HighlightsThis is a novel management of a 21-year-old male with recurrent patellar dislocation.Fulkerson procedure was to realign the patella.Mesenchymal stem cell application was used for the articular cartilage defect.The outcome of this combination treatment was satisfying.
SLAP tears are a common pathology, observed in 26% of patients undergoing shoulder arthroscopy. First described by Andrews et al, SLAP tears were then further subclassified by Snyder et al. The variable relationship between the anterosuperior labrum and the glenohumeral ligaments has important implications for the evaluation and treatment of SLAP lesions. These normal variants include a sublabral recess / foramen (3.3%), a sublabral foramen with a cord-like MGHL (8.6%) and an absent anterosuperior labrum with a cord-like MGHL (i.e. Buford complex, 1.5%). Frequently accepted mechanisms of injury include forceful traction loads to the arm, direct compression loads, and repetitive overhead throwing activities. SLAP lesions are difficult to examine accurately, because that most SLAP lesions occur concomitantly with other shoulder injuries (e.g. glenohumeral instability, rotator cuff tears, biceps tendon ruptures), and they typically have no specific associated pain pattern. Several provocative tests for SLAP tears have been described, however, none of these tests has been found to be highly accurate for diagnosis of SLAP tears. The definitive diagnosis of SLAP lesions is best made through diagnostic arthroscopy. Treatment of these lesions is directed according to its type. Treatment ranges from non-operative management to surgical management including SLAP repair, biceps tenotomy, and biceps tenodesis. The management of Type-II SLAP (most common) of the shoulder remains a controversial topic. Whether to repair a shoulder SLAP lesion or perform a biceps tenodesis depends on a multitude of factors: patient age, activity or work level, type of SLAP tear, location of SLAP tear, and quality of labral tissue. Determining which procedure to perform does not have such a simple, one-size-fits-all solution.
The shoulder is one of the most complex joints of the human body. Consequently, they are susceptible to injury and degeneration. Mechanical shoulder pathology typically results when overuse, extremes of motion, or excessive forces overwhelm intrinsic material properties of the shoulder complex resulting in tears of the rotator cuff, capsule, and labrum. The fundamental central component of the shoulder complex is the glenohumeral joint. It has a ball-and-socket configuration with a surface area ratio of the humeral head to glenoid fossa of about 3:1 with an appearance similar to a golf ball on a tee. Overall, there is minimal bony covering and limited contact areas that allow extensive translational and rotational ability in all three planes. The glenohumeral joint has 2 groups of stabilizers, which are static (passive) and dynamic (active) restrains. Static stabilizers include the concavity of the glenoid fossa, glenoid fossa retroversion and superior angulation, glenoid labrum, the joint capsule, and glenohumeral ligaments, and a vacuum effect from negative intra-articular pressure. Dynamic stabilization is merely the coordinated contraction of the rotator cuff muscles that create forces that compress the articular surfaces of the humeral head into the concave surface of the glenoid fossa. During upper extremity movement, the effects of static stabilizers are minimized and dynamic or active stabilizers become the dominant forces responsible for glenohumeral stability The simple act of arm elevation is a complex task that occurs via the combination of glenohumeral and scapulothoracic motion, together known as scapulohumeral rhythm. In the first 1200, glenohumeral arm abduction, the supraspinatus and deltoid work together and create a force couple that promotes stability, while raising the arm (deltoid contraction). In addition, the humerus must undergo 450 external rotation to not only clear the greater tuberosity posteriorly but also loosen the inferior glenohumeral ligament (IGHL) to allow maximum elevation. There are several anatomical updates regarding the rotator cuff and capsular footprint. The footprint of the supraspinatus on the greater tuberosity is much smaller than previously believed, and this area of the greater tuberosity is actually occupied by a substantial amount of the infraspinatus. The superior-most insertion of the subscapularis tendon extends a thin tendinous slip, which attaches to the fovea capitis of the humerus. The teres minor muscle inserts to the lowest impression of the greater tuberosity of the humerus and additionally inserts to the posterior side of the surgical neck of the humerus.
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