Endoscopic Haglund’s Resection and Percutaneous Double-Row Insertional Achilles Repair

2021 ◽  
pp. 193864002110027
Author(s):  
Christopher P. Miller ◽  
James R. McWilliam ◽  
Max P. Michalski ◽  
Jorge Acevedo
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Suture Anchor ◽  
Surgical Techniques ◽  
Achilles Tendinopathy ◽  
Wound Complications ◽  
Double Row ◽  
Suture Anchor Repair ◽  
Insertional Achilles Tendinopathy

Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with nonsurgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double-row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection. The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using minimally invasive surgery techniques while also incorporating a percutaneous double-row suture anchor repair. The technique utilizes 4 portals to access 2 endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double-row suture anchor repair. Levels of Evidence: Level V

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

2021 ◽  
pp. 193864002110336
Author(s):  
LT Thomas J. Kelsey ◽  
LT Kyle W. Mombell ◽  
CDR Todd A. Fellars
Keyword(s):  
Achilles Tendon ◽  
Suture Anchor ◽  
Maximum Load ◽  
Achilles Tendinopathy ◽  
Catastrophic Failure ◽  
Double Row ◽  
Average Load ◽  
Load To Failure ◽  
Insertional Achilles Tendinopathy ◽  
Repair Techniques

Background In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair’s maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. Methods Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. Results The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure ( P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). Conclusion This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.

Biomechanical Comparison of All-Soft Suture Anchor Single-Row vs Double-Row Bridging Construct for Insertional Achilles Tendinopathy

2020 ◽  
pp. 107110072095902
Author(s):  
Eric Lakey ◽  
Pam Kumparatana ◽  
Daniel K. Moon ◽  
Joseph Morales ◽  
Sophia Elizabeth Anderson ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Early Mobilization ◽  
Achilles Tendinopathy ◽  
Matched Pair ◽  
Clinical Failure ◽  
Suture Anchors ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Insertional Achilles Tendinopathy

Background: Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. Methods: Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. Results: The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. Conclusion: This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. Clinical Relevance: Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.

scholarly journals An evidence-based review of enhanced recovery interventions in knee replacement surgery

2013 ◽  
Vol 95 (6) ◽  
pp. 386-389 ◽  
Author(s):  
MS Ibrahim ◽  
S Alazzawi ◽  
I Nizam ◽  
FS Haddad
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Knee Replacement ◽  
Invasive Surgery ◽  
Enhanced Recovery ◽  
Surgical Techniques ◽  
Cochrane Library ◽  
Computer Assisted ◽  
Evidence Based ◽  
Healthcare Budget

Introduction Total knee replacement (TKR) is a very common surgical procedure. Improved pain management techniques, surgical practices and the introduction of novel interventions have enhanced the patient’s postoperative experience after TKR. Safe, efficient pathways are needed to address the increasing need for knee arthroplasty in the UK. Enhanced recovery programmes can help to reduce hospital stays following knee replacements while maintaining patient safety and satisfaction. This review outlines common evidence-based pre, intra and postoperative interventions in use in enhanced recovery protocols following TKR. Methods A thorough literature search of the electronic healthcare databases (MEDLINE®, Embase™ and the Cochrane Library) was conducted to identify articles and studies concerned with enhanced recovery and fast track pathways for TKR. Results A literature review revealed several non-operative and operative interventions that are effective in enhanced recovery following TKR including preoperative patient education, pre-emptive and local infiltration analgesia, preoperative nutrition, neuromuscular electrical stimulation, pulsed electromagnetic fields, perioperative rehabilitation, modern wound dressings, different standard surgical techniques, minimally invasive surgery and computer assisted surgery. Conclusions Enhanced recovery programmes require a multidisciplinary team of dedicated professionals, principally involving preoperative education, multimodal pain control and accelerated rehabilitation; this will be boosted if combined with minimally invasive surgery. The current economic climate and restricted healthcare budget further necessitate brief hospitalisation while minimising costs. These non-operative interventions are the way forward to achieve such requirements.

Retrieval of retained Jamshidi needle fragments during minimally invasive surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 681-684 ◽  
Author(s):  
Michael Y. Wang ◽  
Spencer Block
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Invasive Surgery ◽  
Open Surgery ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Spinal Fixation ◽  
Anatomical Structures ◽  
Surrounding Bone

As surgical techniques evolve, new intraoperative complications are prone to occur. With percutaneous spinal fixation, the control of implants and instruments can be a challenge when compared with open surgery, particularly if unintended instruments are retained or difficult to retrieve. In this report, the authors describe a case in which Jamshidi needle fragments broke within the vertebral body. Extraction of the fragments was accomplished using a small pedicle screw tap to first engage the retained metal and then to loosen the surrounding bone to allow retrieval and preservation of the anatomical structures needed to complete the intended operation. This technique may prove useful for the retrieval of deformable, cannulated metal pieces in minimally invasive surgery.

An integrated system of telemedicine for minimally invasive surgery

2000 ◽  
Vol 6 (2_suppl) ◽  
pp. 88-89 ◽  
Author(s):  
V Masero ◽  
F M Sanchez ◽  
J Uson
Keyword(s):  
Information System ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Techniques ◽  
Integrated System ◽  
Minimally Invasive Surgical ◽  
Integrated Information System ◽  
Integrated Information

We have developed a telemedicine project called Telesurgex, which is an integrated information system designed for several hospitals as well as the Minimally Invasive Surgery Centre. The project researches and develops telemedicine systems (both hardware and software) and their contents, ensuring that they are really useful and not just a videoconference with medical topics. Another aim of the project is the improvement of teleteaching systems as applied to medicine, mainly teleteaching of minimally invasive surgical techniques.

Minimally invasive mitral valve repair

2018 ◽  
pp. 145-156
Author(s):  
Evelio Rodriguez ◽  
W. Randolph Chitwood
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive Surgery ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Surgical Techniques ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Direct Visualization ◽  
Technical Aspects

The practice of minimally invasive surgery is becoming increasingly widespread in the current era of cardiac surgery. Minimally invasive mitral valve surgery (MIMVS) describes many different surgical techniques used in the management of mitral valve (MV) disease. Variations in surgical techniques include a combination of the type of incision, direct visualization (videoscopic or robotic visualization), cardiopulmonary perfusion techniques, and aortic occlusion (external clamping, endo-clamping, or fibrillatory arrest). In this chapter, the history and current literature related to MIMVS are reviewed in detail. In addition, we discuss both important technical aspects associated with MIMVS, as well as our approach at the Saint Thomas Heart Institute.

scholarly journals Optimal indications and limitations of endoscopic transorbital superior eyelid surgery for spheno-orbital meningiomas

2020 ◽  
pp. 1-8 ◽  
Author(s):  
Doo-Sik Kong ◽  
Yong Hwy Kim ◽  
Chang-Ki Hong
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Cavernous Sinus ◽  
Invasive Surgery ◽  
Infratemporal Fossa ◽  
Wound Complications ◽  
Total Resection ◽  
Plaque Type ◽  
Endoscopic Transorbital ◽  
Orbital Rim

OBJECTIVESpheno-orbital meningiomas (SOMs) are complicated tumors that involve multiple structures at initial presentation, such as the orbit, temporalis muscle, sphenoidal bone, cavernous sinus, and temporal or infratemporal fossa. The infiltrative growth and complexity of this type of meningioma make total resection impossible. In this study, the authors evaluated the surgical outcome of the endoscopic transorbital approach (eTOA) for SOM. In addition, they identified optimal indications for the use of eTOA and analyzed the feasibility of this approach as a minimally invasive surgery for SOMs of varying types and locations at presentation.METHODSBetween September 2016 and December 2019, the authors performed eTOA in 41 patients with SOM with or without orbital involvement at 3 independent tertiary institutions. The authors evaluated the surgical outcomes of eTOA for SOM and investigated several factors that affect the outcome, such as tumor volume, tumor location, and the presence of lateral orbitotomy. Gross-total resection (GTR) was defined as complete resection of the tumor or intended subtotal resection except the cavernous sinus. This study was undertaken as a multicenter project (006) of the Korean Society of Endoscopic Neurosurgery (KOSEN-006).RESULTSThere were 41 patients (5 men and 36 women) with a median age of 52.0 years (range 24–73 years). Twenty-one patients had tumors that involved the orbital structure, while 14 patients had tumors that presented at the sphenoidal bone along with other structures, such as the cavernous sinus, temporal fossa, and infratemporal fossa. Fifteen patients had the globulous type of tumor and 26 patients had the en plaque type. Overall, GTR was achieved in 21 of 41 patients (51.2%), and complications included CSF leaks in 2 patients and wound complications in 2 patients. Multiple logistic regression analysis showed that the en plaque type of tumor, absence of lateral orbital rim osteotomy, involvement of the temporal floor or infratemporal fossa, and involvement of the orbit and medial one-third of the greater sphenoidal wing were closely associated with lower GTR rates (p < 0.05). Multivariate analysis revealed that the en plaque type of tumor and the absence of lateral orbital rim osteotomy were significant predictors for lower GTR rate.CONCLUSIONSThe en plaque type of SOM remains a challenge despite advances in technique such as minimally invasive surgery. Overall, clinical outcome of eTOA for SOM was comparable to the transcranial surgery. To achieve GTR, eTOA is recommended, with additional lateral orbital rim osteotomy for globulous-type tumors, without involving the floor of the temporal and infratemporal fossa.

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