Operative Techniques in Orthopaedics RSS feed: Current Issue. Operative Techniques in Orthopaedics is an innovative, richly illustrated resource that keeps practitioners informed of significant advances in all areas of surgical management. Each issue of this atlas-style journal explores a single topic, often offering alternate approaches to the same procedure. Its current, definitive information keeps readers in the forefront of their specialty.http://www.optechorthopaedics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Operative Techniques in Orthopaedics1048-6666194October 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optechorthopaedics.com/article/PIIS1048666609001888/abstract?rss=yesMasthead10.1053/S1048-6666(09)00188-8Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8iihttp://www.optechorthopaedics.com/article/PIIS104866660900189X/abstract?rss=yesEditorial Board10.1053/S1048-6666(09)00189-XOperative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8iiiihttp://www.optechorthopaedics.com/article/PIIS1048666609001906/abstract?rss=yesTable of Contents10.1053/S1048-6666(09)00190-6Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8iiiiiihttp://www.optechorthopaedics.com/article/PIIS1048666609001918/abstract?rss=yesContributors10.1053/S1048-6666(09)00191-8Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8ivivhttp://www.optechorthopaedics.com/article/PIIS1048666609001487/abstract?rss=yesManagement of sports and soft tissue injuries of the elbow has evolved from benign neglect to arthroscopic evaluation and treatment of a variety of disorders to ligament reconstruction.IntroductionChristopher S. Ahmad, William N. Levine10.1053/j.oto.2009.10.008Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8189189http://www.optechorthopaedics.com/article/PIIS1048666609001323/abstract?rss=yesMost orthopedic surgeons encounter elbow pathology less commonly than other anatomical sites, such as hip, knee, or shoulder. Therefore, it takes considerable time to build experience and comfort with elbow anatomy and physical examination. These basics are critical to understanding the complex pathologic conditions that occur at the elbow and in making an accurate diagnosis, developing appropriate surgical indications and plans, and executing both open and arthroscopic surgery safely with low complication rates.Anatomy and Physical Examination of the ElbowEugene Willis Brabston, James Warner Genuario, John-Erik Bell10.1053/j.oto.2009.09.013Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8190198http://www.optechorthopaedics.com/article/PIIS1048666609001128/abstract?rss=yesImaging of the elbow requires a comprehensive evaluation of both osseous and soft tissue structures. Radiographs remain the initial imaging modality used to assess the painful elbow; however, more comprehensive assessment is afforded by the use of magnetic resonance imaging. Additional dynamic imaging may be performed using musculoskeletal ultrasound. Complex fracture dislocations may be more effectively evaluated using computerized tomography, particularly with 3D reconstruction.Imaging of the ElbowHollis G. Potter, Jennifer Schachar, Shari Jawetz10.1053/j.oto.2009.09.002Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8199208http://www.optechorthopaedics.com/article/PIIS104866660900113X/abstract?rss=yesElbow arthroscopy is a safe and effective tool for the diagnosis and treatment of multiple intra and extra-articular elbow pathologies. However, the elbow's small size, complex three-dimensional anatomy, and proximity to neurovascular structures can make arthroscopic visualization and treatment technically demanding. Complications are uncommon, but include injury to superficial and deep nervous structures, infection, portal site drainage, and compartment syndrome. The safe performance of elbow arthroscopy requires not only an in-depth knowledge of superficial and intra-articular anatomy, but also proper technique. Attention to key set-up components, including, patient positioning, operative and nonoperative arm positioning, arthroscopic instrumentation, arthroscopic pump pressure, and portal placement can facilitate ease of visualization and allow for the prevention of iatrogenic complications. With the appropriate planning, foundation of knowledge, and meticulous surgical technique, elbow arthroscopy can be performed safely and efficiently for a wide range of elbow disorders.Elbow Arthroscopy: Set Up, Portals, and Tools for SuccessMatthew D. Budge, April D. Armstrong10.1053/j.oto.2009.09.003Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8209219http://www.optechorthopaedics.com/article/PIIS1048666609001141/abstract?rss=yesOsteochondritis dissecans (OCD) lesions of the elbow are common in young athletes actively involved in overhead throwing activities. They tend to occur on the capitellum and are often associated with loose bodies and radiocapitellar plicae that can cause painful clicking and locking symptoms. A magnetic resonance imaging is useful to assess the stability of the OCD lesion as well as identify cartilagenous and fibrous loose bodies. The optimal management of elbow OCD remains unknown. Stable lesions can be managed with rest and sports restriction. When this has failed or with unstable lesions, elbow arthroscopy has become a safe and effective therapeutic tool. The surgeon must have a detailed three-dimensional knowledge of the complex anatomy of the elbow, create precise portals, and use fluid management and retractors judiciously. On the basis of the current report, arthroscopic loose body removal, plica excision, and microfracture technique of the remaining base of the OCD lesion has the most predictable functional outcome. Unstable OCD lesions with associated loose bodies that are left untreated predictably lead to elbow arthritis in the long term.Loose Body, Plica, and Osteochondritis DissecansDuong Nguyen10.1053/j.oto.2009.09.004Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8220227http://www.optechorthopaedics.com/article/PIIS1048666609001153/abstract?rss=yesLateral epicondylitis occurs from repetitive motions of the upper extremity in both athletes and non-athletes, and is more recently thought to be related to overuse microtearing of the extensor carpi radialis brevis (ECRB). Less than 10% of all cases are recalcitrant and therefore nonresponsive to conservative management. Surgical treatment for tennis elbow consists of many open and arthroscopic techniques. Open repair aims to excise the diseased tissue, but requires longer postoperative recovery times. Arthroscopic treatment yields equally successful results as compared to open techniques. This article provides a brief overview of lateral epicondylitis and the current evidence for open versus arthroscopic treatment.Lateral Epicondylitis: Open Versus ArthroscopicStephanie Greco, Kate W. Nellans, William N. Levine10.1053/j.oto.2009.09.005Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8228234http://www.optechorthopaedics.com/article/PIIS1048666609001165/abstract?rss=yesCubital tunnel syndrome is the second most common nerve compression in the upper extremity after carpal tunnel syndrome (CTS). There are multiple surgical options to treat cubital tunnel syndrome with no one treatment proving superior. The options include in situ decompression with or without medial epicondylectomy, endoscopic decompression, and subcutaneous, intramuscular, or submuscular transposition. The surgical techniques as well as specific pearls and pitfalls, relevant anatomy, diagnosis, and conservative treatment will be reviewed.Cubital Tunnel Syndrome-Surgical Treatment TechniquesPeter Tang, Kate W. Nellans10.1053/j.oto.2009.09.006Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8235242http://www.optechorthopaedics.com/article/PIIS1048666609001116/abstract?rss=yesIn 1974, Frank Jobe first performed a medial collateral ligament (MCL) reconstruction on professional baseball pitcher Tommy John. Since that time, modifications to the surgical method have evolved to simplify the procedure, reduce complications, and improve results. The MCL is the primary restraint to valgus stress at the elbow. Biomechanically, the native MCL is underpowered to withstand the loads applied to it during high-level overhead athletic activities, such as pitching. The flexor carpi ulnaris muscle and the bony articulation of the elbow assist the MCL as secondary restraints. Nonetheless, injuries to the ligament are fairly frequent in elite as well as college level overhead athletes. Diagnosing MCL injuries depends on an adequate history, physical examination, and supplementary imaging modalities such as x-rays and magnetic resonance imaging. In athletes who wish to return to their previous level of competition, surgical reconstruction is indicated. Modifications to the original Jobe technique have been made that share 3 common tenets: a muscle splitting approach, careful handling of the ulnar nerve, and avoidance of posterior humeral bone tunnels. Three techniques that are described in this manuscript are the modified Jobe technique, the “docking” technique, and the hybrid or DANE TJ technique.Medial Collateral Ligament ReconstructionR. Michael Greiwe, Benjamin Bjerke-Kroll, Christopher S. Ahmad10.1053/j.oto.2009.09.001Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8243250http://www.optechorthopaedics.com/article/PIIS1048666609001335/abstract?rss=yesLateral collateral ligament injuries can be difficult to diagnose and treat. They typically occur because of major trauma but can also be mistaken for more benign causes of elbow pain. In recent years, our understanding of elbow anatomy has allowed us to better diagnose and treat this complex problem.Posterolateral Rotatory Instability of the Elbow: Our ApproachJason A. Stein, Anand M. Murthi10.1053/j.oto.2009.09.014Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8251257http://www.optechorthopaedics.com/article/PIIS1048666609001384/abstract?rss=yesDistal biceps ruptures are relatively uncommon injuries. Tears of the distal biceps tendon occur primarily in middle-aged males. Surgical repair can be performed by a single- or double-incision technique. The single-incision technique offers advantages of simple technique, reliable results, low complications, and cosmetic incision. The repair is performed through a small, transverse incision using a variety of fixation devices. We describe the technique using suture anchors. Operative concerns include identification and protection of the lateral antebrachial cutaneous nerve, safe exposure of the bicipital tuberosity, avoiding injury to the radial recurrent vessels, and secure fixation of the tendon at the repair site. Repair typically restores excellent function and pain relief, allowing return to full activity within 3-4 months. This review describes the technique and includes tips and pearls for navigating the procedure and avoiding common complications.Single-Incision Distal Biceps Tendon RepairLindley B. Wall, Leesa M. Galatz10.1053/j.oto.2009.09.019Operative Techniques in Orthopaedics 19, 4 (2009)2009-10-01Operative Techniques in Orthopaedics2009-10-01194S1048-6666(09)X0007-8258263