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At the Hand and Wrist Fellowship Forum, Asif M. Ilyas, MD (Philadelphia, PA), reviews the latest literature-supported treatment strategies in carpal tunnel release, including open and endoscopic techniques, coupled with a focus on WALANT surgery.

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WALANT Surgery for Carpal Tunnel Syndrome

OrthoPedia: WALANT Surgery for Carpal Tunnel Syndrome

After fighting through the pain and struggling to lift his arms for over 20 years, Jerry Blackstone regained his freedom and ability to command the podium after undergoing bilateral anatomic shoulder replacement surgeries.

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Grammy Award–Winning Choral Conductor Back to Leading Orchestra After Replacing Both Shoulders

I will say that a definition of conducting is the communication of musical ideas through pantomime. How does it sound? How can we make it sound better? How can we make it tell stories from the very beginning? We conduct with our face, with our eyes, with our hands, with our arms, with our whole body. We have to become the music. In the fall of 2019, I had a new conducting position, and just before that started, my left shoulder really began to hurt. I couldn't really lift my arm higher than this, but when I was conducting, I didn't feel pain. And I mean that seriously. When the lights are gone and you're back home and you think, wow, that that really hurts. It's very hard to not allow that stress to enter into the rest of your professional experience. Wear and tear probably played a good amount of part of it. A recent survey of 700 conductors and band directors revealed over 65% reported experiencing shoulder pain or discomfort. The repetitive upward swing of a conductor's arms puts them at very high risk. This constant motion can worsen existing pain, preventing proper healing over time. For Jerry Blackstone, conducting was more than a passion. It was a career spanning over 35 years. After exhausting his options, shoulder replacement surgery was the best way to reclaim his place on the podium. A procedure he ultimately underwent for both shoulders. Before surgery, I had had quite a bit of physical therapy. When my shoulder was diagnosed as frozen shoulder, I would do some medications to help alleviate the pain, especially after a good amount of conducting. And when my shoulder was bothering me, I didn't talk about it. I didn't really want pity. I didn't also want to get in the way of possibilities. I just did it. And then Covid came and I had time. I had no idea if I was ever going to conduct again. And I thought, let's just get this done. Jerry elected for anatomic reconstruction surgery with the Arthrex eclipse system in both shoulders due to advanced glenohumeral osteoarthritis. This innovative procedure uses a stemless design, allowing for a less invasive approach and preserving more of the patient's natural bone. With shorter surgery time and quicker recovery, the eclipse system offered Jerry a chance to regain his strength and return to the podium just months after surgery. I started physical therapy after the surgery about two weeks later and it was just very gentle. I knew better what to expect of the process and what to expect of myself. The recovery is is a small price to pay for the relief and the freedom and the ease that you'll enjoy for a long, long time. I'll never forget the day when he said, just raise your arm over your head. I'll probably even get emotional today talking about it. And I could, and I hadn't been able to do that for 20 years. There's nothing that says to me now. Oh, you had that surgery. Both of my shoulders have been replaced or fixed. The way that I experience that is that I don't have to think about it either side. I'm grateful for the opportunities that I have to still do it for a while. Pain free.

Grammy Award–Winning Choral Conductor Back to Leading Orchestra After Replacing Both Shoulders

Expanding on the trusted Syndesmosis TightRope® platform, the Syndesmosis TightRope PRO implant is the next generation in syndesmotic fixation. Updated instrumentation and lower-profile implants provide efficiency by design, enabling effective treatment of syndesmotic injuries.

Experience the Syndesmosis TightRope® PRO Difference

Experience the Syndesmosis TightRope® PRO Difference

Michael A. Gallizzi, MD (Vail, CO), describes the importance of careful dissection of the scar tissue left over from multiple radiofrequency ablations (RFAs). Slow hemostasis is key when dissecting through the scar tissue.

SpeedPearl: Endoscopic Approach for Revision Medial Branch Nerve Transection

When performing the approach for a revision. Medial branch transection. It is really important to identify the anatomy. The first thing you're going to notice is there's an entire wall of scar that is present over the lateral aspect of the facet joint, covering the transverse process. So during this, it's really important to perform slow hemostasis of all the areas that could be bleeding due to the previous radiofrequency ablation. This causes a significant amount of scar tissue around the medial branch, all the way from the mammillary process to the lateral wall of the facet, the cranial and caudal edge of that transverse process. So when you're doing your approach, it's very important to start identifying these landmarks slowly dissecting through that soft tissue, because you never know if there's going to be a bleeder or the medial branch itself underneath that large wall of scar. So in this video, we're looking at this entire scar ball that's formed from repetitive rfas. And this is why we believe that the medial branch transection is a more effective procedure in general, because we're doing a surgical and precise removal of the medial branch instead of ablating and scarring up this entire area.

SpeedPearl: Endoscopic Approach for Revision Medial Branch Nerve Transection

The All-Onlay MPFL Kit includes everything needed to complete MPFL reconstruction procedures, including three Hybrid Knee FiberTak® anchors and a ratcheting guide to stabilize the patella while drilling and implanting anchors.

All-Onlay MPFL Reconstruction Using Hybrid Knee FiberTak® Anchors

Hybrid knee fiber anchors feature one pre converted tension knotless suture tape loop and one sliding 1.3mm suture tape with swaged needles. The all online Mpfl kit features three hybrid knee fiber anchors on tapered non self punching inserters for easy anchor implantation, and an included ratcheting guide. The knee fiber tack ratcheting guide stabilizes the patella while drilling the pilot hole and implanting the anchor. To begin the technique. Make a two centimetres skin incision from the superomedial corner, extending to the center of the medial edge of the patella. Create a groove on the medial patellar edge using a rongeur or powered burr. Place the spike of the knee fiber tack ratcheting guide firmly on the lateral rim of the patella, and slide the ratcheting drill sleeve down to the medial rim of the patella. Create a pilot hole for the anchor by advancing the 2.8mm hard bone knee fiber tack. Drill until it bottoms out against the back of the drill sleeve. Insert the hybrid knee fibrotic anchor by hand, advancing the tip of the anchor until it is within the pilot hole. Using a mallet, gently advance the inserter until the inserter handle bottoms out against the back of the drill sleeve. Remove the anchor inserter and ratcheting guide. Gently pull the black suture limbs to set the anchor in the patella. Repeat the drilling, insertion, and setting process to place a second anchor, spaced approximately 15mm to 20mm from the first anchor. Pass the prepared graft through the blue knotless loops of both anchors. Tension the graft down to the medial patella by pulling the blue tensioning strands. If using the fluoroscopic template, place the template on the area of the medial epicondyle on the distal femur. Provisionally advance a 2.4mm zebra pin into the femur to a depth of approximately two centimetres, and at the trajectory of the intended anchor placement. Remove the template and create a small medial incision where the pin enters the skin. Slide the drill sleeve from the ratcheting guide down the guide pin and hold it in place on the bone. Remove the zebra pin while maintaining the trajectory of the drill guide sleeve. Advance the knee fibrotic drill until the hub bottoms out against the top of the drill sleeve. Insert the hybrid knee fibrotic anchor by hand, advancing the tip of the anchor until it is within the pilot hole. Using a mallet, gently advance the inserter until the handle bottoms out against the back of the drill sleeve. Insert a curved clamp down to the medial epicondyle and turn the tip of the clamp toward the skin. Using the clamp, pass the looped end of the fiber snare suture back to the patellar insertion area. Loop the whip stitched graft ends through the loop of the fiber. Snare suture and pass the suture from the patellar origin to the insertion point at the medial femoral epicondyle, deliver the sutures out of the medial incision, and pull the graft down to the medial epicondyle. Load the graft sutures through the blue knotless tensioning loop of the anchor with the knee in 30 degrees of flexion. Pull the blue tensioning suture of the femoral anchor to provisionally fixate both limbs of the graft. Take the knee to full extension and, using the attached curved needle, pass the black 1.3mm sliding suture. Tape limb from the anchor through both limbs of the graft. Tie the suture limbs and amputate the excess graft. The black 1.3mm sliding suture tape. Limbs with swaged needles from the patellar anchors provide added versatility and can be used to close the retinaculum, pass through the graft for additional fixation, or to accomplish a VMO advancement as needed.

All-Onlay MPFL Reconstruction Using Hybrid Knee FiberTak® Anchors

This animation demonstrates the use of ArthroCell™ Plus viable bone matrix for spine fusion procedures.

ArthroCell™ Plus Viable Bone Matrix for Spine Fusions

Speaker  Arthur Sell is a viable multiple cellular allograft that is intended for use as a nonimmunogenic cellular bone matrix for bone repair. When combined with the Arthrex graft, gun delivery of the Arthur cell into the disc space is simplified. Once the graft gun is appropriately positioned, actuate the trigger to begin deploying the Arthur cell into the disc space. Arthur Cell provides the three key elements necessary for bone repair osteogenic cells, and an Osteoconductive scaffold with Osteoinductive potential. The Osteogenic components of Arthur Cell include viable mesenchymal stem cells and osteoprogenitor cells. Arthur Cell also contains a blend of microparticulate bone, including a demineralized cortical and cancellous matrix that serves as an osteoconductive scaffold. Osteoinductive growth factors from the scaffold and the defect environment send signals to initiate osteogenic activity that supplements the patient's innate healing processes. Arthur Cell is an alternative to autograft and is intended for use in bone remodeling and repair of bony defects, fusions, and nonunion orthopedic applications.

ArthroCell™ Plus Viable Bone Matrix for Spine Fusions

Elizabeth G. Matzkin, MD (Boston, MA), demonstrates an ACL reconstruction using a GraftLink® construct with RT TightRope® SB implant with FiberTape® suture for the InternalBrace™ technique.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

Hello, I'm Elizabeth Matzkin from Boston, Massachusetts, and today we will be demonstrating an ACL graft reconstruction with internal brace technique and the new tightrope SB. As you can see here, we have our graft out on the table on our Graph Pro ready to go. We have a hamstring semitendinosus that's been quadrupled using a standard grafting technique. And we have our new tightrope SB on both sides of the graft you can see the yellow suture which is the soft button. This is just like our tightropes we've been using for the last ten years, but there's no metal. So for patients that may have metal adversity or a metal allergy, this is going to be perfect. There's also some other advantages to using the soft button, which you will see in our demonstration on our tightrope SB. You can see our blue passing sutures, our white tensioning sutures, our internal brace sutures, and these sutures which are used for elongating, which you will see as we pass the button into the knee for our ACL reconstruction. On the tibial side of our graft, we can see our blue passing sutures. These suture tapes here in the middle are from our graft prep. So there are saved sutures. We can see our white tensioning sutures. And then again, we can see the suture that we're going to use for elongating the suture button when we pass it into the knee. So we have about a 30 millimeter femoral tunnel. So we've marked 30mm from the end of this soft button. I also like to mark my graft around 15 to 20mm. It's often where we have these sutures wrapped around the graft itself. But that will help us as we pull the graft into our tunnel. And we'll mark it also on our tibial side. So here we are. We're in our right knee. We've already prepped our femoral and tibial tunnels. We have sutures passed through them so we can get ready to pass our graph with the new tightrope SB. So we're going to pass this through our suture here on the outside. And then we're going to shuttle our white tensioning sutures and our blue passing sutures through the knee here. As you're doing this, you're going to have one hand pulling through the sutures through the femoral tunnel and your other hand holding on to the the graft. And the extra suture in order to feel the tension as the graft is passing, as we're getting ready to pass our tightrope, SB, we have one hand holding our tensioning and passing sutures and our other hand holding the trailing sutures. This allows us to keep the tightrope sb lengthened as we pass this through. We've also switched our scope to the 70 degree so we can watch this go up our femoral tunnel. So again we're holding both ends of the tightrope. We're watching it up the tunnel. We can see it just passed through and we could feel it flip right there. And the other thing we can look at is we can see our mark that we made. On the sutures, which is also a second way to check that we're at the same length to flip that tightrope. Sb now, to deploy our tightrope SB we can either pull on the implant or pull on the internal brace, as you can see here and now, if I go to pull on my graft, you can see that tightrope is flipped and it's not going anywhere. One nice advantage of the tightrope SB is that once we've flipped it, if we're not happy, or for some reason, we've flipped it on the outside of the Iliotibial band, we can actually elongate it and flip it by pulling tension on both sides of the suture, and we can watch it unfold and we can see we can pull it back down our tunnel and we can start all over. So this is a very nice advantage, which we can't do with our metal tightropes. And you can watch this go flip one more time again, holding both sides of the tightrope. Now that our tightrope SB is flipped on our lateral femoral cortex, we're going to shuttle our graft up into the knee. We'll watch it kind of go up into our femoral tunnel. And here comes our beautiful hamstring. Quadrupled graft link. And see our internal brace here. So graph going into our femoral tunnel we have marked it at 15 to 20mm. So we know how far to pull it in okay. So we have our graph passing to our femoral tunnel. Now we're going to pass it into our tibial tunnel. As you can see here. We're going to keep our tiger trailing sutures outside of the passing suture. We're going to send these down our tibial tunnel. We'll pull some of the slack out of our internal brace suture. And again, we've left behind our trailing suture because that's what allows us to pass our soft button in an elongated fashion. We can remove our femoral trailing suture at this point, because that side has already been docked, and we will hold some tension on our tibial trailing suture as we reduce the graft into the tibial tunnel. Now that our tightrope SB is outside of our tibia, we can remove our tiger trailing suture and our blue passing suture. Now we're ready to tension this inner tibial tunnel. So I have a small hemostat here to take some of the tension off our tightrope, SB, as we provisionally take some of the slack out of it so it doesn't bunch up too much. It'll allow it to lay a little bit more flat when we get down to our tibial bone. Now you can actually put a little pressure on that button and kind of flatten it or pancake it out on the tibial bone. So it lays a little bit flatter as we completely deploy it. And our final tensioning. So now we are going to fix our save sutures from our graph prep, along with the internal brace in our 4.75mm swivel lock anchor. So we have our swivel lock in that has fixed our saved sutures from our graft as well as our internal brace, and we can cut those and then we can still retension our tightrope SB on both the tibial and femoral sides to complete the procedure. So here's our final construct. We have our graph link ACL with tightrope SBS on both our femoral and tibial side with an internal brace technique.

GraftLink® ACL Reconstruction Using the TightRope® SB Implant for the InternalBrace™ Technique

At the Orthopedic Technology and Innovation Forum (OTIF), John D. Adams, MD (Greenville, SC), reviews the latest literature highlighting trends in the surgical management of intertrochanteric fractures and the associated clinical outcomes.

Intertrochanteric Fractures: Literature Review on the Management of Intertrochanteric Fractures

OrthoPedia: Intertrochanteric Fractures: Literature Review on the Management of Intertrochanteric Fractures

The Synergy exoscope is an autoclavable and reusable 0° 4K scope used to provide real-time visible light and near-infrared (NIR) fluorescence imaging during open surgical procedures.

Synergy Exoscope Imaging

Synergy Exoscope Imaging

Daniel A. Worrel, MD (Dallas, TX), discusses his transition to using a knotless soft anchor. During this cadaveric demonstration, he showcases the unique tensionable technology of Knotless FiberTak® soft anchors. Dr. Worrel describes the importance of restoring equal tension across the glenohumeral ligaments. With its small footprint, the Knotless FiberTak anchor allows for more points of fixation across the final repair.

Knotless FiberTak® Anchor: Evolution From Knotted to Knotless

Hello, my name is Daniel Worrall. I am here today to discuss treatment of instability of the shoulder. As I've converted to a knotless anchor. It has provided some additional benefits with regards to obtaining a very strong and stable repair and restoring the stability of the shoulder. We're going to put some anchors in today and we'll demonstrate some of these benefits. So we're here today with a right shoulder specimen that has a pretty typical anteroinferior labral tear off camera. We have placed a single anchor at the 6:00 position to begin our repair. We've already passed the repair suture, which is the blue suture that I've already grabbed. And you can see our our shuttling suture has a tape on one end which I've not grabbed, and a more tubular at the other end to identify it. And then we're going to grab both of these to make sure that they're not overlapping each other. And we will then shuttle the repair suture. You see, I've shuttled my repair suture through my shuttling suture here. And now what we're going to do, there's a little line to mark the appropriate amount of suture that you're going to capture. And then I'm just going to guide it through. And now retrieve it out my single anterior cannula. And one of the additional benefits that I've appreciated is, is that you get a gradual progressive tension as you will pull the labrum forward onto the glenoid rim. I've spent more time than I would like to think about, being careful about the direction at which I tie, so that I did not leave any knots that would abrade the articular cartilage. And this is dramatically simplified that portion of the process. This first anchor is generally to tack it to give us some soft tissue tension as we continue with our repair and capsular graphy. So here we are with our final repair. We've placed five anchors along the anterior glenoid, and we've got an excellent repair of our glenohumeral ligaments. And we've got a nice bumper here. The glenoid rim I was able to dial in the repair and the tension on these anchors without over constraining them. There's no concern for not migration or abrasive wear. I've been very pleased with this, with these knotless anchors, and would encourage you to consider it for your future repairs.

Knotless FiberTak® Anchor: Evolution From Knotted to Knotless

The Arthrex Elbow Fracture Plating System provides a comprehensive portfolio of distal humerus and olecranon plates. Designed to treat all fractures, the set comes with KreuLock™ locking compression screws, allowing the surgeon to both reduce the plate to bone and compress across a fracture. The plating portfolio is perfectly complemented by Arthrex soft- tissue procedures and fracture reduction, including LUCL/MUCL InternalBrace™ ligament augmentation, FiberTape® cerclage, and the ElbowLOC® elbow positioner.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

The Arthrex Elbow Fracture Plating System

The Arthrex Elbow Fracture Plating System

Patrick C. McCulloch, MD (Houston, TX), shares his experience with the Arthrex proximal humeral fracture solutions and how he decides treatment for patients along the continuum of care.

Dr. Patrick C. McCulloch Surgeon Testimonial: The Arthrex Proximal Humeral Fracture Systems Portfolio

Speaker  So if we have a younger patient who's involved in overhead sports, say they play tennis, then we may work hard to do an orif of approximately humerus fracture. If there are elements about that fracture pattern, poor bone quality, an older patient, a lower demand patient, then that's going to move towards a reverse shoulder arthroplasty with a more reliably good outcome. Stem geometry is important in reverse for fracture cases, having a rectangular one with smaller shoulders can help to get you some rotational stability. If you've got enough metaphyseal bone there and not having that too thick proximally so that you can actually do your tuberosity repairs is a nice feature of a reverse stem for fracture.

Dr. Patrick C. McCulloch Surgeon Testimonial: The Arthrex Proximal Humeral Fracture Systems Portfolio

Designed to provide anatomic contour with precise instrumentation, the Arthrex Proximal Tibial Plating System features 4 unique plate styles, equipped with advanced variable-angle locking capabilities and KreuLock™ locking compression screws, to optimize treatment of proximal tibial fractures.

Arthrex Variable-Angle Proximal Tibial Plating System

Arthrex Variable-Angle Proximal Tibial Plating System

Julie Bishop, MD (Columbus, OH), demonstrates the innovative bone block cerclage surgical technique for securing a distal tibia allograft to the anterior glenoid for treatment of critical glenoid bone loss. This subscapularis-sparing arthroscopic cadaveric demonstration shows the procedural steps and technical pearls for safe and reproducible metal-free fixation of the bone graft using interconnected FiberTape® cerclage sutures.

Bone Block Cerclage With Distal Tibia Allograft Surgical Technique

Bone Block Cerclage With Distal Tibia Allograft Surgical Technique

What's NewJUN 6

OrthoPedia: WALANT Surgery for Carpal Tunnel Syndrome

What’s New This Week and Prior

JUN 5

Grammy Award–Winning Choral Conductor Back to Leading Orchestra After Replacing Both Shoulders

JUN 4

Experience the Syndesmosis TightRope® PRO Difference

JUN 3

SpeedPearl: Endoscopic Approach for Revision Medial Branch Nerve Transection

JUN 2

All-Onlay MPFL Reconstruction Using Hybrid Knee FiberTak® Anchors

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