repair

C Surgical Reconstruction Issues

Timing of Surgery

 

Issue

- reported higher incidence with immediate reconstruction in acute phase

- reduced by settling inflammation / effusion and obtaining FROM

- always best to delay if not professional athlete

- problematic if patient has locked bucket handle mensical tear

 

Results

 

Bottoni et al Am J Sports Med 2008

- RCT of early (average 9 days) v late reconstruction (average 85 days)

Arthroscopic SLAP Repair

Shoulder Scope SLAP 2

 

Technique

 

1. Establish portals

 

A.  Posterior portal for viewing

 

B.  Anterior portal

- need to keep low and away from biceps, otherwise difficult to get around biceps

- for suture passage, if in combination with bankart repair often use AI portal instead of AS

MCL and Posteromedial Corner

AnatomyMCL anatomy

 

1. Seebacher's 3 layers of the medial knee

 

Layer 1

- sartorius and sartorius fascia

 

Layer 2

- superficial MCL

- posterior oblique ligament

- semimembranosus

 

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

 

2. MCL

 

Superficial MCL