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Kakegawa A, Sumitomo N, Nagira A, Ichinose Y, Fukushima N. The calcaneofibular ligament groove at the inferior fibula, an ultrasonographic anatomical landmark. Surg Radiol Anat 2024; 46:739-747. [PMID: 38573504 DOI: 10.1007/s00276-024-03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Calcaneofibular ligament (CFL) injuries are harder to diagnose than anterior talofibular ligament (ATFL) ones. This study aimed to clarify the fibular attachment of the CFL and verify the bony landmark for evaluating the CFL on ultrasonography. METHODS Fifty-nine ankles were used in this anatomical study. To confirm the control function of the CFL, we performed passive movement manually using cadaveric ankles and observed the ankle positions where the CFLs were tense. Histological observation of CFL attachment of the fibula was performed using Masson's trichrome stain. The ATFL and CFL were removed, and the bone morphology of the CFL attachment and inferior fibular end was imaged using a stereomicroscope and a 3D scanner. Using ultrasonography, we evaluated the bone morphology of the fibular attachment of the CFL in short-axis images of 27 healthy adult ankles. RESULTS The CFL was tensed according to ankle motions: supination, maximum dorsi flexion, maximum plantar flexion, and mild plantar flexion-external rotation. Below the CFL attachment of the fibula was a slight groove between the inferior tip and the obscure tubercle of the fibula. This groove was observed in 81.5% of cases using short-axis ultrasonography. CONCLUSION The CFL was tensed in various ankle positions to control the movements of the talocrural and subtalar joints. There was a slight groove at the inferior end of the fibula where the CFL coursed downward. We called it the CFL groove and proposed that it could serve as a landmark for the short-axis image of ultrasonography.
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Affiliation(s)
- Akira Kakegawa
- Faculty of Human Care, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshimaku, Tokyo, Japan.
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan.
| | - Norimi Sumitomo
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Ayata Nagira
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Yuko Ichinose
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
| | - Nanae Fukushima
- Department of Anatomy, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, Japan
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Ozeki N, Koga H, Nakamura T, Nakagawa Y, Hoshino T, Amemiya M, Sekiya I. Real-Time Virtual Sonography-Guided Ossicle Removal in Unresolved Osgood-Schlatter Disease. Arthrosc Tech 2024; 13:102897. [PMID: 38690341 PMCID: PMC11056614 DOI: 10.1016/j.eats.2023.102897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/27/2023] [Indexed: 05/02/2024] Open
Abstract
Osgood-Schlatter disease (OSD) reduces participation in sports activities for adolescents, and, in unresolved cases of the disease in which daily life or sports activity after skeletal maturity are affected, surgical intervention to remove the ossicle is performed to alleviate symptoms. We present a real-time virtual sonography (RVS)-guided ossicle removal in unresolved OSD. The knee joint angle is set at 20°, which is the same position used in magnetic resonance imaging. A 1.5-cm longitudinal skin incision is made at the medial side of the tuberosity. An ultrasound probe covered with a sterile sleeve is then placed longitudinally at the level of tuberosity. The forceps is inserted to peel the patellar tendon off the posterior side of the ossicle. Then the anterior side of the ossicle is peeled off in both the transverse and longitudinal views. When the ossicle is unstable enough, forceps are used to grasp the ossicle and carefully remove it. RVS can see magnetic resonance imaging information in the surrounding area beyond what can be detected by the ultrasound probe, and RVS enables easy determination of the anatomical position of the ossicle, and removal of the ossicle is achieved with low invasiveness.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Takashi Hoshino
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Masaki Amemiya
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
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Fujishiro H, Nimura A, Azumaya M, Hattori S, Hoshi O, Akita K. Anatomical study of the bone morphology of the anterior talofibular ligament attachment. Anat Cell Biol 2023; 56:334-341. [PMID: 37482888 PMCID: PMC10520850 DOI: 10.5115/acb.23.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/23/2023] [Accepted: 05/19/2023] [Indexed: 07/25/2023] Open
Abstract
Anterior talofibular ligament (ATFL) injuries are the most common cause of ankle sprains. To ensure anatomically accurate surgery and ultrasound imaging of the ATFL, anatomical knowledge of the bony landmarks around the ATFL attachment to the distal fibula is required. The purpose of the present study was to anatomically investigate the ATFL attachment to the fibula with respect to bone morphology and attachment structures. First, we analyzed 36 feet using microcomputed tomography. After excluding 9 feet for deformities, the remaining 27 feet were used for chemically debrided bone analysis and macroscopic and histological observations. Ten feet of living specimens were observed using ultrasonography. We found that a bony ridge was present at the boundary between the attachments of the ATFL and calcaneofibular ligament (CFL) to the fibula. These two attachments could be distinguished based on a difference in fiber orientation. Histologically, the ATFL was attached to the anterodistal part of the fibula via fibrocartilage anterior to the bony ridge indicating the border with the CFL attachment. Using ultrasonography in living specimens, the bony ridge and hyperechoic fibrillar pattern of the ATFL could be visualized. We established that the bony ridge corresponded to the posterior margin of the ATFL attachment itself. The ridge was obvious, and the superior fibers of the ATFL have directly attached anteriorly to it. This bony ridge could become a valuable and easy-to-use landmark for ultrasound imaging of the ATFL attachment if combined with the identification of the fibrillar pattern of the ATFL.
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Affiliation(s)
- Hitomi Fujishiro
- Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mizuki Azumaya
- Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichi Hattori
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Sports Medicine, Kameda Medical Center, Chiba, Japan
| | - Osamu Hoshi
- Department of Anatomy and Physiological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Xie X, Chen L, Fan C, Song S, Yu Y, Jiao C, Pi Y. The lowest point of fibula (LPF) could be used as a reliable bony landmark for arthroscopic anchor placement of lateral ankle ligaments ----compared with open Broström procedure. BMC Musculoskelet Disord 2023; 24:759. [PMID: 37749543 PMCID: PMC10521499 DOI: 10.1186/s12891-023-06876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Arthroscopic technique procedures was wide accepted for the treatment of chronic ankle instability (CAI). But little acknowledge was involved to the bony landmarks and anatomic features of different bundles of lateral ligaments under arthroscopic view. METHODS Sixty patients with acute or chronic lateral ankle ligaments injury (LAI) were collected prospectively, and divided randomly into two groups. In arthroscopic group, the bone tunnels were made on the LPF arthroscopically. And in open group, the bone tunnels were made on the Fibular obscure tubercle (FOT) in open procedure. The inferior bundle of ATFL and Arcuate fibre was also identified reference to the LPF and labeled by a PDS II suture penetration. Following that, The distances of the bone tunnels to the different bony markers were measured and compare between two groups. The penetrating locations of PDS II on the inferior bundle of ATFL and Arcuate fibre were also confirmed intraoperatively. And the safe angle of anchor implantation on the axial view was measured on postoperative CT scan. RESULTS The distances of bone tunnel to the fibular tip, the fibular insertion of anterior-inferior tibiofibular ligament (AITFL), and the FOT in arthroscopic and open locating groups were 4.9 ± 2.2 and 6.3 ± 2.2 mm, 13.5 ± 2.7 and 12.4 ± 1.1 mm, 5.8 ± 2.2 and 5.6 ± 1.0 mm, respectively. The distances of bone tunnels to the FOT and fibular tip on 3d-CT view was 4.4 ± 1.5 and 4.6 ± 0.9 mm, 14.4 ± 3.2 and 13.2 ± 1.8 mm in arthroscopic and open group, and there were no significant differences between two groups. The safe angle of arthroscopic anchor placement on the axial plan was ranged from 24.9 ± 6.3o to 58.1 ± 8.0o. The PDS II sutures penetrating on the inferior bundles of ATFL and the arciform fibres were also comfirmed successfully by open visualizaion.The average distance of penetration point to the horizontal line cross the fibular tip was 2.3 ± 2.7 mm (ranged from - 3.1 to 6.0 mm), and to the vertical line cross the FOT was 2.7 ± 2.7 mm (ranged from - 2.5 to 7.5 mm). CONCLUSION Take the lowest point of fibula under arthroscopy (LPF) as a bony reference, we could identify the iATFL under arthroscopic visualization. By this way, we could place the suture anchors properly to the fibular footprint and suture the iATFL fibres successfully.
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Affiliation(s)
- Xin Xie
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Linxin Chen
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Cunshuai Fan
- Orthopedics Dept.1, Pingdingshan first people's Hospital, Pingdingshan city, Henan province, PR China
| | - Shouyi Song
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Yin Yu
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Chen Jiao
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Yanbin Pi
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
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You GX, Huang L, Li MH, Xiong B, Peng WL, Shi HY, Zhang L. The safe zone of distal fibula was determined based on the classification of lateral malleolus fossa. J Orthop Surg Res 2023; 18:714. [PMID: 37736730 PMCID: PMC10514986 DOI: 10.1186/s13018-023-04194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Lateral malleolus fractures are very common, and the distal fibular geometry is complex. This study aimed to classify the lateral malleolus fossa (MF) into different types by characterizing the lateral MF imaging morphology and exploring the relationship between the lateral MF and internal fixation position after distal fibula fractures. METHODS Anteroposterior CT reconstruction was performed on 248 subjects. After reconstruction, the deepest point of the lateral MF was located, and then, the cross-sectional shape of the lateral MF was observed and classified. RESULTS According to the morphology of the CT cross section, the lateral MF was divided into three types: type C (43.1%), type V (32.2%), and type Flat (24.7%). Type V (3.98 ± 0.82) was significantly longer than type C(2.83 ± 0.54) and type Flat (1.84 ± 0.42) in cd. Similarly, in ∠α, Type Flat(136.31 ± 9.63) was the largest, followed by type C (116.51 ± 8.79), and type V (89.31 ± 9.07) was the smallest. Other measurements were not found any significant differences between the above. CONCLUSION According to the morphology of the CT cross section, the lateral MF was divided into three types: type C, type V and type Flat. Type V is most likely to be invaded when fixing the distal fibula. Screws less than 9 mm should be selected when fixing, and screws no more than 10 mm should be selected when there are type C and type Flat of MF.
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Affiliation(s)
- Gui-Xuan You
- School of Physical Education, Southwest Medical University, Luzhou, 646000, China
| | - Lei Huang
- School of Physical Education, Southwest Medical University, Luzhou, 646000, China
| | - Ming-Hui Li
- School of Physical Education, Southwest Medical University, Luzhou, 646000, China
| | - Bin Xiong
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Wan-Lin Peng
- Department of Medical Imaging, Southwest Medical University, Luzhou, 646000, China
| | - Hou-Yin Shi
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000, China.
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Hattori S, Onishi K. Ultrasound-guided surgery in musculoskeletal medicine. J Med Ultrason (2001) 2022; 49:513-515. [DOI: 10.1007/s10396-022-01255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022]
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Omodani T, Takahashi K, Ueno K. Ultrasound-guided screw fixation for patellar stress fracture in a female basketball player: A case report. Medicine (Baltimore) 2022; 101:e30040. [PMID: 35984166 PMCID: PMC9387984 DOI: 10.1097/md.0000000000030040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Stress fracture of the patella is an overuse disorder that occurs in the lower extremity. Surgery may be considered if conservative treatment does not work or if a quicker and more reliable return to sports is expected. Surgery is usually performed under fluoroscopic guidance based on the premise that the proper placement of the internal fixation material can be determined on radiographic images. PATIENT CONCERNS A 16-year-old female basketball player gradually became aware of pain in the anterior aspect of her right knee during basketball, without any particular history of trauma. A computed tomography scan revealed a small bone fragment on the lateral side of the distal end of the patella. DIAGNOSIS Stress fracture of the patella. INTERVENTIONS Since it was difficult to determine the exact location of the bone fragment on radiographs, the surgery was performed under ultrasound guidance rather than fluoroscopy. While checking the bone fragment with ultrasound images, insertion of the guide pin, drilling, and screw fixation were performed under ultrasound guidance. OUTCOMES Postoperative computed tomography showed accurate screw insertion into the bone fragment. Two months after surgery, bony fusion was confirmed, and the patient returned to her preinjury level of basketball. CONCLUSION Ultrasound-guided screw fixation was useful in this case in which internal fixation of fractures is difficult under fluoroscopic guidance.
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Affiliation(s)
- Toru Omodani
- Sports Medicine & Joint Center, Funabashi Orthopedic Hospital, Funabashi, Japan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
- *Correspondence: Toru Omodani, Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213 (e-mail: )
| | - Kenji Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopedic Hospital, Funabashi, Japan
| | - Keishin Ueno
- Sports Medicine & Joint Center, Funabashi Orthopedic Hospital, Funabashi, Japan
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Hattori S, Onishi K, Chan CK, Yamakawa S, Yano Y, Winkler PW, Hogan MV, Debski RE. Ultrasound-Guided Anterior Talofibular Ligament Repair With Augmentation Can Restore Ankle Kinematics: A Cadaveric Biomechanical Study. Orthop J Sports Med 2022; 10:23259671221111397. [PMID: 35958291 PMCID: PMC9358583 DOI: 10.1177/23259671221111397] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 12/26/2022] Open
Abstract
Background: Anterior talofibular ligament (ATFL) repair of the ankle is a common surgical procedure. Ultrasound (US)-guided anchor placement for ATFL repair can be performed anatomically and accurately. However, to our knowledge, no study has investigated ankle kinematics after US-guided ATFL repair. Hypothesis: US-guided ATFL repair with and without inferior extensor retinaculum (IER) augmentation will restore ankle kinematics. Study Design: Controlled laboratory study; Level of evidence, 4. Methods: A 6 degrees of freedom robotic testing system was used to apply multidirectional loads to fresh-frozen cadaveric ankles (N = 9). The following ankle states were evaluated: ATFL intact, ATFL deficient, combined ATFL repair and IER augmentation, and isolated US-guided ATFL repair. Three loading conditions (internal-external rotation torque, anterior-posterior load, and inversion-eversion torque) were applied at 4 ankle positions: 30° of plantarflexion, 15° of plantarflexion, 0° of plantarflexion, and 15° of dorsiflexion. The resulting kinematics were recorded and compared using a 1-way repeated-measures analysis of variance with the Benjamini-Hochberg test. Results: Anterior translation in response to an internal rotation torque significantly increased in the ATFL-deficient state compared with the ATFL-intact state at 30° and 15° of plantarflexion (P = .022 and .03, respectively). After the combined US-guided ATFL repair and augmentation, anterior translation was reduced significantly compared with the ATFL-deficient state at 30° and 15° of plantarflexion (P = .0012 and .005, respectively). Anterior translation was not significantly different for the isolated ATFL-repair state compared with the ATFL-deficient or ATFL-intact states at 30° and 15° of plantarflexion. Conclusion: Combined US-guided ATFL repair with augmentation of the IER reduced lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair did not reduce laxity due to ATFL deficiency, nor did it increase instability compared with the intact ankle. Clinical Relevance: US-guided ATFL repair with IER augmentation is a minimally-invasive technique to reduce lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair may be a viable option if accompanied by a period of immobilization.
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Affiliation(s)
- Soichi Hattori
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Sports Medicine, Kameda Medical Center, Kamogawa, Japan
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Onishi
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Calvin K. Chan
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Satoshi Yamakawa
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuji Yano
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Philipp W. Winkler
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - MaCalus V. Hogan
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Foot and Ankle Injury Research (FAIR) Group, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Richard E. Debski
- Orthopaedic Robotics Laboratory, Center for Biotechnology and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ozeki N, Koga H, Nakamura T, Nakagawa Y, Ohara T, An JS, Sekiya I. Ultrasound-Assisted Arthroscopic All-Inside Repair Technique for Posterior Lateral Meniscus Tear. Arthrosc Tech 2022; 11:e929-e935. [PMID: 35646579 PMCID: PMC9134676 DOI: 10.1016/j.eats.2022.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic repair of the posterior horn of the lateral meniscus (LM) from an anterolateral portal has a risk of popliteal artery injury. Here, we present an ultrasound-assisted, arthroscopic, all-inside repair technique for a posterior LM tear to reduce the risk of neurovascular injury. An ultrasound probe covered with a sterile sleeve is placed horizontally at the popliteal fossa by an assistant surgeon, and the popliteal artery and posterior LM are confirmed. From the anterolateral portal, an arthroscopic probe is inserted to push the posterior capsule of the lateral compartment, while an ultrasound image detects the tip of the probe. After the probe is confirmed not to be directed toward the popliteal artery, an all-inside suture device is introduced from the anterolateral portal. While the meniscus is penetrated, the surgeon can confirm by ultrasound images that the needle is directed away from the popliteal artery. The guide suture is pulled anteriorly to secure the anchors tightly, and an ultrasound confirms that the anchors are positioned behind the posterior portion of the LM. All sutures are secured under the assistance of ultrasound images, followed by arthroscopic confirmation of a properly secured LM by the all-inside repair technique.
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Affiliation(s)
- Nobutake Ozeki
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan,Address correspondence to Nobutake Ozeki, M.D., Ph.D., Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiyuki Ohara
- Clinical center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University Hospital of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Jae-Sung An
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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