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The treatment of massive and irreparable rotator cuff tears remains a challenge for shoulder surgeons. When treating patients with chronic rotator cuff tears, especially those with severe fatty degeneration, severe tendon retraction, or muscle atrophy, the risk of re-tear and persistent severe pain persists. Therefore, surgeons can choose from numerous options. Superior capsular reconstruction (SCR) was introduced as a technique to maintain the stability of the upper shoulder and stabilize the muscles without repairing the supraspinatus and infraspinatus. Various autograft and allograft techniques have been developed. SCR performed using an autograft has the disadvantage of requiring harvesting the tensor fascia lata. Although allografts reduce harvest time, they also increase donor-site morbidity and the time required for healing. To solve the healing problem, we have introduced an SCR technique through grafting with the Achilles tendon-bone. Although this is an unproven technique for patients with chronic irreparable rotator cuff tears, our short-term outcomes seem promising. Further studies and follow-ups are needed to determine the success of this technique. © 2019 by the Arthroscopy Association of North America. Published by Elsevier.Latissimus dorsi tendon ruptures are less-common injuries that can occur in elite throwing athletes. Proteasome inhibitor Physical examination of the thrower with a latissimus injury may show ecchymosis of the upper arm and asymmetry of the posterior axillary fold along with possible weakness in shoulder adduction, extension, and internal rotation. Magnetic resonance imaging is used to confirm the diagnosis. Latissimus tendon ruptures are largely treated nonoperatively; surgical repair is only advocated for in professional throwing athletes with complete avulsion injuries or midsubstance latissimus tendon tears. Surgical repair options include the use of suture anchors, cortical suture buttons, or transosseous sutures via a single posterior axillary incision or a 2-incision technique. Given the limited literature on this topic, there have been no studies evaluating the different fixation options or surgical approaches for tendon repair. This article and accompanying video show the technique and discusses the technical pearls of a latissimus tendon repair using suture button fixation via a single-incision approach. © 2019 by the Arthroscopy Association of North America. Published by Elsevier.There has been increased emphasis on medial meniscus repair in the anterior cruciate ligament-reconstructed knee, as this improves stability. We describe an arthroscopic sign of an unstable medial meniscal tear that is diagnostic. The "crevice sign" is a longitudinal fissure located on the distal medial femoral condyle. In the anterior cruciate ligament-deficient knee, there is increased strain on the medial meniscus. A posterior longitudinal medial meniscal tear can occur at the time of the index injury or with subsequent instability events. During this injury, the knee pivots and the anterior edge of the unstable medial meniscus digs into the articular cartilage of the medial femoral condyle, resulting in a longitudinal split of the distal femoral condyle articular cartilage. If this sign is observed during arthroscopy, it is recommended that surgeons thoroughly probe the medial meniscus to ensure no pathology is missed. © 2019 by the Arthroscopy Association of North America. Published by Elsevier.According to recent anatomic studies, the anterior cruciate ligament (ACL) appears to be a flat, "ribbon-like" structure, with a thin, oval-shaped insertion on the femur and a C-shaped tibial insertion. According to this anatomy, we describe an ACL-reconstruction technique that aims to approximate this natural anatomy. The basic principle of this technique is not to use conventional round tunnels but create tunnel shapes that resemble more closely the original ACL insertion sites. Using either a rectangular quadriceps tendon graft or a "flat" hamstring graft may not only provide a biomechanical advantage with increased rotational stability but also improve bone-tendon healing due to increased bone-tendon contact and decreased diffusion length. Creating a C-shaped tibial tunnel also avoids laceration of the anterior horn of the lateral meniscus, which is frequently harmed during conventional tibial tunnel drilling. © 2019 by the Arthroscopy Association of North America. Published by Elsevier.Management of chondral lesions of the femoral head can be challenging. Previously described approaches include arthroscopic surgery for small lesions and open surgical dislocation for larger lesions. In 2001, Ganz popularized the trochanteric flip osteotomy for surgical dislocation, and this remains the workhorse for treatment of large chondral lesions. However, by using a Smith-Peterson (direct anterior) approach and a femoral head allograft, large lesions may be treated while avoiding both trochanteric osteotomy and donor-site morbidity. We present our technique using a Smith-Peterson approach and osteochondral implantation of fresh femoral head allograft for surgical treatment of a femoral head chondral lesion. © 2019 by the Arthroscopy Association of North America. Published by Elsevier.Glenoid rim fractures are recognized as a risk factor for recurrent instability after anterior shoulder dislocation. In addition to traditional open treatments of bony Bankart lesions, several arthroscopic techniques of fixation and reconstruction recently have been described. We present a technique of arthroscopic nonrigid fixation for large glenoid rim fractures, as an alternative to existing procedures. © 2019 by the Arthroscopy Association of North America. Published by Elsevier.Revision anterior cruciate ligament reconstructions can be performed using either a single-stage or 2-stage technique. There are several benefits to using a single-stage approach when technically possible. Although not always feasible, eliminating the necessity of a 2-stage approach for certain indications is clearly preferable because it requires fewer operative procedures, leads to a more rapid recovery, and is cost effective. Here, we describe the use of fast-setting bone graft substitutes in the setting of single-stage revision anterior cruciate ligament reconstruction. The authors have found this technique useful in converting what would sometimes otherwise be approached using 2 stages into a single-stage procedure. © 2020 Published by Elsevier on behalf of the Arthroscopy Association of North America.
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