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Christophe MATHOULIN

Clinique Bizet
Paris, France
MD
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23.8K views
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Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
C Mathoulin
Surgical intervention
29 days ago
71 views
1 like
0 comments
12:20
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
C Mathoulin
Surgical intervention
8 months ago
285 views
5 likes
1 comment
04:08
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
C Mathoulin
Surgical intervention
8 months ago
132 views
1 like
0 comments
17:40
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
C Mathoulin
Surgical intervention
8 months ago
117 views
1 like
0 comments
04:24
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
C Mathoulin
Surgical intervention
8 months ago
208 views
4 likes
0 comments
06:03
Arthroscopic Wafer procedure for ulnar carpal abutment
Ulnocarpal abutment is the inversion of the distal radio ulnar index with a positive ulnar variance (long ulna) and is most frequently secondary to distal radius fractures. The relative ‘shortening of the radius’ leads to a conflict between the ulnar head and the proximal lunatum. The natural evolution of this condition is usually a central perforation of the TFCC complex. This arthrogenic lesion eventually leads to arthritis of the medial proximal lunate as well as the ulnar head. Persistence of the abutment may further lead to lunotriquetral dissociation. There are many management options for the distal radioulnar component of distal radius malunions and the therapeutic choice depends on clinical evaluation and imaging of this joint. In this video, we present the arthroscopic treatment, which remains the simplest and best solution for the patients.
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
C Mathoulin
Surgical intervention
9 months ago
91 views
3 likes
0 comments
09:08
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
C Mathoulin
Surgical intervention
9 months ago
78 views
4 likes
0 comments
06:06
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
C Mathoulin
Surgical intervention
5 years ago
469 views
6 likes
0 comments
06:26
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
Lengthening of extensor muscle origin as treatment of lateral epicondylitis
Lateral epicondylitis (tennis elbow) is the most common affliction of the elbow. It is an inflammatory condition producing pain localized around the lateral elbow and dorsal forearm region. Though often put in the category of tendinitis, it is actually a result of an injury to the extensor musculotendinous origin at the lateral humoral epicondyle. It usually responds to non-surgical treatment. In case of failure, a surgical treatment is requested. It consists in the lengthening of the extensor muscle origin. This original technique allows a prompt recovery of full range of motion.
This video was captured using the VITOM system from KARL STORZ.
C Mathoulin
Surgical intervention
6 years ago
845 views
20 likes
0 comments
05:18
Lengthening of extensor muscle origin as treatment of lateral epicondylitis
Lateral epicondylitis (tennis elbow) is the most common affliction of the elbow. It is an inflammatory condition producing pain localized around the lateral elbow and dorsal forearm region. Though often put in the category of tendinitis, it is actually a result of an injury to the extensor musculotendinous origin at the lateral humoral epicondyle. It usually responds to non-surgical treatment. In case of failure, a surgical treatment is requested. It consists in the lengthening of the extensor muscle origin. This original technique allows a prompt recovery of full range of motion.
This video was captured using the VITOM system from KARL STORZ.
Management of scapholunate tears: open versus arthroscopic treatment
The understanding of scapholunate ligament lesions has made great strides in recent years, largely thanks to the work undertaken by the two wrist surgery "heavyweights" who are Dr. Marc Garcia-Elias and Dr. Christophe Mathoulin.
Although they do not use the same approach to treat scapholunate ligament lesions (Marc Garcia-Elias opens the wrist and Christopher Mathoulin tries to process them arthroscopically), they have both reached the same conclusion:
- the scapholunate ligament is more than just an interosseous ligament but rather a real scapholunate ligament complex with intrinsic and extrinsic components;
- proprioception is involved in the stability of scapholunate space;
- and early diagnosis and treatment seem essential to obtain good results.
This peer-to-peer conversation between these two friends is not a battle, but rather an extremely modern development on a long debated topic... have fun!
Moderator: Riccardo Luchetti, MD
M Garcia-Elias, C Mathoulin, R Luchetti
Lecture
6 years ago
641 views
3 likes
0 comments
37:58
Management of scapholunate tears: open versus arthroscopic treatment
The understanding of scapholunate ligament lesions has made great strides in recent years, largely thanks to the work undertaken by the two wrist surgery "heavyweights" who are Dr. Marc Garcia-Elias and Dr. Christophe Mathoulin.
Although they do not use the same approach to treat scapholunate ligament lesions (Marc Garcia-Elias opens the wrist and Christopher Mathoulin tries to process them arthroscopically), they have both reached the same conclusion:
- the scapholunate ligament is more than just an interosseous ligament but rather a real scapholunate ligament complex with intrinsic and extrinsic components;
- proprioception is involved in the stability of scapholunate space;
- and early diagnosis and treatment seem essential to obtain good results.
This peer-to-peer conversation between these two friends is not a battle, but rather an extremely modern development on a long debated topic... have fun!
Moderator: Riccardo Luchetti, MD
Arthroscopic dorsal capsuloplasty as treatment for chronic scapholunate tear
The sprain of the scapholunate ligament generates chronic instability, which leads to a chondral change with carpus arthritis. The use of wrist arthroscopy allows the diagnosis of these lesions, even at an early stage, and, sometimes, provides a therapeutic strategy by performing a stable fixation. In some chronic cases when the ligament cannot be repaired but the scapholunate space is reducible (stage 2 to 4 according to Garcia-Elias’ classification), a new arthroscopic dorsal capsuloplasty has been performed in order to avoid a complex reconstruction with common stiffness. The patients were operated on in outpatient settings under regional anesthesia using a pneumatic tourniquet. The capsuloplasty is arthroscopically performed between the dorsal capsule and the dorsal part of the scapholunate ligament, using a PDS suture loop. Scapholunate and scaphocapitate Kirschner wires are placed only at stage 4 after scaphoid reduction. A volar splint was placed for a period of 2 months.
C Mathoulin
Surgical intervention
8 years ago
842 views
5 likes
0 comments
12:38
Arthroscopic dorsal capsuloplasty as treatment for chronic scapholunate tear
The sprain of the scapholunate ligament generates chronic instability, which leads to a chondral change with carpus arthritis. The use of wrist arthroscopy allows the diagnosis of these lesions, even at an early stage, and, sometimes, provides a therapeutic strategy by performing a stable fixation. In some chronic cases when the ligament cannot be repaired but the scapholunate space is reducible (stage 2 to 4 according to Garcia-Elias’ classification), a new arthroscopic dorsal capsuloplasty has been performed in order to avoid a complex reconstruction with common stiffness. The patients were operated on in outpatient settings under regional anesthesia using a pneumatic tourniquet. The capsuloplasty is arthroscopically performed between the dorsal capsule and the dorsal part of the scapholunate ligament, using a PDS suture loop. Scapholunate and scaphocapitate Kirschner wires are placed only at stage 4 after scaphoid reduction. A volar splint was placed for a period of 2 months.
Double loop for arthroscopic repair of large triangular fibrocartilage complex (TFCC) tear
The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.
C Mathoulin
Surgical intervention
8 years ago
811 views
13 likes
1 comment
08:19
Double loop for arthroscopic repair of large triangular fibrocartilage complex (TFCC) tear
The triangular fibrocartilage complex (TFCC) has an important biomechanical function for the carpus and the distal radioulnar joint. TFCC lesions are responsible for ulnar side wrist pain and need to be repaired in order to restore a normal wrist. In some cases, TFCC lesions range from ulnar styloid to radial insertion. Wrist arthroscopy makes diagnosis and treatment possible in the least invasive way. The surgical treatment consists in reinserting the TFCC using the new double loop suture with absorbable PDS material. The film describes how to place a double suture of the entire TFCC tear by using an only one-way suture technique.
Arthroscopic removal of volar ganglia
Arthroscopic removal of volar ganglia is a reasonable and safe approach, which requires understanding of specific technical gestures. The main indication being esthetic, the use of wrist arthroscopy is perfect. This video will show you how to perform this reliable procedure in a safe way. This young woman has a small volar ganglion, causing pain by creating pressure difference in the radiocarpal joint. Removing this kind of volar ganglion can be satisfied only by the radiocarpal joint. We will use a 3-4 portal for the scope and a 1-2 instrumental portal. Locating the origin of the ganglion can be assisted by external manipulation. It is usually located between the scapho radio-capitate ligaments and long radiolunate ligaments. Ganglion removal is carried out from the inside of the joint using a shaver. The operation may be considered completed when the anterior capsulectomy is performed and, possibly when we see the tendons. It is not necessary to close the portals, a simple dressing will be applied, and the patient may be able to totally use her hand and wrist the same day.
C Mathoulin, P Liverneaux
Surgical intervention
8 years ago
976 views
21 likes
0 comments
07:44
Arthroscopic removal of volar ganglia
Arthroscopic removal of volar ganglia is a reasonable and safe approach, which requires understanding of specific technical gestures. The main indication being esthetic, the use of wrist arthroscopy is perfect. This video will show you how to perform this reliable procedure in a safe way. This young woman has a small volar ganglion, causing pain by creating pressure difference in the radiocarpal joint. Removing this kind of volar ganglion can be satisfied only by the radiocarpal joint. We will use a 3-4 portal for the scope and a 1-2 instrumental portal. Locating the origin of the ganglion can be assisted by external manipulation. It is usually located between the scapho radio-capitate ligaments and long radiolunate ligaments. Ganglion removal is carried out from the inside of the joint using a shaver. The operation may be considered completed when the anterior capsulectomy is performed and, possibly when we see the tendons. It is not necessary to close the portals, a simple dressing will be applied, and the patient may be able to totally use her hand and wrist the same day.
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
C Mathoulin, P Liverneaux
Surgical intervention
8 years ago
1111 views
29 likes
0 comments
21:38
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.