ТРАВМАТОЛОГИЯ ЖӘНЕ ОРТОПЕДИЯ 3-4/2014
Diagnosis of the ACL tear is not
straightforward and the instability should be
assessed clinically. Sometimes it is very difficult
to detect subtle instability and EUA is the only
way to determine it.
Surgical treatment of ACL has been
offered for many years. Surgical technique,
choice of graft, methods of fixation have been
gradually improving. Better understanding
of ACL anatomy has led to new, improved
technique – anatomical ACL reconstruction. It
allows placement and fixation of the graft to
the footprints of native ACL. Graft placed that
way stabilizes the knee in antero-posterior
direction and also provides rotational stability,
which previous techniques failed to address.
Some surgeons prefer to recreate both ACL
bundles separately – so called double bundle
technique. It is still debatable whether this
technique is more advantageous as compared
to single bundle ACL reconstruction.
Anatomical ACL reconstruction is presented
step by step in this presentation with pitfalls and
pearls.
We present series of more then 150 patients
with short term follow up.
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MODERN TECHNIQUES IN SHOULDER REPLACEMENT SURGERY
CHARALAMPOS ZOURELIDIS
Dubai Bone & Joint Center, UAE
First shoulder replacement was performed in 1893. Since then there was continuous development in surgical techniques
and implants. Nowadays more then 45000
shoulder replacement procedures are performed in USA only.
Early glenoid loosening has been the
most common complication following shoulder replacement surgery. Therefore many
surgeons preference was to perform only
hemiarthroplasty. However long term data
revealed that patients satisfaction following shoulder hemiarthroplasty was not very
high. Significant improvements in design of
glenoid components and surgical techniques
increased glenoid survival following total
shoulder replacement.
Since 2006 total shoulder replacement operations performed in USA outnumber hemiarthroplasty procedures. We review recent
literature regarding outcomes, survival and
complications following shoulder replacement
surgery.
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Since 1980’s reverse polarity shoulder
replacement implant has emerged for rotator
cuff arthropathy. The design of reverse polarity shoulder replacement has been improving
and modern implants and techniques are very
promising in terms of patient satisfaction and
survival.
Another promising technique is resurfacing
shoulder replacement. It allows several advantages such as bone stock preservation, low incidence of periprosthetic fractures, no need for
osteotomy and easy revision surgery. Modern
implants are discussed in presentation.
Treatment of the young patient with glenohumeral arthritis remains difficult problem.
After trial of conservative treatment surgical
options are very limited. Arthroscopic debridement, cartilage repair or reconstruction using
various biological grafts have been reported
with various success rate. Shoulder replacement should be postponed as much as possible. We review latest literature regarding outcomes of these options.