Autologous free iliac crest bone grafting of glenoid through the rotator interval using double-barrelled cannula.

PURPOSE: The primary aim of this study is to prove that reconstructing the anterior glenoid defect with iliac crest graft arthroscopically using double-barrelled cannula through the rotator interval is safe and prevents both recurrence of instability and the neurovascular injury because subscapularis muscle is not split and procedure is far away from important structures. METHODS: Thirteen patients with anterior shoulder instability and engaging Hill-Sachs lesion were reviewed after arthroscopic reconstruction of the anterior glenoid with iliac crest autogenous graft. Patient satisfaction and Western Ontario Instability Score (WOSI) were evaluated on clinical examination. Computed tomography was used to analyse graft position on sagittal and axial planes. RESULTS: The mean follow-up was 28.7 months (SD 7.1), and age at surgery was 31 years (21 to 64 years). Post-operatively there was only one dislocation due to trauma. There was statistically significant improvement of WOSI scores (p: 0.001). There was not any neurological injury. Graft position on the axial plane was described as flush in 5 cases (41%), lateral in 2 (16%), too lateral in one (8%) and medial in 4 of the cases (33%). Graft position could be accepted as high in only three patients (23%). CONCLUSION: Arthroscopic reconstruction of glenoid defect using autogenous iliac bone graft, through rotator interval, without splitting subscapularis is safe and effective without any neurological injury, producing substantial graft position and good functional outcomes in patients.

Young Bovine Hip Model for Hip Arthroscopy Training.

Hip arthroscopy is associated with risks for complications, especially for novice surgeons. The present article reports use of a young bovine hip as a valid educational tool for key components of arthroscopic treatment of femoroacetabular impingement syndrome, ie, labrum repair and cam excision. The purpose of this Technical Note is to describe the steps of arthroscopic femoroacetabular impingement treatment in the bovine hip.

Bony landmarks, distances and their correlations to each other, which can be used during periacetabular osteotomy: a CT study performed on dysplastic hips.

As a surgical technique for hip dysplasia, Bernese periacetabular osteotomy (PAO) still poses technical difficulties and unclear surgical steps like the depth of the first 'ischial' cut, the start of the iliac cut and the width of the retroacetabular cut to prevent either iatrogenic joint entrance or posterior column fracture. Twenty-seven dysplastic hips (CE < 25°) were randomly matched with nondysplastic hips (n: 27, CE > 25°). 3D CT sections of the hips were evaluated and the width of the ischium, the distance from the infra-acetabular groove to the ischial spine, from the anterior superior iliac spine (ASIS) to the joint or sciatic notch or the sciatic spine, from the most medial point at the acetabulum to the posterior column, ischial spine or sciatic notch were measured for each group and correlated. The distances (mm) from the infra-acetabular groove to the ischial spine (42 ± 4, 44 ± 4, P: 0.03), the anterior superior iliac spine to the joint (52 ± 6, 60 ± 3, P: 0.03), the most medial point at the acetabulum to the posterior column (34 ± 2, 36 ± 2, P: 0.005) were shorter in the dysplastic group. The distance from the ASIS to the sciatic notch was correlated with the distance from the infra-acetabular groove to the ischial spine, from the ASIS to the joint and the most medial point at the acetabulum to the posterior column. The distance from the ASIS to the sciatic notch can be used intraoperatively to guess the X-ray guided or blindly osteotomized stages to predict the width or depth of the osteotomy to prevent intraarticular extension or posterior column fracture.