Endoscopic Endonasal Far-Medial Approach: 2-Dimensional Operative Video.

INDICATIONS CORRIDOR AND LIMITS OF EXPOSURE: Endoscopic endonasal far-medial approach provides an effective and safe corridor to access the parasagittal structures of the lower clivus such as the medial jugular tubercle (JT) and occipital condyle (OC) for lesions that displace neurovascular structures laterally. ANATOMIC ESSENTIALS NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT: Parapharyngeal internal carotid arteries (ICAs) run posterolateral to the eustachian tubes and lateral to the OC. The supracondylar groove is a superficial landmark for the hypoglossal canal, which divides the lateral extension of clivus into the JT and OC. ESSENTIAL STEPS OF THE PROCEDURE: Typically, approach starts with opening of the sphenoid sinus to localize the paraclival ICA. An "inverted U" rhinopharyngeal (RP) flap exposing the supracondylar groove and lower clivus. Doppler and navigation can confirm the course of the ICA. Drilling is started in the midline in the lower clivus and extended laterally to expose the hypoglossal canal, JT, and OC. PITFALLS/AVOIDANCE OF COMPLICATIONS: Neurovascular injuries can be avoided by using intraoperative Doppler and nerve stimulator. Multilayer reconstruction with vascularized nasoseptal (NSF) and RP flaps minimize postoperative cerebrospinal fluid leak. VARIANTS AND INDICATIONS FOR THEIR USE: The contralateral transmaxillary approach provides an increased angle of access behind foramen lacerum and the petrous ICA.The endoscopic endonasal far-medial approach can be used for a variety of pathologies, including petroclival or JT meningiomas, chordomas and chondrosarcomas, and hypoglossal schwannomas, inferiorly extending cholesterol granulomas and even rare, ventral posterior inferior cerebellar artery aneurysms.The patients consented to the procedure.

Anterior cruciate ligament reconstruction using hamstring tendon graft without detachment of the tibial insertion.

INTRODUCTION: We report results of the anterior cruciate ligament reconstruction using a four-strand hamstring graft without detachment of the tibial insertion of the tendons. MATERIAL AND METHODS: In 74 patients the hamstring graft was fixed using an endobutton on the femoral side and a barbed staple on the tibial side. There were 69 male and 5 female patients. The mean age at the time of operation was 35.1 years (21-53 years). Postoperatively, an accelerated rehabilitation was followed with no protective braces. The mean follow-up period was 64 months (range 48 to 84 months). RESULTS: All patients achieved full range of motion with a stable knee joint. The mean side-to-side difference using KT-1000 was 1.43 mm (SD 3.86). The average Lysholm score improved from 42 to 79.2 and the Tegner score improved from 3.4 to 5.9. CONCLUSION: Detachment of hamstring tendons from their tibial insertion is unnecessary and our results with accelerated rehabilitation without protective braces are satisfactory and comparable to other studies.

Uncemented rotating-platform total knee arthroplasty: a 4-year to 12-year follow-up.

One hundred nine primary uncemented, rotating-platform, low-contact stress total knee arthroplasties in 85 patients were reviewed 4 to 12 years after the operation as a prospective study on consecutive cases. All patients were followed up annually with subjective questionnaires and radiological assessment. At the time of final review, 69 patients with 87 rotating-platform total knee arthroplasties were still alive. All were reviewed at the final follow-up using the American Knee Society Score (clinical and radiological). The average knee score was 86.42, and the average functional score was 65.1. No evidence of radiological loosening was observed in any patient. One knee was revised because of medial collateral ligament laxity. The 10-year survival rate was 99.08%.

Hydroxyapatite-coated RM cup in primary hip arthroplasty.

We reviewed 113 patients with 127 primary total hip arthroplasties using a hydroxyapatite-coated RM (Robert Mathys) cup. Average patient age was 61 (30-70) years and mean follow-up was 9.4 (6-13) years. Four patients were lost to follow-up and nine patients died of unrelated causes during the course of the study. Three acetabular components were revised; two cups were radiologically loose and one was revised for marginal erosion. No radiolucency was noted in any of the three zones in the remaining cups. There were no cases of cup migration or dislocation. The life table method predicted a 10-year survival rate of 97.9% with revision of the acetabular component for any cause as the endpoint.