Journal: Arthroscopy Techniques
Article Title: Arthroscopic Fixation of a Large Osteochondral Fragment From the Glenoid After First Episode Dislocation
doi: 10.1016/j.eats.2020.01.022
Figure Lengend Snippet: In this video, we describe our technique for arthroscopic fixation of a large osteochondral fragment from the anterior glenoid after a first episode dislocation. Preoperative 3-dimensional computed tomography scan showed inferior displacement of a osteochondral fracture measuring approximately 50% of the anteroposterior diameter of the glenoid. The procedure is performed in the lateral decubitus position, allowing better exposition of the glenoid surface. Four portals are used: a standard posterior portal, an anterosuperior portal, an anteroinferior portal, and a trans-subscapularis portal. Viewing from the posterior portal, it is possible to see the large osteochondral fragment displaced to the axillary recess and attached to the inferior labrum. It is also possible to visualize no displacement of the anterior labrum. First attempt to reduction of the osteochondral lesion with an arthroscopic suture retriever showed instability of the fragment. We can also see that the bare spot is within the fragment, confirming the size is at least 50% of the anteroposterior diameter of the glenoid. Switching the camera to the anterosuperior portal allows better understanding of the fracture. Looking from the posterior portal a percutaneous trans-subscapularis portal was done because of best angle of approach for fragment manipulation with a 1.5-mm K-wire. Because of the presence of 2 mm of subchondral bone, the wire was used as a joystick for reduction and temporary fixation with help of the arthroscopic grasper and elevator. Viewing from anterosuperior portal, it was possible to see the reduction, and 2-mm displacement was accepted to avoid the risk of osteochondral fragmentation because of excessive manipulation. A cannulated screw guidewire was introduced from the anteroinferior portal, then a cannulated self-drilling compression screw (SpeedTip CCS 2.2, Medartis) was inserted. Caution was taken to turn the screw until the screw head was completely inserted under the cartilage. Palpation with the probe was done to check for any prominence of the screw. This step was repeated 2 times to have a 3-point fixation of the fragment, achieving better stability. The second screw was fixed through the subscapularis without the use of a cannula, and the third screw through a cannula from the anteroinferior portal. From the posterior portal, it is possible to palpate with the probe the stability of the fragment after fixation with three screws. X-rays and computed tomography scan were done after 16 months and showed incorporation of the osteochondral fragment, with optimal positioning of the screws and no evidence of osteoarthritis.
Article Snippet: A cannulated screw guidewire was introduced from the anteroinferior portal, then a cannulated self-drilling compression screw (SpeedTip CCS 2.2, Medartis) was inserted.
Techniques:
