Dissertations / Theses on the topic 'Arthroscopy'
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1
Holmlund, Anders. "Arthroscopy of the temporomandibular joint." Stockholm : Kongl Carolinska Medico Chirurgiska Institutet, 1987. http://catalog.hathitrust.org/api/volumes/oclc/16908431.html.
2
Arens, Hendrikus Johannes. "Arthroscopy of the shoulder." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Maastricht University [Host], 1992. http://arno.unimaas.nl/show.cgi?fid=5718.
3
Chesnais, Pascal Roger. "A graphic/photographic arthroscopy simulator." Thesis, Massachusetts Institute of Technology, 1988. http://hdl.handle.net/1721.1/72263.
4
Ali, Shahnewaz. "Robotic vision for knee arthroscopy." Thesis, Queensland University of Technology, 2022. https://eprints.qut.edu.au/235890/1/Shahnewaz%2BAli%2BThesis%282%29.pdf.
Abstract:
This research focuses on visualisation challenges associated with anatomical imaging of complex joints such as the human knee. Current imaging systems are inadequate to provide 3D perception and lack the level of situational awareness needed for performing highly complex minimally invasive surgeries like knee arthroscopy. As a result, unintended tissue damage is common occurrence and training new surgeons takes a very long time. To improve surgical precision and training, this study presents a series of novel methods and computational tools that provide 3D perception for safer surgery with added ability of automatically recognition of multiple tissue types in real time.
5
Jacobson, Eva. "Pain management in outpatient knee arthroscopy /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-642-5/.
6
Antico, Maria. "4D ultrasound image guidance for autonomous knee arthroscopy." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/211437/1/Maria_Antico_Thesis.pdf.
Abstract:
This thesis proposes a novel guidance concept for autonomous surgical robots using ultrasound imaging and advanced artificial intelligence techniques. Automatic real-time interpretation of the images acquired during the operations allows the robots to navigate the surgical space safely and identify the target anatomy correctly. In particular, automatic image quality assessment, outlining and tracking structures and tools, and uncertainty management were implemented in a surgical platform. The first application on the knee through cadaver and volunteer studies showed the feasibility and produced results comparable to clinical standards.
7
Högberg, Erland. "Synovial metabolism after knee joint arthroscopy : a microdialysis study /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-652-2/.
8
Strydom, Mario Llewellyn. "Robotic manipulation of a human leg for knee arthroscopy." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/212257/1/Mario_Strydom_Thesis.pdf.
Abstract:
This research developed an automated leg manipulation system that is coupled with essential measurement and guidance algorithms, to build the fundamental pillars toward robotic knee surgery. It enables joint manipulation through joint identification, joint measurement, and kinematic modelling. Algorithms are developed and evaluated to consider the problems of identifying and measuring the space inside the knee joint. To robotically manipulate a human leg safely, a nine degree of freedom kinematic model is presented and verified through tracking of anatomical points inside the leg. It demonstrates that robotics can make a significant contribution to improve the outcomes for the medical community.
9
Dibble, Edward Alexander. "A novel haptic system for use in training knee arthroscopy." Thesis, Imperial College London, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423202.
10
Logan, Ivan Paul. "Soft tissue modelling and a virtual environment for knee arthroscopy training." Thesis, University of Hull, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267034.
11
Taylor, Zeike Amos. "Patient-specific models of cartilaginous tissues based on laser scanning confocal arthroscopy." University of Western Australia. School of Mechanical Engineering, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0097.
Abstract:
[Truncated abstract] An important field of research in orthopaedic biomechanics is the elucidation and mathematical modelling of the mechanical response of cartilaginous tissues. Such research has applications in the understanding of joint function and degenerative processes, as well as in surgical planning and simulation, and engineering of tissue replacements. In the case of surgical and tissue engineering applications especially, patient-specific mechanical properties are highly desirable. Unfortunately, obtaining such information would generally involve destructive mechanical testing of patient tissue, thus rendering the tissue functionally unusable. Development of a laser scanning confocal arthroscope (LSCA) within our School will soon allow non-invasive extraction of 3D microstructural images of cartilaginous tissues in vivo. It is also envisaged that, linked to a suitably formulated constitutive formulation, such information could allow estimation of tissue mechanical response without physical biopsy. This thesis describes the development of techniques to potentially allow non-invasive patient-specific estimation of tissue mechanical response based on confocal arthroscopy data. A microstructural constitutive model is developed which is capable of directly incorporating LSCA-derived patient-specific structural information. A fibre composite type homogenisation approach is used as the basis for the model. ... The result is a series of orientation tensors describing the 3D orientation of linear features in the image stack. The developed analysis techniques are used to estimate fibre volume fraction and orientation distribution for each of the meniscal specimens. The developed constitutive model and image-derived structural parameters are finally used to estimate the reaction force history of two meniscal cartilage specimens subjected to partially confined compression. The predictions are made on the basis of the specimens? individual structural condition as assessed by confocal microscopy and involve no tuning of material parameters. Although the model does not reproduce all features of the experimental curves, as an unfitted estimate of mechanical response the prediction is quite accurate. In light of the obtained results it is judged that more general non-invasive estimation of tissue mechanical properties is possible using the developed framework. The likely limitations and potential areas of improvement are discussed.
12
Xu, Daquan 1965. "Epidemiology of pain and pain management after knee surgery : arthroplasty and arthroscopy." Thesis, McGill University, 2003. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80899.
Abstract:
Background. Pain after knee surgery has been reported as a common problem. It is highly ranked in terms of intensity and has important consequences on both quality of life and psychological well-being. However, assessment and management of postoperative pain remain a key clinical problem.Objectives. To describe the occurrence of pain after total knee arthroplasty (TKA) and knee arthroscopy; identify the predictors of postoperative pain and evaluate the consequences of pain on quality of life and on depression status.
Methods. Patients were recruited from nine university and regional hospitals in the province of Quebec and were followed for three months after knee surgery. Time points of postoperative day 7 and month 3 were our prime interest. We used a prospective cohort design to investigate characteristics of postoperative pain and a case-control design to identify the impact of postoperative pain on quality of life and on depression. Both logistic regression and multiple linear regression models were used to analyze postoperative pain intensity and the impact of postoperative pain respectively. (Abstract shortened by UMI.)
13
Van, Overstraeten Luc. "Le complexe scapho-lunaire, un nouveau concept !un autre regard sur l'instabilité du carpe." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209193.
Abstract:
Les buts de cette thèse sont les suivants :préciser les critères de datation d’une lésion ligamentaire scapho-lunaire instable ;analyser l’apport de l’imagerie par résonance magnétique (IRM) dans le diagnostic lésionnel des ligaments extrinsèques du carpe ;étudier l’apport de l’arthroscopie en particulier dans la classification de l’instabilité prédynamique scapho-lunaire et dans le testing des ligaments extrinsèques ;isoler une éventuelle nouvelle structure anatomique stabilisatrice du carpe ;et enfin évaluer à court terme les résultats de la capsulodèse à l’intercarpien dorsal selon Viegas. Trois critères arthroscopiques sont décrits et analysés statistiquement sur 100 arthroscopies, pour dater le traumatisme responsable d’une lésion ligamentaire instable du carpe. La turbidité du liquide synovial (T0 à T4), l’infiltration synoviale hémorragique (S0 à S2) et l’état du cartilage (C0 à C4) sont corrélés au délai post-traumatique. La turbidité et l’infiltration synoviale hémorragique sont les plus significatives (p < 0.001). La corrélation entre le grade de chondropathie et le délai post-traumatique est également significative (p < 0.01). L’infiltration synoviale est le caractère prédictif le plus puissant. La combinaison des trois critères renforce la prédictibilité. Il est dès lors possible de confirmer l’anamnèse, de préciser s’il s’agit d’une lésion instable aiguë ou subaiguë (moins de six semaines), ou chronique récente (six semaines à trois mois) ou chronique ancienne (plus de trois mois), ou encore de documenter un état antérieur inconnu du patient. Les ligaments extrinsèques du poignet peuvent être examinés de façon précise par IRM. Deux études, l’une sur poignets indemnes, l’autre rétrospective sur poignets pathologiques, ont permis de préciser le système d’imagerie et le mode d’utilisation les plus efficaces dans l’examen de ces ligaments. L’analyse de ces structures anatomiques fines aux directions obliques et courbes est optimalisée par l’utilisation d’un appareil de résonance magnétique à haute résolution, et par des séquences spécifiques permettant l’obtention de coupes infra-millimétriques. La reconnaissance des ligaments extrinsèques est améliorée par l’injection intra-articulaire ou intraveineuse de produit de contraste. Les découvertes de l’IRM sont corrélées aux informations cliniques et à l’arthroscopie. Les deux études montrent l’intérêt de l’IRM à haute résolution pour déterminer précisément la localisation, la dimension et l’étendue des lésions des ligaments extrinsèques dorsaux et palmaires radio-carpiens et ulno-carpiens impliqués dans le carpe. L’expérience future et des corrélations IRM/arthroscopie sont nécessaires pour définir la place de l’imagerie par résonance magnétique dans la mise au point des patients présentant des lésions traumatiques du poignet. La classification de l’European Wrist Arthrosocpy Society (EWAS) ordonne l’instabilité arthroscopique scapho-lunaire en quatre stades selon l’importance de l’ouverture de l’interligne scapho-lunaire. Elle précise le stade III de la classification de Geissler en distinguant l’élargissement du côté palmaire (IIIa), celui du côté dorsal (IIIb) ou l’élargissement complet (IIIc). Une étude arthroscopique cadavérique a précisé l’implication lésionnelle des ligaments extrinsèques sur le type d’instabilité scapho-lunaire. Quatre séries de coupes séquentielles ont été réalisées, distinguant deux groupes (selon des sections de ligaments palmaires ou dorsaux). La série est courte et l’analyse statistique n’est pas significative, mais il existe des tendances :la section des parties palmaire et intermédiaire du ligament interosseux scapho-lunaire (SLIOL) et des ligaments extrinsèques palmaires (radio-scapho-capitatum RSC) et radio-lunaire long (LRL)) cause un élargissement arthroscopique palmaire ( stade IIIa) ;la section supplémentaire de la partie dorsale du SLIOL aggrave l’instabilité arthroscopique (stade IIIc) sans aucune modification radiologique. La section combinée de la partie dorsale du SLIOL et du ligament intercarpien dorsal (DIC) produit un élargissement arthroscopique dorsal (stade IIIb) ;la section supplémentaire de la partie palmaire du SLIOL aggrave l’instabilité arthroscopique ( stade IIIc ) sans modification radiologique. La section combinée de tout le SLIOL, des extrinsèques palmaires et du DIC induit une instabilité arthroscopique (stade IV) et des modifi cations radiologiques. Lorsque tout le SLIOL est sectionné, il est nécessaire de sectionner au moins un ligament palmaire et un ligament dorsal extrinsèque pour obtenir un stade IV. Une méthode systématique de testing arthroscopique des ligaments extrinsèques du carpe est décrite. La plupart des ligaments extrinsèques du carpe sont accessibles à la palpation de leur portion endoarticulaire (RSC, LRL, radio-lunaire court (SRL), ulno-lunaire (UL), ulno-triquetral (UL), radiocarpien dorsal (RCD), triquétro-capitatum (TC), scapho-trapézien (ST), DIC). Une majorité d’entre eux peut être examinée en vision directe par portes arthroscopiques dorsales ou ulnaire. Une gradation lésionnelle de ces ligaments extrinsèques est décrite en fonction de la tension et de la continuité de leurs fibres. Le septum capsulo-scapho-lunaire dorsal (DCSS) est un épaississement capsulaire dorsal qui relie le rebord dorsal de la crête articulaire carpienne du radius, se dirige distalement et s’insère sur la partie dorsale du ligament interosseux scapho-lunaire, sur le scaphoïde et sur le lunatum. Une étude athroscopique cadavérique a montré que la section sélective du DCSS produisait une dissociation arthroscopique scapho-lunaire constante mais aucune modification radiologique du carpe. Elle a permis de conclure que le DCSS joue un rôle de stabilisateur scapho-lunaire dont la lésion entraîne une instabilité prédynamique. L’étude clinique présentée compare les données préopératoires et postopératoires de vingt-cinq poignets opérés de capsulodèse à l’intercarpien dorsal selon Viegas entre 2006 et 2010. Il s’agit d’une capsulodèse réalisée à ciel ouvert qui semble respecter l’isométrie ligamentaire du poignet. Tous les patients ont été évalués arthroscopiquement avant de bénéficier du geste. La laxité scapho-lunaire correspondait dans trois cas à une laxité grade 2 de Geissler, dans seize cas à une laxité grade 3 et dans six cas à une laxité grade 4. Le recul moyen était de 20 mois (13 – 45 mois). L’évaluation clinique au dernier recul a noté une mobilité en arc de flexion extension de 109° et en inclinaison radio-ulnaire de 66°. La force de poigne était de 27,9 kgf. La douleur à l’EVA était à 2,7 et le score PRWE de 43,8. Radiographiquement, le diastasis scapho-lunaire de face a été mesuré à 1,88mm, l’angle scapho-lunaire à 54°. Le recul est évidemment trop court pour estimer la pérennité de l’efficacité de cette capsulodèse. A la revue, le patient avait repris toutes ses activités sans symptomatologie dans onze cas, avec inconfort dans neuf ou présentait une certaine incapacité dans trois cas. Sur ces trois mauvais résultats, deux ont évolué vers l’arthrose et ont été repris. L’instabilité scapho-lunaire, qu’elle soit aiguë ou chronique, reste une problématique difficile. Il faut informer les soignants de première ligne mais aussi la population sur l’évolution sournoise de certaines entorses :retour à l’indolence en quelques mois mais décompensation silencieuse et arthrose invalidante et handicapante après quelques années ou décennies. Le patient victime d’une entorse du poignet est en droit d’obtenir en urgence un traitement adapté qui peut éviter plus tard une catastrophe professionnelle et/ou sociale. Des critères diagnostiques sont désormais disponibles pour dater le traumatisme responsable de l’entorse et donner l’âge de l’instabilité. L’embrochage articulaire en période traumatique aiguë (ou subaiguë) permet d’obtenir une cicatrisation anatomique et stable des lésions ligamentaires. La stabilité scapho-lunaire paraît donc dépendre de l’intégrité non seulement du ligament interosseux (SLIOL) mais également des ligaments extrinsèques palmaires et dorsaux et des attaches capsulaires dont certaines comme le DCSS peuvent être différenciées en véritables structures anatomiques. Il s’agit là d’un véritable complexe scapho-lunaire (CSL) dont l’atteinte des composants peut être documentée par l’imagerie et le caractère instable précisé par l’arthroscopie. L’imagerie progresse. L’arthroscanner reste le golden standard de l’évaluation radiologique des ligaments interosseux. L’arthro IRM permet d’investiguer les ligaments extrinsèques du carpe et de documenter leurs lésions. L’arthroscopie donne une approche différente des structures stabilisatrices du carpe et en particulier des composantes du CSL par rapport aux méthodes diagnostiques conventionnelles d’imagerie. L’étude morphologique des ligaments interosseux et extrinsèques reste limitée à la surface des portions strictement intra-articulaires, mais l’analyse peut se compléter par un testing précis et spécifique de chaque ligament. Une nouvelle classification de l’instabilité scapho-lunaire prédynamique permet d’orienter le diagnostic des lésions ligamentaires extrinsèques associées. Des études de corrélations clinico-radio-arthroscopiques pourraient participer à l’évaluation de tests cliniques spécifi ques des éléments constitutifs du complexe scapho-lunaire. La capsulodèse dorsale selon Viegas qui renforce la partie dorsale du ligament interosseux scapho-lunaire reconstruit également le septum capsuloligamentaire dorsal. Elle améliore à court terme l’instabilité scapho-lunaire. The goals of this thesis are to determine the criteria for dating an unstable scapholunate ligament tear; to assess the use of magnetic resonance imaging (MRI) for the diagnosis of lesions of the extrinsic ligaments; to study the use of arthroscopy particularly for predynamic scapholunate instability and the testing of extrinsic ligaments; to possibly describe a new anatomical structure of carpal stabilisation; and finally, to evaluate with short follow-up the results of Viegas’s capsulodesis. Three arthroscopic criteria for dating wrist trauma causing unstable carpal ligament lesion are described and recorded in 100 arthroscopies, then subjected to statistical analysis. The turbidity of synovial fluid (T0 to T4), the hemorrhagic synovial infiltration (S0 to S2) and the state of the cartilage (C0 to C4) are correlated to the duration post trauma. The turbidity and the haemorrhagic synovial infi ltration are the most significant predictive criteria (p < 0.001). The correlation between the degree of chondropathy and posttraumatic delay is also significant (p < 0.01). The synovial infiltration has the most predictive value. The combination of three criteria increases predictivity. It is then possible to confirm the history, to determine whether it is an acute or subacute (less than 6 weeks) unstable lesion, recent chronic (6 weeks to 3 months) or old chronic (more than 3 months), or to record a pre-existing lesion. The extrinsic ligaments of the wrist can be accurately assessed by MRI scan. Two retrospective studies specified the image system and the most efficient procedure to investigate these ligaments. Imaging of these thin structures with an oblique and curved course is better performed using a three-dimensional MRI with high resolution and specific sequences with infra-millimetric cuts. The visualisation of pathologic extrinsic ligaments is improved with MRI arthrography or use of contrast. The MRI findings are correlated to clinical and arthroscopic findings. Both studies showed the benefit of high-resolution MRI to determine the site, dimensions and extent of the extrinsic ligamentous lesions of the carpus. Further study and correlations of MRI with arthroscopy are necessary to determine the exact place of MRI in the management of wrist sprains. The European Wrist Arthroscopy Society (EWAS) sequence classifies the arthroscopic scapholunate instability in four stages according to the scapholunate gap.It divides the stage III of Geissler’s classification into volar widening (IIIa), dorsal widening (IIIb) and complete widening (IIIc). An arthroscopic cadaveric study was done to describe the impact of extrinsic ligament lesions on the type of scapholunate instability. Four sequential series of cuts were performed, distinguishing two different groups: volar ligament cuts and dorsal cuts. The series is small and the statistical analysis is not significant, however, a pattern emerged: cutting the volar and proximal scapholunate interosseous ligament (SLIOL) with the radioscapholunate ligament (RSL) and long radiolunate ligament (LRL) provoked a stage IIIA instability. The additional sectioning of the dorsal SLIOL increased the arthroscopic instability (stage IIIC) with no radiological change. Cutting the dorsal SLIOL with dorsal intercarpal ligament (DIC) provoked a dorsal arthroscopic scapholunate gap (stage IIIb); the additional sectioning of all SLIOL, volar extrinsic ligament and DIC caused an arthroscopic instability (stage IV) as well as radiologic changes. In addition to complete SLIOL sectioning, the section of at least one volar ligament and one dorsal ligament was required to cause a stage IV. A systematic method of arthroscopic testing of extrinsic carpal ligaments is described. Most extrinsic ligaments are accessible to the palpation of their intraarticular part (RSC, LRL, short radiolunate (SRL), ulnolunate (UL), ulnotriquetral (UL), dorsal radiocarpal (RCD), triquetrocapitate (TC), scaphotrapezial (ST), and DIC)). They can be almost all be directly viewed through dorsal or ulnar portals. A classification of extrinsic ligament lesions is described according to the tension and the continuity of the fibres. The dorsal capsuloligamentous scapholunate septum (DCSS) is a thickening of the dorsal capsule, the dorsal intercarpal ligament (DIC), and the scapholunate interosseous ligament (SLIOL) with attachments to scaphoid and lunate. An arthroscopic and fluoroscopic study has shown that the selective cutting of DCSS provoked a constant arthroscopic scapholunate change but no radiologic change. This structure appears to play a role in the stability of the scapholunate joint. The preoperative and postoperative findings of 25 patients operated using the open Viegas’ capsulodesis between 2006 and 2010 were compared. Before the procedure, the Geissler’s laxity grade was determined using arthroscopy for all patients: three cases had a grade 2, 16 cases with a grade 3 and six cases a grade 4. The mean follow-up was 20 months (13 to 45). The last clinical evaluation showed a flexion-extension range of 109° and a range of inclination of 66°. The grip strength was 27.9kgf on average; the EVA 2.7 and the PRWE score 43.8. On X-ray, the scapholunate gap was 1.88 mm on average and the scapho-lunate angle, 54°. The follow up is obviously too short to appreciate the radiological improvement following this capsulodesis. At final review, the patients returned to all activities without symptom in 11 cases, with disconfort in nine cases, difficulties in two cases and with disability in three cases. Among these three bad results, two were re-operated fore degenerative arthritis. Scapholunate instability whether acute or chronic remains a difficult problem. Firstline carers and the general population should be informed about the progressive deterioration of some tears: return to a pain free status after a few months but silent collapse and disabling osteoarthritis after a few decades. The patient suffering from a wrist sprain is entitled to appropriate emergency treatment, which can avoid later professional and/or social disability. Diagnostic criteria are now available to date the causative trauma and to determine the age of the instable lesion. K-wire fixation in the acute or subacute phase can achieve anatomic and stable scarring of a ligament injury. Scapholunate stability depends not only on the integrity of the interosseous ligament (SLIOL) but also on extrinsic volar and dorsal ligaments and capsular attachments. Some of them, like the DCSS, are real anatomical structures. They constitute a true scapholunate complex (SLC). A lesion of any of its components can be documented using X-ray and the resulting instability with the arthroscopy. Imaging technology is in continuous progress. CT Arthrography remains the golden standard for assessment of the interosseous ligaments. MRI arthrography can show lesions of the extrinsic carpal ligaments. Arthroscopy offers a different approach to stabilizers of the carpus and particularly to the components of SLC compared to conventional imaging methods. Morphological study of the extrinsic and interosseous ligaments is limited to the surface of their intraarticular portions, but the analysis can be enhanced by accurate and specific assessment of each ligament. A new classification of predynamic arthroscopic scapholunate instability can help diagnose associated extrinsic ligament injuries. Clinical, radiological and arthroscopic correlations can help to develop clinical tests for SLC components. Symptomatic reducible chronic scapholunate instability can be improved by dorsal capsulodesis. Strengthening the dorsal part of SLIOL according.
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished
14
Greaves, Laura Lindsey. "Effect of acetabular labral tears, repair and resection on hip cartilage strains : a 7T MR study." Thesis, University of British Columbia, 2008. http://hdl.handle.net/2429/4078.
Abstract:
Acetabular labral tears are associated with hip osteoarthritis. A current surgical treatment
strategy for a torn labrum, labral resection, has recently shown poor patient outcomes with
radiographic signs of osteoarthritis two-years post-operation. Since mechanical factors play a
role in the etiology of osteoarthritis, identifying the mechanical role of the labrum may
enhance current surgical treatment strategies.
In this pilot study, we assessed the relationship between mean cartilage strain, maximum
cartilage strain and the three-dimensional cartilage strain distribution in six human cadaver
hips with various pathologic conditions of the labrum. We developed a novel technique of
mapping cartilage strain using quantitative magnetic resonance imaging (qMRl). qMRl provides
a non-invasive means of quantifying the cartilage strain distribution in the hip in three dimensions.
Each specimen was assessed first with an intact labrum, then after surgically
simulating a longitudinal peripheral labral tear, then after arthroscopically repairing the tear,
and after labral resection. We validated the precision of the technique through use of an
additional specimen which served as a control.
To minimize motion artifact in the high-resolution MR images, we determined that 225
minutes was required for cartilage to reach a steady-state thickness under load. We also
determined 16.5 hours was required for cartilage to recover to a steady-state unloaded
thickness.
The difference in mean and maximum cartilage strain when the labrum was repaired and
resected was assessed using a paired t-test. We found that the resected group had an
increased mean and maximum cartilage strain of 4% and 6%, respectively and the 3D cartilage
strain distribution was elevated throughout the region of interest. When the condition of the
intact labrum was compared to the torn labrum, we found no change in mean and maximum
cartilage strain, and little obvious change in the 3D pattern of cartilage strain distribution.
Based on our findings of increased cartilage strain after labral resection when compared to
labral repair, we hypothesize that the labrum’s contribution of additional surface area assists in
load distribution, which spares cartilage from excessive loads. We therefore recommend that the longitudinal peripheral torn labrum should not be resected if it is possible to be repaired,
because in vivo, labral resection may create an environment with increased articular cartilage
strain, which is thought to be associated with cartilage degeneration.
15
Pospíchal, Oldřich. "Návrh kinematiky a řezné geometrie funkční části artroskopických kleští." Master's thesis, Vysoké učení technické v Brně. Fakulta strojního inženýrství, 2014. http://www.nusl.cz/ntk/nusl-231468.
Abstract:
This Thesis presents a design innovation in arthroscopic forceps. Based on surveying the subject-matter literature on arthroscopic surgery of the knee, design changes are proposed to alter the cutting geometry of the functional end of the instrument to improve its utility. The proposed changes are imple-mented in a prototype, which is then compared with the current design. The comparison is made by testing the functioning of the instrument and the force required to shear the test material.
16
Sherman, Kevin Paul. "The specifications and role of a virtual environment system for knee arthroscopy training." Thesis, University of Hull, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.343159.
17
Bubenik, Loretta June. "Evaluation of lameness associated with arthroscopy or arthrotomy of the normal canine cubital joint." Thesis, Virginia Tech, 2001. http://hdl.handle.net/10919/31961.
Abstract:
This study compared lameness and post-operative recovery in animals undergoing arthroscopy or arthrotomy of the cubital joint. It was a prospective, randomized, experimental study in which fourteen mature, healthy dogs were evaluated. Dogs were randomly assigned to treatment groups with seven undergoing arthrotomy and seven undergoing arthroscopy of the left cubital joint. Dogs were evaluated using kinetic gait assessment, subjective evaluation scores, and cubital joint range of motion (ROM). Evaluations were performed prior to surgery and on days 2, 4, 7, 15, 22, and 29 after surgery. Preoperative radiographs of both cubital joints and postoperative radiographs of the operated limb were evaluated. Significant differences in peak vertical force and vertical impulse force were not observed between surgery groups (p=0.88 and 0.49, respectively). Joint ROM was not significantly different between groups (p = 0.09 for flexion and 0.91 for extension). For all dogs, joint ROM and radiographic evaluations remained within normal range throughout the study period. Additionally, significant differences in subjective lameness scores, weight bearing and pain were not observed between groups (p³ 0.19 for all variables). Therefore, post-operative morbidity may not be an important factor when making a decision to perform either arthroscopy or arthrotomy for exploration of the medial aspect of the canine cubital joint.Master of Science
18
Lateur, Gabriel. "Développement de l'utilisation d'une sonde d'endo-échographie adaptée à l'arthroscopie de l'épaule." Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALS015.
Abstract:
A l’heure actuelle, la chirurgie orthopédique évolue vers la recherche constante d’une agressivité tissulaire minimale pour le patient et vers une efficacité du geste opératoire optimisée. Depuis quelques années, les cliniciens utilisent les techniques échographiques à but diagnostic et thérapeutique notamment dans la pathologie du membre supérieur, pour laquelle il devient de plus en plus fréquent que les chirurgiens orthopédistes, se forment aux techniques échographiques rendant plus aisée la lecture des différentes images et leur interprétation. Le développement de la sonde d’endo-échographie « M15 » a pour objectif d’allier les avantages de l’échographie externe à ceux de l’exploration arthroscopique pour les praticiens, en leur donnant davantage d’accès aux structures profondes d’intérêt de l’épaule et en leur permettant une visualisation de meilleure qualité. L’objectif de ce travail de thèse était de déterminer la place de l’endo-échographie au cours des procédures arthroscopiques au niveau de l’épaule.La première partie de ce travail a permis de poser les bases de l’anatomie et des principales pathologies pouvant affecter l’ensemble articulaire de l’épaule ainsi que les bases de l’arthroscopie et de l’échographie au niveau de cet ensemble articulaire. Cela nous a semblé un prérequis indispensable avant de passer au développement des possibilités d’utilisation de sonde d’endo-échographie au décours de procédures d’arthroscopie d’épaule.Dans la deuxième partie de ce travail de thèse, nous avons évalué la faisabilité d’une exploration endo-échographique de structures d’intérêt de l’épaule au décours d’une procédure d’arthroscopie à l’aide de la sonde M15. Nous avons présenté les principes de l’endo-échographie puis nous avons exposé les résultats de l’étude de reproductibilité de la procédure entre manipulateurs de niveau d’expérience différent et enfin nous avons pu comparer les modalités d’exploration des structures d’intérêt de l’épaule par endo-échographie versus exploration par échographie externe. Ces travaux expérimentaux sont, à notre connaissance, les premiers à avoir permis de définir la place de l’endo-échographie au décours de procédures d’arthroscopie d’épaule.La troisième partie de ce travail nous a permis d’évoquer les perspectives de développement et d’applicabilité clinique de ces travaux autour de ce travail princeps et notamment les aspects concernant la vascularisation tissulaire de l’épaule et ses moyens d’évaluation per opératoire par sonde d’endo-échographie ainsi que son application lors de la prise en charge des pathologies courantes de l’épaule comme les ruptures interstitielles des tendons de la coiffe des rotateurs, l’exérèse de calcifications intra tendineuses et l’exploration des tendinites du long biceps. Il nous semble indispensable de valider l’exploration de ces structures et pathologies en per opératoire. Nous voulons nous orienter vers la définition de l’applicabilité de la procédure à des pathologies spécifiques afin que ce système d’imagerie endoscopique peropératoire dont nous avons validé l’utilisabilité ex-vivo puisse être validé en pratique courante in-vivoCurrently, orthopedic surgery is evolving towards the constant search for minimal tissue aggressiveness for the patient and towards an optimized operative procedure. For a few years now, clinicians have been using ultrasound techniques for diagnostic and therapeutic purposes, particularly in the pathology of the upper limb, for which it is becoming more and more frequent that orthopedic surgeons are being trained in ultrasound techniques making it easier to read the various images and their interpretation. The development of the M15 endo-ultrasound probe aims to combine the advantages of external ultrasound with those of arthroscopic exploration for practitioners, by giving them more access to the deep structures of interest of the shoulder and allowing them a better quality visualization. The objective of this thesis work was to determine the place of endo-ultrasound during arthroscopic procedures at the shoulder.The first part of this work aims to lay the foundations of the anatomy and the main pathologies that can affect the articular complex of the shoulder as well as the bases of arthroscopy and ultrasound at the level of this complex. This seemed to us to be an essential prerequisite before moving on to developing the possibilities of using an endo-ultrasound probe during arthroscopic shoulder procedures.In the second part of this thesis, we assessed the feasibility of an endo-ultrasound exploration of structures of interest in the shoulder during an arthroscopic procedure using the M15 probe. We presented the principles of endo-echography then we exposed the results of the study of reproducibility of the procedure between manipulators of different level of experience and finally we were able to compare the methods of exploration of the structures of interest of the shoulder by endo-ultrasound versus exploration by external ultrasound. These experimental works are, to our knowledge, the first to have defined the place of endo-ultrasound in the course of shoulder arthroscopy procedures.The third part of this work allowed us to develop the perspectives of research and clinical applicability of these works around this original work and in particular the aspects concerning the vascularization of the shoulder and its means of intraoperative evaluation by endo-ultrasound probe as well as its application when taking care of common shoulder pathologies such as interstitial ruptures of the rotator cuff tendons, the removal of intra-tendinous calcifications and exploration of tendinitis of the long head of the biceps. We believe that it is essential to validate the exploration of these structures and pathologies during surgery procedure. We want to orient ourselves towards the definition of the applicability of the procedure to specific pathologies so that this intraoperative endoscopic imaging system whose usability has been validated ex-vivo can be validated in current practice in-vivo
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Waraporn, Aumarm [Verfasser]. "Comparative diagnosis of Canine Elbow Dysplasia between Radiography, Computer Tomography and Arthroscopy / Waraporn Aumarm." Berlin : Freie Universität Berlin, 2008. http://d-nb.info/1022599852/34.
20
Kvasniuk, D. I. "Using optio-polarizational methods and arthroscopy in early diagnostics and treatment of septic arthritis." Thesis, БДМУ, 2022. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/19678.
21
Opie, Jeremy. "Development of interfaces for orthopaedic surgeons to control minimally invasive surgical robots during knee arthroscopy." Thesis, Queensland University of Technology, 2020. https://eprints.qut.edu.au/207127/1/Jeremy_Opie_Thesis.pdf.
Abstract:
This thesis uses a human centred design approach to explore novel approaches that allow a surgeon to cooperatively perform knee arthroscopies with a robot. This research consists of three studies, through which a set of insights about the challenges that surgeons face and ways to mitigate them was developed. The thesis contributes findings about key challenges orthopaedic surgeons face during knee arthroscopy, findings about surgeons’ preferences when interacting with a robot, and a novel method to elicit design feedback from surgeons.
22
Al-Riyami, Masoud. "Traumatic Chondral Lesions of the Knee in Athletes with Emphasis on Arthroscopy, MRI, and Knee Function." Thesis, University of Sheffield, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486789.
Abstract:
Background: Traumatic chondral lesions of the knee are common in football and rugby players, The diagnosis is often confirmed by arthroscopy, considered appropriate because of persistent pain and effusion. The natural course of these injuries is not well known. Clinical diagnosis is difficult and MRI is not always reliable. Aims: 1. To introduce a simplified arthroscopic mapping system of the weight-bearing surfaces of the knee which can be used to describe the location of these chondral lesions. 2. To correlate the location and severity of these lesions with a novel knee function score designe~ to reflect the demands of football and rugby. 3. To assess the accuracy of different MRI sequences in diagnosing chondral lesions using the arthroscopic mapping system as a standard. 4. To evaluate the short-term functional outcome of microfractured lesions using MRI and function scores. Methods: Forty two consecutive football and rugby players with traumatic isolated chondral lesions observed at arthroscopy were included after appropriate consent. Lesion size and grade were recorded with the mapping system. All subjects were scanned two to three weeks after surgery using a 3-Tesla MRI. At eight to 12 weeks from surgery they were tested with the functional knee score. Twenty four out of 42 subjects with grade III IV lesions underwent microfracture at the time of arthroscopy. They were assessed at 3, 6, 12 and 18 months by functional knee score and MRI. A second look arthroscopy was carried out in 10 players five to seven months after surgery to evaluate lesion healing because there was discrepancy between. a 'normal' MRI and persistent clinical symptoms. Results: Fifty five lesions on weight-bearing surfaces were found in the 42 subjects. The average size of the lesion was 197 square mm. Pain, effusion, tenderness on palpation and positive compression rotation test were the predominant symptoms and signs. The medial femoral condyle (MFC) was affected most with 36 (65 %) of the lesions. the lesions were concentrated in the B areas (p < 0.05). Grade IV lesions were the most common with 26 lesions (47.3 %). These lesions were concentrated in the B areas (p < 0.05). Cartilage specific sequences (CSS) showed a sensitivity of 89 percent and specificity of 98 percent to identify the chondral lesions. Lesion location and grade determined by MRI were comparable to arthroscopy, but size was underestimated by MRI (p < 0.05). Both the functional knee score and MRI showed good correlation in assessing healing after microfracture at six, 12 and 18 months (r2 =0.993,0.986 and 0.993, respectively). Conclusion: The distribution of the traumatic chondral lesions over the weight-bearing surfaces of the knee is unequal, and neither location nor grade predict functional outcome. Cartilage specific sequences have relatively high sensitivity but are not reliable enough to replace arthroscopy in diagnosing cases with typical symptoms and signs. Microfracture shows excellent short term out-comes. Both the functional knee score and MRI are reliable enough on average to confirm healing at the defect site, and a second look arthroscopy may be required in some cases.
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McCarthy, Avril Dawn. "Development and validation of a virtual environment as a training tool for surgeons in knee arthroscopy." Thesis, University of Sheffield, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366114.
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Willberg, Lotta. "Patellar and Achilles tendinopathy : sclerosing injections and ultrasound guided arthroscopic shaving." Doctoral thesis, Umeå universitet, Idrottsmedicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-80194.
Abstract:
Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for tendon pain. Immuno-histochemical analyses of biopsies have shown sensory and sympathetic nerves in close relation to the high blood flow outside the tendon. These findings have led to new ideas about development of new treatment methods for chronic painful tendinopathy. In study I, we evaluated the already in use, US-guided sclerosing polidocanol injection treatment of midportion Achilles tendinopathy, using two different concentrations of the substance. This study aimed to find out if there was a faster return to pain-free activity by using the concentration 10 mg/ml compared to the formerly used 5 mg/ml. There were no significant differences in the clinical results between the groups. In study II - Technical note, we aimed to develop a new one-stage surgical treatment method for patellar tendinopathy. This method was based on research concerning the innervation patterns and US and CD findings in patellar tendinopathy/ “jumper’s knee”. Technically we added ultrasound guidance to knee arthroscopy to identify and visualize the region of interest during a surgical shaving procedure. In study III, we tested the newly invented US and CD-guided arthroscopic shaving technique in a pilot study. The short-term clinical results were promising and the majority of the patients returned to pain-free activity after a short rehabilitation period. In study IV, we compared the US and CD-guided artrhroscopic shaving method with the already in use sclerosing polidocanol injection treatment in a randomized study. At short-term follow-up, the patients treated with US and CD-guided arthroscopic shaving had significantly less pain during rest and activity, were significantly more satisfied with the treatment, and had a faster return to sports, compared to the patients in the sclerosing injection group. There were no complications. In study V, at longer-term followup (endpoint 46 months) there was a significant decrease in pain during activity in both groups. There were no remaining significant differences in the pain levels during activity between the groups. The tendon structure had improved significantly in both groups. There was a significant decrease in the antero-posterior thickness of the proximal patellar tendon in patients treated with US and CD-guided arthroscopic shaving, but not in the sclerosing injection group. The CD flow had diminished significantly in both groups, and there was a correlation between low CD flow and high patient satisfaction in both groups, The CD flow decreased faster in the surgical group than in the injection group. In conclusion, this newly invented US and CD-guided arthroscopic shaving treatment, focusing on treatment outside the tendon, has shown good clinical results with pain relief and a fast return to sports activity, in patients with patellar tendinopathy.
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McLeod, Michelle M. "Neuromuscular and Musculoskeletal Outcomes Following Arthroscopic Partial Meniscectomy or Meniscal Repair." University of Toledo / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1417769863.
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Gynther, Göran W. "Inflammatory and degenerative disease in the temporomandibular joint." Stockholm, Sweden : Dept. of Oral and Maxillo-Facial Surgery, Dept. of Immunology, Microbiology, Pathology and Infectious Diseases, Huddinge University Hospital, Karolinska Institutet, 1996. http://catalog.hathitrust.org/api/volumes/oclc/35254114.html.
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Erlandsson, Rasmus. "A retrospective cohort study evaluating the risk of re-arthroscopy two years after Anterior Cruciate Ligament reconstruction." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86734.
Abstract:
Introduction: The Anterior Cruciate ligament (ACL) is one of the most important ligaments in the knee providing joint stability. Rupture of ACL is the most common sports injury. About half of the patients undergo surgical reconstruction. The Orthopaedic clinic in Region Örebro county underwent a reorganization in 2016. Aim: The aim of this study was to evaluate the two-year risk of re-arthroscopy in the same knee after primary ACL-reconstruction. Material and Methods: A retrospective cohort study. All patients from 1st January 2005 until 31st December 2017 with primary ACL reconstruction in Region Örebro county were included. Data was collected from medical records and The Swedish National Anterior Cruciate Ligament Register. Results: 431 patients were included. The total risk of re-arthroscopy was 13.0%. Meniscal surgeries and age did not affect the outcome. Fixation method in femur and tibia affected the outcome, as did choice of graft. There was a small numerical difference before (13.4%) vs after (12.1%) the reorganization, but it was not statistically significant either unadjusted or adjusted for age and meniscal surgeries (p=0.721). Conclusions: Our study indicates that choice of graft and fixation method in femur and tibia affect the re-arthroscopy rate. Regarding graft, the semitendinosus tendon alone was the better option, and for fixation both for femur and tibia it seems like Tightrope was the best option and screw the worst. The reorganization did not affect the outcome but might have other benefits.
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Doğuç, Gökhan Doruk Baydar Metin Lütfi. "Artroskopik girişim uygulanan gonartrozlu hastalarda erken dönem sonuçlarının değerlendirilmesi /." Isparta : SDÜ Tıp Fakültesi, 2003. http://tez.sdu.edu.tr/Tezler/TT00101.pdf.
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Loftin, Patrick Glenn. "Comparison of arthroscopic lavage, needle lavage, and lavage volume on the recovery of colored microspheres from the tarsocrural joint of the horse." Kansas State University, 2015. http://hdl.handle.net/2097/19001.
Abstract:
Master of ScienceDepartment of Clinical Sciences
Warren L. Beard
Objectives: To quantify recovery of colored microspheres from cadaver tarsocrural joints via arthroscopic or needle lavage, and to compare recovery for 1-5L of lavage fluid. Study design: Randomized experimental trial. Methods: 8 adult Quarter Horse cadavers had 1.5 million 15μm, colored microspheres injected into each tarsocrural joint. Each joint was randomly assigned to receive lavage with an arthroscope and egress cannula (group A) or three (1 ingress, 2 egress) 14 gauge needles (group N) with 5L 0.9% NaCl. The egress fluid from each liter of lavage was collected separately, and the number of microspheres present in each recovered liter was determined via spectrophotometry. Results: A significant interaction (p<0.01) was present between treatment group and liter. The number of microspheres recovered in the first liter of lavage fluid was significantly higher in the needle group than in the arthroscope group (p<0.01). For both groups the number of microspheres recovered in the first liter of lavage fluid represented a majority of the total microspheres collected, and was significantly different from the subsequent liters collected (p<0.01). The number of microspheres recovered did not differ between liters 2, 3, 4, and 5, within or between treatment groups. Conclusions: In this model, tarsocrural lavage with three 14-gauge needles was more effective at removing colored microspheres from the joint than arthroscopic lavage, suggesting the number or placement of portals present may be more important than portal size and flow rate. No difference in microsphere recovery was seen with lavage volumes greater than 1L.
30
Serena, Alberto. "Synovial membrane microarthroscopy of the equine midcarpal joint technique application and evaluation of four vital stains /." Auburn, Ala., 2005. http://repo.lib.auburn.edu/2005%20Summer/master's/SERENA_ALBERTO_5.pdf.
31
Шищук, Володимир Дмитрович, Владимир Дмитриевич Шищук, and Volodymyr Dmytrovych Shyshchuk. "Артроскопия - диагностика и лечение внутрисуставных повреждений коленного сустава (собственный опыт)." Thesis, Издательство СумГУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/15233.
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Шищук, Володимир Дмитрович, Владимир Дмитриевич Шищук, Volodymyr Dmytrovych Shyshchuk, Дмитро Володимирович Шищук, Дмитрий Владимирович Шищук, Dmytro Volodymyrovych Shyshсhuk, and Ю. М. Бадіон. "Артроскопія, як метод сучасної діагностики та лікування патології колінного суглоба." Thesis, Видавництво СумДУ, 2010. http://essuir.sumdu.edu.ua/handle/123456789/5533.
33
Garfjeld-Roberts, Patrick. "Improving simulation training in orthopaedics." Thesis, University of Oxford, 2018. http://ora.ox.ac.uk/objects/uuid:c48dcc24-6850-476f-b143-b02cda4e0429.
Abstract:
The way surgical trainees acquire technical skills is changing in modern surgical training programmes: simulation is proposed as a key part of those changes. Arthroscopy is a surgical technique that is increasing in both incidence and technical complexity; where simulation is becoming common, but evidence is limited. Real-world performance improvements can be measured following simulation training in other fields, but equivalent measures of intra-operative performance are inadequate. Thus, although surgical simulation is popular and improves simulated performance, there is little objective evidence that it improves intra-operative performance. The original contribution of this thesis is to objectively demonstrate the transfer of simulation training into improved intra-operative technical skills. To achieve this, a systematic literature review investigated the quantitative metrics currently used to measure arthroscopic performance, identifying wireless motion analysis as a potential method to assess performance intra-operatively. Motion analysis is a recognised objective method to measure surgical activity which correlates with surgical experience, so wireless motion analysis was validated against a wired motion analysis method commonly used in simulation but not feasible for intra-operative use. Wireless motion analysis metrics were further validated with a simulated arthroscopy list: this environment allowed deliberate practice of arthroscopic sub-skills with proximate feedback for independent practice. This simulated arthroscopy list with wireless motion analysis was used in two randomised studies: the penultimate study of this thesis investigated the impact of simulated practice on the arthroscopic learning curve and showed that performance improved rapidly with independent practice but was not modified by feedback, while the final study investigated additional simulation practice during early surgical training, and objectively demonstrated that additional simulation training improved intra-operative performance compared to traditional training alone. This thesis is the first to objectively show that simulation affects intra-operative behaviour. It sets the groundwork for further investigations into efficient, cost-effective simulation and the impact of simulation training on patient outcomes.
34
Quach, Lucian. "Application of gestural guided continuum robots in orthopaedic surgery." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/208080/1/Lucian_Quach_Thesis.pdf.
Abstract:
This thesis describes the design and control of snake like concentric tube robots for the purposes of minimally invasive, orthopaedic arthroscopic procedures, although similarities can be drawn in multiple surgical contexts. It analyses multiple aspects of delivering the technology, including different forms of robot hardware, the role of robots in surgery and different control modalities including gesture recognition. A prototype tube robot developed by the Australian Centre for Robotic Vision is tested and end user feedback provided to further refine its development.
35
Martikainen, M. (Matti). "Day-case anaesthesia in adult knee arthroscopy:with special reference to recovery and cost-effectiveness after general and spinal anaesthesia." Doctoral thesis, University of Oulu, 2002. http://urn.fi/urn:isbn:9514267729.
Abstract:
Abstract
The number of ambulatory surgical procedures is increasing throughout the world. This is partly due to the development of a number of new anaesthetic, analgesic and adjuvant drugs, each with more rapid onset and shorter duration of action, over the past two decades. An interest in the issues discussed in this thesis arose out a desire to improve the quality of anaesthesia for patients who undergo day-case surgery. A second aim was to compare the different anaesthetic methods in terms of recovery from anaesthesia and costs.
A total of 233 patients undergoing day-case knee arthroscopy under either 2% or 5% lidocaine spinal anaesthesia or general anaesthesia with desflurane, isoflurane, propofol or sevoflurane were investigated in two prospective, randomised clinical trials. The overall aims were to find the most suitable, satisfactory and economically feasible method for adult ambulatory knee arthroscopy and to assess the factors that affect the immediate postoperative period and the one-week recovery profile at home.
The patients were highly satisfied with all the methods of anaesthesia. There was a slight tendency in favour of general anaesthesia compared to spinal anaesthesia. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively and continued to be low during the first postoperative week. After short-acting general anaesthesia with desflurane, isoflurane and propofol, home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Home readiness was significantly delayed after 2% lidocaine spinal anaesthesia compared to sevoflurane inhalation anaesthesia. General anaesthesia with isoflurane was cheaper than the other general anaesthetics, i.e. desflurane, sevoflurane, propofol, or 2% and 5% lidocaine spinal anaesthesias. Propofol anaesthesia was the most expensive. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia.
In busy ambulatory surgery units, remarkable savings may be achieved by using short-acting general anaesthetics, i.e. desflurane and isoflurane, instead of propofol or sevoflurane general anaesthesias or lidocaine spinal anaesthesia. This is due to the lower costs of desflurane and isoflurane compared to sevoflurane and propofol and the shorter time needed for postoperative care compared to spinal anaesthesia.
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Budrienė, Edita. "Infekcijų kontrolės valdymas ankstyvam pooperaciniam infekcinių komplikacijų atsiradimui po artroskopinių operacijų." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2013. http://vddb.laba.lt/obj/LT-eLABa-0001:E.02~2013~D_20130604_151755-51137.
Abstract:
Tyrimo tikslas: nustatyti infekcinių komplikacijų rizikos veiksnius ir jų kontrolės valdymo mechanizmą artroskopinių operacijų metu.
Tyrimo metodai. Anketinė apklausa, stebėjimo tyrimas operacinėje, dokumentinė analizė ir statistinė analizė. Anketavimui buvo naudojami klausimynai, o stebėjimo tyrimui – kriterijai, įtakojantys infekcijų kontroliavimą operacijų metu.
Tiriamieji. Tyrimas vyko 2013 m. sausio – balandžio mėnesiais. Jo metu buvo sudarytos dvi tiriamųjų grupės (anketinis tyrimas) ir atliktas operacinės personalo stebėjimo tyrimas.
Pirmąją grupę sudarė 6 (85,7 proc.) Ortopedijos traumatologijos skyriuje dirbantys chirurgai.
Antrąją grupę tiriamųjų sudarė Ortopedijos traumatologijos skyriaus operacinėje 14 (93,3 proc.) dirbančių operacinės slaugytojų.
Stebėjimo tyrimo metu operuojant pacientus, buvo stebima operacinėje dirbančių chirurgų ir operacinės slaugytojų veiksmai, kurie įtakoja infekcijos kontrolės valdymą. Šio tyrimo metu išoperuotas 51 pacientas. Operacijos atliktos LSMUL KK Ortopedijos traumatologijos klinikoje Ortopedijos traumatologijos skyriaus operacinėje. Po operacijų pacientai gulėjo LSMUL KK Ortopedijos klinikoje Ortopedijos traumatologijos skyriuje.
Rezultatai. Palygintos chirurgų ir operacinės slaugytojų žinios apie infekcijos kontrolės valdymą, nustatyti operacinio personalo judėjimo ypatumai artroskopinių operacijų metu bei įvertinta chirurgų ir operacinės slaugytojų nuomonė apie veiksnius, kurie padėtų valdyti infekcijų riziką.
Išvados... [toliau žr. visą tekstą]Aim of research: to identify risk factors for infectious complications and the control mechanism during arthroscopic surgery. Research methods: A questionnaire, an observational study at operating, documentary analysis and statistical analysis. Question forms were used in questionnaires; whereas the criteria that influence infection controls during operations were used for the observation research. Research. The study took place in January – April, 2013. Two groups of persons under investigation (questionnaire survey) have been formed and the operating personnel tracking study was carried out. The first group consisted of 6 surgeons (85.7 percent) working at Orthopedics and Traumatology departments. The second group consisted of 14 (93.3 percent) Orthopedics and Traumatology department surgery nurses. Infection control management practices of operating surgeons and nurses that make an influence on infection controls have been monitored on surgery patients. 51 patients underwent surgeries in the course of this study. Surgeries were made at Orthopedic Traumatology Clinics of Orthopedics and Traumatology Department at LUHS Kaunas Clinics. After surgery, the patient were staying at Orthopedic Traumatology Department of LUHS Kaunas Clinics Orthopedic Clinic. Results. A comparison of infection control management knowledge between surgeons and surgery nurses was made, movement characteristics of operational staff during arthroscopic surgeries were identified and the infection... [to full text]
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Lino, Junior Waldo. "A reparação do labio da glenoide associada a reducação do volume capsular astroscopico na instabilidade do ombro." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312281.
Abstract:
Orientador: William Dias BelangeroTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Realizamos o tratamento artroscópico da instabilidade traumática do ombro anterior e ântero-inferior, associando três procedimentos ¿ a reparação do lábio da glenóide, a redução do volume capsular e o fechamento do intervalo rotador ¿ com o objetivo de analisar os resultados, considerando estabilidade e função. Entre janeiro de 1999 e dezembro de 2003, 27 pacientes foram submetidos ao tratamento artroscópico, por reparação do lábio da glenóide com âncoras metálicas, redução do volume capsular por capsulorrafia térmica e sutura do espaço rotador. Esses pacientes foram avaliados no pré e pós-operatórios, pelas escalas de UCLA e Rowe e, no pós-operatório, utilizando a escala de ASES. Durante um período de seguimento médio de 32,4 meses (variando de 22 a 74 meses), todos os ombros permaneceram estáveis. Usando a escala da UCLA, houve melhora do período pré-operatório, passando de 24,7 pontos (em média) para 32,81 pontos (em média) no período pós-operatório. A melhora também foi observada pela escala de Rowe, com a média 39,81 no pré-operatório, para 90,74 no período pós-operatório. Na escala de ASES a média foi de 92,22. Todos os ombros permaneceram estáveis e houve melhora funcional marcante dos pacientes que foram tratados. Esses resultados são comparáveis àqueles observados na cirurgia aberta, considerando critérios de seleção de pacientes similares
Abstract: We performed arthroscopic treatment of traumatic anterior and anteroinferior shoulder instability combining three procedures--labrum repair, reduction of capsular volume and suture of the rotator cuff interval--with the aim of analysing the results with regard to stability and function. Between January 1999 and December 2003, 27 patients underwent arthroscopic treatment for labrum repair with metal anchors, reduction of capsular volume through thermal capsulorrhaphy and suture of rotator cuff interval. These patients were evaluated in the pre- and postoperative period using the UCLA and Rowe scales and in the postoperative period using the ASES scale. During a mean follow-up period of 32.4 months (range 22-74 months) all shoulders remained stable. Using the UCLA scale, there was improvement from the preoperative period, with a mean score of 24.7, to the postoperative period, with a mean of 32.81. Improvement was also shown by the Rowe scale, with a mean score of 39.81 in the preoperative period and 90.74 in the postoperative period. On the ASES scale the mean score was 92.22. All shoulders remained stable and there was marked functional improvement in the patients who were treated. These results are comparable to those obtained with open surgery, observing similar patient selection criteria
Doutorado
Pesquisa Experimental
Doutor em Cirurgia
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Kemper, Daniella Aparecida Godoi. "Comparação da ação analgésica do emprego sistêmico de tramadol, fenilbutazona, ou ambas as combinações em equinos submetidos à artroscopia." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-01112013-142658/.
Abstract:
A utilização do tramadol por via sistêmica é uma ótima opção no tratamento analgésico pós-operatório em outras espécies, promovendo analgesia satisfatória e de duração moderada com mínimos efeitos colaterais. Entretanto, os efeitos do emprego deste fármaco na espécie eqüina ainda são pouco conhecidos, bem como sua real aplicação, pois faltam estudos clínicos nesta espécie. Portanto, este estudo teve o intuito de comparar a ação analgésica da administração de tramadol, fenilbutazona, ou ambas combinações em cavalos submetidos à cirurgias de artroscopia. Avaliou-se o efeito analgésico através da escala numérica de dor, escala descritiva composta, escala facial e escala proposta por Lascelles. Foram também avaliadas as alterações na freqüência cardíaca, freqüência respiratória, alterações de motilidade gastrointestinal, recuperação anestésica, bem como os níveis sérico de cortisol, TNF-α, IL-1Ra, e IL-10. Foram utilizados 18 animais provenientes do Serviço de Cirurgia do Hospital Veterinário da Universidade de São Paulo. Estes animais foram distribuídos em 3 grupos de forma aleatória, com 6 animais em cada grupo. Os animais receberam os analgésicos antes do estímulo cirúrgico, o grupo T recebeu tramadol, na dose de 2 mg/kg pela via intravenosa, o grupo F recebeu fenilbutazona, na dose de 4,4 mg/kg pela via intravenosa e o grupo TF recebeu a associação de ambos os fármacos. Os parâmetros FC, FR, temperatura, motilidade intestinal e analgesia foram avaliados por 6 horas. Os resultados foram analisados estatisticamente pelos testes de Kruskal-Wallis, Friedman, ANOVA, e ao pós teste de Tukey, com nível de significância de 5%. Não houve diferença entre os tratamentos em relação ao peso, idade, tempo cirúrgico, escore de recuperação anestésica, FC, FR, temperatura, motilidade gastrointestinal, dosagem sérica de cortisol e citocinas, e nas escalas de avaliação de dor. Com base nos resultados obtidos, pôde-se concluir que o tramadol, a fenilbutazona e a associação tramadol-fenilbutazona promoveram analgesia de boa qualidade no pós-operatório de artroscopia em cavalos; o tramadol na dosagem de 2 mg/kg mostrou eficácia analgésica semelhante à fenilbutazona; e não foram observado efeitos adversos relacionados aos parâmetros fisiológicos durante o período do estudo.The use of tramadol systemically is a great option for treating postoperative pain in other species, providing satisfactory analgesia with moderate duration and minimal side effects. However, the effects of this drug in horses are still poorly understood, and also its application, because clinical trials are lacking in this species. Therefore, the present study aimed to compare the analgesic effect of tramadol, phenylbutazone, or both combinations in horses undergoing arthroscopic surgery. The analgesic effect was evaluated using numeric pain scale, descriptive composite pain scale, facial scale and the scale proposed by Lascelles. Changes in heart rate, respiratory rate, gastrointestinal motility, anesthesia recovery, and the serum levels of cortisol, TNF-α, IL-1Ra, and IL-10 were also evaluated. Eighteen animals from the Department of Surgery of the Veterinary Hospital at the University of São Paulo were used. These animals were divided into 3 groups randomly, with 6 animals in each group. The animals received analgesics before surgical stimulus, group T received tramadol, 2 mg/kg intravenously, group F received phenylbutazone, 4,4 mg/kg intravenously, and group TF received the combination of both drugs. The parameters HR, temperature, motility and analgesia were assessed for 6 hours. The results were statistically analyzed by the tests Kruskal-Wallis, Friedman, ANOVA and Tukey post test, with significance level of 5%. There was no difference between treatments in relation to weight, age, duration of surgery, anesthetic recovery score, HR, temperature, gastrointestinal motility, serum cortisol and cytokines, and the rating scales of pain. Based on these results, we conclude that tramadol, phenylbutazone and tramadol-phenylbutazone promoted good analgesia in arthroscopy postoperative period in horses; tramadol dosage of 2 mg/kg presented similar analgesic efficacy to phenylbutazone, and there was no adverse effect related to physiological parameters during the study period.
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Stievani, Fernanda de Castro. "Desenvolvimento de protocolo de reabilitação no período pós-operatório inicial de artroscopia em equinos." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-05012015-145247/.
Abstract:
O presente estudo teve por objetivo avaliar protocolo de reabilitação para o período pós-operatório inicial de artroscopias visando diminuir a inflamação no local operado e aumentar a mobilidade articular. Foram utilizados 12 equinos (total de 20 articulações) encaminhados para artroscopia com diagnóstico de osteocondrite dissecante. Dessas, dez articulações receberam protocolo de reabilitação nos primeiros cinco dias do período pós-operatório. O protocolo consistiu em crioterapia, movimentação passiva da articulação e exercício controlado de baixa intensidade, além de uso sistêmico de anti-inflamatório. O outro grupo, também composto por dez articulações, recebeu apenas a terapia utilizada rotineiramente no HOVET-USP, consistido de repouso em baia e antiinflamatório. As articulações foram avaliadas quanto à circunferência em centímetros, ângulo de flexão, termografia, grau de claudicação. Amostras de líquido sinovial foram coletadas imediatamente antes do procedimento cirúrgico (D1), após 48h (D3) e após 96h (D5) para análise física, qualidade do coágulo de mucina, e quantificação de biomarcadores (IL-1, IL-6 e IL-10, PGE2 e SAA). As análises de exame de claudicação, circunferência articular, ângulo de flexão articular e termografia não apresentaram diferenças significativas entre os grupos, nem entre os diferentes dias do mesmo grupo. Na análise do líquido sinovial, a cor e o aspecto apresentaram piora do D1 para o D3, de amarelo claro para avermelhado e de límpido para turvo, respectivamente, nos dois grupos. No entanto, no grupo tratado houve melhora do D3 para o D5, tanto para cor (de avermelhado para maioria xantocrômica e amarela) como aspecto (de maioria turva para ligeiramente turva). No grupo controle os líquidos permaneceram sem alteração em cor e aspecto de D3 para D5, e nas comparações entre os grupos não houve diferença para D1, D3 e D5. A viscosidade do líquido sinovial no grupo controle diminuiu significativamente quando comparados D1, D3 e D5. Já no grupo tratado a diminuição da viscosidade só foi observada quando comparados D1 e D5. O coágulo de mucina apresentou piora de D1 para D3 no grupo controle, com elevação não significativa de D3 para D5, enquanto que para o grupo tratado não houve diferença significativa de D1 para D3 e de D3 para D5, quando comparados o D5 dos dois grupos, o tratado obteve melhor qualidade. As concentrações de interleucina nas amostras não forneceram dados suficientes para análise. Na análise das concentrações de PGE2 não houve diferença entre os grupos nos diferentes momentos, ocorrendo elevação de D3 para D5 em ambos os grupos, porém, no grupo tratado não há diferença entre D1 e D5. Já para SAA os grupos apresentaram comportamento similar de resposta, com elevação de D1 para D3 e queda de D3 para D5, porém menos acentuado no grupo tratado, o que levou a diferença entre os grupos em D3. Pode-se concluir, que o protocolo de reabilitação, apesar de não gerar diferença significativa para as avaliações de exame físico dos animais, proporcionou melhor qualidade de líquido sinovial quanto a cor, aspecto, viscosidade e precipitado de mucina, além de evidenciar menores elevações nas concentrações de marcadores inflamatórios no liquido sinovial durante o período estudado.The purpose of this study was to evaluate a rehabilitation protocol for the initial postoperative period of metatarsophalangeal, metacarpophalangeal and tarsocrural´s arthroscopies, which seeks to, minimize local inflammation, diminish swelling, promote better joint range of motion and pain relief during such period. Twelve horses participated in this study - amounting to 20 joints - with dissecans ostheochondritis diagnosis. The first group was formed by ten joints, which were treated under rehabilitation protocol for the first 5 days as from the surgery (Treated group). The rehabilitation protocol consisted of cryotherapy, passive range of motion, low intensity exercise and non-steroidal anti-inflammatory drug. The second group also formed of ten joints received the standard HOVET-USP therapy, which consists of rest and non-steroidal anti-inflammatory drug Both groups were treated with the same non-steroidal anti-inflammatory drugs. The joints were measured for circumference, maximal flexion angle, thermography, and lameness score on the day before the surgery (D0) and during the first four days after the surgery. Synovial fluid samples were collected immediately before surgery (D1), within 48 hours (D3), and within 96 hours from the surgery (D5). The analysis evaluated gross appearance (color and aspect), viscosity and mucin clot quality, as well as biomarkers (Il-1, Il-6, Il- 10, PGE2, and SAA) quantification. Lameness examination, joint circumference, flexion angle and thermography evaluation were not significantly different between groups. In synovial fluid analyses de color and aspect have worsen from D1 (clear light yellow) to D3 (turbid hemorrhagic) in both groups. On treated group color and aspect improved from D3 (turbid hemorrhagic) to D5 (xanthochromic and yellow slightly turbid). On treated group there was no difference between D3 and D5. When the groups were compared, none significant differences was seen. The fluid viscosity of control group had significant decrease from D1, to D3 and from D1 and D5. In treated group this viscosity decrease was only seen between D1 and D5. The mucin clot formation worsened when D1 e D3 of control group was compared and remains similar from D3 to D5. In treatment group there were no differences when compared D1 with D3 and D3 with D5. The comparison between groups of D5 has shown treated group improved clot. The interleukin couldn´t be measured on sufficient number of samples for the statistics method. There were no differences between groups on all moments. The PGE2 response was similar in both group with a rise on concentration from D3 to D5. In treated group D1 was similar to D5. This results suggests more evident inflammatory response in the control group. For the SAA the groups have shown similar responses, with an increase from D1 to D3 and decrease from D3 to D5. The response on treated group was less intense and demonstrates lower values in D3 when compared with D3 control group. It was concluded with this study that rehabilitation protocol improved synovial fluid analyses for, color, aspect, viscosity and mucin clot. It even had promoted lower concentrations of inflammatory biomarkers for the treated group during the period.
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Oliveira, Ronaldo Silva de. "Modelo Experimental da Artros copia do quadril cadÃveres de recÃm-nascidos submetidos do Extresse Axial." Universidade Federal do CearÃ, 2001. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=1774.
Abstract:
CoordenaÃÃo de AperfeiÃoamento de NÃvel SuperiorO desenvolvimento do artroscÃpio possibilitou ao cirurgiÃo ortopÃdico o acesso a diversas articulaÃÃes. O quadril, que apresenta complexa anatomia e topografia, permaneceu por muito tempo como uma barreira para os artroscopistas. Com os avanÃos ocorridos ao longo da Ãltima dÃcada, as indicaÃÃes vÃm crescendo a cada ano. Isto fez da artroscopia do quadril uma valiosa tÃcnica que preencheu uma lacuna no esclarecimento diagnÃstico, freqÃentemente pouco elucidativos mesmo com utilizaÃÃo de modernos mÃtodos; possibilitando o tratamento de um nÃmero cada vez maior de afecÃÃes desta articulaÃÃo. Em adultos o mÃtodo à ainda pouco utilizado e em crianÃas apresenta indicaÃÃes muito restritas. Assim, foi decidido realizar um trabalho que propiciasse o desenvolvimento de um modelo experimental de treinamento do mÃtodo artroscÃpico, e atravÃs deste, observar aspectos histomorfolÃgicos de estruturas intra-articulares submetidas à traÃÃo axial. Utilizando quadris de 20 cadÃveres de recÃm-nascidos foi testada a possibilidade de realizar o procedimento. Seis fetos (A1 a A6), representaram o projeto piloto, servindo para desenvolver o modelo de pesquisa e catorze o estudo principal (B1 a B14), seguindo critÃrios estabelecidos com o projeto piloto. Em todos os fetos realizou-se o procedimento utilizando Ãtica de 2,2 mm de espessura com 30 de angulaÃÃo e em todos aplicada traÃÃo axial que variou de 68 a 88 N. Foram utilizados dois portais: antero-lateral e lateral, e no final feito artrotomia e anÃlise histomorfolÃgica das estruturas: pulvinar, labrum acetabular e ligamento redondo do quadril. Ficou estabelecido com o estudo piloto que o procedimento somente à possÃvel realizar com fetos maiores, pois nos quatro fetos em que o peso era abaixo de 1500 g, o procedimento foi tecnicamente impossÃvel. A traÃÃo Foi necessÃria para uma completa inspeÃÃo da articulaÃÃo. Constatou-se ainda que atravÃs de um sà acesso nÃo foi possÃvel visualizar toda a articulaÃÃo, mas, que a utilizaÃÃo de dois acessos, os portais lateral e antero-lateral, oferecem boa seguranÃa sendo possÃvel reproduzir o mÃtodo artroscÃpico e identificar a maior parte das estruturas anatÃmicas intra-articulares. Concluiu-se que a artroscopia do quadril tem tÃcnica difÃcil, mas factÃvel em cadÃveres de recÃm-nascidos com peso superior a 1700 g e nÃo foram encontradas lesÃes macroscÃpicas ou histolÃgicas sobre as estruturas estudadas em fetos submetidos a uma traÃÃo de atà 88 N.
Surgical access to different joints was made possible due to the development of the arthroscope. On account of its complex anatomy and topography the endoscopic access to the hip joint seemed to be an unattainable goal by many specialists for a long period of time. Last decade progress turned arthroscopic examination indications an ever growing need. The procedure helped to fill out the gap in the diagnostic area of hip joint diseases making possible the treatment of many illnesses affecting the joint. Despite this progress the exam is not widely performed in adult patients. Also, usage in children presents very restricted limitations. This paper was aimed at developing an experimental model of hip arthroscopy and to study the histomorphological damages resulted from its use in structures subjected to traction. Twenty newborn cadavers were used. Six fetuses use used during the pilot project (A1-A6). The remainder fourteen fetuses were used during the main study (B1-B14). Optical system (2.2 mm diameter) and 30o angulation were used. Axial traction was applied to all cases (68-88 N). Antero-lateral and lateral ports were used for surgical access to the hip. Histomorphological studies of pulvinar, labrum acetabulare and hip round ligament were carried out in each case. A pilot study has demonstrated that the application of this technique is not feasible in fetuses weighing less than 1500g. The traction was required to secure a complete inspection of the articulation. Using just one port was not possible to visualize all structures. The simultaneous use of lateral and anterolateral ports provided adequate exposure to all joint structures. It is concluded that hip arthroscopy is not an easy procedure although feasible in newborn cadavers weighing more than 1700 g. No macroscopic or histological lesions were identified in fetuses submitted to traction of up to 88 N
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Tatarunas, Angelica Cecilia. "Estudo artroscópico das articulações do ombro e joelho no cão." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-14072005-134915/.
Abstract:
O objetivo do presente trabalho foi o estudo artroscópico das articulações do ombro e do joelho no cão. Durante o exame artroscópico avaliou-se possibilidade de visibilização das estruturas intra-articulares, facilidades e dificuldades inerentes à técnica e complicações. Fez-se análise citológica de líquido sinovial e histopatológica de membrana sinovial da articulação do joelho. Realizou-se a artroscopia em 10 articulações (9 cães) do ombro portadoras de osteocondrite dissecante e em 53 articulações (50 cães) do joelho, as quais apresentaram ruptura de ligamento cruzado cranial total ou parcial associada ou não a lesão de menisco medial ou lateral e luxação medial de patela. Na articulação do ombro as complicações consistiram na dificuldade de confecção dos portais artroscópico e instrumental pela técnica de triangulação, lesão iatrogênica de cartilagem, deslocamento prematuro do artroscópio e acúmulo de fluído nos tecidos moles periarticulares. As estruturas observadas foram sulco intertubercular, tubérculo supraglenoidal, tendão do M. bíceps braquial, cartilagem da cabeça do úmero (cranial e caudal) e da cavidade glenoidal, ligamento glenoumeral medial, bolsa articular caudal e sinóvia. As lesões de cartilagem observadas durante estudo artroscópico destas articulações foram condromalácea, erosão, eburnação e fibrilação na cabeça do úmero e erosão na cavidade glenoidal, além de retalho de cartilagem livre (próximo ao defeito na cabeça do úmero, na bolsa articular caudal, próximo ao tendão do M. bíceps braquial e na porção medial da articulação) ou fixo junto ao defeito na cabeça do úmero. Em um animal o retalho de cartilagem foi removido via artroscopia e nos demais através de artrotomia. Durante exame artroscópico da articulação do joelho observou-se região suprapatelar, patela, tróclea, côndilo lateral e medial do fêmur, côndilo lateral e medial da tíbia, menisco lateral e medial, tendão do M. extensor digital longo, ligamento cruzado cranial e caudal, ligamento intermeniscal, ligamento mucoso e sinóvia. Complicações consistiram principalmente de infiltração de tecidos moles periarticulares e obstrução do campo de visão pelo coxim adiposo infrapatelar. Diferenças entre o diagnóstico artroscópico e a confirmação após artrotomia concentraram-se na diferenciação entre ruptura completa e parcial do ligamento cruzado cranial (n=3) e afecção de menisco (n=6). A artroscopia trouxe informações sobre a membrana sinovial, alteração em menisco lateral e ligamento cruzado caudal não perceptível durante artrotomia. O estudo citológico denotou processo não inflamatório na maioria das articulações estudadas. Em análise histopatológica obteve-se processo inflamatório crônico, agudo e uma articulação com sinovite linfocitica plasmocitica. A artroscopia é uma técnica endoscópica que demanda intenso treinamento para a sua realização; e, permite um exame rico em minúcias que traz informações significativas que poderão ajudar a elucidar as afecções articulares que acometem a espécie canina.The aim of this approach is shoulder and knee arthroscopic study in the dog. During the arthroscopic exam it was analyzed the possibility to see the structures into the joint; facilities and difficulties concerning the technique and its complications. Cytological synovial fluid and histopathological synovial membrane studies of the knee joint were performed. The arthroscopy was carried out in ten shoulder joints (nine dogs) which had osteochondritis dissecans and in fifty-three knee joints (fifty dogs), which had complete or partial cranial cruciate ligament rupture associated or not with medial or lateral meniscal damage and medial patella luxation. In the shoulder joint the complications consisted of the difficulty in doing the arthroscopic and instrumental portal using the triangulation technique, iatrogenic lesion, premature removal of the arthroscopy and periarticular infiltration. The observed structures were intertubercular groo, supraglenoid tubercle, tendon of biceps brachii muscle, cartilage of the humeral head (cranial and caudal) and glenoid cavity, medial glenohumeral ligament, caudomedial gutter and synovium. The lesions of the articular cartilage observed during the exam in the shoulder joint were chondromalacia, erosion, eburnation, fibrillation in the humeral head and erosion of the glenoidal cavity besides joint mice (near the defect on the humeral head, on the caudomedial gutter, near the tendon of biceps brachii muscle and in the medial gutter) and flap in the caudomedial humeral head. In one animal the flap was removed by arthroscopy while in the others it was removed by arthrotomy. During the arthroscopic exam of the knee joint it was remarked suprapatellar joint pouch, patella, trochlea, lateral and medial femoral condyle, lateral and medial tibial condyle, lateral and medial meniscus, tendon of long digital extensor muscle, cranial and caudal cruciate ligament, intermeniscal ligament and synovium. The main complications consisted of periarticular infiltration and obstruction of the field of vision by the infrapatellar fat pad. The differences between the diagnostic after arthroscopy and confirmation by arthrotomy were the differentiation between complete and partial rupture of the cranial cruciate ligament (n=3) and meniscal lesion (n=6). The arthroscopy exam provides information about lateral meniscal and caudal cruciate ligament lesion which are not noticeable by arthrotomy. The cytological study showed no-inflammatory process in most of the joints. In the histopathological analysis the results were chronic and acute inflammatory process and one joint having plasmacytic lymphocytic synovitis. The arthroscopy is an endoscopic technique that requires continuous training to be achieved and gives a detailed exam with significant information which could help to explain a lot of diseases in joints of the canine species.
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Joglar, Filipa Varela de Almeida. "Contribuição para o estudo da utilização da artroscopia em equinos em Portugal : estudo de 50 casos." Master's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2011. http://hdl.handle.net/10400.5/3518.
Abstract:
Dissertação de Mestrado Integrado em Medicina VeterináriaO desenvolvimento da técnica artroscópica permitiu um grande avanço na ortopedia veterinária, tendo revolucionado o diagnóstico das doenças articulares em equinos e o seu tratamento cirúrgico por métodos minimamente invasivos. O acompanhamento da actividade cirúrgica durante, aproximadamente, 3 anos permitiu a recolha de uma quantidade considerável de dados relativos à realização de artroscopias e tenoscopias em Portugal. Ainda que possam não representar a totalidade da realidade portuguesa, são um importante contributo para o seu estudo, tendo sido o primeiro trabalho do género a ser realizado, tanto quanto foi possível apurar. A casuística apresentada neste trabalho confirma a importância da aplicabilidade desta técnica cirúrgica em equinos para a resolução de uma grande variedade de afecções, com um mínimo de traumatismo cirúrgico e, consequentemente, com um menor tempo de recuperação pós-cirúrgica e menor dor, mesmo que tenham sido intervencionadas várias articulações em simultâneo. Foram acompanhados 50 animais, submetidos a 59 anestesias gerais, resultando num total de 85 acessos cirúrgicos a várias articulações e à bainha sinovial digital. O principal objectivo da maioria foi a resolução cirúrgica de uma afecção concreta. Em alguns casos, o primeiro objectivo foi a obtenção de um diagnóstico mais específico e a sua posterior resolução cirúrgica. Foram realizados 63 acessos cirúrgicos para diagnóstico e/ou terapêutica de osteocondrose; três acessos para diagnóstico e resolução de três casos de Doença Articular Degenerativa; dois acessos para remoção de fragmentos plantares na articulação metatarso-falângica; dois acessos para a resolução de uma fractura do osso acessório do carpo; um acesso para desbridamento de um quisto subcondral do osso metacarpiano III; um acesso para remoção de fragmentos de fractura de primeira falange; e um acesso para confirmação e remoção de um corpo radiopaco correspondente a metaplasia óssea do tendão extensor digital comum ao nível da articulação interfalângica distal. Foi também realizada uma lavagem articular, em consequência de uma artrite séptica na articulação metacarpo-falângica, a qual surgiu como possível complicação de uma injecção intra-articular. Foram também feitos 10 acessos por tenoscopia à bainha sinovial digital, dos quais sete para a realização de desmotomias do ligamento anular digital palmar ou plantar e três acessos para lavagem de uma bainha para resolução de uma tenossinovite séptica. Este trabalho é bastante generalista por se ter baseado numa amostra muito heterogénea, o que dificultou a obtenção de conclusões inequívocas mas permitiu constatar tendências e impressões gerais acerca da população equina em Portugal.
ABSTRACT - CONTRIBUTION TO THE STUDY OF EQUINE ARTHROSCOPY UTILIZATION IN PORTUGAL: STUDY OF 50 CASES - The advent of arthroscopy was a significant breakthrough in veterinary orthopedics having revolutionized the diagnosis of joint disease in horses and its surgical treatment through non invasive methods. During approximately three years, the follow-up of the surgical activity allowed the gathering of a considerable amount of data on the realization of equine arthroscopies and tenoscopies in Portugal. It is an important contribute to its study, even though it may not represent the whole Portuguese reality, it is first study of this kind made in Portugal, as far as the author’s knowledge. The information collected confirms the importance of the applicability of this technique in equine patients to treat a great variety of diseases, with minimal surgical trauma and so, a faster recovery period and less pain, even if multiple joints were operated simultaneously. In this study, 50 equine patients were monitored after undergoing 59 general anesthesias which resulted in a total of 85 surgical procedures on several joints and on the synovial digital sheath, with the main goal of surgical resolution of a specific problem. In some of the cases the purpose was primarily of a diagnostic nature, then followed by surgical resolution. There were made 63 surgical approaches in order to either diagnose or treat osteochondrosis; three patients underwent surgery with a diagnostic and therapeutic purpose due to Degenerative Joint Disease; two patients were operated in order to remove plantar fragments in the metatarsophalangeal joint; a patient underwent two surgeries due to a fracture of the accessory carpal bone; one patient was treated for a subchondral cyst present in the third metacarpal bone; one patient was operated to remove fragments of a broken first phalanx; and another patient underwent surgery for confirmation and removal of a fragment due to osseous metaplasia of the common digital extensor tendon at face of the distal interphalangeal joint. This procedure was also used to do a joint lavage as a result of septic arthritis in a metacarpophalangeal joint which possibly emerged as a complication of an intraarticular injection. There were 10 approaches to the synovial digital sheath. Seven of them were made to palmar or plantar digital annular ligament desmotomies and the other three were lavages of a synovial sheath with a septic tenosynivitis. This is a very general study because the test sample of the population was very heterogeneous, which made the achievement of unequivocal conclusions very difficult but allowed to notice some tendencies and general impressions about the Portuguese equine population.
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Wavreille, Vincent Alain. "Correlation Between Histopathologic, Arthroscopic and Magnetic Resonance Imaging Findings in Dogs with Medial Coronoid Disease." The Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1397060501.
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Ribeiro, Ana Sofia da Costa. "O uso de artroscopia no diagnóstico e tratamento da displasia do cotovelo canino." Bachelor's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2011. http://hdl.handle.net/10400.5/3273.
Abstract:
Dissertação de Mestrado Integrado em Medicina VeterináriaA articulação do cotovelo é sede das principais afecções responsáveis pela claudicação dos membros torácicos em cães. A displasia do cotovelo (DC) conduz a vários graus de doença articular degenerativa em cães em crescimento, de várias raças grandes, e compreende quatro doenças do desenvolvimento com sede nesta articulação: a não-união do processo ancóneo, osteocondrite dissecante do côndilo umeral, incongruência articular e fragmentação do processo coronóide medial, sendo esta última a mais frequente. Tem-se vindo a utilizar diversas técnicas imagiológicas de forma a melhorar o diagnóstico, no entanto, a radiografia simples continua a ser o meio mais utilizado, pelo seu baixo custo e fácil acesso, servindo de base à classificação da DC segundo o International Elbow Working Group. Ao longo dos últimos anos tem-se vindo a assistir a um aumento da utilização da artroscopia como meio de diagnóstico, pois possibilita a observação directa de alterações cartilagíneas, ao contrário dos outros meios. Desta forma, tornou-se o gold standard no diagnóstico de patologia articular e a sua associação à Tomografia Axial Computorizada (TAC) permite uma grande precisão diagnóstica. Adicionalmente, a artroscopia permite o tratamento da DC em simultâneo com o seu diagnóstico e em termos terapêuticos apresenta vantagens em relação à artrotomia, pois é uma cirurgia minimamente invasiva, com baixa probabilidade de infecção e tempo de recuperação inferior. O prognóstico, mesmo com tratamento artroscópico, é variável consoante a doença, idade e presença de osteoartrose. Independentemente do tipo de tratamento utilizado a progressão de osteoartrose é inevitável.
ABSTRACT - The elbow joint is the location of the main diseases responsible for the lameness of the anterior limb in dogs. Elbow dysplasia (ED) leads to several degrees in terms of degenerative joint disease on growing dogs, of several large breeds, and consists of four developmental pathologies based on this joint: the ununited anconeal process, osteochondritis dissecans of the humeral condyle, articular incongruence and fragmentation of the medial coronoid process, the latter being the most frequent. Several different imaging techniques have been used till this day; however, the simple x-ray is still the most used, due to its low cost and easy access, serving as base for the ED classification according to the Elbow Working Group. Over the past few years, it has been witnessed an increase in use of the arthroscopy as a mean of diagnostic, since it allows the direct observation of cartilaginous lesions, as opposed to other means. Thus, it has become the gold standard in diagnostic of articular pathology and when combined with computerized tomography, allows great precision on the diagnostic. Additionally, arthroscopy allows the treatment of elbow dysplasia while simultaneously diagnosing and in therapeutic terms it has many advantages comparing with arthrotomy because the surgery is minimally invasive, with low chances of infection and lower recovery time. Prognostic, even with arthroscopic treatment, varies accordingly to disease, age, and presence of osteoarthritis. Independently of the kind of treatment used, the osteoarthritis progression is inevitable.
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Johansson, Louise. "Analysis of cartilage surfaces using laser speckle imaging." Thesis, Linköping University, Department of Biomedical Engineering, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-5830.
Abstract:
An arthroscope is a diagnostic instrument for visualisation of the interior of a joint. By adding a laser to an arthroscope and feeding the images to a computer, one gets an method to measure the structure of the cartilage covering the joint. This gives an added diagnostic value. The laser will create laser speckles and this report covers the basic theories behind this. The anatomy of the joints, the properties of cartilage and the background on the disease arthritis are also covered, as well as the field of surface topography and image processing.
Experiments were performed on three different materials - metals of different definite surface roughness, polymerised collagen and bovine articular cartilage.
The conclusion is that the technique would work, providing that some obstacles could be overcome. The technique itself is very precise and detects nanometric differences in the surface structure, making it extremely interesting for research purposes, such as follow-ups on treatments and studies of arthritis and cartilage repair.
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Cruz, Rodrigo Silvério Ferreira da. "Tratamento cirúrgico da osteocondrite dissecante em equinos: estudo retrospectivo e análise crítica." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-07032012-150325/.
Abstract:
A osteocondrose é uma das principais doenças ortopédicas de desenvolvimento que acomete os equinos, sendo usualmente definida como uma falha no processo de ossificação endocondral. Infelizmente os seus mecanismos não estão bem definidos, mas acredita-se em uma etiologia multifatorial relacionada com predisposição genética, desequilíbrio ou excesso nutricional, fatores endócrinos e forças biomecânicas atuando nas articulações. Uma das formas de manifestação da osteocondrose é a osteocondrite dissecante, quando, após interrupção do processo de ossificação, há um desarranjo das colunas de condrócitos e necrose da camada basal, gerando uma área de fragilidade, onde forças biomecânicas podem resultar na separação de fragmentos cartilaginosos ou osteocondrais. Sua incidência esta relacionada com animais jovens, de crescimento rápido, em articulações predispostas como tibiotársica, metacarpo/metatarsofalangeana e femurotibiopatelar. Normalmente a lesão se desenvolve no primeiro ano de vida, mas os sinais clínicos podem aparecer mais tardiamente ou inclusive passarem despercebidos. Dentro dos sinais clínicos o mais comum é a efusão articular, que pode vir ou não associada à claudicação. O diagnóstico é confirmado através de exame radiográfico, com alterações em locais predispostos para formação de OCD, como crista intermédia da tíbia, cristal troclear lateral do talus, bordo dorsoproximal da primeira falange, bordo plantaromedial da primeira falange e crista troclear lateral do fêmur. Como essas lesões podem acometer mais de um membro locomotor, a articulação contralateral deve ser radiografada ou até mesmo os quatro membros quando se tratar de metacarpo/ metatarsofalangeana. Apesar de existirem diversas formas de tratamento, a maioria dos autores recomenda a retirada cirúrgica via artroscópica, já que esta possui um maior índice de sucesso com melhores resultados funcional e estético. Existem trabalhos divergentes com relação ao prognóstico e momento em que se deve submeter esses animais a cirurgia. Com o objetivo de responder essas dúvidas e apresentar os resultados obtidos com o tratamento cirúrgico a médio e longo prazo este trabalho foi realizado. Nesse estudo foram analisados 75 casos de animais acometidos por OCD, com um total de 106 articulações, tratados cirurgicamente, nos quais a cirurgia ocorreu há um tempo mínimo de 12 meses e máximo de 5 anos. As lesões acometeram principalmente (65%) animais até quatro anos, na fase anterior à doma ou no momento da doma (63%), sendo que a maioria não apresentava sinais clínicos (36%) ou apresentava claudicação associada à efusão articular (33%). A maioria das lesões se localizou na articulação tibiotársica (57%), e nessa articulação o local mais acometido foi a crista intermédia da tíbia (71%). Após o procedimento cirúrgico 72% dos animais não apresentaram sinais clínicos, sendo que a melhora foi mais significativa nos animais de 3 e 4 anos (100%) e pouco se obteve de melhora com relação a claudicação nos animais acima de 6 anos (27%).Osteochondrosis is a major developmental orthopedic disease affecting horses and is usually defined as a failure in the endochondral ossification process. Unfortunately its mechanisms are not defined but it is believed to be a multifactorial etiology related to a genetic predisposition, nutritional imbalance or excess, endocrine factors and biomechanical forces acting on the joints. Osteochondritis dissecans, one of the presentations of osteochondrosis, occours when after stopping the process of ossification, there is a breakdown of the chondrocytes columns and necrosis of the basal layer, creating an area of weakness, where biomechanical forces when applied can result in the separation of cartilage or osteochondral fragments. Its incidence is related to foals with rapid growth, in predisposed joints as tarsocrural, metacarpal/ metatarsalphalangeal and femorotibiopatellar. Usually the lesion develops in the first year of life, but clinical signs may appear later or even go unnoticed. Within the clinical signs, joint effusion is the most common, which may come or not associated with lameness. The diagnosis is confirmed by radiographic examination including changes in prone locations to OCD formation, as intermediate ridge of the tibia, lateral ridge trochlear of the talus, dorsal proximal edge of the first phalanx, plantar medial edge of the first phalanx and the lateral trochlear ridge of the femur. Because these lesions may involve more than one limb, the contralateral joint should be radiographed or even four limbs in the metacarpal/ metatarsalphalangeal. Although there are various forms of treatment most authors recommend surgical excision arthroscopically as this has a higher success rate with best functional and cosmetic results. There are conflicting studies concerning prognosis and best time to refer the animal for surgery. To answer these questions and present the results obtained with surgical treatment in the medium and long term this work was done. In this study we analyzed 75 cases of horses suffering from OCD, with a total of 106 joints treated surgically, which where the treated took place over a minimum of 12 months and a maximum of five years. OCD affected mainly animals up to 4 years (65%) in the period prior to tame or time-taming (63%), and the majority had no clinical signs (36%) or had lameness associated with joint effusion (33%). Most lesions were located in the tarsocrural joint (57%), in the intermediate ridge of the tibia (71%). After surgery 72% of horses showed no clinical signs, and the improvement was more significant in animals 3 and 4 years (100%) and little improvement of lameness in the animals over six years (27%).
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Contador, Carmen Gragera. "Perioperatório nas artroscopias equinas." Bachelor's thesis, Escola Superior Agrária de Elvas - Instituto Politécnico de Portalegre, 2022. http://hdl.handle.net/10400.26/39919.
Abstract:
O presente trabalho é um relatório de estágio resultado de um período de 3 meses de
estágio na clínica equina BJCM-Vet, entre Outubro de 2021 e Janeiro de 2022. O estágio
teve como principais áreas a medicina interna, odontologia, medicina desportiva e
ortopedia e cirugias (nomeadamente orquiectomias e artroscopias). A estagiária esteve
envolvida na preparação do material e instrumentos e realização de radiofrequências,
stock da clínica, profilaxia e resenhos. Neste sentido foi escolhido como tema principal
as artroscopias, indicadas na sua maioria para a remoção de fragmentos osteocondrais
nas articulações, ressaltando o papel que tem o Enfermeiro Veterinário durante este
tipo de cirugias. Durante o estágio foram acompanhados um total de 233 animais e
especificamente 41 cirugias, nomeadamente 14 artroscopias, 1 tenoscopia, 25
orquiectomias e 1 cirurgia oftalmológica. A artroscopia é um procedimento
minimamente invasivo que permite abordar a articulação através de uma pequena
incisão. O Enfermeiro Veterinário, como parte da equipa de cirugia, tem um papel crucial
na realização deste procedimento, de forma a reduzir o tempo da cirugia e facilitar o
trabalho aos cirurgiões, nomeadamente na avaliação pré-operatoria; na realização de
exames laboratoriais, anamnese e exame físico; no transoperatório; e no período pósoperatório. Constata-se assim que os cuidados perioperatórios são de elevada
importância para o suceso do procedimento cirúrgico, permitindo uma recuperação
com qualidade.The present report is a professional internship report resulting from a 3 month internship period at the equine clinic BJCM-VET, between October 2021 and January 2022. The internship had as prinicipal areas internal medicine, dentistry, sports medicine and orthopedics, surgeries (namely castrations and artroscopy), as well as the previous preparation of the necessary material and instruments, radiofrequencies, clinic stock, prophylaxis and reviews. In this sense, arthroscopies were chosen as the main topic, mostly indicated for the removal osteochondral fragments in the joints, emphasizing the role that the veterinary nurse has during this type of surgery. A total of 41 surgeries were followed, namely 14 arthroscopies, 1 tenoscopy, 25 orchiectomies and 1 ophtalmologic surgery. Arthroscopy is a minimally invasive procedure that allows addressing a joint through a small incision. The veterinary nurse, as part of the surgery team, has a crucial role in carrying out this procedure, in order to reduce the surgery time and facilitate the surgeons´work, namely in the preoperative evaluation; performing laboratory test, anamnesis and physical examination; intraoperatively; and in the postoperative period. It appears that perioperative care is of high importance for the success of the surgical procedure, allowing a quality recovery.
info:eu-repo/semantics/publishedVersion
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Silva, Marilene Machado. "Desenvolvimento de protocolo de avaliação, por determinação de escore, das alterações encontradas nas doenças articulares em equinos e sua correlação com evolução após tratamento." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/10/10137/tde-13112014-143630/.
Abstract:
O presente estudo teve por objetivo classificar, em tabelas de pontuação, as lesões articulares encontradas em equinos submetidos à artroscopia e correlacionar os escores com sua evolução após tratamento. Foram analisadas, de forma prospectiva, articulações tibiotársicas e metacarpo/metatarsofalangeanas de equinos de esporte encaminhados ao HOVET-USP. Cada articulação foi pontuada em tabelas de escore relacionadas a anamnese, e exames físico, ultrassonográfico, radiográfico e artroscópico. As pontuações foram somadas, determinando-se um escore por exame para cada articulação. A pontuação das imagens radiográficas e artroscópicas foram realizadas por estudo encoberto de três e quatro avaliadores, respectivamente. O proprietário ou médico veterinário responsável pelo animal respondeu a questionário relacionado à evolução do quadro e este foi correlacionado aos escores alcançados pela articulação, determinando-se o prognóstico para os escores. Foram avaliadas 78 articulações tibiotársicas e 48 metacarpo/metatarsofalangeanas. As pontuações mais frequentes na anamnese(>50%) foram as relacionadas ao início do quadro ou animais encaminhados por achados radiográficos ao exame pré-venda. Ao exame físico mais de 50% das articulações apresentaram claudicação, positividade ao teste de flexão, diminuição do ângulo máximo de flexão articular e aumento de temperatura articular externa. No exame radiográfico as alterações mais frequentes foram o aumento de volume de partes moles (37,4%) a presença de esclerose (40%) e osteólise do osso subcondral (67%), e fragmentos osteocondrais únicos evidentes (47,3%) com medidas abaixo de 5mm (30%). A ultrassonografia demonstrou alterações mais frequentes relacionadas ao líquido sinovial segundo seu aspecto, com predominância de material amorfo (33,1%) e quantidade aumentada em até a metade do volume fisiológico (40%), além da irregularidade do osso subcondral (41,3%). A presença de vasos sanguíneos evidentes (65,8%), do aumento volume e na quantidade das vilosidades da membrana sinovial (50%) e na presença de fibrilação (75,8%), fissuras (54,2%) e erosão superficial (70%) da cartilagem foram as alterações mais encontradas ao exame artroscópico, onde observaram-se, também, os fragmentos osteocondrais únicos (61,7%) e fixados ao local da lesão (86,7%). Os valores médios do escore radiográfico foram maiores (p=0,05) para as lesões palmares/plantares dos boletos (11,33±5,03) e para as articulações tibiotársicas (11,27±4,32) do que para as lesões dorsais dos boletos (9,18±3,5). As lesões nos boletos, dorsais (7,16±4,83) ou palmares/plantares (8,33±5,27) obtiveram médias de escore maiores (p=0,011) ao exame ultrassonográfico do que as tibiotársicas (5,65±3,36) e o inverso aconteceu na artroscopia com a média das tibiotársicas (12,96±6,22) superiores (p<0,001) às dos boletos (8,51±3,61) lesões dorsais ou lesões palmares/plantares (7,26±2,77). Houve concordância entre os avaliadores do exame radiográfico para as articulações tibiotársicas, e boletos com lesão dorsal e palmar/plantar. Mas apenas nas metacarpo/metatarsofalangeanas dorsais e palmares/plantares entre os avaliadores da artroscopia. A regressão logística mostrou que os escores relacionados à anamnese (1,178), exame ultrassonográfico (1,193) e artroscópico (1,213) determinam a chance de insatisfação do proprietário (acurácia de 80%). E sugere a utilização de calculadora para a obtenção da chance de insatisfação do proprietário para novos casos. Assim, concluiu-se que, as tabelas para normatização e pontuação aplicadas possibilitaram a determinação de escores para os exames realizados de forma satisfatória. Permitindo correlaciona-los com a chance de insatisfação frente o resultado atingido após o tratamento.This study aimed to classify joint damage in horses undergoing arthroscopy, using a scoring matrix, and correlating scores with post-treatment recovery. We prospectively analyzed tibiotarsal and metacarpophalangeal/metatarsophalangeal joints of athletic horses referred for arthroscopy to the Veterinary Hospital of the University of São Paulo. Each joint was ranked based on anamnesis-related scoring tables, as well as physical, ultrasound, radiographic and arthroscopic examinations. Scores were summarized to determine a ranking for each joint examined. Three and four blind assessors performed scoring of radiographic and arthroscopic images, respectively. The animals owner or responsible veterinarian answered a report related to the disease progression and this was correlated to the joint assessment score, determining a prognosis for joint scores. Seventy-eight tibiotarsal joints and 48 metacarpophalangeal/metatarsophalangeal were evaluated. The most common anamnesis scores (> 50%) were related to the onset of symptoms or pre-purchase radiographic findings. During physical examination, over 50% of the joints induced lameness, positive results to flexion tests, reduced joint maximum flexion angles and increased superficial joint temperature. During radiographic examination, frequently noticed alterations were increased volume of soft tissues (37.4%), the presence of sclerosis (40%), osteolysis of the subchondral bone (67%), and evident osteochondral fragments (47.3%) measuring below 5mm (30%). Ultrasonography showed more frequent changes related to synovial fluid according to appearance, with a predominance of amorphous material (33.1%) and increases of up to half in physiological volume (40%) amount, in addition to irregularity of the subchondral bone (41.3 %). Most-found alterations noticed during arthroscopic examination were the presence of apparent blood vessels (65.8%), increased volume and quantity of synovial membrane villi (50%), the presence of cartilage fibrillation (75.8%), fissures (54.2%), cartilage surface erosion (70%), unique (61.7%) and non-displaced osteochondral fragments (86.7%). The mean values of radiographic scores were higher (p = 0.05) for lesions of the fetlock palmar/plantar (11.33 ± 5.03) and tibiotarsal joints (11.27 ± 4.32) than for dorsal fetlock (9.18 ± 3.5). Lesions in the fetlock, dorsal (7.16 ± 4.83) or palmar/plantar (8.33 ± 5.27) had higher mean scores (p = 0.011) during ultrasound examination than the tibiotarsal (5.65 ± 3.36), while the reverse was observed in arthroscopy with the tibiotarsal average higher (12.96 ± 6.22, p <0.001) than fetlock dorsal (8.51 ± 3.61) or palmar/plantar lesions (7.26 ± 2.77). There was general agreement among radiographic examination evaluators for tibiotarsal joints, and dorsal and palmar fetlock lesions. However, arthroscopy evaluators agreed only on metacarpal/metatarsophalangeal, dorsal and palmar/plantar. Logical regression showed that the scores related to anamnesis (1,178), ultrasonography (1,193) and arthroscopy (1,213) correlated to the owners dissatisfaction (80% accuracy), and suggests the use of a score calculator for obtaining the chance of dissatisfied owners for new cases. Thus, it was concluded that, the tables and classifications proposed for anamnesis, physical, radiographic, ultrasonographic and arthroscopic examination enabled a useful score determination allowing correlation between the joint score and owners dissatisfaction with the outcome of arthroscopic treatment of non-infectious joint diseases in horses.
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Jones, Christopher Wynne. "Laser scanning confocal arthroscopy in orthopaedics : examination of chondrial and connective tissues, quantification of chondrocyte morphology, investigation of matirx-induced autologous chondrocyte implantation and characterisation of osteoarthritis." University of Western Australia. School of Mechanical Engineering, 2007. http://theses.library.uwa.edu.au/adt-WU2008.0061.
Abstract:
[Truncated abstract] Articular cartilage (AC) covers the surface of synovial joints providing a nearly frictionless bearing surface and distributing mechanical load. Joint trauma can damage the articular surface causing pain, loss of mobility and deformation. Currently there is no uniform treatment protocol for managing focal cartilage defects, with most treatment options targeted towards symptomatic relief but not limiting the progression into osteoarthritis (OA). Autologous chondrocyte implantation (ACI) and more recently matrix-induced autologous chondrocyte implantation (MACI), have emerged as promising methods for producing hyaline or hyaline-like repair tissue, however there remains some controversy regarding the exact histological nature of the tissue formed. Histological characterisation of AC repairs requires destructive tissue biopsy potentially inducing further joint pathology thereby negating the treatment effect. OA is recognised as a major cause of pain, loss of function and disability in Western populations, however the exact aetiology is yet to be elucidated. The assessment of both OA and cartilage repair has been limited to macroscopic observation, radiography, magnetic resonance imaging (MRI) or destructive biopsy. The development of non-destructive AC assessment modalities will facilitate further development of AC repair techniques and enable early monitoring of OA changes in both experimental animal models and clinical subjects. Confocal laser scanning microscopy (CLSM) is a type of fluorescence microscopy that generates high-resolution three-dimensional images from relatively thick sections of tissue. ... Biomechanical analysis suggested that the mechanical properties of MACI tissue remain inferior for at least three months. This study showed the potential of a multi-site sheep model of articular cartilage defect repair and validated its assessment via LSCA. Finally, the LSCA was used to arthroscopically image the cartilage of an intact fresh frozen cadaveric knee from a patient with clinically diagnosed OA. Images were correlated to ICRS (Outerbridge) Grades I-IV and histology. The LSCA gave excellent visualization of cell morphology and cell density to a depth of up to 200'm. Classical OA changes including clustering chondrocytes, surface fibrillation and fissure formation were imaged. Fair to moderate agreement was demonstrated with statistically significant correlations between all modalities. This study confirmed the viability of the LSCA for non-destructive imaging of the microstructure of the OA cartilage. In conclusion, the LSCA identified histological features of orthopaedic tissues, accurately quantified chondrocyte morphology and demonstrated classical OA changes. While the development and investigation of an ovine model of cartilage repair showed the treatment benefit of MACI, some biomechanical issues remain. Ultimately, the LSCA has been demonstrated as a reliable nondestructive imaging modality capable of providing optical histology without the need for mechanical biopsy. Medical Subject Headings (MESH): articular cartilage; autologous chondrocyte implantation; matrix-induced autologous chondrocyte implantation; biomechanics; cartilage; confocal microscopy; diagnosis; histology; image analysis; immunohistochemistry; magnetic resonance imaging; microscopy; osteoarthritis
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Nilsson, Johanna. "Lower extremity function in patients following hip arthroscopy and an asymptomatic control group. A cross-sectional comparison based on self- reported outcomes and performance based measures." Thesis, Linnéuniversitetet, Institutionen för idrottsvetenskap (ID), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-64867.
Abstract:
Background: This study aimed to evaluate physical function, measured with self-reported outcomes and performance-based measures (PBMs), in patients 6-10 months following hip arthroscopy (HA) compared to an asymptomatic control group. Methods: A cross-sectional comparison (21 patients, 22 controls) based on self-reported outcomes (HAGOS), range of motion (ROM), muscle strength and PBMs (The Y-balance test (cm), medial and lateral triple hop test (cm) and Illinois agility test (s)). Independent sample t test was performed to asses between-group differences. Results: HA-patients reported significantly worse self-reported outcomes in all HAGOS subscales, greatest difference was in QoL (-37,3 (95% CI -47,9; -26,8) p<0.001). HA-patients also reported significantly lower results (p<0.05) in active and passive flexion (ROM) and external rotation (strength). No significant differences were observed regarding PBMs. Conclusions: HA-patients reported significantly lower hip function following HA compared with the control group. Lower muscle strength and ROM were observed in patients however, few differences were significant. No significant differences were observed regarding PBMs. This could indicate that physical function is re-established in patients 6-10months after surgery or that tests were not sensitive enough to detect potential remaining functional limitations in this patient group.