A technique for arthroscopic mattress suture placement

ABSTRACTS anatomy of the elbow joint and the proximity of neurovascular structures to portal sites and intraarticular landmarks. Methods: Elbow arthroscopy was performed on 12 cadaver elbows. Seven portals were investigated, including superolateral and posterior transhumeral portals, each of which has not been previously described. The relationship of the portals to superficial and deep neurovascular structures was measured. The intraarticular anatomy that could be seen from each of these portals was documented by photography and verified by anatomical dissection. Finally, the proximity of the major neurovascular structures to the various intraarticular landmarks was measured. Results: The anterolateral portal is dangerous, being only 4.8 mm from the radial nerve with the elbow flexed and 1.3 mm with the elbow extended. Instead, the superolateral portal averaged 9.9 and 4.8 mm from the radial nerve in flexion and extension, respectively. In addition, the superolateral portal provides a clearer view of both the medial and lateral sides of the joint. The posterior transhumeral portal is safe and viable, but the view of the anterior joint is not superior to the superolateral portal. The radial nerve lies directly on the elbow capsule at the level of the radiocapitellar joint. Joint distension and elbow flexion provide only limited protection because the nerve is fixed just distal to the joint by the arcade of Frose. Conclusions: Use of the superolateral portal provides a much better view of the elbow and is much safer than conventional anterolatertal portals. The radial nerve is at extreme risk at the radiocapitellar articulation. A Technique for Arthroscopic Mattress Suture Placement. Raymond Thal. Reston, Virginia, U.S.A. A technique for arthroscopic mattress suture placement for arthroscopic Bankart suture repair is described. In recent years, many techniques and instrument systems have been developed for performing arthroscopic Bankart suture repair. All of the described techniques use placement of multiple, simple sutures in the anterior inferior glenohumeral ligament (AIGHL). The use of mattress sutures allows for inversion of the repaired ligament and greater repair strength, and provides a greater area of ligament apposition to bone. Fewer sutures are used, which minimizes the possibility of suture in-

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terposition between ligament and bone. This reduces the possibility of the sutures inhibiting the healing of the repaired ligament to bone. A suture punch is used to place a simple suture in the AIGHL. A suture loop is then placed in the ligament adjacent to the first suture by feeding both ends of a monofilament suture through the suture punch simultaneously. The suture loop is used as a suture passer to pull a free end of the first suture through the ligament, creating a mattress suture. This is repeated at multiple locations in the AIGHL. The sutures are then passed transglenoid and tied posteriorly. Laser Chondroplasty of Grade II and III Lesions Using the Shaver and a Holmium-YAG Laser: 1-Year Clinical Results. Jurgen Toft. Munich, Germany. Between May and July 1991, 50 patients were operated on for grade III chondromalacia in the Outpatient Center for Spine and Knee Surgery. This group only includes lateral hypercompression syndromes with a maltracking of the patella. No essential chondral lesions of the trochlea existed in this group. No additional abnormalities other than the pathology in the femoropatellar joint were registered. Subjective information on pain, swelling, and use in daily life and in sports were obtained at the follow-up examination 1 year postoperatively. The subjective parameters covered the radiologic control of patella position and retropateUar sclerosis, and included isokinetic strength testing of the quadriceps musculature. Because the retropatellar crepitation could not be quantified, this phenomenon was disregarded. No major girth differences or restrictions of motion were found 1 year postoperatively, and therefore were not reported. Regarding subjective results, 92% of the patients rated the surgical result as good or excellent; 94% were able to use the operated leg without any problem in their daily life and at work; and 76% resumed the sport they used to practice before knee surgery. Moreover, patients subjectively reported that the retropatellar "grinding" decreased. Six percent of the patients observed mild swelling after sports activities. Regarding objective results, 96% of the patients showed an open capsular window, and 4% developed a fibrosis around the lateral release due to postoperative hemarthrosis. Radiologically, the retropatellar sclerosis on the Arthroscopy, 11ol. 9, No, 3, 1993