Recurrent patellar dislocation is a common condition in young and active individuals, with medial patellofemoral ligament (MPFL) injury being the primary pathological factor in most cases. Anatomic double-bundle MPFL reconstruction has been established as an effective treatment for patellar instability; however, the optimal fixation method remains a matter of debate. Conventional techniques often employ suture anchors and interference screws for patellar and femoral fixation, which may require larger medial incisions, compromise the extensor mechanism, and increase the risk of bone tunnel fracture or graft laceration because of screw divergence. To overcome these limitations, we describe an MPFL reconstruction technique using dual adjustable-loop cortical button fixation on both the femoral and patellar sides. This approach provides suspensory fixation with a minimal implant, preserves bone stock and soft-tissue integrity, and enables controlled graft tensioning under arthroscopic visualization. This technique represents an alternative to traditional anchor- or screw-based MPFL reconstruction methods.
Arthroscopic techniques have gradually replaced open surgery as a routine method for treating posterior cruciate ligament tibial avulsion fractures. However, traditional arthroscopic surgery is associated with problems such as limited visualization, unstable fixation, and unsatisfactory reduction. By comparing various methods reported in the literature and integrating clinical experience, our team has developed an optimized technique to address current surgical challenges. Using dual posteromedial portals, we adopt a "single-suture" method, in which the same epidural needle and a single suture are employed to encircle the posterior cruciate ligament via the lateral aspect of the anterior cruciate ligament, with dual EndoButtons applied for fixation. This technique not only precisely avoids the meniscofemoral ligaments and anterior cruciate ligament but also eliminates the need for separating the anterior cruciate ligament and posterior cruciate ligament, thus simplifying the procedure and reducing surgical injuries in the whole fixation process. It enhances fixation stability and surgical efficiency and preserves the posterior septum to promote postoperative functional recovery.
Treatment options for severe glenoid bone defects caused by recurrent anterior shoulder instability include autologous coracoid transfer and bone graft reconstruction. The effect of bone-grafting techniques is satisfactory, and the fixation methods for the bone block include screws or suture buttons. However, problems caused by metal plants and high bone resorption rates are a serious concern. In addition, the current anchor suture fixation technique is prone to unstable fixation and bone block rotation. Therefore, we describe an arthroscopic technique for severe glenoid bone defects that use autologous iliac bone grafting, combined with labrum anchors and pulley knot to fix the bone block, known as the "3-pulley 4-point antirotation suture anchor technique." Four labrum suture anchors are placed on the upper and lower edges of the glenoid defect to form 4 force points (4-point fixation), and the pulley technique is used for knotting to make the fixation more secure and solve the problem of easy rotation.
Proximal full-thickness rectus femoris tendon tears are debilitating injuries in high-demand athletes, particularly those involved in sprinting and soccer. Although direct repair remains the mainstay of treatment, concerns exist regarding tendon healing, strength restoration, and the risk of retear. Contemporary suture anchor fixation techniques employing a double-row transosseous-equivalent construct, combined with biologic augmentation with autologous bone marrow aspirate concentrate and a highly purified type I bioinductive collagen implant, offer a potential means to increase the tendon-bone contact area and reinforce the repair construct. We describe our preferred open technique using a double-row transosseous-equivalent construct to maximize tendon footprint coverage and compression, combined with bone marrow aspirate concentrate and bioinductive collagen implant to enhance tendon-to-bone healing biology.
The fibular collateral ligament, the popliteo-fibular ligament and the popliteus tendon are the 3 main elements of the posterolateral corner (PLC), which is regularly injured in case of multiligament knee injuries. PLC reconstruction is recommended over repair in a large most situations, including acute cases. We describe an anatomic reconstruction of the PLC using either allografts or hamstring tendons.
Medial meniscus posterior root tears and anterior cruciate ligament (ACL) injuries disrupt knee biomechanics and accelerate joint degeneration, particularly in the presence of varus malalignment. This technical note describes a combined surgical approach that integrates medial meniscus posterior root repair, ACL reconstruction, and high tibial osteotomy (HTO) to restore joint stability, optimize load distribution, and prevent osteoarthritis progression. The procedure is performed arthroscopically using anteromedial and anterolateral portals. Meniscal root and ACL footprints are prepared, and sutures are passed using a loop-stitch technique. A biplanar high tibial osteotomy is then performed distal to the guide pins to correct varus alignment, with plate fixation positioned posteriorly and distally for optimal stability. The meniscal root tunnel is drilled at a 45° angle, followed by ACL tunnel placement and graft fixation using interference screws and a suspensory button system. This combined approach enables simultaneous restoration of meniscal function, knee stability, and mechanical alignment, potentially improving long-term outcomes compared with isolated procedures.
Large bony Bankart lesions remain a complex problem in the management of anterior shoulder instability. Traditional fixation with screws or suture anchors can be limited by fragment size, thin cortical bone, or medial extension of the fragment, where anchor placement may be technically challenging or unreliable. We describe an arthroscopic surgical technique using cortical button fixation for large bony Bankart lesions, particularly when medial extension makes conventional anchor placement difficult. With the patient in the beach chair position, diagnostic arthroscopy is performed using a 30° arthroscope. Following mobilization of the bony fragment and preparation of the glenoid neck, a transosseous tunnel is drilled from the posterior glenoid cortex to the fragment base. High-strength sutures are passed and secured using a cortical button construct, allowing controlled reduction and stable compression of the fragment. Capsulolabral repair is performed as required. Arthroscopic cortical button fixation provides a low-profile, fragment-preserving solution for large bony Bankart lesions, particularly when medial extension limits conventional anchor-based fixation.
A rotator cuff (RC) tear is often closely associated with lesions occurring in the long head of the biceps tendon, typically presenting as pulley structural impairment, long head of the biceps tendon instability, and tears at the lateral corner of the RC interval. At present, there are many surgical methods for the injury of the supraspinatus and biceps tendon, but there are many problems such as the number of anchors, the complexity of surgical procedures, and less attention is paid to the lateral corner of the RC interval and the pulley structure. Therefore, we describe a hybrid technique, which uses fewer anchors to repair the supraspinatus and infraspinatus and biceps tenodesis and repair the lateral corner of the RC interval at the same time.
Massive irreparable rotator cuff tears remain a challenge for the orthopaedic surgeon a great spectrum from conservative to surgical procedures have been described. Superior capsular reconstruction is an option in active young patients with massive irreparable rotator cuff tears without arthritis, which reduce the humeral head superior migration, restoring the glenohumeral fulcrum while maintaining stable force couples. However, it is a demanding high-cost procedure with substantial retear rate. A recent report has been published, showing an open procedure using semitendinosus autograft. In this technique, we describe an all-arthroscopic superior capsular reconstruction using hamstring allograft in V-shaped configuration. We believe our technique can be technically reproducible at a lower cost with excellent clinical outcomes.
Surgical repair remains the standard of care for complete patellar tendon ruptures. However, healing is often challenging due to the tendon's poor biological environment and high tensile stress at the repair site. Bioinductive implants have been introduced to enhance tendon healing; however, they often lack early structural reinforcement. This report presents the FiberLocker System (ZuriMED Technologies AG, Zurich, Switzerland) which includes a FiberLocker Instrument and a SpeedPatch as a suture-free augmentation method for patellar tendon repair. The FiberLocker Instrument embeds the SpeedPatch polyethylene terephthalate, a synthetic nonwoven scaffold composed of a high-strength polymer, into the native tendon. Unlike traditional techniques that rely on sutures passed through tendon tissue, this system employs a reciprocating microblade mechanism that directly integrates polyethylene terephthalate fibers into the native tendon. This interwoven patch-tendon construct increases the surface area for load distribution, enhances biomechanical support at the time of repair, and reinforces the repair site without the need for additional sutures.
Peroneal tendon dislocation is an uncommon ankle injury that may be misinterpreted as a lateral ankle sprain due to similar clinical characteristics. It frequently leads to delayed treatment and recurrent instability. Although various surgical approaches have been described, including osseous procedures such as groove deepening and soft-tissue reconstruction, no single technique has been universally accepted as the gold standard for treating peroneal tendon dislocation. This technical note describes a modified Das De procedure for the treatment of recurrent peroneus longus tendon dislocation (Eckert and Oden type A). Preoperative imaging in affected patients may show peroneal tenosynovitis without evident tendon dislocation. However, intraoperative observations validated intact tendons with superior peroneal retinaculum insufficiency. The retinaculum is repaired and fortified, and postoperative provocative testing typically shows stable tendon positioning without redislocation. By preserving anatomical integrity and minimizing osseous manipulation, this modified procedure provides a safe, reproducible, and effective alternative for treating symptomatic peroneal tendon dislocation in young and active patients.
Focal cartilage defects of the capitellum humeri are frequently underestimated, despite their substantial contribution to elbow pain and functional impairment in young and physically active patients. Arthroscopic autologous minced cartilage implantation is a single-stage biological cartilage repair technique that has shown favorable clinical and imaging outcomes in larger joints. Osteochondral lesions of the capitellum humeri of the elbow, particularly in the setting of osteochondritis dissecans, represent a challenging condition in young and physically active patients. However, detailed descriptions of the arthroscopic surgical technique and its application in the elbow joint remain limited. Therefore, the purpose of this Technical Note is to describe a step-by-step arthroscopic technique for autologous minced cartilage implantation in focal osteochondral lesions of the capitellum humeri. Indications, surgical pearls and pitfalls, and postoperative care are outlined, and the potential advantages of this technique in the treatment of elbow cartilage lesions are discussed.
Massive irreparable rotator cuff tears remain a surgical challenge. Whereas the subscapularis and infraspinatus can often be repaired anatomically, the supraspinatus frequently presents an irreparable defect. Current options such as superior capsular reconstruction provide only static, compensatory solutions. This article describes a segmented double-unit bridging technique using an autologous semitendinosus tendon for anatomical and dynamic reconstruction. The harvested tendon is divided into 2 independent segments, each folded to form a robust graft unit. These 2 units are sequentially implanted: the first bridges the anterior portion of the supraspinatus defect, followed by the second for the posterior portion. This double-unit, segmented bridging technique simplifies graft handling and suture management compared with single-graft techniques and enables stable, anatomical repair. It offers a practical surgical solution for restoring shoulder biomechanics in massive irreparable rotator cuff tears.
The Trillat procedure was developed for the management of anteroinferior (AI) instability in patients with irreparable cuff tears and those with shoulder hyperlaxity with no glenohumeral bone loss. The latter patient group has traditionally been managed nonoperatively first, with surgical intervention only in those with unsuccessful conservative care with significant impediments to their function. Although many procedures have been described to correct this instability, we believe that a combination of coracoid osteotomy and its medial-inferior shift to provide a sling effect via the conjoint tendon and obliteration of the subcoracoid space, as well as a pan-capsular shift to reduce the glenohumeral volume addresses this instability. Our all-arthroscopic technique is minimally invasive, using just 3 portals, and provides access to other articular pathology.
Posterior cruciate ligament (PCL) tears can spontaneously heal, but often heal with excess laxity. In contrast to well-documented arthroscopic proximal and distal PCL tear repairs, the most prevalent mid-substance tear is typically managed conservatively, or with full reconstruction. We describe an arthroscopic technique for mid-substance PCL repair, applying construct elements from current anterior cruciate ligament repair to bidirectionally unite the 2 halves of the torn PCL, then reinforce the repair with suture tape. This all-arthroscopic repair aims to directly restore PCL continuity and maintain tension, without compromising its inherent healing potential.
Arthroscopic medial meniscal root repair is essential for restoring native meniscal function in patients with root tears, especially when the articular cartilage remains intact. The pull-out technique is commonly used; however, suture cut-through remains a concern when the meniscal tissue is of poor quality. To address this issue, we describe a modified oblique ripstop technique, which incorporates an obliquely oriented horizontal mattress stitch to reinforce the meniscal root and prevent suture cut-through. This configuration aligns the ripstop suture perpendicular to the cinch stitch, thereby enhancing resistance to pull-out forces. This technique is simple, reproducible, and may offer biomechanical advantages in compromised meniscal tissue conditions.
Lateral meniscus oblique radial tears, particularly high-grade types 3 and 4, are common in acute anterior cruciate ligament injuries and contribute to significant knee instability and meniscal extrusion if left unrepaired. Surgical repair is necessary to restore normal knee kinematics and meniscal function. This article describes a reproducible all-inside surgical technique for repairing a type 3 lateral meniscus oblique radial tear.
The aim of this article is to illustrate our technique for total elbow arthroplasty, acknowledging the key technological advancements and evidence-based techniques that have emerged in the last 2 decades. In this technical note, we describe our pearls for a reproducible and reliable total elbow arthroplasty procedure. We also provide evidence-based recommendations on implant selection, surgical approach, management of the triceps, and situations where total elbow arthroplasty is more beneficial over open reduction internal fixation for distal humerus fractures.
This paper describes an arthroscopic technique for managing anterior cruciate ligament (ACL) tibial avulsion fractures. The procedure combines a 3-tunnel anchoring construct with cortical button fixation in a crossed-loop configuration. The method aims to enhance 3-dimensional stability and provides improved fixation strength compared with conventional 2-tunnel approaches. The technique employs standard anterolateral/anteromedial portals with minimal access incisions (<5 mm), which feature 3 precisely placed 2.5 mm bone tunnels (2 anterior and 1 posterior to the anterior cruciate ligament footprint for optimal load distribution). A key point involves placing 1 to 2 cortical buttons at crossed angles, which directly promotes anatomical healing of the fracture site. This technique is particularly advantageous for comminuted fractures involving fragments smaller than 5 mm, offering reduction in soft-tissue dissection compared with open surgical approaches. The procedure should be performed by senior arthroscopic surgeons with at least 5 years of experience and is contraindicated in patients with osteoporosis (bone density T-score < -2.5).
The posterior cruciate ligament (PCL) is a critical stabilizing structure within the knee joint. Although its injury is relatively uncommon, severe cases can lead to significant dysfunction and long-term sequelae. PCL reconstruction is an essential treatment for PCL injuries, and among traditional techniques, trans-tibial interference screw fixation is a common method. However, due to the higher graft length requirement in PCL reconstruction, interference screw fixation is prone to fixation laxity resulting from insufficient graft length. To address the issue, we describe an improved PCL reconstruction technique utilizing an autologous hamstring tendon graft with tibial double knotless anchor fixation and femoral suspensory fixation. This method enhances graft-bone tunnel contact, effectively resolves fixation failure issues caused by graft length limitations, and provides greater fixation security and biomechanical advantages.
