• Archives of Plastic Surgery
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• v.48 no.6
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• pp.635-640
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• 2021

Background Injuries to the proximal interphalangeal (PIP) joint are common and complex. However, the treatment of osteochondral defects of the head of the proximal phalanx has rarely been described. Herein, we propose a new technique for the management of unicondylar defects of the proximal phalanx that can restore joint amplitudes and provide PIP stability. Methods In this cadaveric feasibility study, unicondylar defects were generated using striking wedges and chisels. First, a transverse tunnel measuring 2 mm in diameter passing through the head of the proximal phalanx was made. A second tunnel at the base of the middle phalanx with the same diameter was then created. The hemitendon of the flexor carpi radialis graft was passed through each of these tunnels. The proximal end of the graft was interposed in the area with a loss of bone substance. The ligamentoplasty was then tensed and fixed by two anchors on the proximal phalanx. Joint amplitudes and frontal stability were measured preoperatively and postoperatively. Results There was no significant change in the joint's range of motion: preoperatively, the mean mobility arcs were -2° to 113.80°, and they were -2° to 110° after the procedure (P=0.999). There was no significant difference in joint stability (P>0.05). Conclusions Ligamentoplasty with PIP interposition appears to be a possible solution for the management of unicondylar defects of the proximal phalanx. An evaluation of clinical results is planned in order to definitively confirm the validity of this procedure.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.209-213
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• 2006

Purpose: Conventional transtibial approach for the anterior cruciate ligament (ACL) reconstruction tended to place the femoral tunnel in too vertical position (11 or 1 o'clock), which could provide the postoperative anteroposterior (AP) stability but not provided the rotational stability. Therefore we present a surgical technique to make the transtibial femoral tunnel at 10 or 2 o'clock position. Surgical approach: To make a transtibial femoral tunnel at the 10 or 2 o'clock position, the direction and position of the tibial drill guide was important. We set the tibial drill guide at $40{\sim}45$ degrees and the intraarticular guide tip was 1 mm anterior and medial to the conventional site. The starting point for the guide pin on the proximal tibia was proximal to the pes anserinus and anterior to the medial collateral ligament. The tibial tunnel was initially drilled 1mm less than the diameter of the graft. Then femoral offset guide could be easily placed at 10 or 2 o'clock position through the tibial tunnel. The tibial tunnel and the femoral tunnel of 30 mm in length were made with the reamer that was same size with the graft. Conclusion: We report a surgical technique to create a transtibial femoral tunnel at 10 or 2 o'clock position in ACL reconstruction to provide the rotational stability as well as the AP stability.