Menisectomy made easy with the 3 portal technique" by Dr J Maheshwari from New Delhi - Sep 2015


Menisectomy made easy with the 3 portal technique" by Dr J Maheshwari from New Delhi
Arthroscopic Anchorless capsulolabral repair for recurrent anterior shoulder instability by Dr. Manabendra Basumallick from Kolkata. - Nov 2014


Tripling of the semi-T graft for ligament reconstruction surgery by Dr Anant Joshi - Oct 2014


BTB Graft Harvesting by Dr. S Arumugam - Sep 2014


All soft tissue technique of MPFL reconstruction by Dr. Pranjal Kodkani - Aug 2014


Arthroscopic Baker Cyst decompression by Dr. (Prof) Amite Pankaj - Jul 2014


Assessment and importance of hill sach's lesions in recurrent dislocation shoulder by Dr. Pratap Kumar - Jun 2014


Aperture Femoral Fixation in ACL Reconstruction by - May 2014


MCL Micro Perforation to increase medial knee joint space by Dr. Sachin Tapasvi - Apr 2014


One of the key features of an arthroscopy is to teach all accessible areas of the joint, and to see and probe them. Many a times we encounter tight areas which do not allow our instruments to pass easily. Forceful insertion of instruments are associated with a high risk of iatrogenic damage to the articular cartilage and meniscus. There is also a risk of instrument breakage that may have disastrous consequences.

A tight posterior and medial corner is a frequently encountered problem. Pie crusting of the superficial MCL using a number 18 needle percutaneously is a commonly performed technique to open up a tight posterior and medial space. The following video demonstrates this technique. It is a safe technique which does not compromise the stability of the MCL.
Anatomical Posterolateral Reconstruction by Dr. Deepak Chaudhary & Dr. Deepak Joshi - Mar 2014



The Superficial Quad Technique - Feb 2014


The MPFL is a very important medial patellar stabilizer. Last decade has seen multiple ways to reconstruct the damaged MPFL. Most techniques involve use of an autograft tendon. However there are many complications reported related to patellar fixation. ‘The Superficial Quad Technique’ invented by Dr Deepak Goyal is one such technique that addresses these problems in ten simple steps.1 Q tendon is a three layered structure and the graft is harvested from the superficial part of the tendon. The distinct advantages of this new technique are as follows. First, the graft is a better anatomic match to the original medial patellofemoral ligament (MPFL) in terms of width, breadth, and length. The natural or native MPFL is thin, broad, and sheet-like; so is the superficial quadriceps slip used in this procedure. Two, the superficial quadriceps tendon graft is not as stiff as the commonly used hamstring tendon graft. A strong, stiff graft puts more load on the patellofemoral joint and can cause patellar fracture later. Three, the superficial quadriceps graft does not have to be held in place with screws or wires. This makes it possible to attach the graft to the medial border of the patella where the MPFL is located normally. The result is a more accurate re-creation of patella biomechanics and elimination of complications from patellar fixation. This is helpful because most common problems that develop after MPFL reconstruction can be traced back to either the type of graft material or the way in which the graft is fixed at patella. Four, in the short term study of Dr Goyal (mean three years), the results are equal to outcomes when compared with using the hamstring tendon.

There are few concerns regarding the possible damage to the Q tendon while using the technique. Dr Goyal has addressed this concern in response to a letter to the editors.2 He emphasized that out of the two words used in the name of the Superficial Quad Technique; the word superficial is very important. As soon as surgeon starts calling this technique as MPFL reconstruction using quadriceps tendon; he is very likely to go deep. The graft is really very-very superficial and hence right from the start of incision, surgeon should keep ‘superficial’ more in mind than ‘quadriceps’. The accompanying video clearly shows, how much superficial one should remain and hence avoid the damage to Q tendon. Size of incision is another concern, but it is getting reduced now and it is possible to harvest the graft and do patellar fixation with < 7 cm incision.

Reference: 
  • Deepak Goyal, MB, MS(Ortho), DNB(Ortho), MNAS. Medial Patellofemoral Ligament Reconstruction. The Superficial Quad Technique. In The American Journal of Sports Medicine. May 2013. Vol. 41. No. 5. Pp. 1022-1029.
  • Goyal Deepak. The superficial quad technique: Response to letter to the editor. Am J Sports Med. 2013;41(10):NP47
Arthroscopic Rotator Cuff Repair : Importance of - Jan 2014


Each rotator cuff tear is unique and it is important to determine the tear pattern and understand the tear configuration prior to attempting repair. The most useful instrument to achieve this is the arthroscopic grasper. This step of obtaining a trial reduction prior to repair is very similar to fracture fixation and is a crucial step that should not be overlooked. This step is critical in planning the type of repair, deciding the position of anchors, and placement of sutures. This simple step sets up the entire flow of the repair and ensures a planned and precise execution of rotator cuff repair.

This short video emphasises the importance of this surgical step in various types of arthroscopic rotator cuff repairs
Hamstring Graft Harvest - Nov 2013


Hamstring graft harvest
 

Why?

It is sometimes difficult to find the correct plane of dissection to locate the hamstring tendons as a source of graft harvest in ligament reconstruction surgery. Towards the anterior border of the tibia, the three layers of the knee coalesce & finding the correct plane of dissection is very difficult. This tip describes one way of consistently locating the semi t & gracilis as sources of graft harvest for a ligament reconstruction surgery.


How?

A dural dissector has just the right radius of curvature to gently lever out the first layer of warren & marshall from the second layer. The dissecting end of the instrument slides in smoothly between the two layers of the knee at the level of the MCL, thereby allowing a clean sharp dissection between the layers.


Pearls

Try to see that there is white on both ends of your dissection. The undersurface of the pes fascia & the outer surface of the superficial mcl are both white in colour (after inflating the tourniquet). Once you locate this plane, you are reassured that you are in the right plane for harvesting the hamstring graft.