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Souza, Eduardo Dias de, Joao Luiz Vieira da Silva, Lucas Antônio Ferraz Marcon, and João Elias Ferreira Braga. "Technical description of a low-cost ankle arthroscopy simulator." Journal of the Foot & Ankle 14, no. 2 (August 30, 2020): 173–77. http://dx.doi.org/10.30795/jfootankle.2020.v14.1135.
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Objective: To describe a low-cost, accessible, reproducible ankle arthroscopy simulator model which, after validation, will allow the development and improvement of technical skills required in arthroscopic surgical practice. Methods: This study describes the production of an ankle arthroscopy model that simulates camera, arthroscope, and ankle joint. Results: The simulator works properly when connected to a monitor, television, computer, or cell phone. Conclusion: A reproducible, accessible, low-cost ankle arthroscopy simulator can be developed using components available from local and online stores, with an approximate cost of R$232.00. Level Evidence V; Economic and Decision Analyses – Development of an Economic or Decision Model; Expert Opinion.
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Shultz, Christopher L., Samuel N. Schrader, Benjamin D. Packard, Daniel C. Wascher, Gehron P. Treme, and Dustin L. Richter. "Is Diagnostic Arthroscopy at the Time of Medial Patellofemoral Ligament Reconstruction Necessary?" Orthopaedic Journal of Sports Medicine 8, no. 8 (August 1, 2020): 232596712094565. http://dx.doi.org/10.1177/2325967120945654.
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Background: Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined. Purpose: To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded. Results: Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy. Conclusion: Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.
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Ellis, Henry, Eric Edmonds, Yi-Meng Yen, Philip Wilson, Emily Tran, Peter Cannamela, and Kevin Shea. "CHALLENGES IN SMALL KNEE ARTHROSCOPY: A QUALITATIVE AND QUANTITATIVE PEDIATRIC CADAVERIC EXPERIENCE." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0026. http://dx.doi.org/10.1177/2325967120s00267.
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Background: Arthroscopy may be utilized for treatment of septic arthritis of the pediatric knee, with success reported in ages from 3 months to 12 years. There is limited data on the ability to arthroscopically assess articular structures and ensure adequate evaluation without arthrotomy. Hypothesis/Purpose: The purpose of this study is: (1) utilize arthroscopy in small cadaveric knees to improve qualitative and quantitative knowledge of pediatric articular structures and (2) to obtain pilot data for common procedures performed in pediatric patients Methods: Five small pediatric cadaveric specimens (1-4 years) underwent arthroscopy (2.7 mm Stryker arthroscope). Medial and lateral compartments were assessed for meniscus size/mobility/height, compartmental joint space, ACL insertion, patellar chondral height and length, and position of the medial patellofemoral ligament were recorded. Utilizing standard anterior medial and lateral portals, the ability to visualize the structures of the posteromedial and posterolateral compartments was recorded. Procedures pertinent to immature ACL reconstruction and meniscal repair (unstable discoid) were critically evaluated to provide source data for future work. Results: Prior to arthroscopy, all specimens underwent volume-assessed knee insufflation (average 11.4 cc normal saline). Arthroscopic visualization of the menisco-capsular attachment was possible posteromedially in 4/6, and posterolaterally in 5/6 knees. Qualitative arthroscopic relationships were similar to adult references; including patellar-trochlear articulation and lateral meniscal positional relationship to the ACL insertion (see Figure 1). The ACL center was within 2 mm of the posterior aspect of the anterior horn of the lateral meniscus in all specimens. The average height of the medial compartment space under valgus load was 1.5 mm (1 – 2 mm), and lateral space under varus was 2.2 mm (2-3 mm); further emphasizing the need for small joint instruments. The width of the medial and lateral menisci are noted in Table 1. All-inside meniscal devices designed for skeletally mature specimens should be used with caution (Figure 1). Traditionally described inside-out technique for immature ACL reconstruction with an iliotibial band demonstrated significant proximity of the passing device to the neurovascular bundle (Figure 1). Conclusion: The entirety of the small knee is assessable via standard diagnostic arthroscopy, when a 2.7mm arthroscope is utilized. These findings suggest that intra-articular pathology can be reliably identified utilizing this surgical technique. However, the ability to work on the infant meniscus and cartilage with standard arthroscopic instruments is likely limited given the constraints of joint height. [Table: see text][Figure: see text]
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Carender, Christopher N., Alan G. Shamrock, Kyle R. Duchman, Natalie A. Glass, T. Sean Lynch, and Robert W. Westermann. "Arthroscopy Volume in United States Residency Programs: Are New Trainees Prepared?" Journal of Hip Surgery 03, no. 03 (August 7, 2019): 124–29. http://dx.doi.org/10.1055/s-0039-1694766.
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AbstractArthroscopy is a technically demanding procedure with a prolonged learning curve. The purpose of this study is to determine if current arthroscopic case volume over the course of an orthopaedic surgery residency is sufficient to meet the number of cases required to achieve competence and/or mastery in complex arthroscopic tasks as well as hip arthroscopy. Publicly available Accreditation Council for Graduate Medical Education case log data for arthroscopic procedures from accredited orthopaedic residencies were reviewed from 2007 to 2017. Linear and segmental regression analyses were used to identify temporal trends, with significance set to p < 0.05. From 2007 to 2013, there was a significant increase in the median number of shoulder and knee arthroscopy case logs (p < 0.001). A sharp decline in the median number of shoulder and knee arthroscopy case logs was seen in 2013 to 2014 (p < 0.001), and the number remained low from 2014 to 2017 (p = 0.02, p = 0.03). The median number of hip arthroscopy procedures logged increased significantly from zero cases in 2012 (range: 0–48 cases) to five cases in 2017 (range: 0–76 cases) (p = 0.02). Over the study period, the median number of total arthroscopic procedures decreased from 301 to 186 (p = 0.01). In the United States, the majority of orthopaedic surgery residents graduate with case log numbers that meet theoretical minimum requirements for competence in basic diagnostic arthroscopy of the shoulder, hip, and knee. Resident experience with hip arthroscopy has increased; however, the majority of residents are graduating with little to no hip arthroscopy experience. Moreover, the median number of total arthroscopic procedures has declined to the point where the average graduate may not be able to perform complex hip or shoulder arthroscopy tasks based on previously published data. These findings support the need for further investigation into the best methods for training residents interested in performing arthroscopy as part of their careers. This was a level of evidence III, retrospective cohort study.
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MUTIMER, J., J. GREEN, and J. FIELD. "Comparison of MRI and Wrist Arthroscopy for Assessment of Wrist Cartilage." Journal of Hand Surgery (European Volume) 33, no. 3 (June 2008): 380–82. http://dx.doi.org/10.1177/1753193408090395.
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In order to perform motion-preserving procedures for wrist arthritis rather than total joint fusion, it is important to determine the integrity of specific areas of wrist cartilage. This is generally performed using a wrist arthroscope and by directly visualising the cartilage. Twenty patients with wrist pain were investigated over a 1-year period with both MRI and wrist arthroscopy. Kappa analysis was used to compare the two methods of cartilage assessment. There is only a fair correlation ( K = 0.38) between the two methods. With only a fair correlation between arthroscopy and MRI, it cannot be concluded that the two methods are equivalent for assessing wrist cartilage and, as such, wrist arthroscopy still has an important role to play in the assessment of a painful degenerative wrist.
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Heenan, G. Matthew, Kisan Parikh, Armin Tarakemeh, J. Paul Schroeppel, Scott Mullen, and Bryan G. Vopat. "Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0020. http://dx.doi.org/10.1177/2473011419s00206.
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Category: Ankle, Arthroscopy Introduction/Purpose: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,428) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,236) or lateral ankle ligament reconstruction (n=1,211). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=314), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=473), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Cost was higher for arthroscopy groups: repair with arthroscopy ($5,991.32) versus repair without arthroscopy ($3,677.11; p<0.001); reconstruction with arthroscopy ($5,744.83) versus reconstruction without arthroscopy ($4,601.13; p=0.001). Proportionately more patients had complications in the repair without arthroscopy group than in the repair with arthroscopy group (9.87%, 5.41%; p=0.013). Proportionately more patients had newly-diagnosed intra-articular defects in arthroscopy groups: repair with arthroscopy (57.0%) versus repair without arthroscopy (35.6%; p<0.001); reconstruction with arthroscopy (63.0%) versus reconstruction without arthroscopy (39.8%; p<0.001). Proportionately more patients underwent reoperation for intra-articular defects in the combined arthroscopy group (6.89%) than in the combined non-arthroscopy group (4.18%; p=0.006). The average time until reoperation for intra-articular defects was shorter in the combined arthroscopy group (302.536 days) than in the combined non-arthroscopy group (473.886 days; p=0.045). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was over 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.
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Bonilla, Alvaro G. "Standing Needle Arthroscopy of the Metacarpophalangeal and Metatarsophalangeal Joint for Removal of Dorsal Osteochondral Fragmentation in 21 Horses." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 05 (May 24, 2019): 420–26. http://dx.doi.org/10.1055/s-0039-1688984.
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Abstract Objective The aim of this study was to report the technique, experience and outcome of standing arthroscopic removal of dorsal osteochondral fragmentation of the metacarpophalangeal and metatarsophalangeal joint using a 1.2-mm needle arthroscope. Study Design This was a prospective clinical study. Materials and Methods All horses referred for standing arthroscopic removal of dorsoproximal first phalanx fragments or fragments embedded in the distal aspect of the synovial plica were included. Relevant information from the cases was recorded. Follow-up was obtained by a telephone questionnaire. Results Twenty-one horses with a mean age of 4.5 years old were included. Osteochondral fragments removed were from the proximal margin of first phalanx in 18 horses (24 joints), in the synovial plica in 2 horses (2 joints) or free-floating fragment in 1 horse (1 joint). Fifteen out of twenty-one horses were unilaterally affected and 6/21 bilaterally. Fifteen out of twenty-seven affected joints were forelimbs and 12/27 hindlimbs. All articular structures within the dorsal recess of the joint were visible. The arthroscope was deemed easy to use and manoeuvre. Only minor complications occurred during the procedure. Surgery time was 15 to 20 minutes for most patients. Conclusions All fragments were successfully removed and needle arthroscopy allowed a thorough evaluation of the dorsal aspect of the joint. The technique offers an alternative for standing fetlock arthroscopy for surgeons concerned about equipment damage or portability.
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Kim, Jeon-Gyo, Heuichul Gwak, and Sangmyung Roh. "Second-Look Arthroscopic Findings and Clinical Outcomes After Management of Intra-Articular Lesions in Acute Ankle Fractures with Arthroscopy." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000054.
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Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: Anatomically successful surgical reduction of ankle fractures does not always result in a clinically favorable outcome. The purpose of the present study was to compare initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes. Methods: A total of 39 patients (40 ankles, 20 male, 20 female) who underwent surgery for ankle fracture between March 2009 and August 2016 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Intra-articular lesions (osteochondral lesion, loose body, injury of ligaments and fibrosis) were evaluated via ankle arthroscopy. Arthroscopic finding of osteochondral lesion were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the international Cartilage Repar System (ICRS). Clinicial outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Visual Analogue Scale (VAS) Results: Chondral lesions were found in 26 ankles (65%) with initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in second-look arthroscopy was 15 cases. Accoding to the Ferkel and Cheng staging at second-look arthroscopy, 4 of 23 ankles with chondral lesions of talus was getting worse (more than stage D). In terms of ICRS overall repair grades, 4 ankle (15%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles respectively in second-look arthroscopy. Correlation were found between AOFAS scores, VAS and intra-articular lesions with second-look arthroscopy. Conclusion: Second-look arthroscopic examination combined with treatment of intra-articular lesion arising from ankle fracture surgery may consider to improve clinical outcomes.
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Heenan, G. Matthew, Kisan B. Parikh, Armin Tarakemeh, Scott M. Mullen, John Paul Schroeppel, and Bryan George Vopat. "Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0032. http://dx.doi.org/10.1177/2325967119s00325.
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Objectives: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,188) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,141) or lateral ankle ligament reconstruction (n=1,063). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=219), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=325), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Average cost per patient was higher for both arthroscopy groups: repair with arthroscopy ($6,207.78) versus repair without arthroscopy ($3,677.11; p < 0.0001); reconstruction with arthroscopy ($5,758.21) versus reconstruction without arthroscopy ($4,601.13; p = 0.0039). There was a significantly higher proportion of patients with complications in the reconstruction without arthroscopy group than in the reconstruction with arthroscopy group (7.59%, 4.31%; p = 0.0431), but the difference between repair groups was insignificant (p = 0.0626). The proportion of patients with newly diagnosed intra-articular defects was significantly higher in both arthroscopy groups: repair with arthroscopy (53.0%) versus repair without arthroscopy (35.6%; p < 0.0001); reconstruction with arthroscopy (56.0%) versus reconstruction without arthroscopy (39.8%; p < 0.0001). There was a significantly higher proportion of patients who underwent reoperation for intra-articular defects in the combined (repair plus reconstruction) arthroscopy group (7.18%) than in the combined non-arthroscopy groups (4.91%; p = 0.049). Most importantly, the average time until reoperation for intra-articular defects was significantly shorter in the combined arthroscopy group (271.923 days) than in the combined non-arthroscopy group (411.473 days; p = 0.024). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was nearly 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.
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Desai, Mihir J., Hari Ramalingam, and David S. Ruch. "Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis." HAND 12, no. 3 (April 28, 2017): NP32—NP36. http://dx.doi.org/10.1177/1558944716668844.
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Background: Heterotopic ossification (HO) is a well-known complication following the surgical treatment of fractures and dislocations about the elbow but it is not commonly discussed as a complication following arthroscopy. We present a case of a young athlete who developed HO after the arthroscopic treatment of lateral epicondylitis. Methods: This is a case report chart review of a 24 year old male with lateral epicondylitis. After failing conservative measures, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) origin ensued. The treatment and patient’s final disposition were reported. Results: The patient developed heterotopic ossification of the elbow follow arthroscopic debridement of the ECRB origin. Further surgery was required to excise the heterotopic ossification. Good recovery of motion was achieved. Conclusion: To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. As the use of elbow arthroscopy continues to grow, there is a need for identification of the risk factors and primary prophylaxis for HO.
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Rog, Dominik, Tuna Ozyurekoglu, and Kumar K. Karuppiah. "Arthroscopic Abrasion Arthroplasty Is Not Superior to Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Arthritis." HAND 14, no. 6 (May 25, 2018): 791–96. http://dx.doi.org/10.1177/1558944718778405.
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Background: A few arthroscopic options have been proposed for the treatment of early stages of the arthritis of the thumb carpometacarpal (CMC) joint. The purpose of this study was to compare the results of arthroscopic abrasion arthroplasty with ligament reconstruction and tendon interposition (LRTI). Methods: In this retrospective cohort study, 11 patients who underwent thumb CMC joint arthroscopic abrasion arthroplasty were compared with 15 patients who were randomly selected from a group of 80 LRTI arthroplasty patients during the same study period, with a minimum 1 year follow-up. Preoperative and postoperative evaluations included radiographs and measurements of grip strength, visual analog scale (VAS) pain scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The mean preoperative VAS score in both groups was 6.8. Mean preoperative DASH scores were 61.1 in the arthroscopy group and 67.4 in the LRTI group. Postoperative VAS score at final follow-up was 4.8 in the arthroscopy group and 1.2 in the LRTI group ( P < .05). Postoperative DASH scores 9 months after surgery were 23 for the LRTI group and 55.2 for the arthroscopy group ( P < .05). Eight patients in the arthroscopy group had a second surgery due to persistent pain. Conclusions: Patients undergoing arthroscopic abrasion arthroplasty had high revision rates, higher postoperative pain, and lower patient-rated outcomes than patients undergoing LRTI procedure. The poor results in the arthroscopy group may be secondary to the inherent instability of the CMC joint and lack of use of any biological or artificial interposition material.
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Wilkens, Suzanne C., Frederique L. Vissers, Adam Nazzal, and Neal Chen. "The Incidence of Arthroplasty After Initial Arthroscopy for Trapeziometacarpal Arthrosis." HAND 13, no. 5 (August 20, 2017): 600–605. http://dx.doi.org/10.1177/1558944717725382.
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Background: It remains unclear how many patients undergo secondary surgery after initial arthroscopy for trapeziometacarpal (TMC) arthrosis. We studied the factors related to secondary TMC arthroplasty after TMC arthroscopy. We also examined secondary questions of: (1) what percentage of patients underwent secondary TMC arthroplasty; and (2) how much time elapsed from initial arthroscopy to arthroplasty. Methods: In this retrospective study, we included all adult patients who were treated with arthroscopy of the TMC joint at 2 level I hospitals and affiliates. Factors were assessed for their independent association with secondary TMC arthroplasty using bivariate and multivariable analyses. Results: Fourteen of 84 (17%) thumbs underwent secondary TMC arthroplasty an average of 11 months after the initial arthroscopy. Synovectomy alone and smoking tobacco were independently associated with secondary TMC arthroplasty when compared with arthroscopic (partial) trapeziectomy with additional tendon interposition or allograft. Conclusions: This study demonstrated that 1 in 6 thumbs underwent secondary TMC arthroplasty, an average of 11 months after the initial arthroscopy. Coupling arthroscopy with partial trapeziectomy, interposition, or extension osteotomy may be a preferable strategy to isolated synovectomy. In addition, smoking tobacco is associated with inferior outcomes regardless of surgical procedure.
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Brown, Mathew, Andrew Wallace, Andrew Lachlan, and Susan Alexander. "Arthroscopic Soft Tissue Procedures for Anterior Shoulder Instability." Open Orthopaedics Journal 11, no. 1 (August 31, 2017): 979–88. http://dx.doi.org/10.2174/1874325001711010979.
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Background:Arthroscopy has rapidly transformed the treatment of anterior shoulder instability over the past 30 years. Development of arthroscopic equipment has permitted the investigation and diagnosis of the unstable shoulder, and fixation methods have evolved to promote arthroscopy from an experimental procedure to one of first-line mainstream treatment.Methods:Key research papers were reviewed to identify the fundamental principles in patient diagnosis and appropriate selection for arthroscopic treatment. The evolution of arthroscopy is described in this article to facilitate the understanding of current treatment.Results:Accurate diagnosis of the shoulder instability subtype is essential prior to selection for surgery. Different surgical techniques are described to address different pathology within the glenohumeral joint related to instability and the appropriate method should be selected accordingly to optimise outcome.Conclusion:Anterior shoulder instability can be treated successfully using arthroscopic surgery, but the surgeon must treat each patient as an individual case and recognise the different subtypes of instability, the associated pathological lesions and the limitations of arthroscopy. The article concludes with a suggested algorithm for the treatment of anterior shoulder instability.
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Merkulov, V. N., E. A. Karam, O. G. Sokolov, A. G. El'tsin, V. N. Merkulov, E. A. Каram, O. G. Sokolov, and A. G. El'tsin. "Arthroscopic Diagnosis and Treatment of Knee Articular Cartilage Injuries in Children." N.N. Priorov Journal of Traumatology and Orthopedics 10, no. 2 (June 15, 2003): 74–78. http://dx.doi.org/10.17816/vto200310274-78.
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Experience in knee arthroscopy in children with acute knee trauma and sequelae of knee injuries is presented. There were 417 patients, aged 4-18, who were under treatment at the clinic in the period from 1994 to 2002. One hundred forty four patients (34.5%) had injury of articular cartilage. In 12 cases diagnostic and in 132 cases diagnostic and curative arthroscopy was performed. Evident advantages of arthroscopy in diagnosis of intraarticular knee structures injuries, especially cartilagenous tissue were emphasized. Protocol of diagnostic examination including clinical, roentgenologic, ultrasonographic methods as well as CT and MRT (as indicated) is suggested. Indications to knee arthroscopy in children and adolescents are determined. Clinical-arthroscopic classification of knee articular cartilage injuries is given. Due to exact diagnosis and adequate curative tactics total restoration of knee function was achieved in 75% of patients with articular cartilage injuries.
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Stornebrink, Tobias, J. Nienke Altink, Daniel Appelt, Coen A. Wijdicks, Sjoerd A. S. Stufkens, and Gino M. M. J. Kerkhoffs. "Two-millimetre diameter operative arthroscopy of the ankle is safe and effective." Knee Surgery, Sports Traumatology, Arthroscopy 28, no. 10 (February 17, 2020): 3080–86. http://dx.doi.org/10.1007/s00167-020-05889-7.
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Abstract Purpose Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.
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Takao, Masato, Yuji Uchio, Kohei Naito, Ikuo Fukazawa, and Mitsuo Ochi. "Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain." American Journal of Sports Medicine 33, no. 5 (May 2005): 686–92. http://dx.doi.org/10.1177/0363546504270566.
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Background After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. Hypothesis Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. Results In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. Conclusion The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.
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Karthik, Karuppaiah, Zaid Ali, Toby Colegate-Stone, Adel Tavakkolizadeh, and Jonathan Compson. "Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion." Journal of Hand and Microsurgery 12, no. 02 (July 7, 2019): 100–106. http://dx.doi.org/10.1055/s-0039-1692929.
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Abstract Introduction Patients with scaphoid nonunion and wrist pain may have a wide spectrum of potential concomitant pathologies that may be diagnosed and potentially managed arthroscopically. The aim of this study is to assess the usefulness of wrist arthroscopy in the assessment and treatment of scaphoid nonunion and any associated injuries. Materials and Methods We retrospectively reviewed 34 consecutive patients with established scaphoid nonunion between January 2006 and December 2012 who had undergone arthroscopic assessment. The average age of the patients was 40 years (range: 25–64), and all the patients had arthroscopic assessment of the wrist joint before definitive surgery. The patients with associated intra-articular problems, which could be addressed along with the scaphoid open reduction internal fixation (ORIF) and bone grafting (BG), had definite procedure in the same sitting. However, if the patients had major intra-articular pathology that needed change in the management plan, they had staged definitive treatment after discussing with them about the arthroscopic findings. Results Arthroscopic assessment of the 34 joints showed varying degrees of arthritis affecting radioscaphoid joint (41%) followed by injuries to the triangular fibrocartilage complex (TFCC) (35%), lunotriquetral ligament (LTL) tears (32%), and scapholunate ligament (SLL) injuries (26%). Concomitant procedures performed during the wrist arthroscopy included debridement of synovitis (62%), TFCC debridement (32%), loose body removal (17%), and DRUJ stabilization and TFCC repair (3%). Twenty-nine patients had arthroscopy and definitive procedure in the same sitting, and the remaining had staged or delayed definitive treatment. Conclusion Our study highlights the usefulness of wrist arthroscopy in assessment and management of the scaphoid nonunion and associated pathologies. Besides in 18% of our patients, the initial management plan changed after arthroscopy. Level of Evidence This is a Level IV study.
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Nurm, Triin, Paulo Torres, and Jayasree Ramas Ramaskandhan. "Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Osteochondral Lesions (OCL’s)?" Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000064.
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Category: Ankle, Arthroscopy Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL’s in symptomatic patients. Methods: A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results: Between April 2012 and July 2016, 48 patients who fulfilled the criteria were included. There were 27 male and 21 female patients, the average age was 43.4. Average time interval between MRI and arthroscopy was 9 months. There was a significant negative relationship between OCL’s reported as stable on MRI to arthroscopic findings, r=-.31, p=0.03. Of the 21 patients who had OCL’s reported as stable on the MRI, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI and it was also unstable arthroscopically. In 27 patients, there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on arthroscopic findings. Conclusion: This study demonstrates that MRI has a poor predictive value for the stability of OCL’s of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings.
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Wininger, Austin E., Sherif Dabash, Thomas J. Ellis, Shane J. Nho, and Joshua D. Harris. "The Key Parts of Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Implications for the Learning Curve." Orthopaedic Journal of Sports Medicine 9, no. 6 (June 1, 2021): 232596712110187. http://dx.doi.org/10.1177/23259671211018703.
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Background: Hip arthroscopy is a rapidly growing surgical approach to treat femoroacetabular impingement (FAI) syndrome with a significant learning curve pertaining to complication risk, reoperation rate, and total hip arthroplasty conversion. Hip arthroscopy is more frequently being taught in residency and fellowship training. The key, or critical, parts of the technique have not yet been defined. Purpose: To identify the key components required to perform arthroscopic treatment of FAI syndrome. Study Design: Consensus statement. Methods: A 3-question survey comprising questions on hip arthroscopy for FAI was sent to a convenience sample of 101 high-volume arthroscopic hip surgeons in the United States. Surgeon career length (years) and maintenance volume (cases per year) were queried. Hip arthroscopy was divided into 10 steps using a Delphi technique to achieve a convergence of expert opinion. A step was considered “key” if it could (1) avoid complications, (2) reduce risk of revision arthroscopy, (3) reduce risk of total hip arthroplasty conversion, or (4) optimize patient-reported outcomes. Based on previous literature, steps with >90% of participants were defined as key. Descriptive and correlation statistics were calculated. Results: A total of 64 surgeons (63% response rate) reported 5.6 ± 2.1 steps as key (median, 6; range, 1-9). Most surgeons (56.3%) had been performing hip arthroscopy for >5 years. Most surgeons (71.9%) had performed >100 hip arthroscopy procedures per year. Labral treatment (97% agreement) and cam correction (91% agreement) were the 2 key steps of hip arthroscopy for FAI. Pincer/subspine correction (86% agreement), dynamic examination before capsular closure (63% agreement), and capsular management/closure (63% agreement) were selected by a majority of respondents but did not meet the study definition of key. There was no significant correlation between surgeon experience and designation of certain steps as key. Conclusion: Based on a Delphi technique and expert opinion survey of high-volume surgeons, labral treatment and cam correction are the 2 key parts of hip arthroscopy for FAI syndrome.
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Schäfer, Dirk, Andreas Boss, and Beat Hintermann. "Accuracy of Arthroscopic Assessment of Anterior Ankle Cartilage Lesions." Foot & Ankle International 24, no. 4 (April 2003): 317–20. http://dx.doi.org/10.1177/107110070302400402.
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Purpose: The accuracy of arthroscopic evaluation of the size of an osteochondral lesion in the ankle joint was assessed in 10 cadaver feet. Materials and Methods: A rectangular osteochondral defect was created in the anterior part of the talus. A 5 mm 30° arthroscope was utilized for evaluation of the size of the lesion from an anterior midline portal under carbon dioxide. Results: The size of the defect averaged 77.2±31 mm 2 (24–108 mm 2 ). The difference between area of the defect and measurement of three independent investigators averaged 52%, 49% and 49%, respectively. Conclusion: The assessment of the size of an osteochondral lesion in the ankle joint based on arthroscopy implicates over- and underestimation of the defect.
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Manoharan, G., N. Sharma, and P. Gallacher. "Competence in using the arthroscopy stack system: a national survey of orthopaedic trainees in the UK." Annals of The Royal College of Surgeons of England 102, no. 2 (February 2020): 149–52. http://dx.doi.org/10.1308/rcsann.2019.0131.
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Introduction Surgeons are required to have a sound knowledge regarding all operating theatre equipment they wish to use. This is important to ensure patient safety and theatre efficiency. Arthroscopy forms a significant part of all orthopaedic subspecialty practice. Proficiency in performing arthroscopic procedures is assessed during registrar training. The aim of this survey was to determine the competence of orthopaedic trainee registrars in setting up the arthroscopy stack system and managing intraoperative problems. Materials and methods Electronic survey forms were sent to all orthopaedic training programme directors in the UK to be forwarded to trainees in their deanery. The electronic survey contained 13 questions aimed at determining trainee experience and competence level with working with the arthroscopy stack system. Results A total of 138 responses were received from 14 deaneries in the UK. Almost all registrars had experienced intraoperative delays because of equipment malfunction that required addressing by more competent staff. However, 82% of respondents had not received any formal training for operating the arthroscopy stack system. Some 82% of registrars of ST7 grade or above, who had performed over 50 arthroscopic procedures and achieved a level 4 PBA competence, were unable to set up the stack system and successfully address these delays. Conclusions Inadequate training is delivered to orthopaedic registrars from both the training programme and arthroscopy-themed courses with regards to set-up and operation of the arthroscopy tower system. This training should be part of the curriculum to ensure patient safety and efficient theatre practice.
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Besomi, Javier, Valeria Escobar, Santiago Alvarez, Juanjose Valderrama, Jaime Lopez, Claudio Mella, Joaquin Lara, and Claudio Meneses. "Hip arthroscopy following slipped capital femoral epiphysis fixation: chondral damage and labral tears findings." Journal of Children's Orthopaedics 15, no. 1 (February 1, 2021): 24–34. http://dx.doi.org/10.1302/1863-2548.15.200178.
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Purpose This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE). Methods This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses. Results We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8–20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions. Conclusion A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage. Level of evidence IV
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Frizziero, L., F. Zizzi, R. Leghissa, and A. Ferruzzi. "New methods in arthroscopy: preliminary investigations." Annals of the Rheumatic Diseases 45, no. 7 (July 1, 1986): 529–33. http://dx.doi.org/10.1136/ard.45.7.529.
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Alshara, Mohamed Baqir. "Microfracture Arthroscopy Efficacy In Treatment Of Articular Cartilage Insult Of Knee." AL-Kindy College Medical Journal 14, no. 1 (October 10, 2018): 24–28. http://dx.doi.org/10.47723/kcmj.v14i1.12.
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Background: The treatment of articular cartilage defects is one of the most clinical challeng for orthopedic surgeons. Articular cartilage is a highly organized tissue with complex biomechanical properties and substantial durability. However, it has a poor ability for healing, and damage from trauma or degeneration can result in morbidity and functional impairment. debilitating joint pain, dysfunction, and degenerative arthritis Objectives: The purpose of study is to show effectiveness of micro fracture arthroscopy as a method of treatment for such problem .
Type of the study: Cross-sectional study. Methods: Arthroscopic surgery was done to 52 patients who complain of knee pain limping and show clinical or radiological evidence of cartilaginous injury and we used arthroscopic micro fracture technique for those patient who have injury of no more than4cm2 then we instruct patient to not put any weight over knee for 2-3 months and followed clinically according to Lyshlom scor and by MRI and some of them by second look arthroscopy to assess the healing.
Results: Fifty two patients under go micro fracture arthroscopy . Thirty four patients (65.4%) reported good or excellent subjective results , thirteen patients (25%) had fair knee function, and only five patients (9.6%) reported poor result
Conclusions: Micro fracture arthroscopy is a cheap effective method for repairing cartilaginous lesion .
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Rossetti, Renata Bello, Cristina de Oliveira Massoco, Ana Carolina Alves Penna, and Luis Claudio Lopes Correia da Silva. "An experimental study to compare inflammatory response due to liquid or gas joint distension in horses submitted to arthroscopy." Acta Cirurgica Brasileira 27, no. 12 (December 2012): 848–54. http://dx.doi.org/10.1590/s0102-86502012001200004.
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PURPOSE: To assess comparatively the inflammatory response that follows CO2 or Ringer's lactate joint capsular distension of horses submitted to experimental arthroscopy METHODS: Each animal was submitted to a bilateral tarsocrural arthroscopy employing gas distention in one joint and fluid distention in the contralateral joint. Synovial fluid was evaluated at 0, six, 12, 24 and 48 hours post-operative. RESULTS: The use of CO2 for arthroscopy causes an acute and mild synovitis alike to the liquid capsular distension, showing similar synovial fluid increase of leukocytes, TP, and TNF-α. Although synovial fluid PGE2 content was higher in joints submitted to CO2 distension, lower levels of hemoglobin and leukocytes oxidative burst after surgery indicates that CO2 arthroscopy decreased intra-articular bleeding and activation of infiltrating leukocytes. CONCLUSIONS: The use of CO2 for arthroscopic examination causes acute and mild synovitis that is similar to the effects caused by the liquid capsular distension. CO2 also seems to decrease intra-articular bleeding and activation of leukocytes.
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Puhakka, Jani, Teemu Paatela, Eve Salonius, Virpi Muhonen, Anna Meller, Anna Vasara, Hannu Kautiainen, Jussi Kosola, and Ilkka Kiviranta. "Arthroscopic International Cartilage Repair Society Classification System Has Only Moderate Reliability in a Porcine Cartilage Repair Model." American Journal of Sports Medicine 49, no. 6 (March 18, 2021): 1524–29. http://dx.doi.org/10.1177/0363546521998006.
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Background: The International Cartilage Repair Society (ICRS) score was designed for arthroscopic use to evaluate the quality of cartilage repair. Purpose: To evaluate the reliability of the ICRS scoring system using an animal cartilage repair model. Study Design: Controlled laboratory study. Methods: A chondral defect with an area of 1.5 cm2 was made in the medial femoral condyle of 18 domestic pigs. Five weeks later, 9 pigs were treated using a novel recombinant human type III collagen/polylactide scaffold, and 9 were left to heal spontaneously. After 4 months, the pigs were sacrificed, then 3 arthroscopic surgeons evaluated the medial femoral condyles via video-recorded simulated arthroscopy using the ICRS scoring system. The surgeons repeated the evaluation twice within a 9-month period using their recorded arthroscopy. Results: The porcine cartilage repair model produced cartilage repair tissue of poor to good quality. The mean ICRS total scores for all observations were 6.6 (SD, 2.6) in arthroscopy, 5.9 (SD, 2.7) in the first reevaluation, and 6.2 (SD, 2.8) in the second reevaluation. The interrater reliability with the intraclass correlation coefficient (ICC) for the ICRS total scores (ICC, 0.46-0.60) and for each individual subscore (ICC, 0.26-0.71) showed poor to moderate reliability. The intrarater reliability with the ICC also showed poor to moderate reliability for ICRS total scores (ICC, 0.52-0.59) and for each individual subscore (ICC, 0.29-0.58). A modified Bland-Altman plot for the initial arthroscopy and for the 2 reevaluations showed an evident disagreement among the observers. Conclusion: In an animal cartilage repair model, the ICRS scoring system seems to have poor to moderate reliability. Clinical Relevance: Arthroscopic assessment of cartilage repair using the ICRS scoring method has limited reliability. We need more objective methods with acceptable reliability to evaluate cartilage repair outcomes.
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Dojode, Chetan Muralidhara Rao, Murali Krishna, Andrew James Shepherd, Chandan Muralidhara Rao Dojode, Raviprasad Kattimani, Gandavaram Srikant Reddy, and Dhritiman Bhattacharjee. "No differences in healing among different closure methods of arthroscopic portals: a systematic review." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 2, no. 6 (September 28, 2017): 297–307. http://dx.doi.org/10.1136/jisakos-2017-000132.
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BackgroundDuring arthroscopy the small skin incisions made over the joints are called arthroscopy portals. There are different methods described for arthroscopic portal closure. Very few randomised controlled trials and no systematic reviews have compared the methods of arthroscopic portal closure, and there are no clear guidelines recommending any one closure method. There is therefore a need for a systematic review that provides high-quality evidence to help surgeons choose the appropriate arthroscopic portal closure technique.ObjectiveTo undertake a systematic review to ascertain the outcome with three different closure methods for arthroscopic portals: (1) suturing; (2) application of sterile adhesive tapes; and (3) leaving wounds open covered with a dressing.MethodsRandomised controlled trials comparing the closure methods of arthroscopic portals were selected using strict search criteria from electronic databases (MEDLINE, EMBASE, CINAHL, BNI and Cochrane Library) and trial registers. Two independent authors conducted the study selection, data extraction and quality assessment of each study. Quality appraisal was done using the Cochrane Collaboration risk of bias tool. Three studies were eligible for inclusion and a narrative synthesis of the findings is provided.ResultsOne study did not show a statistically significant difference between suturing and leaving the wound open with a dressing. However, two studies found that leaving wounds open covered with a dressing had a significantly better outcome. In one of these studies, sterile adhesive tapes were used and the outcomes were better than with suturing but not so good as leaving the wounds open covered with a dressing.ConclusionSuturing of arthroscopic portal wounds confers no benefit over leaving them open covered with a simple dressing or applying sterile adhesive tapes. Meta-analysis was not performed, so a full estimate of effect size cannot be derived from this review. Managing arthroscopic portals by leaving them open covered with a dressing or by applying tissue adhesive tape can be safe alternative techniques to suturing. There is a need for randomised controlled trials with a larger sample size representing different populations in a number of centres with better methodological quality and outcome measures.Level of evidenceLevel 1 Systematic review of Randomised Control Trials (Level I studies).
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Smith, Kenneth S., Katherine Drexelius, Shanthan Challa, Daniel K. Moon, Joshua A. Metzl, and Kenneth J. Hunt. "Outcomes Following Ankle Fracture Fixation With or Without Ankle Arthroscopy." Foot & Ankle Orthopaedics 5, no. 1 (January 1, 2020): 247301142090404. http://dx.doi.org/10.1177/2473011420904046.
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Background: Ankle fractures are one of the most common orthopedic injuries, and although most patients have a satisfactory outcome following operative fixation, there are patients that have persistent pain despite anatomic reduction. Intra-articular injuries have been suggested as one potential cause of these suboptimal outcomes. Our study assesses the clinical impact of performing an ankle arthroscopy during ankle fracture open reduction and internal fixation (ORIF). Methods: This was a retrospective chart review of all patients who underwent operative fixation of a bimalleolar or trimalleolar ankle fracture at our institution from 2014 through 2018. We extracted all demographic data, fracture pattern, operative procedures performed, tourniquet times, arthroscopic findings and any arthroscopic interventions. We then conducted a phone and e-mail survey. Our study included 213 total patients (142 traditional ORIF, 71 ORIF plus arthroscopy) with an average age of 40 years. The average follow-up was 32.4 months with a survey follow-up rate of 50.7% (110/213). Results: The average tourniquet time for the arthroscopy cohort was 10 minutes longer (89 minutes vs 79 minutes). During the arthroscopy, there was a 28% (20/71) rate of full-thickness osteochondral lesions, 33% (24/71) rate of loose bodies, and a 49% (35/71) rate of partial-thickness cartilage injury. The mean Patient Reported Outcome Information System (PROMIS) physical function score among Weber B fibula fractures was 45.8 and 42.3 in the arthroscopy and nonarthroscopy groups, respectively ( P = .012). In addition, the patient satisfaction rate in Weber B fibula fractures was higher in those patients who underwent arthroscopy compared with ORIF alone (93% vs 75%, P = .05). Patients who had a tibiotalar joint dislocation at the time of the ankle fracture had a significantly higher PROMIS physical function score (46.6 vs 40.2, P = .005) when their surgery included arthroscopy. Conclusion: Ankle arthroscopy at the time of ORIF led to statistically significant improvements in patient-reported outcomes for Weber B fibula fractures and ankle dislocations. There was no increase in complication rates and the arthroscopy took 10 minutes longer on average. Level of Evidence: Level III, retrospective cohort study.
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Fukushima, Kensuke, Gen Inoue, Kentaro Uchida, Hisako Fujimaki, Masayuki Miyagi, Naoshige Nagura, Katsufumi Uchiyama, Naonobu Takahira, and Masashi Takaso. "Relationship between synovial inflammatory cytokines and progression of osteoarthritis after hip arthroscopy: Experimental assessment." Journal of Orthopaedic Surgery 26, no. 2 (April 17, 2018): 230949901877092. http://dx.doi.org/10.1177/2309499018770922.
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Purpose: Synovial membrane inflammation is the most commonly presenting finding during hip arthroscopy and may have a role in the pathomechanism of hip osteoarthritis (OA). The aim of this study was to determine the relationship between synovial cytokine levels and progression of OA after hip arthroscopy. Methods: We prospectively examined 20 patients (20 hips) who underwent arthroscopic hip surgery. For all patients, radiographs and severity of pain were evaluated preoperatively. During arthroscopy, we harvested a sample of the synovial membrane and determined the levels of six typical inflammatory cytokines with real-time polymerase chain reaction. We compared the levels of these cytokines in patients who showed OA progression and non-progression after hip arthroscopy. Results: Although the average age of patients who showed OA progression postoperatively tended to be higher, there were no significant differences in characteristics involving clinical assessment between patients who showed OA progression and those who showed non-progression. Intraoperative tumour necrosis factor α (TNFα) expression was significantly higher in patients who showed OA progression postoperatively ( p = 0.042). Conclusions: Elevation of TNFα level might be a predictor of OA progression after hip arthroscopy.
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Shim, Dong-Woo, Yeokgu Hwang, Yoo Jung Park, Jin Woo Lee, and Seung Hwan Han. "Detection of Tram Track Lesion in the Ankle Joint; A Comparative Study of Magnetic Resonance Imaging with Ankle Arthroscopy." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000371.
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Category: Ankle, Arthroscopy Introduction/Purpose: Tram track lesion in the ankle joint has been occasionally found during the ankle arthroscopy and there has been few studies relating the pathophysiology, diagnostic method and treatment of the lesion. This study aimed to show the effectiveness of magnetic resonance imaging (MRI) for detection of tram track lesion in the ankle joint comparing with ankle arthroscopy. Methods: We retrospectively assessed 175 ankles in 170 patients with anterior bony impingement syndrome in the ankle who underwent arthroscopic surgery between January 2013 and July 2015. Anterior ankle bony spurs were scored in preoperative weight-bearing radiographs using the impingement classification. MRIs were reviewed for the detection of tram track lesions according to our definition (focal high signal intensity along the talar dome cartilage surface on coronal view), which were then compared with arthroscopic findings. The grade of cartilage defect was stratified according to international cartilage repair society (ICRS) grading system by arthroscopic finding. Results: Fourteen (8.0%) ankles were identified with tram track lesion on MRI and 16 (9.1%) ankles were identified with tram track lesion at ankle arthroscopy. Overall sensitivity of MRI for detection of tram track lesion was 87.5% and specificity was 100%. On plane weight-bearing radiographs, 4 patients had grade 1, 2 patients had grade 2 and 10 patients had grade 3 impingement spurs. Under the ICRS grading system, 4 cases were grade 2, 4 cases were grade 3, and 8 cases were grade 4 at arthroscopy. Comparing with MRI, 2 cases of grade 2, 4 cases of grade 3 and 8 cases of grade 4 were detected (Table). Impingement spur grade showed no significant correlation with arthroscopic ICRS grade of tram track lesion (p = 0.609). Conclusion: Tram track lesions in the ankle joint can be confidently detected on MRI with high sensitivity and specificity. Early detection and following treatment of the lesion can maximize the clinical outcome that eliminates the possibility for further damage to the cartilage and consequent osteoarthritic change.
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Samoy, Y., E. Coppieters, L. Mosselmans, B. Van Ryssen, and E. de Bakker. "Arthroscopic features of primary and concomitant flexor enthesopathy in the canine elbow." Veterinary and Comparative Orthopaedics and Traumatology 26, no. 05 (2013): 340–47. http://dx.doi.org/10.3415/vcot-12-09-0111.
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SummaryObjectives: To investigate the possibilities and limitations of arthroscopy to detect flexor enthesopathy in dogs and to distinguish the primary from the concomitant form.Materials and methods: Fifty dogs (n = 94 elbow joints) were prospectively studied: dogs with primary flexor enthesopathy (n = 29), concomitant flexor enthesopathy (n = 36), elbow dysplasia (n = 18), and normal elbow joints (n = 11). All dogs underwent an arthroscopic examination of one or both elbow joints. Presence or absence of arthroscopic characteristics of flexor enthesopathy and of other elbow disorders were recorded.Results: With arthroscopy, several pathological changes of the enthesis were observed in 100% of the joints of both flexor enthesopathy groups, but also in 72% of the joints with elbow dysplasia and 25% of the normal joints. No clear differences were seen between both flexor enthesopathy groups.Clinical significance: Arthroscopy allows a sensitive detection of flexor enthesopathy characteristics, although it is not very specific as these characteristics may also be found in joints without flexor enthesopathy. The similar aspect of both forms of flexor enthesopathy and the presence of mild irregularities at the medial coronoid process in joints with primary flexor enthesopathy impedes the arthroscopic differentiation between primary and concomitant forms, requiring additional diagnostic techniques to ensure a correct diagnosis.
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Smith, Kenneth S., Katherine D. Drexelius, Shanthan C. Challa, Daniel K. Moon, Joshua A. Metzl, and Kenneth J. Hunt. "Patient Outcomes Differences Following Ankle Fracture Fixation with or without Ankle Arthroscopy." Foot & Ankle Orthopaedics 5, no. 2 (April 1, 2020): 2473011420S0001. http://dx.doi.org/10.1177/2473011420s00013.
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Category: Arthroscopy; Ankle; Trauma Introduction/Purpose: Ankle fractures are one of the most common types of fractures, yet there is currently no consensus about how best to treat these patients. The treatment approach typically includes open reduction-internal fixation (ORIF), but not all patients have a good clinical outcome. Intra-articular injuries have been suggested as one potential cause of these sub-optimal outcomes. Use of arthroscopy at the time of surgery is useful in identifying intra-articular lesions in acute ankle fractures, however, there is no evidence that arthroscopic intervention changes the patient’s outcome. Ankle arthroscopy increases the duration and potential complications of anesthesia administration and also increases cost. Our study assesses the clinical impact of arthroscopy accompanying an ankle fracture ORIF, which is essential to promote positive outcomes, while decreasing unnecessary complications and costs. Methods: This is a retrospective chart review. We queried all patients that underwent operative fixation of a bimalleolar or trimalleolar ankle fracture at our institution from January 1, 2014 through November 1, 2018. From this list, we excluded patients less than 18 years old and patients that had concomitant injuries to other body parts that required surgery. In addition, we only included Weber B and Weber C fibula fracture to homogenize the data. We then performed a chart review to extract all demographic data, fracture pattern, surgical procedures performed, tourniquet times, any revision surgeries, arthroscopic findings and any interventions performed due to the arthroscopic portion of the procedure. We then conducted a phone and email survey utilizing the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form and the two question Patient Acceptable Symptom State (PASS). Results: Our study included 213 total patients (142 traditional ORIF, 71 ORIF plus arthroscopy) with an average age of 40 (standard deviation 14.2). The average follow up was 32.4 (13.1) months with a survey follow up rate of 50.7%. The demographic information between the two cohorts was statistically similar. The average tourniquet time for the arthroscopy cohort is 10 minutes longer (89 minutes versus 79 minutes). During the arthroscopy, there was a 28.2% rate of full thickness osteochondral lesions, 33.8% rate of loose bodies, and a 49.2% rate of small cartilage injury not requiring intervention. The mean PROMIS physical function score amongst Weber B fibula fractures was 45.8 and 42.3 in the arthroscopy and non-arthroscopy groups respectively (P value 0.012). In addition, the patient satisfaction rate in Weber B fibula fractures was higher in those patients that underwent arthroscopy as compared to ORIF alone (93.1% versus 75.5%, P value of 0.05). Patients that suffered a tibiotalar joint dislocation at the time of the ankle fracture had a significantly higher PROMIS physical function score (46.6 versus 40.2, P value 0.005) when their surgery included arthroscopy. Conclusion: Ankle arthroscopy at the time of ORIF led to higher mean patient reported outcomes for every tested metric but this reached statistical significance only when looking at the Weber B fibula fractures and ankle dislocations. There was no increase in complication rate and the arthroscopy took only 10 minutes longer on average. [Table: see text]
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Ahn, Jae Hoon, Dojoon Park, Yong Taek Park, Joonyoung Park, and Yoon-Chung Kim. "What should we be careful of ankle arthroscopy?" Journal of Orthopaedic Surgery 27, no. 3 (July 30, 2019): 230949901986250. http://dx.doi.org/10.1177/2309499019862502.
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Purpose: Ankle arthroscopy has been used as a standard tool by foot and ankle surgeons. To overcome the narrowness of ankle joint, a noninvasive distraction technique is used for the successful visualization in ankle arthroscopy. The aim of this study was to investigate the incidence and type of complications associated with ankle arthroscopy using a noninvasive distraction technique and to report a troublesome complication. Methods: We reviewed 514 patients’ charts from 2003 to 2011. The same noninvasive distraction technique was used. Patients’ demography, duration of follow-up, diagnoses, procedures, and complications related to ankle arthroscopy were analyzed. Results: There were 388 male and 126 female; mean age was 37.2 years; mean follow-up duration was 33 months. The diagnoses were osteochondral lesion of talus, chronic ankle instability, anterolateral soft tissue impingement syndrome, and anterior bony impingement. We performed arthroscopic synovectomy, osteochondral procedure, bony spur excision, and loose body removal. The mean time of arthroscopic procedure was 47 min. There were neurologic complications (eight cases), skin necrosis of posterior thigh (three cases), instrument breakage (two cases), and superficial wound infection (one case). All complications were well resolved. The total duration of distraction plus tourniquet inflation exceeded 120 min in the three cases of skin necrosis. Skin necrosis was deemed to be resulted from the long tourniquet time. Conclusion: The noninvasive distraction technique is safe and effective for ankle arthroscopy. However, the distraction plus tourniquet requires attention because it can cause high pressure on posterior thigh resulting in soft tissue injury.
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Baraza, Njalalle, and Jordan Leith. "Are Prophylactic Intravenous Antibiotics Required in Routine Shoulder Arthroscopic Surgery? A Systematic Review of the Literature." Joints 06, no. 01 (March 2018): 054–57. http://dx.doi.org/10.1055/s-0038-1636950.
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Purpose The purpose of this study was to find out from the literature the difference in infection rates between patients who did and patients who did not receive prophylactic antibiotics in arthroscopic shoulder surgery. Methods We conducted a comprehensive search of the literature using Medline Ovid for prospective studies that looked at infection as the primary outcome following shoulder arthroscopy. The articles were then assessed for study design, outcome, and relevance to the specific question as part of the critical appraisal. Results Eight partially relevant articles were obtained from the search, but there were no prospective studies comparing infection in patients who had prophylactic antibiotics versus those who did not in shoulder arthroscopy. Conclusion No compelling evidence exists on the role of prophylactic antibiotics in preventing infections in shoulder arthroscopy. Level of Evidence Level IV, systematic review of level IV studies.
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Gandra, Arvind. "Role of arthroscopy for early diagnosis and early therapeutic intervention in knee synovitis compared to histopathology." International Journal of Research in Orthopaedics 4, no. 6 (October 24, 2018): 881. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20184379.
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<p class="abstract"><strong>Background:</strong> Arthroscopy has been found to be very useful for early diagnosis and also found useful for early therapeutic interventions in patients with synovitis of the knee joint disorders. The objective of the study was to study the role of arthroscopy for early diagnosis and early therapeutic intervention in knee synovitis.</p><p class="abstract"><strong>Methods:</strong> Hospital based prospective study was carried out at Department of Orthopedics, Dr. D. Y. Patil Medical College, Pune over a period of August 2006 to October 2008 among 30 cases as per the inclusion and exclusion criteria. All patients underwent arthroscopy, clinical examination and histopathology of knee joint tissues. Comparison was made between clinical diagnosis and histopathology as well as between arthroscopy findings and histopathology.<strong></strong></p><p class="abstract"><strong>Results:</strong> Pain and swelling of knee joint was reported by all patients. Anemia was seen in 70% of the cases. The accuracy of arthroscopic diagnosis was more than clinical diagnosis. Where clinical diagnosis failed to diagnose conditions like villonodular synovitis, pyogenic synovitis and gouty arthritis, the arthroscopic diagnosis was 100% accurate in the first two conditions and 66.7% accurate in the last condition. Where clinical diagnosis was accurate to 80-83% in cases of rheumatoid arthritis, septic arthritis and tubercular arthritis, the arthroscopic diagnosis was 100% accurate. Where in case of osteoarthritis, the clinical diagnosis could identify only 20% of the conditions, arthroscopic diagnosis was able to diagnose 40% of the actual cases.</p><p><strong>Conclusions:</strong> Arthroscopic diagnosis was more accurate as compared to clinical diagnosis and it was almost 100% in all cases of knee joint diseases except in two. Thus arthroscopic diagnosis can be relied upon and treatment can be started on this basis in view of time consuming and costly histopathological tests.</p>
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Seijas, Roberto, Jordi Català, Miguel Ángel Cepas, Andrea Sallent, Oscar Ares, and David Barastegui. "Radiation Exposure from Fluoroscopy during Hip Arthroscopy." Surgery Journal 05, no. 04 (October 2019): e184-e187. http://dx.doi.org/10.1055/s-0039-3400278.
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Abstract Objective Hip arthroscopy for femoroacetabular impingement treatment is a procedure that is not exempted from complications. The most common complications are related to the arthroscopic portals and the traction system. The use of fluoroscopy helps in hip arthroscopy; however, the radiation exposure is a risk that has not yet been studied. Materials and Methods A retrospective study with 100 arthroscopies was performed. Surgical indication in all cases was femoroacetabular impingement. Surgical times and radiation exposure during the procedure had been recorded and reviewed for the present study. Results A mean of 138.20 cGy cm2 radiation exposures was observed per patient and procedure for a mean time of radiation exposure of 0.36 minutes. These values are much lower than the values described as being at risk by the nuclear security commissions. Conclusions Radiation exposure in a hip arthroscopy due to femoroacetabular impingement is in margins well below the limits at risk for the patient.
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Shah, Ashish, Brent Cone, Cesar de Cesar Netto, Parke Hudson, Ibukunoluwa Araoye, Bahman Sahranavard, Zachariah Pinter, Sung Lee, Caleb Jones, and Shelby Bergstresser. "Timing of arthroscopy does not impact recurrence rate of ankle instability in patients undergoing lateral ligament repair surgery." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000363.
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Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Although the initial treatment is conservative, some patients may develop chronic instability requiring surgical repair. Arthroscopy is often performed prior to ligament reconstruction to evaluate concomitant intraarticular and cartilage injuries. Arthroscopic treatment may be performed immediately prior to ligament repair (single stage), or it may be scheduled days/weeks prior to ligament repair (double stage). Concerns of single stage arthroscopic treatment are related to the increased difficulty in dealing with ligaments and soft-tissue injuries hindered by fluid extravasation. Our study compares outcomes between single and double stage arthroscopy in patients undergoing lateral ligament repair surgery. Methods: In this retrospective study we reviewed charts of patients with chronic lateral ankle instability who underwent ankle arthroscopy followed by lateral ligament repair from 2011 to through 2015. A total of 102 patients were included in the study, 65 patients in the single stage group, and 37 in the double stage group. Surgical failure was defined as recurrence of ankle instability at any point in the follow up period after the procedure. Demographic data and recurrence rate of instability were compared between the groups using chi-squared test. Results: Women comprised 72% (73/102) percent of the total patient population. No significant differences in demographic data were found between the two groups. There was no difference in the recurrence rate of lateral ankle instability between patients who underwent 1-stage versus 2-stage arthroscopic treatment. The rate was similar between the groups: 10.8% (7/65) of patients with the single stage technique and 8.1% (3/37) of patients in the double stage group (p=0.6208). Conclusion: In the treatment of chronic lateral ankle instability, the use of single-stage arthroscopy and lateral ligament repair showed similar rates of surgical failure when compared to the double-stage procedure. A single stage approach may be a more efficient use of time and hospital resources, and avoids the need to place the patient under anesthesia multiple times. Arthroscopy may be performed immediately prior to lateral ligament repair without concern for increased risk of recurrence of instability.
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Yasui, Youichi, Charles P. Hannon, Ethan J. Fraser, Jakob Ackermann, Lorraine Boakye, Keir A. Ross, Gavin L. Duke, Yoshiharu Shimozono, and John G. Kennedy. "Lesion Size Measured on MRI Does Not Accurately Reflect Arthroscopic Measurement in Talar Osteochondral Lesions." Orthopaedic Journal of Sports Medicine 7, no. 2 (February 1, 2019): 232596711882526. http://dx.doi.org/10.1177/2325967118825261.
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Background: Lesion size is a major determinant of treatment strategy for osteochondral lesions of the talus (OLTs). Although magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of OLTs, the reliability of the MRI measurement compared with the arthroscopic measurement is unknown. Purpose: To compare preoperative lesion size measured on MRI versus intraoperative lesion size measured during arthroscopy. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively reviewed a consecutive series of patients treated with bone marrow stimulation for OLTs. The diameter of the lesion was measured at its widest point in 2 planes, and MRI measurements were compared with those made during arthroscopy using a custom-made graduated probe. Results: A total of 39 patients with 45 OLTs were analyzed. Mean ± SD area measurements on MRI were significantly greater than the equivalent arthroscopic measurements (42.2 ± 30.5 vs 28.6 ± 23.1 mm2, respectively; P = .03). Compared with the arthroscopic measurement, MRI overestimated OLT size in 53.3% (24/45) of ankles and underestimated OLT size in 24.4% (11/45). The mean MRI diameter measurement was significantly greater than the arthroscopic measurement in the coronal plane (MRI diameter vs arthroscopic measurement coronal plane, 6.1 ± 2.6 vs 4.9 ± 2.3 mm, P = .03; sagittal plane, 8.0 ± 3.6 vs 6.3 ± 3.6 mm, P = .05). Further, MRI overestimated coronal diameter in 48.9% (22/45) of ankles and underestimated in 26.7% (12/45) compared with the arthroscopic measurement. Similarly, sagittal plane MRI diameter measurements overestimated lesion size in 46.7% (21/45) of ankles and underestimated lesion size in 28.9% (13/45) compared with the arthroscopic findings. Conclusion: In a majority of lesions, MRI overestimated OLT area and diameter compared with arthroscopy. Surgeons should be aware of the discrepancies that can exist between MRI and arthroscopic measurements, as these data are important in making treatment decisions and educating patients.
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Potter, Benjamin K., Brett A. Freedman, Romney C. Andersen, John A. Bojescul, Timothy R. Kuklo, and Kevin P. Murphy. "Correlation of Short Form-36 and Disability Status with Outcomes of Arthroscopic Acetabular Labral Debridement." American Journal of Sports Medicine 33, no. 6 (June 2005): 864–70. http://dx.doi.org/10.1177/0363546504270567.
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Background Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. Hypothesis Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores. Study Design Case series; Level of evidence, 4. Methods The records of active-duty soldiers who underwent hip arthroscopy at the authors’ institution were retrospectively reviewed. Forty consecutive patients who underwent hip arthroscopy for the primary indication of labral tear formed the basis of the study group. Patients completed the modified Harris hip score, the Short Form-36 general health survey, and a subjective overall satisfaction questionnaire. Results Thirty-three patients, with a mean age of 34.6 years, were available for follow-up at a mean of 25.7 months postoperatively. Fourteen (43%) patients were undergoing medical evaluation boards (military equivalent of workers’ compensation or disability claim). Pearson correlation coefficients for comparing the Short Form-36 Bodily Pain, Physical Function, and Physical Component subscale scores to the modified Harris hip score were 0.73, 0.71, and 0.85, respectively (P <. 001). The mean modified Harris hip score was significantly lower in patients on disability status than in those who were not (92.4 vs 61.1; P <. 0001). The Short Form-36 subscale scores were significantly lower in disability patients (P <. 02). Patient-reported satisfaction rates (70% overall) were 50% for those undergoing disability evaluations and 84% for those who were not (P <. 04). There was no significant difference in outcomes based on patient age, surgically proven chondromalacia, or gender for military evaluation board status. Conclusion The Short Form-36 demonstrated good correlation with the modified Harris hip score for measuring outcomes after arthroscopic partial limbectomy. Arthroscopic debridement yielded a high percentage of good results when patients undergoing disability evaluations were excluded. Disability status may be a negative predictor of success after hip arthroscopy.
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Hull, Michael, John T. Campbell, Rebecca Cerrato, Clifford Jeng, and R. Frank Henn. "Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000205.
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Category: Arthroscopy, Midfoot/Forefoot Introduction/Purpose: Arthroscopy has been increasingly utilized to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized. Methods: Ten (10) fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. Arthrosocopy was performed with gravity distraction utilizing a 1.9 mm 30° arthroscope and small joint instruments. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The percentage of cartilage visualized (visualized / total cartilage x 100%) was measured using ImageJ® software. Measurements include surface area visualized on axial imaging as well as arc visualized on lateral imaging Results: On the distal 2-dimensional projection of the joint surface, an average 57.5% (49.6 – 65.3) of the metatarsal head and 100% (100-100) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72° (65-80) was visualized out of an average total articular arc of 199° (192-206), for an average 36.5% (32.2 – 40.8) of the articular arc. Conclusion: The results suggest that hallux MTP arthroscopy visualizes a sizable portion of the joint surfaces. However, incomplete visualization could potentially miss a hallux metatarsophalangeal lesion. Further imaging preoperatively may improve diagnostic confidence.
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Lu, Jian-Zuo, Jia-Xing Fu, Da-feng Wang, Zhong-Liang Su, and Yuan-Bo Zheng. "The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949901990027. http://dx.doi.org/10.1177/2309499019900274.
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Introduction: The efficacy of intra-articular fentanyl supplementation for pain control after knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-articular fentanyl supplementation for pain intensity after arthroscopic knee surgery. Methods: We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through May 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of intra-articular fentanyl supplementation for arthroscopic knee surgery. This meta-analysis is performed using the random-effects model. Results: Four RCTs are included in the meta-analysis. Overall, compared with control group after knee arthroscopy, intra-articular fentanyl supplementation is associated with reduced pain scores at 1 h (standard mean difference (Std MD) = −3.50; 95% confidence interval (CI) = −5.68 to −1.32; p = 0.002), 2 h (Std MD = −4.73; 95% CI = −8.75 to −0.71; p = 0.02), and 8 h (Std MD = −5.02; 95% CI = −9.73 to −0.30; p = 0.04) but shows no substantial impact on pain scores at 4 h (Std MD = −3.94; 95% CI = −7.93 to 0.05; p = 0.05) or the supplementary analgesia (risk ratio = 0.56; 95% CI = 0.09–3.59; p = 0.54). Conclusions: Intra-articular fentanyl supplementation does benefit in pain control after knee arthroscopy.
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Hauschild, Jordan, Jessica C. Rivera, Anthony E. Johnson, Travis C. Burns, and Christopher J. Roach. "Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study." Orthopaedic Journal of Sports Medicine 9, no. 5 (May 1, 2021): 232596712110038. http://dx.doi.org/10.1177/23259671211003873.
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Background: Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures. Purpose/Hypothesis: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale. Study Design: Controlled laboratory study. Methods: Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests. Results: There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training ( P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL ( P = .0045) and VR ( P = .0003), with no significant difference between the groups. Conclusion: A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool. Clinical Relevance: There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.
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Willegger, Madeleine, Katharina Czerny, and Lena Hirtler. "Accessibility of the Metatarsal Head Comparing Distraction and Plantarflexion in a 2-Portal Technique for First Metatarsophalangeal (MTP 1) Joint Arthroscopy." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0049. http://dx.doi.org/10.1177/2473011420s00490.
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Category: Arthroscopy; Midfoot/Forefoot Introduction/Purpose: Arthroscopic treatment of osteochondral lesion of the first metatarsophalangeal (MTP1) joint is an established procedure. Non-invasive distraction is most commonly applied when a dorsal 2-portal technique is used. Alternatively, plantarflexion can be utilized. In order to compare the arthroscopic reachability of the first metatarsal head, a laboratory study in anatomical specimens was performed. Methods: Twenty matched pairs (n=40) of fresh-frozen lower leg specimens were obtained and randomly assigned into two groups, a distraction (DIS) and a plantarflexion (PF) group, respectively. A standard 2-portal approach (dorsolateral and dorsomedial portals) with a 1.9mm 30° scope was used. The arthroscopic accessibility of the first metatarsal head was evaluated using chondral picks. Markings at the metatarsal heads were made intraoperatively and measured after exarticulation. Results: In the DIS group the mean accessible area was 58.03%, while the accessible area in the PF group was 55.93%. Though there is a small difference between the two groups, this difference was not statistically significant (p=0.51). Range of motion of the MTP 1 joint did not affect reachability. In one specimen (2.5%) the dorsomedial hallucal nerve was injured during arthroscopy. Conclusion: Access to the MTP1-joint for the treatment of osteochondral lesions is similar using distraction or plantarflexion during arthroscopy. The plantarflexion technique has the advantage of less surgical equipment needed. The dorsomedial hallucal nerve is at danger at the medial portal.
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Brianskaia, Ananstasiya I., Alexei G. Baindurashvili, Mikhail A. Konev, Evgeny V. Prokopovich, Maksim S. Nikitin, and Polina P. Sergeeva. "Should arthroscopy in adolescents: Three years of clinical experience." Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 4, no. 2 (June 15, 2016): 12–15. http://dx.doi.org/10.17816/ptors4212-15.
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Background.Shoulder joint injuries and shoulder instability often occur in adolescents.Materials and methods. During a 3-year period, we performed arthroscopic surgery on 42 patients with shoulder joint injuries.Results and discussion. The majority (76.2%) of the patients on whom we performed arthroscopic shoulder joint surgery were male. This is likely due to more aggressive physical activity among males. Most of the patients were injured during exercise (n = 27, 64.3%). Arthroscopy is a highly effective surgical method for the treatment of shoulder joint injuries. Prolonged non-operative treatment with no well-established indications and an incorrect diagnosis can lead to rapid progression of degenerative and dystrophic changes of the shoulder joint and may result in shoulder joint dysfunction.
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ARICAN, MUSTAFA, HANIFI EROL, SAIT UCAN U., and ÖZNUR KÖYLÜ. "Diagnostic techniques for the carpal and fetlock joints in horses with arthritis." Medycyna Weterynaryjna 75, no. 05 (2019): 6249–2019. http://dx.doi.org/10.21521/mw.6249.
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The aim of this study was to compare diagnostic techniques for the assessment of cartilage damage in the carpal and fetlock joints in horses with arthritis. The techniques compared were synovial fluid analysis, as well as radiographic, thermographic, ultrasonographic, and arthroscopic examinations. Sixteen horses of both sexes with arthritis, weighing 438 + 51 kg and at different ages were used as material. Before a detailed examination, an evaluation of the conformation and symmetry of the musculoskeletal system was performed. Nerve blocks definitively localized lameness to a specific site. Thermographic, radiographic, ultrasonographic, and arthroscopic examinations were performed after routine clinical examination. Synovial fluid and sera were collected for further analysis. In conclusion, although all examination techniques may yield useful information, their severe limitations were revealed, particularly in the detection of early articular cartilage damage. Arthroscopy is more reliable than other methods in cases of joint capsule lesions and intra-capsular lesions, as well as cartilage and synovial hyperplasia. Arthroscopy is considered to be advantageous and necessary.
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Cusworth, Brian, Devon Nixon, Sandra Klein, Jeffrey Johnson, and Jeremy J. McCormick. "Outcomes following repeat ankle arthroscopy for osteochondral lesions of the talus (OLTs)." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000148.
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Category: Ankle, Arthroscopy Introduction/Purpose: Management of symptomatic osteochondral lesions of the talus (OLTs) previously treated with arthroscopy remains controversial. Many advocate for open surgical intervention, particularly in patients with larger OLTs. Minimal data, however, exists on the role for repeat ankle arthroscopy. Here, we describe our experience with repeat arthroscopy for symptomatic OLTs, hypothesizing similar pain and satisfaction scores regardless of OLT size. Methods: Our surgical database was queried to identify patients who underwent repeat arthroscopy from February, 1997 – May, 2015. From that cohort, we identified a subset of patients with a diagnosis of symptomatic OLT who were treated with arthroscopic debridement and microfracture. We then performed a retrospective chart review. Phone surveys were conducted to assess clinical outcomes including pain and satisfaction scores as well as to record any subsequent surgery reported by the patient. Using previously defined criteria for size threshold, OLTs were categorized as either small (=150 mm2) or large (> 150 mm2) based on operative dimensions noted at the time of repeat surgery. Results: We identified 15 patients who underwent repeat arthroscopy for symptomatic OLTs. Patients reported reasonable satisfaction (average: 7.3, SD: 2.7) but moderate residual pain (average: 4.6, SD: 3.3) at midterm follow-up (average: 5.0 years, SD: 2.8). Further surgery after repeat arthroscopy was performed in 20% (3/15) of patients. Only 1 patient developed a postoperative complication (superficial DVT treated with observation). Small (n=6) and large OLTs (n=9) had similar postoperative pain scores (4.2 ± 3.7 versus 4.9 ± 3.2), postoperative satisfaction levels (7.5 ± 3.4 versus 7.2 ± 2.3), and reoperation rates (33% versus 22%) (P>.05). Patients with larger OLTs were younger at the time of repeat arthroscopy (P=.026) with no differences in sex or BMI (P>.05) between groups. Conclusion: At midterm follow-up, repeat arthroscopy for symptomatic OLTs demonstrated reasonable satisfaction but with moderate residual pain and a 20% rate of subsequent surgery. There was no statistically significant difference in postoperative pain scores, satisfaction scores, or reoperation rates between small and large OLTs. Repeat arthroscopy for symptomatic OLTs can be done safely – however, patients should be educated to have guarded optimism regarding their outcome.
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Biraris, Sandeep R. "Indian Arthroscopy Society Live Webinars: New era of online arthroscopy education during COVID-19 global pandemic." Journal of Arthroscopic Surgery and Sports Medicine 2 (January 10, 2021): 8–12. http://dx.doi.org/10.25259/jassm_45_2020.
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Objectives: COVID-19 originated from Wuhan, China, in December 2019, and it spread all over the world, leading to devastating pandemic. This has affected large gatherings of people. As there was lockdown in many countries, elective surgeries like arthroscopy were on hold. Many surgeons were involved in online education. This has helped in developing and achieving the arthroscopy academic content online. We, hereby, put forward our experiences of starting the online education initiative of Indian Arthroscopy Society (IAS). Our objective was to study the response to the IAS webinars and digital contents in view of watch hours, viewerships etc. Materials and Methods: All the data was collected from the analytics of the official YouTube channel. All the digital content including over 100 webinars and 39 video uploads were studied. Results: Total viewers were 88,560. Date-wise average viewers per day were 456.49. The total watch time of all the viewers was 17,539.5015 h (average watch hours were 90.41 h). This also led to around 1,377,647 impressions. There were 100 live webinars and around 39 different arthroscopy videos uploads. Conclusion: Good teamwork among all the members has led to a successful online education initiative, which has supported the need for arthroscopy education in this COVID-19 pandemic. Due to these webinars, the IAS has taken a leap towards the digital education activity and it has positively helped the desiring delegates to update their knowledge, learn, and interact with the leaders in the field of Arthroscopic Surgery, from India and abroad.
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Wylie, James D., Michael P. McClincy, Nishant Uppal, Patricia E. Miller, Young-Jo Kim, Michael B. Millis, Yi-Meng Yen, and Eduardo N. Novais. "Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: a comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy." Journal of Children's Orthopaedics 14, no. 2 (April 1, 2020): 98–105. http://dx.doi.org/10.1302/1863-2548.14.190194.
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Purpose Our primary research question was to investigate the severity of deformity and articular damage as well as outcomes in patients undergoing hip arthroscopy compared with open surgery for the treatment of symptomatic slipped capital femoral epiphysis (SCFE) deformity. Methods Retrospective review of surgical treatment of symptomatic SCFE deformity with a minimum one-year follow-up. Patients were divided into three groups: the arthroscopic group, surgical hip dislocation(SHD) group and SHD with femoral osteotomy (SHD+ITO) group. Deformity severity was quantified. Hip outcome was assessed by the modified Merle d’Aubigné Postel (MDP) scores. Results There were more severe slips treated by SHD and SHD+ITO. There was more severe deformity in the SHD+ITO group than the arthroscopy group (p < 0.001). There were more full thickness acetabular cartilage defects in the SHD and the SHD+ITO groups (> 40%) compared with the arthroscopy group (11%; p = 0.03). The SHD+ITO and SHD group had lower MDP scores compared with the arthroscopy group both before and after surgery but no difference was detected in the amount of improvement from surgery across groups (p > 0.05). Moderate and severe SCFEs had worse preoperative scores but improvement was not different compared with mild SCFEs (p > 0.05). Conclusion Patients undergoing open treatment had more severe SCFE deformity with more extensive articular damage at reconstructive surgery compared with patients undergoing arthroscopy. All groups with SCFE deformity had improved pain and hip function postoperatively. Level of Evidence III
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Cassinelli, Spenser J., Thomas G. Harris, Eric Giza, Christopher Kreulen, Lauren M. Matheny, Colin M. Robbins, and Thomas O. Clanton. "Use of Anatomical Landmarks in Ankle Arthroscopy to Determine Accuracy of Syndesmotic Reduction: A Cadaveric Study." Foot & Ankle Specialist 13, no. 3 (May 21, 2019): 219–27. http://dx.doi.org/10.1177/1938640019846972.
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Background. The aim of this study was to determine the accuracy of ankle arthroscopy as a means for diagnosing syndesmotic reduction or malreduction and to determine anatomical landmarks for diagnosis. Methods. Six matched-pair cadavers (n = 12) with through-knee amputations were studied. Component parts of the syndesmosis and distal 10 cm of the interosseous membrane (IOM) were sectioned in each. The 12 specimens were divided into 2 groups: 6 specimens in the in-situ group fixed with suture button technique and 6 specimens in the malreduced group rigidly held with a 3.5-mm screw. Specimens were randomized to undergo diagnostic arthroscopy by 3 fellowship-trained foot and ankle orthopaedic surgeons in a blinded fashion. Surgeons were asked to determine if the syndesmosis was reduced or malreduced and provide arthroscopic measurements of their findings. Results. Of 36 arthroscopic evaluations, 34 (94%) were correctly diagnosed. Arthroscopic measurement of 3.5 mm diastasis or greater at the anterior aspect of the distal tibiofibular syndesmosis correlated with a posteriorly malreduced fibula. Arthroscopic evaluation of the Anterior inferior tibiofibular ligament (AITFL), IOM, Posterior inferior tibiofibular ligament (PITFL), lateral fibular gutter, and the tibia/fibula relationship were found to be reliable landmarks in determining syndesmotic reduction. An intraclass correlation coefficient (ICC) for interrater reliability of 1.00 was determined for each of these landmarks between 2 surgeons (P < .001). The ICCs between 2 surgeons’ measurements and the computed tomography measurements were found to be 0.896 (P value < .001). Conclusions. Ankle arthroscopy is a reliable method to assess syndesmotic relationship when reduced in situ or posteriorly malreduced 10 mm. Levels of Evidence: Level V: Cadaveric
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Tatari, Mehmet Hasan, Yunus Emre Bektaş, Demirhan Demirkıran, and Hülya Ellidokuz. "15-Year-Experience of a Knee Arthroscopist." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0012. http://dx.doi.org/10.1177/2325967114s00129.
Full textAbstract:
Objectives: Arthroscopic knee surgery is a an experience-demanding procedure throughout diagnostic and reconstructive parts. Altough the literature says that there must be no need for diagnostic arthroscopy today, most arthroscopic surgeons have gained experience and developed themselves by the help of diagnostic arthroscopy and some basic procedures like debridement and lavage. The purpose of this study was to observe what happenned in the 15-year-experience of an orthopaedic surgeon who deals with knee arthroscopy. The hypothesis was that the mean age of the patients, who have undergone arthroscopic procedures, would decrease, and the percentage of the diagnostic and debridement applications would diminish and reconstructive procedures would increase. Methods: For this purpose, 959 patients who have undergone knee arthroscopy in 15 years, were evaluated retrospectively. The gender, age, operation year and the procedure applied for the patients were enrolled on an Excel file. Chi-Square test was used for statistical evaluation. The patients were divided into three groups according to the year they were operated. Period 1 included the patients who were operated between the years 1999-2003, Period 2 between 2004-2008 and Period 3 between 2009-2013. According to their ages, the patients were evaluated in three groups; Group 1 included the patients ≤ 25 years old while Group 2 between 26-40 and Group 3 ≥ 41. Arthroscopic procedures were evaluated in three groups: Group X: meniscectomy, chondral debridement, lavage, synoviectomy, loose body removal. Group Y: ACL and PCL reconstruction, meniscal repair. Group Z: Microfracture, lateral release, meniscal normalization, second look arthroscopy, diagnostic arthroscopy before osteotomy. Results: Among all patients, 60 % was male and Group 3 (45.4 %) was the larger group in population. The procedures in Group X were used in most of the operations ( 59.2 %). The population of the patients in the periods increased gradually throughout the years: 24 % in Period 1, 36.6 % in Period 2 and 39.4 % in Period 3. While the population of Group 3 was higher than the others in the first two periods, Group 2 was the leader in the last period (p< 0.001). While male/female ratio was statistically insignificant in Periods 1 and 2, the number of the males in Period 3 was statistically higher than the females (p< 0.001). The procedures in Group Y were used significantly for males in Periods 2 and 3 (p< 0.001). The procedures in Group X were used significantly for females (p< 0.001) while the ones in Group Y were applied for males (p< 0.001). Among all arthroscopic procedures, Group X was the leader in Period 1 (85 %) but this frequency decreased throughout the years and the procedures in Group Y increased gradually more than twice consisting more than half of the procedures in Period 3 (p< 0.001). Conclusion: Throughout the years, the age of the patients, for whom arthroscopic procedures were done, and the percentage of debridement and diagnostic procedures have decreased, while the population of the patients and the number of the reconstructive procedures, especially for males, have increased. The results were statistically significant. In our opinion, this statistical conclusion must be the usual academic development of an orthopeadic surgeon who deals mostly with knee arthroscopy in his daily practice. This must be a guide for young arthroscopists.