Arthroscopic lat dorsi transfer
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This document discusses the tendon transfer technique of transferring the latissimus dorsi tendon to replace the torn posterior rotator cuff. It outlines the indications, prerequisites, pre-habilitation, biomechanics, surgical principles, positioning, portals, technique steps, post-surgery rehabilitation in 4 stages, and results from prospective studies showing 79.5% patient satisfaction and 89.8% intact tendons on MRI at 1 year follow up. Key factors for success include realistic expectations, pre-op specialist rehab, a committed patient, good communication, and secure graft fixation via either open or arthroscopic surgery.
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2. It discusses different alignment techniques in TKA including anatomical, mechanical, and kinematic alignment. Kinematic alignment aims to restore the natural three motion axes of the knee.
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This document discusses the treatment of peroneal tendon pathology. It begins with an overview of peroneal tendon tears, noting they are commonly misdiagnosed and surgical results are less predictable for chronic or extensive tears. Surgical treatment options discussed include debridement, tenosynovectomy, tendon repair with or without augmentation, and reconstruction. The document then reviews peroneal anatomy, conservative treatment, surgical techniques including open, tendoscopic, and use of grafts. Post-surgical rehabilitation and potential complications are also summarized. Outcomes of allograft reconstruction were reported as restoring strength and function with low risks.
Patellar Instability
This document discusses patellar instability, including relevant anatomy, predisposing factors, clinical features, radiological evaluation, and management. It begins with an introduction classifying patellar instability as acute, recurrent, or habitual. Relevant anatomy includes the patella, trochlea, and static and dynamic stabilizers of the patellofemoral joint. Risk factors include ligamentous laxity, alignment issues, and anatomical factors like patella alta or trochlear dysplasia. Clinical exams and radiological tests are used to evaluate patients. Management involves conservative treatments like bracing and physical therapy or surgical options like lateral release, MPFL reconstruction, and realignment procedures depending on the individual case.
Foot and ankle trauma - Derek Park
This document discusses the management of foot and ankle trauma. It begins with an overview of the anatomy of the ankle joint and examination of the foot and ankle. It then covers the assessment and management of ankle fractures, including distinguishing stable from unstable fractures. Weight bearing x-rays may better determine stability compared to stress views. Finally, it discusses the management of Achilles tendon ruptures, noting early loading and mobilization leads to better outcomes compared to immobilization.
G18 malunions
Malunion is defined as skeletal malalignment that can be angular, rotational, or translational. Corrective osteotomy aims to anatomically correct the deformity through precise osteotomies and stable fixation to improve function, decrease pain, and prevent arthrosis. Successful management requires a thorough preoperative evaluation of the deformity, soft tissues, and joints, as well as appropriate patient expectations and surgeon experience. Key factors include performing the correct osteotomy, achieving adequate fixation stability, and allowing early range of motion.
Tendon transfers around the shoulder
This document discusses tendon transfers around the shoulder for conditions such as brachial plexus injuries and irreparable rotator cuff tears. It provides guidelines for tendon transfers, including using synergistic muscles with a straight line of pull. It describes procedures like the latissimus dorsi transfer to restore shoulder function for massive rotator cuff tears. The document also discusses tendon transfers combined with shoulder arthroplasty to restore shoulder rotation.
PCL injuriessss,mechanism,diagnosis and treatment.pptx
This document discusses the mechanism of injury, diagnosis, classification, and management of posterior cruciate ligament injuries. Key points include:
- Injuries occur from direct blows to the knee or hyperextension/flexion injuries. Diagnosis involves clinical exams and imaging like x-rays.
- Injuries are classified from Grade 1 to 3 based on degree of tibial translation. Non-operative management is used for Grade 1 with bracing and PT.
- Surgical management is for Grade 2-3 injuries or those with other ligament injuries. Reconstruction techniques include open or arthroscopic procedures to replace the torn ligament with a graft.
Lecture 27 parekh pttd3 and 4
This document discusses operative care for stage 3 and 4 posterior tibial tendon dysfunction (PTTD). It describes the indications for and technique of triple arthrodesis, which fuses the subtalar, talonavicular, and calcaneocuboid joints to correct rigid flatfoot deformity and ankle arthritis. Preoperative planning and postoperative management are reviewed. Complications including malalignment, nerve injury, stiffness, arthritis, and nonunion are also summarized. The goal of triple arthrodesis is to achieve a stable, painless, plantigrade foot through anatomical realignment and fusion of the hindfoot joints.
Tkr
This document provides an overview of total knee replacement (TKR). It discusses the anatomy of the knee joint, common conditions requiring TKR, and the evolution of TKR procedures over 50 years. It describes different types of TKR prostheses including cruciate-retaining, posterior-stabilized, constrained, and unicompartmental designs. The document outlines the surgical technique for TKR including bone cuts and a medial para-patellar surgical approach. Post-operative rehabilitation and potential complications are also summarized.
NCCT OR CECT PELVIS BONE.pptx, INDICATIONS OF PELVIS BONE
This document provides information about CT scans of the pelvis bone, including indications, contraindications, patient preparation, positioning, and imaging protocol. It describes the pelvis bone anatomy and functions. CT scanning is described as a fast, non-invasive imaging method that provides 3D images of the pelvis bone to evaluate fractures, hip abnormalities, and other conditions. The protocol involves topograms, axial imaging from the iliac crest to hips pre-and post-contrast administration, with parameters like slice thickness, interval, and reconstruction algorithms provided. Patient care after the scan is also outlined.
Journal bukit
1) Pelvic fractures are associated with significant morbidity and mortality, with the ischiopubic bones, sacroiliac joint, and sacrum being most commonly injured.
2) Pelvic fractures are classified using the Tile or Young-Burgess classifications, with type I injuries usually managed non-operatively and type II and III injuries generally requiring surgical stabilization due to instability.
3) The timing of surgical fixation is dependent on hemodynamic status and associated injuries, with early fixation (<24 hours) associated with lower morbidity but also higher risk of bleeding in unstable patients. External fixation can be used initially in hemodynamically unstable patients before definitive fixation.
Injuries around the knee
This document provides an overview of common injuries around the knee joint. It describes the anatomy of the knee including bones and ligaments. Common mechanisms of injury are discussed for fractures around the knee like condylar fractures of the femur, patella fractures, and tibial plateau fractures. Injuries to the ligaments including ACL, PCL, MCL and LCL are also summarized. Treatment approaches for many of these injuries including nonsurgical and surgical options are highlighted. Other topics covered include meniscal injuries, knee dislocations, and patella dislocations. Complications of various knee injuries are also mentioned.
Extra-Osseous TaloTarsal Stabilization - HyProCure: The Scientific Evidence i...
EOTTS is a procedure that uses an internal fixation device to stabilize the talus bone and prevent excessive motion on the calcaneus and navicular bones. It is differentiated from inter-osseous and intra-osseous procedures by being purely soft tissue based. Research shows EOTTS reduces abnormal forces on structures like the posterior tibial tendon and plantar fascia by over 50% by restoring normal talo-tarsal joint motion. Cadaver studies prove EOTTS stabilizes talus positioning and decreases pressures in the tarsal tunnel that can cause neuropathy. Clinical studies show EOTTS improves function and reduces pain for patients with recurrent talo-tarsal dislocations.
Proximal tibial fracture
In the elderly osteoporotic fractures although the principles are the same but some special considerations in management of the soft tissues and the bony injuries are considered.
Acl tear
The ACL provides primary stability to the knee by limiting anterior tibial translation. It has an average tensile strength of 2160 N. An ACL tear is commonly seen in sports involving sudden stops and changes in direction. Clinical exams like the Lachman and anterior drawer tests can indicate an ACL tear. MRI is the gold standard for diagnosis. Treatment options include conservative management or arthroscopic reconstruction using grafts like hamstring tendons. Post-op rehabilitation is crucial and athletes may return to sports around 6-9 months following surgery.
Acl tear
The ACL provides primary stability to the knee by limiting anterior tibial translation. It has an average tensile strength of 2160 N. An ACL tear is commonly seen in sports involving sudden stops and changes in direction. Clinical exams like the Lachman and anterior drawer tests can indicate an ACL tear. MRI is the gold standard for diagnosis. While conservative treatment is possible, surgery is often pursued to reconstruct the torn ligament using grafts like the patellar tendon. Post-operative rehabilitation and physiotherapy are important for a successful recovery.
KNEE REPLACEMENT IN RECURVATUM KNEE.pptx
Knee replacement in a recurvatum deformity is one of the most challenging scenarios. This uncommon surgery is based on a few simple principles which are explained in this ppt. Hyperextension can be a part of neurological disorder, primary ligament laxity, mal-alignment around the joint, post traumatic conditions etc. a careful dissection and minimal bone cuts are essential points in this surgery. Contrary to regular principle we end up stuffing the joint to balance the posterior capsular hammock.
Hope this ppt helps you with your surgery planning.
Pcl pp
The posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. The PCL prevents the femur from sliding off the anterior edge of the tibia and prevents hyperextension of the knee. Injuries to the PCL typically occur from direct blows to the flexed knee, falling on the knee, or hyperextension injuries. Treatment involves rest, bracing, and physical therapy, with surgery required for complete tears.
AJM Sheet: pes cavus
1. The cavus foot work-up involves identifying the underlying etiology, whether the deformity is forefoot or rearfoot driven, the plane of the deformity, and if it is rigid or flexible.
2. Common causes of cavus foot include neuromuscular conditions like cerebral palsy and Charcot-Marie-Tooth disease.
3. Treatment depends on the classification - soft tissue procedures for flexible deformities and osteotomies or arthrodesis for rigid ones. Identifying the specific nature of the deformity guides appropriate treatment.
Total knee replacement nursing management
Total knee replacement surgery aims to relieve pain and restore mobility and function. It involves replacing damaged cartilage and bone in the knee joint with prosthetic components. Pre-operative evaluation assesses a patient's medical history, physical exam, labs, and risk factors. Post-operatively, patients undergo physical therapy including range of motion exercises to regain mobility while avoiding high-impact activities. Nursing care focuses on wound monitoring, pain management, and early ambulation to aid recovery.
Ligamentous injury around knee joint
This document discusses principles and management of ligamentous knee injuries. It covers the mechanisms of injury, classification, anatomy and biomechanics of the ACL, PCL and meniscus. It also discusses clinical assessment including special tests, imaging, treatment options of non-surgical rehabilitation versus surgical reconstruction, and post-operative rehabilitation. The take home message is that isolated grade 1-2 ligament injuries can often be managed non-surgically, while reconstruction has better outcomes for collateral ligaments and goals of rehabilitation focus on range of motion, graft protection, proprioception and muscle strength recovery.
Similar to Arthroscopic lat dorsi transfer (20)
PCL injuriessss,mechanism,diagnosis and treatment.pptx
PCL injuriessss,mechanism,diagnosis and treatment.pptx
NCCT OR CECT PELVIS BONE.pptx, INDICATIONS OF PELVIS BONE
NCCT OR CECT PELVIS BONE.pptx, INDICATIONS OF PELVIS BONE
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More from Lennard Funk
ACJ Disloc Management 2022.pdf
This document discusses the management of AC joint dislocations. It notes that while literature indicates surgery for type 4, 5, and 6 dislocations, classification using radiographs is unreliable. Further, clinical results are comparable between operative and non-operative treatment, but complications are more common with surgery. The author's indications for surgery are for those who cannot cope functionally or with work/social demands, such as overhead athletes. His experience using the LARS ligament for AC joint reconstruction is described along with postoperative rehabilitation phases and results showing a mean 15% reduction in displacement and low complication rates. Revision procedures for failed reconstructions also have good results.
Clavicle Fractures Pro Cyclists 2021.pdf
Clavicle fractures in pro cyclists are unique injuries that require careful management. Operative treatment with plate and screws results in improved healing times, higher union rates, and an earlier return to competition compared to non-operative treatment. The decision to return to cycling depends on fracture healing as well as an assessment of risk versus benefit by a multidisciplinary team in consultation with the patient.
ACJ Osteolysis.pdf
This document summarizes a study evaluating the clinical outcomes of direct arthroscopic acromioclavicular (AC) joint excision for osteolysis. Osteolysis of the AC joint is caused by excessive overhead motions and is commonly seen in weightlifters and rugby players, causing pain and limited shoulder range of motion. The study retrospectively reviewed 16 patients who underwent direct arthroscopic AC joint excision over a 2 year period. Patients showed significant improvements in their Constant Shoulder Score and QuickDASH score between pre-op and post-op assessments at a mean follow-up of 21 months. Patients also reported high satisfaction ratings. The study concluded that direct arthroscopic AC joint excision is an effective treatment for osteolysis with significant
Chronic Pectoralis Major Injuries Len Funk 2020
This document discusses chronic injuries to the pectoralis major muscle and surgical techniques for repairing them. It provides details on indications for surgery, including factors that make for good and poor surgical candidates. Surgical techniques described include preparing and attaching an allograft tendon to the pec major footprint using suture anchors. Post-op rehabilitation is outlined in phases focusing initially on range of motion and later on strengthening. Ultrasound imaging is used post-operatively to monitor healing. Outcomes of surgeries performed are also mentioned.
Rotator Cuff Augment 2018.pdf
This document discusses rotator cuff augmentation, which involves adding graft material to reinforce rotator cuff repairs. There are several types of grafts, including autografts from the patient's own tissue, allografts from human donors, xenografts from animals, and synthetic grafts. The evidence for whether augmentation improves outcomes comes from a limited number of randomized controlled trials and observational studies of varying quality. While allograft augmentation seemed to produce better results than controls in some studies, the overall evidence is inconclusive due to the low quality and small size of available studies. More research is still needed to determine whether and when augmentation provides meaningful benefits over standard rotator cuff repair without grafting.
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
the common questions patients will ask once they have had a scan and a tear has been reported, particularly if they have had no injury of trauma, they ask what caused my tear. If I have a tear what can you do to fix it, it’s got to be fixed. How can I get better if it is not fixed. I have already had physiotherapy and that didn’t fix it so how will more physiotherapy. Some patients who are not keen on surgery, do I really need to have an operation. I have not had an injury.
there are multiple options thrown into the mix here which we need to consider for an individual patient.
The below illustration shows a very rough decision making tool that I would use in determining surgical or treatment options for particular patients.
A younger patient who has both pain and weakness with a massive cuff tear, if it is partially repairable a biological augment would be suitable.
If their predominant weakness is external rotation i.e. a positive Hornblower sign but good elevation, a lat dorsi tendon transfer.
For an older patient who has a predominant weakness but no significant pain, deltoid rehabilitation programme is indicated.
If they do have pain, a suprascapular nerve procedure such as an ablation would be beneficial.
For those that have significant pain and weakness with failed non-operative options, a reverse shoulder replacement would be the best option.
The balloon as we said, has a very limited place and this is for the older patient with slight loss of function and pain with higher demands.
For those that have more significant pain and elevation weakness, a superior capsular reconstruction would be my preferred option.
Should We Repair Rotator Cuff Tears OPN 2017.pdf
Lennard Funk & Puneet Monga
Prepared for Orthopaedic Product News, 2017
Rotator cuff disease is very common. There is as much enthusiastic discussion and debate on its management as there was 80 years ago when Codman (1937) first described the pathology and surgical management. There is great variation amongst surgeons as to the management of rotator cuff tears biased by experience and their understanding of the literature, skills levels and regional variations. There has been a lot of research done on the pathology, non-operative and operative treatments over the last two decades. Also, over the last decade there have been massive strides in the development of new surgical techniques and technologies. However, despite these advances there is as much discussion and debate!
Anterior shoulder instability st4-6
This document discusses the evolution and current approaches to shoulder instability surgery. It begins with a brief history of instability surgery techniques from Hippocrates to modern arthroscopic and open surgical procedures. It then covers classification of instability, pathological lesions, management decisions, and surgical procedure principles. Key points discussed include the Stanmore classification system, types of soft tissue lesions like Bankart tears and bone defects like bony Bankart fractures and Hill-Sachs lesions. Decision factors for open versus arthroscopic surgery are outlined. Surgical techniques like Bankart repair, capsular plication, bone graft procedures for glenoid deficiency, and remplissage for large Hill-Sachs lesions are summarized.
ACJ revision surgery for failed reconstructions and excisions
This document discusses ACJ revision surgery. It provides information on the functional anatomy of the AC joint, causes of failed ACJ excision or reconstruction, and describes a technique for ACJ revision surgery. The technique involves removing scar tissue from previous procedures, taking micro samples, performing an anatomical reconstruction of the CC and AC ligaments using LARS ligaments and a biceps flip or CAL transfer, and performing a delto-trapezial reefing. Results from 23 revision cases over 7 years showed improved Constant scores, low rates of re-displacement and infection, and no need for further revision after a mean follow up of 37 months.
Pectoralis Major Injuries for BESS 2020
This document discusses pectoralis major injuries, including anatomy, diagnosis, treatment options, and outcomes. It provides an overview of the author's experience treating tears in athletes from various sports. Diagnosis involves clinical exam and imaging like ultrasound or MRI. Treatment can be non-operative with strength loss, or operative with surgical repair which often provides best results, especially for distal tears. Post-operative rehabilitation is outlined in phases focusing first on range of motion and later on strengthening. Reported outcomes include patients regaining 90% of strength on average and returning to sports within 6 months.
Anterior shoulder Instability in the young athlete 2020 bostaa
This document discusses anterior glenohumeral joint instability in younger athletes. It notes that recurrence rates after non-operative treatment are high, between 70-100% in most studies. Arthroscopic stabilization also has high recurrence rates, particularly in those under age 16. The Latarjet procedure has shown good outcomes in both adolescent and adult populations with low recurrence rates and high rates of return to previous sport levels. For a semi-pro rugby player with anterior instability, surgery may be considered given the presence of major structural lesions, inability to continue playing, and pressures to return mid-season. The Latarjet procedure would be a good surgical option in this younger athlete population.
Superior Capsular Reconstruction Outcomes Wrightington 2020
Hariharan Mohan, Jagwant Singh, Michael Walton, Lennard Funk, Puneet Monga
Cautious optimism following SCR may be offered to this challenging subset of patients with symptomatic irreparable rotator cuff tears. It is likely that the relatively low re-operation rates can be further improved by considering the negative prognostic factors in defining indications for surgery. Further studies with longer term followup are recommended.
Shoulder Instability Sports - Decision Making
Lennard Funk presented on the clinical and radiological assessment of shoulder instability in athletes. He discussed evaluating anterior and posterior instability through physical examination tests in different positions and assessing glenoid and humeral bone loss on imaging studies like MRI arthrograms. Funk also covered management strategies and decision making, which involves considering factors related to the patient, their profession, the type and extent of pathology, and the treating physician.
Scapula Pain
Isolated scapula pain is uncommon, but very difficult to diagnose and manage. In this presentation I run through the known causes and an approach to the diagnosis, in order to guide best treatment.
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
Posterior and combined labral tears are more common than previously thought, especially in young active populations. The study reviewed 442 patients undergoing shoulder stabilization surgery and found that posterior and combined tears accounted for 47% of cases, compared to only 53% being isolated anterior tears. Rates of posterior and combined tears were even higher in sporting populations (52%) compared to non-sporting populations (32%). Rugby players in particular had a high rate of posterior and combined tears (53%). The study concludes that posterior and combined shoulder instability is more prevalent than reported, especially in contact sports.
Pectoralis major allograft reconstruction
Presentation at ISAKOS, 2019
We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 required allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively.
The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no improvement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).
What the surgeon wants from radiologist
The document discusses shoulder injuries in sports. It provides guidance on what information is important to understand from MRI reports for rotator cuff tears, including the size and location of the tear and the extent of muscle atrophy. It emphasizes the importance of collaboration between surgeons and radiologists for accurate diagnoses. The treatment approach for sports injuries depends on factors like the patient's age, type of sport played, and time since injury.
Rotator cuff tear management 2019
Rotator cuff tears do not always require surgical repair. The decision depends on factors like the patient's age and activity level as well as the size and chronicity of the tear. Smaller tears in younger, more active patients may heal with non-operative treatment or repair, while larger, chronic tears in older individuals often do not heal after repair. When repair is not indicated for massive, irreparable tears, options include tendon transfers, superior capsular reconstruction, augmented repairs, and InSpace balloon spacers. Ultrasound is useful for initial evaluation and post-operative monitoring but MRI may better assess tear size and tissue quality factors that predict repair outcomes.
Perioperative pain management toni hundle the arm clinic 2019
Peri-operative pain management from Anaesthetist, Dr Toni Hundle for The Arm Clinic at HCA The Wilmslow Hospital 2019
Hydrodistension outcomes 2017
Hydrodistention is a treatment for frozen shoulder (FS) that is gaining popularity again. However, no large, long-term outcome data has been published yet. Our aims were to evaluate hydrodistension for the treatment of primary frozen shoulder (FS) in a large cohort of patients with long follow-up period.
We present a case series of eighty-nine patients (36 males and 53 females) with a mean age of 52 years (33-73). Eleven (12.4%) had disease associations. We excluded post-operative secondary stiff shoulders. The mean volume injected was 33.7ml (16-66). 36/89 (40%) had capsular rupture. Six (6.7%) had adverse effects. The mean follow-up was 104.5 weeks (8-238).
Mean improvement in forward flexion was 165.4, abduction 111.6, external rotation was hand above head with elbow back (and internal rotation in extension to T12. Mean improvement in quickDASH score was 17.1 (p<0.001) and Constant Score was 70.0 (p<0.001). Mean improvement in VAS was 7.3 (p<0.001). No patients had night pain (p<0.001). Eighty-eight (99%) returned to their previous occupation. Seventy-six (85%) returned to their previous level of sport. Gender, previous intra-articular steroid injection, volume of the injectate, type of steroid used, capsular rupture and underlying aetiology had no impact on outcome.
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ACJ revision surgery for failed reconstructions and excisions
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Anterior shoulder Instability in the young athlete 2020 bostaa
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Superior Capsular Reconstruction Outcomes Wrightington 2020
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The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
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12. Comprehend the vectorial analysis of the normal ECG
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Arthroscopic lat dorsi transfer
- 2. Indicationfortendontransfer • MRCT withWeakness • Functionalstrengthloss+/-pain
- 3. Clinically • Pain • Weakness • Functionloss ▫ IncludingADLs
- 4. Pre-requisitesofTransfer • Intactdeltoid • IntactSubscapularis-maintainforce-couple • Goodbone-fixation • Compliantpatient(youngactive)
- 5. Pre-Habilitation • shouldertherapist • OptimiseDeltoid&function • Activitymodifications • Re-assessbeforesurgery
- 6. Biomechanics ▫ GerberJSES2008 ▫ 3differentinsertionsites ▫ Ant/post/inf GT ▫ PosteriormostmechanicallyadvantageoustoER
- 7. Principlesofthetechnique • Open: • HarvestTendon • Mobilisetendon • Arthroscopy: • Preparesurfaces • Developtrack • Transfertendon • Fixation
- 8. Position
- 14. PosteriorRelease
- 15. HumerusPrep
- 16. Sutureretrieval
- 17. TendonRetrieval
- 18. TendonRetrieval
- 19. TendonFixation
- 20. FinalFixation
- 21. PostSurgery ERbrace-comfortonly painmanagement limitNSAIDs coldcompression Woundcare Earlyrehab.
- 22. Stage1PostSurgery (approx0-3weeks) • Painmanagement • Woundmonitoring • ClosedactiveassistedROMwithinsafezones • Notforgettingthekineticchain
- 26. Stage2(approx3-6Weeks) • Reduceslingsupport–weanfromERwedge • ContinuetoincreaseactiveassistedROMclosedchain (Proprioceptivevalue) Qualityofmovement • Facilitatinghandoverelbow • BegingentleisometricERinneutral Thelatdorsi’snewrole Shoulderdoc
- 28. Stage3(approx6-12Weeks) • ContinuewithactiveROMreinforcinghandoverelbow • Tips… • Breakthemovementdown • Startwitheccentricallyloweringarmtoaid re-education (Donaldsonetal2011)
- 30. Stage3Exercise
- 32. Stage4(3Months+) • Progressfunction- load/endurance • unconstrainedROM • Fitness&conditioning • Returntowork
- 33. Stage4(3Months+)
- 35. Results-Arthroscopic FrenchMULTICENTERPROSPECTIVESTUDY • J.Grimberg,J.Kany,Ph.Valenti,J.Garret,LD. Duranthon,VKChang • (Paris,SaintJean,Lyon,Hawaï) • SECECmeeting,Lyon2011
- 36. RESULTS • 49Patients(27DrJK,11DrPhV,11DrJG) • Meanageatsurgery:59,4(31-73) • 23primarysurgeries,26secondarysurgeries(1to 6previoussurgicalprocedures) • Meanfollowup:21,2months(12-42) • Nolosttofollow-up.
- 39. MRI:oneyearpostop • 44patients:89,8%ofpatientscontrolled • 41intacttendons:93%ofcontrolledpatients • 3tendon-bonesecondarypulloutprobablylinkedto boneweakness
- 41. PREDICTINGFACTORS • NOINFLUENCEONCLINICALRESULTS • Age>or<65 • Sex • Manual/Light/Sedentarywork • Preopactiveanteflexion>or<90° • Zoneoftendonfixation:superiororposterior • PEJORATIVEFACTORS • Worker’scompensation • Preoperativesurgery
- 42. Summary • SetREALISTICExpectations • pre-opspecialistrehab. • PatientMUSTbecommitted • CommunicationVITAL • goodgraftfixation • Open/arthroscopic(?)