Posterolateral instability of theknee: treatment using the clancy biceps femoris tenodesis

Posterolateral instability of the knee is perhaps the most challenging injury facing the sports medicine physiciantoday. Diagnosis requires a thorough understanding of the complex anatomy, function, and biomechanics of the posterolateral structures. In isolated cases of posterolateral instability, the physical findings may be subtle and easily overlooked. Similarly, in complex injuries involving the posterolateral structures, the physical findings may be confusing and misdiagnosed as an isolated cruciate ligament injury. Failure to appropriately diagnose and treat a posterolateral injury can lead to significant functional disability and failure of associated ligamentous reconstruction. Optimal results may be achieved if the injury is diagnosed acutely and surgical treatment is carried out promptly with stabilization of the posterolateral structures and any associated ligamentous insufficiencies. The clinical and biomechanical results of the Clancy biceps tenodesis have proven the procedure successful for controlling varus and external rotational laxity. Rerouting of the biceps femoris tendon with tenodesis to the lateral femoral epicondyle creates a new fibular collateral ligament and tightens the posterolateral capsule and arcuate complex. In addition, tenodesis eliminates the dynamic external rotation of the tibia by the biceps femoris muscle, which actively exacerbates posterolateral subluxation. When performed properly, the biceps tenodesis can eliminate posterolateral instability and restore functional stability to the knee.     

Arthroscopic biceps tenodesis: Indications and technique

Biceps tendon pathology commonly occurs in combination with other shoulder disorders, such as subacromial impingement and rotator cuff tears. Although the arthroscopic treatment of impingement and rotator cuff tears has previously been reported, arthroscopic biceps tenodesis has rarely been described. In this article, we present our technique of arthroscopic biceps tenodesis, which uses a uniquely designed Bio-Tenodesis screw system. This system allows intra-articular manipulation of the biceps tendon, ensures placement of the tendon into the base of the bone socket, allows insertion of the screw while maintaining the position and tension in the tendon, and ensures an adequate screw-tendon-bone interface.     

Chronic instability of the ankle

Evans tenodesis is one of the techniques used much for correcting the chronic lateral instability of the ankle. Long-term results (average follow-up 8 years) are reported for 113 operations on 109 patients. It is concluded that the method used gives a good functional result when the major complaint is recurrent sprains of the ankle. Functional stability does not necessarily correlate with mechanical stability when tested clinically or by radiographs.     

Coracoid impingement syndrome, rotator interval reconstruction, and biceps tenodesis in the overhead athlete

Anterior shoulder problems are extremely common in throwing athletes. Coracoid impingement syndrome, lesions of the long head of the biceps tendon, and rotator interval lesions are included in the extensive differential diagnosis which exists for anterior shoulder pain. In this chapter, we focus on the anatomy, pathophysiology, clinical presentation, diagnosis, and surgical treatment of these conditions.     

Arthroscopic biceps tenodesis with interference screw fixation: The lateral decubitus position

The tendon of the long head of biceps brachii is an important stabilizer within the glenohumeral joint. Bicepstendon pathology commonly occurs in the presence of concomitant shoulder disorders, such as subacromial impingement, and rotator cuff tears. Biceps tenodesis is indicated in the case of a partial tear (50%), an unstable biceps tendon due to an incompetent medial sling, and in the presence of a torn subscapularis. This article will describe our technique of arthroscopic biceps tenodesis with biodegradable interference screw fixation. This technique uses a uniquely designed Bio-Tenodesis screw system (Arthrex Inc., Naples, FL) and is performed with the patient in the lateral decubitus position.     

Iatrogene Langzeitschäden nach nicht-anatomischer lateraler Bandrekonstruktion am oberen Sprunggelenk

Patients with chronic anterolateral ankle instability with recurrent ankle sprains qualify for a surgical intervention. Various surgical techniques of reconstruction have been proposed in the past century and can be classified in anatomic- and non-anatomic reconstructions methods. The mid-to long-term results showed that particularly non-anatomic tenodesis-techniques lead to degenerative changes in the ankle joint,. Nowadays, consensus exists that the anatomic reconstruction for chronic lateral ankle instability should be preferred.The present article gives an overview over the three most common non-anatomic tenodesis-techniques and illustrates their most frequent complications.     

Long-term functional outcome after surgery of chronic ankle instability A 5-year follow-up study of the modified Evans procedure

Chronic ankle instability is a rather common consequence of poorly healed rupture of the lateral ligaments of the ankle. In some rare cases, instability symptoms can be caused by general laxity of the joints, but since these cases are normally bilateral, they can easily be distinguished from posttraumatic instability. This report presents the long-term (average follow-up 4.6 years) functional outcome after a modified Evans tenodesis of 48 patients. The follow-up examination consisted of a questionnaire evaluating the subjective assessment of the ankle, and clinical examination measuring ankle stability, range of motion and swelling, and atrophy of the calf muscles. Additionally, the functional recovery of the ankle was assessed by a standardized performance test protocol. According to the subjective assessment, 25 subjects (52%) considered the ankle fully recovered, or at least much better than before surgery. In the performance test, however, only 17 subjects (35%) achieved an excellent or good score. In the performance test protocol, two functional tests, walking down a staircase and balancing on a square beam, best demonstrated the impaired function of the injured ankle. The modified Evans procedure could restore the stability of the ankle to the preinjury level, although the ankle range of motion was significantly impaired, and swelling of the ankle and atrophy of the calf muscles were frequent findings at the follow-up. In conclusion, surgical treatment of chronic ankle instability by the Evans procedure restores the mechanical stability of the joint, but too frequently the function of the ankle does not return to the pre-injury level.     

Rupture of the Short Head of the Biceps and Coracoid Fractures: Mechanism and Refixation

Injuries of the short head of the biceps are rarely seen in clinics as seen by a lack of published articles. Most of the literature report on coracoid fractures, whereas these scapula process fractures remain less common in the upper extremity. They are caused by direct impact or are associated with acromioclavicular or anterior shoulder dislocation as it may occur in sports. The attached biceps short head, coracobrachialis and pectoral minor tendon are likely to tension an avulsion and displace a fragment. The most favorable treatment is a non-operative therapy, especially if the displacement of fragments is little and the coracoclavicular ligaments maintain the fragments in position. Widely displaced fractures cause a high nonunion rate and surgical reposition and fixation is recommended in such cases. Different fixation techniques are present due to its rare and heterogenic occurrence. However, surgically treated fractures are likely to heal and patients gain full range of motion after three months. We present a case report from our department and demonstrate different operative techniques in a cadaver model.