface to receive the graph. A single suture is placed in the anterior labrum and received for cutaneous lee and this allows lateral retraction that is utilized to facilitate graft delivery After creating adequate post here capsule er access while viewing from the superior anterior portal. The latter j. Guide is placed from the posterior portal until the flange sits flush on the glenn oid and the guide is in direct contact posterior lee Kirshner wires are then placed through the post here. Guide until they are visualized to be at the anterior margin of the glen oid. These wires should be placed parallel to each other parallel to the ground and surface and with a six millimeter offset after the guide is removed. The wires are over drilled using a 3.5 millimeter cannula. Did drill following the top hat sleeves from the flip cutter drills are placed over the calculated drills which are then removed, leaving the flip top hats in place, the inferior flip clutter is in place into the top. Ad advance across the Glenwood from the post here until Antero until it's visualized. The flip cutter has been gently spun and gently retracted until perfect rounded flesh cut is obtained in the in for half of the glen oid process is repeated through the superior drill hole. This should result in a near perfect planing cut of the anterior Glenna without any significant step off. Along with superior inferior access. Flip cutters are then removed and replaced with fiber sticks. Arthur rex devices such that there is a passing stage from poster to enter through each of the drills. Just to be a telegraph has a graph of choice for the authors and the tibial holograph discussed the appropriate size. Typically eight of graft is sufficient to restore approximately 30% of global bone loss. Using the same ladder J offset guide that was used on the Glenroy to drill holes are created oriented parallel to the long axis of the graft to 2.6 millimeter fiber attacks have been loaded retrograde through the graph tools such as the Tales of the Future are passed from anterior to post here to the graft outside the shoulder, the fiber attack loops through which a trailing stitches placed remain on the anterior aspect of the graft. The prepared graft is then soaked in prp First the mid glenn ID portal is replaced with the larger 16 millimeter cannula and the two previously placed passing stitches that were placed through the glen oid are retrieved through the mid glenn ID portal with the camera in the anterior superior portal, the passing futures are pulled from the back. This allows the glen I'd graft to be delivered through the large mid glenn ID portal posterior lee. The inferior fiber attack, passing future has passed through the loop end of the superior fiber attack and delivered to the superior anchor. Likewise, the superior passing suture is placed in the loop end of the inferior fiber attack loop and delivered through the inferior anchor. This creates a double mattress self locking mechanism. As the graphs is delivered, the passing futures are progressively and alternately attention until the graph is compressed to the desired position on the Glenroy there should be a near an atomic restoration of alignment between the cartilage services of the graft and the Glenwood. Once the graft is positioned appropriately, attention has turned to the labrum. The sutures Previously placed the anterior loops are now passed through the native anterior labrum, which repairs the native labrum to the an atomic anterior aspect of the graft remaining Prp is then placed into the joint, patients are placed in a sling post operatively and neutral rotation for six weeks. With pendulum movements allowed immediately and gradual return to passive motion at three weeks. Full return to activities permitted at six months. Thank you
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