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Arthroscopy and upper limb surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.


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Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
C Mathoulin
Surgical intervention
4 months ago
148 views
4 likes
0 comments
06:03
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
C Mathoulin
Surgical intervention
4 months ago
219 views
5 likes
0 comments
04:08
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
C Mathoulin
Surgical intervention
4 months ago
104 views
1 like
0 comments
17:40
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
C Mathoulin
Surgical intervention
4 months ago
91 views
1 like
0 comments
04:24
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
C Mathoulin
Surgical intervention
5 months ago
50 views
3 likes
0 comments
09:08
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
C Mathoulin
Surgical intervention
5 months ago
55 views
4 likes
0 comments
06:06
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
C Mathoulin
Surgical intervention
5 years ago
466 views
6 likes
0 comments
06:26
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
Lengthening of extensor muscle origin as treatment of lateral epicondylitis
Lateral epicondylitis (tennis elbow) is the most common affliction of the elbow. It is an inflammatory condition producing pain localized around the lateral elbow and dorsal forearm region. Though often put in the category of tendinitis, it is actually a result of an injury to the extensor musculotendinous origin at the lateral humoral epicondyle. It usually responds to non-surgical treatment. In case of failure, a surgical treatment is requested. It consists in the lengthening of the extensor muscle origin. This original technique allows a prompt recovery of full range of motion.
This video was captured using the VITOM system from KARL STORZ.
C Mathoulin
Surgical intervention
5 years ago
829 views
20 likes
0 comments
05:18
Lengthening of extensor muscle origin as treatment of lateral epicondylitis
Lateral epicondylitis (tennis elbow) is the most common affliction of the elbow. It is an inflammatory condition producing pain localized around the lateral elbow and dorsal forearm region. Though often put in the category of tendinitis, it is actually a result of an injury to the extensor musculotendinous origin at the lateral humoral epicondyle. It usually responds to non-surgical treatment. In case of failure, a surgical treatment is requested. It consists in the lengthening of the extensor muscle origin. This original technique allows a prompt recovery of full range of motion.
This video was captured using the VITOM system from KARL STORZ.
Endoscopic microsurgery: a new concept
In this authoritative lecture, Dr. Philippe Liverneaux focuses on endoscopic microsurgery. Conventional microsurgery requires large incisions and extensive dissections while it is performed in a small operating field. In this context, the concept of endoscopic microsurgery appears to be a logical way to be put to the test.
We rely on four years of practical experience using the Da Vinci™ robot at the European Institute of Telesurgery in Strasbourg, France. To-date, 40 patients have been operated on by our Hand Surgery and Peripheral Nerve Department.
Endoscopic Microsurgery combines the properties of microsurgery, endoscopic surgery, and telesurgery. Not only does it allow to magnify the vision of the operating field, but it also allows to multiply the operator's hand movements, and all the more so by means of minimally invasive approaches. Its evolution necessitates the development of a dedicated robot and specific instrumentation capable of handling such procedures.
P Liverneaux
Lecture
6 years ago
439 views
2 likes
0 comments
19:34
Endoscopic microsurgery: a new concept
In this authoritative lecture, Dr. Philippe Liverneaux focuses on endoscopic microsurgery. Conventional microsurgery requires large incisions and extensive dissections while it is performed in a small operating field. In this context, the concept of endoscopic microsurgery appears to be a logical way to be put to the test.
We rely on four years of practical experience using the Da Vinci™ robot at the European Institute of Telesurgery in Strasbourg, France. To-date, 40 patients have been operated on by our Hand Surgery and Peripheral Nerve Department.
Endoscopic Microsurgery combines the properties of microsurgery, endoscopic surgery, and telesurgery. Not only does it allow to magnify the vision of the operating field, but it also allows to multiply the operator's hand movements, and all the more so by means of minimally invasive approaches. Its evolution necessitates the development of a dedicated robot and specific instrumentation capable of handling such procedures.