Table Of ContentG. Lajtai · S.J. Snyder · G. R. Applegate Shoulder Arthroscopy and MRI Techniques
G. Aitzetm Ol ler · C. Gerber · (Eds.)
Springer-V erlag Berlin Heidelberg GmbH
The Shoulder
Robert Schoffmann
Oii painting
G. Lajtai · S.J. Snyder
G. R.Applegate · G. Aitzetmuller
C. Gerber · (Eds.)
SHOULDER
AR ROSCOPY
A D
MRI TECH IQUES
With 834 Figures and 20 Tables
Springer
ISBN 978-3-642-62771-2 ISBN 978-3-642-55604-3 (eBook) Library of Congress Cataloging-in-Publication Data
DOI 10.1007/978-3-642-55604-3 Shoulder arthroscopy and MRI techniques/Lajtai Georg . . . [e t
al.]. p.; cm. Includes bibliographical references and index.
ISBN 3540431128 (alk. paper) 1. Shoulder joint - Endoscopic
surgery. 2. Shoulder joint-Magnetic resonance imaging.l. Laj
tai, G. (Georg) [DNLM: 1. Shoulder Joint-surgery. 2.Arthros
copy - methods. 3· Magnetic Resonance Imaging - methods.
WE 810 S5586173 2002] RD557.5 .S5437 2002 617.5'72059-dc21
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Preface
1
This publication is a "must have" and now. The shoul The only thing the reader will miss is the experience
der topic is of great interest to the orthopaedic com of attending this great international congress ISC -
munity. The list of contributors is a proverbial inter www.shoulder.org; the hospitality of the hosts, Georg
national collection of who's who in shoulder surgery. Lajtai, Franz Unger and Gernot Aitzetmiiller, as well
The information is new, reflecting presentations as the ambience of the beautiful setting in the Austri
made at an international congress in Austria only 8 an mountains.
months before publication. This feat must be un Congratulations to Georg Lajtai and his co-editors
precedented in textbook publication. The content as well as Springer for making this information avail
material takes the reader from the fundamentals able in such a timely way. Only e-mail could have
to the most advanced and sophisticated of shoulder been faster.
diagnoses and treatment modalities.
As you would expect in such a fine text; the mate Lanny L. Johnson
rial is comprehensive, well organized, properly se
quenced, well written, subjected to careful editing,
supported by excellent illustrations, and with well
documented references. It succeeds where most pub
lications of this type fail; it provides up to date, state
of the art dissertations.
This book was supported by the
F;,e;;tOr •t..c. fv~.or.Jo~t;c.tl
Forchstrasse 340
8oo8 Zurich
Switzerland
www.resortho.com
Dedication
'
1d edicate this book to my parents Elfriede and Ladis
laus, who gave me the time to develop myself, as well
as to my familly- Mona, Julian and Nikolaus - for un
derstanding my lifestyle.
1a lso dedicate this book to my teachers:
L. L. Johnson, S. J. Snyder, and C. Gerber
Georg Lajtai
Contents
1
1 Shoulder Arthroscopy: 3 lnstrumentation in Shoulder Arthroscopy . 31
Struggles and Successes N. Espinosa · G. Lajtai · C. Gerber
L. L. Johnson
3.1 lntroduction ......... . 31
1.1 Struggles . . . . . . . . . . . . . . . . 1 3.2 Equipment ... . ...... . 31
1.2 The Second MajorArea of Problems. 2 3.2.1 Operating lnstruments. 31
1.3 Anatomical Landmarks . . 2 3.3 lrrigation and Pump Systems. 38
1.4 Anatomical Variations. . . 3 3.3.1 The Reservoir for the Liquid . 38
1.5 Glenohumerallnstability . 7 3.3.2 Pump Systems . . 39
1.6 Degenerative Arthritis . . 9 3.3.3 Cannula Systems . . 40
1.7 Undersurface Rotator CuffTears . 11 3.4 Optical Equipment. . 42
1.8 The Subacromial Space . . . 13 3.4.1 Light Sau rce . 42
1.9 The Acromioclavicular Joint 14 3.4.2 Light Cables .. . 44
1.1 O Surgical Technique. ... 14 3.4.3 Arthroscopes . . 45
1.11 Diagnostic Arthroscopy. 15 3.4.4 Cameras. . . . . 45
1.12 Operative Arthroscopy . 15
1.13 Rotator Cuff Disease. . . 17
1.14 Learning Arthroscopic Shoulder Surgery. 19 4 Suture Anchors .... . ..... . .... . . 47
1.15 New Technology . . . . 20 D. Meyer · G. Lajtai · C. Gerber
1.16 The Internet . . . . . . . 21
1.17 Results and Outcomes. . 21 4.1 lntroduction . . . . . . . . 47
1.18 Expanded Applications 4.2 Types of Suture Anchors . 47
of Arthroscopic Techniques. 21 4.2.1 Materials . . . . . . 47
1.19 Future ............ . 21 4.3 Types of lnsertion-and
Fixation-Mechanisms in Bone . 49
4.3.1 Straight lnsertion . . . . 49
2 Positioning ofthe Patient . .... ...... 25 4.3.2 Screw-Type Anchors . 50
G. Lajtai · G. Aitzetmuller 4.3.3 Toggling Anchors. . 52
D. Meyer · C. Gerber 4.3.4 Expanding Anchors 52
4.4 Fixation of Soft Tissue . . 53
2.1 Lateral Decubitus Position 25 4.4.1 Suture ...... . 53
2.1.1 Procedure. . . . . 25 4.4.2 Knotless Anchors . 53
2.1.2 Tips . . . . . . . . . 27 4.5 Performance and Failure
2.1.3 Adva ntages of the of Suture Anchors . . . . 54
Lateral Decubitus Position. 29 4.5.1 Pu llout from Bone 54
2.2 Beach-Chair Position . . . . . . 30 4.5.2 Structural Failure . 54
2.2.1 Procedure. . . . . . . . . 30 4.5.3 Suture Damage Through the Eyelet 54
2.3 Comparison of the Advantages 4.6 Hints for Anchor Selection
and Disadvantages of the and Deployment . . . . . . . 55
Above-Mentioned Resting Positions . . . . 30 4.6.1 Anchor lnsertion Site. 55
4.6.2 Financial Aspects. 58
4.7 Summary .......... . 58
X Contents ,
5 Arthroscopic Knot-Tying Techniques . . . . 59 7 Arthroscopic Anatomy
F. Unger · G. Lajtai · D. Meyer · C. Gerber and Normal Variants . . 101
o o o o o o o
F. Unger · G. Lajtai · C. Gerber
5.1 lntroduction . . . . . . . . . . 59
5.2 Terminology, Suture Material 7.1 lntroduction. . . . . . . . . . . 101
and lnstruments . . . . 59 7.2 Anatomy of the Glenohumeral Joint. 101
5.2.1 Suture Materials . . . . 59 7.2.1 Biceps Tendon .. 101
5.2.2 Cannulas ... . ... . 60 7.2.2 Rotator Interval . 103
5.3 General Guidelines and Technical Hints. 60 7.2.3 Humeral Head .. 103
5.4 Knot Patterns. . . . . . . 61 7.2.4 Glenoid ... . . 104
5.4.1 Nonsliding Knots .. 61 7.2.5 Glenoid Labrum. 104
5.4.2 Sliding Knots . ... 63 7.2.6 Joint Capsule and
o
5.4.2.4 A Very Special Knot: Glenohumeral Ligaments 105
The Outback Knot 7 .2.7 Rotator Cuff . . . . . 107
o
(Heinz Hoenecke). . . . . . . . . 67 7.2.8 Subscapular Recess ... . 11
o
5.5 Causes and Suggestions for Avoiding 7.2.9 Normal Variants .. . .. . 110
Mistakes in Knot Tying . . . . . . . . . 71 7.3 Anatomy of the Subacromial Space 112
5.5.1 The Knot ls Not Sufficiently Tight 7.4 Acromioclavicular Joint . . 114
From the Beginning ..... 71 7.5 Course of Examination. . . 114
5.5.2 The Knot Loosens Slowly . . 71 7 .5.1 Glenohumeral Joint. 114
5.5.3 Solutions, if Knots Are Loose. 71 7.5.2 Subacromial Space . 115
5.6 Tips and Tricks . . . . . . . . . . . . 71 7.6 Summary . .. .. . . .. . 116
5.7 Biomechanical Studies and Discussion . 71
5.8 Summary . . . . . . . . . . . . . . . . . . 72
8 MR lmaging of the Shoulder:
Basic lntroduction to MRI,
6 Surgical Approaches. ....... ...... 75 WhatTo look For and Potential Problems 117
G. Lajtai · G. Aitzetmuller G. R. Applegate
D. Meyer · C. Gerber
8.1 lntroduction . . 117
6.1 lntroduction .... . 75 8.2 Principles of Magnetic
6.2 Anatomy . . . . . . . . . . . . . . . . . . 77 Resonance lmaging .. 117
6.3 Approaches to the Glenohumeral Joint. 77 8.2.1 Tl-and T2-Weighted lmages 118
6.3.1 Dorsal Approach . . . . . . . . . . 77 8.3 Quality ............. . 118
6.3.2 Anterior Approaches. . . . . . . . 80 8.3.1 Equipment. ... . ... . 119
6.3.3 Cranial Approach (Neviaser Portal) . 89 8.3.2 MRI Shoulder Protocol .. 120
6.3.4 Changing of Portals . . . . . . . . 90 8.3.3 Radiologic lnterpretation 121
6.3.5 The Half Pipe . . . . . . . . . . . . 91 8.4 lndications . . . . . . . . . . . . 121
6.4 Approaches to the Subacromial Space . 94 8.5 Normal Anatomy and Normal Variants 121
6.4.1 Dorsal Subacromial Approach 94 8.5.1 Rotator Cuff . . . . . 121
6.4.2 Anterior Subacromial Approach 95 8.5.2 Glenoid Labrum. . . 125
6.4.3 Lateral Subacromial Approach . . 96 8.5.3 Sublabral Foramen . 126
6.5 Approach to the Acromioclavicular Joint . 96 8.5.4 Buford Complex. 126
6.5.1 Superior and Transcutaneous 8.6 MR Arthrography. 128
Approach . . . . . . . . . . . . . . . 97 8.6.1 Theory . . . . . . 128
6.5.2 Inferior from the Subacromial Space . 97 8.6.2 Technique ... . 128
6.6 lmpaired Visualization . . . . . . . . 98 8.6.3 Three-Dimensional MRI from an
6.6.1 Blood Pressure Control. . . . . 98 lntra-articular Perspective .... 129
6.6.2 lntra-articular Filling Pressure . 98
6.6.3 Electrocoagulation . 98
6.6.4 Laser. . . . . . . . . . . . . . . 98
