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Journal articles on the topic 'Arthroscopy'
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1
Ahn, Jae Hoon. "Subtalar Arthroscopy." Orthopaedic Journal of Sports Medicine 7, no. 11_suppl6 (November 1, 2019): 2325967119S0045. http://dx.doi.org/10.1177/2325967119s00451.
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The subtalar joint plays an important role in the movement of the ankle and foot. The complex anatomy of the subtalar joint makes it difficult for surgeons to evaluate the entire joint even with extensile approach. The arthroscopy of posterior subtalar joint was first described by Parisien in 1985. The development of good quality small-diameter arthroscopes and refined arthroscopic techniques has contributed to the improvement of the subtalar arthroscopy. The reported advantages of the subtalar arthroscopy include faster postoperative recovery and decreased postoperative pain. The subtalar arthroscopy can be applied as a diagnostic and therapeutic tool. The diagnostic indications are persistent pain, swelling, stiffness, or locking of the subtalar area resistant to conservative treatment. Therapeutic indications include debridement of sinus tarsi syndrome and chondromalacia, excision of subtalar impingement lesions and osteophytes, lysis of adhesions with post-traumatic arthrofibrosis, synovectomy, removal of loose bodies, removal of a symptomatic os trigonum, calcaneal fracture assessment and reduction, and arthroscopic arthrodesis of the subtalar joint. The subtalar arthroscopy can be done in supine position using thigh holder or in lateral decubitus position. The arthroscope generally used is a 2.7-mm 30 degrees short arthroscope. Noninvasive distraction with a strap around the hindfoot can be helpful. Usually anterolateral, middle, and posterolateral portals are utilized for inspection and instrumentation within the subtalar joint. After insertion of the arthroscope, thorough inspection of the joint can be done using 13-point examination techniques. Two-portal posterior subtalar arthroscopy in prone position can be performed as well with 4.0-mm 30 degrees arthroscope, depending on the type and location of the subtalar pathology. The joint capsule and the adjacent fatty tissue should be partially resected for better visualization. The subtalar arthroscopy is a technically demanding procedure, which requires proper instrumentation and careful operative technique. Possible complications after subtalar arthroscopy are nerve damage and persistent wound drainage. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.
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Tonogai, Ichiro, Fumio Hayashi, Yoshihiro Tsuruo, and Koichi Sairyo. "Comparison of Ankle Joint Visualization Between the 70° and 30° Arthroscopes: A Cadaveric Study." Foot & Ankle Specialist 11, no. 1 (September 27, 2017): 72–76. http://dx.doi.org/10.1177/1938640017733099.
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Ankle arthroscopy is an important diagnostic and therapeutic tool. Arthroscopic ankle surgery for anterior ankle impingement or osteochondral lesions (OCLs) is mostly performed with a 30° arthroscope; however, visualization of lesions is sometimes difficult. This study sought to compare ankle joint visualization between 70° and 30° arthroscopes and clarify the effectiveness of 70° arthroscopy. Standard anterolateral and anteromedial portals were placed with 4-mm 70° or 30° angled arthroscopes in a fresh 77-year-old male cadaveric ankle. The medial ligament and surrounding tissue were dissected via a medial malleolar skin incision. Kirschner wires were inserted into the distal tibia anterior edge; 5-mm diameter OCLs were created on the medial talar gutter anteriorly, midway, and posteriorly. The talar dome and distal tibia anterior edge were visualized using both arthroscopes. The 70° arthroscope displayed the anterior edge of the distal tibia immediately in front of the arthroscope, allowing full visualization of the posterior OCL of the medial talar gutter more clearly than the 30° arthroscope. This study revealed better ankle joint visualization with the 70° arthroscope, and may enable accurate, safe, and complete debridement, especially in treatment of medial talar gutter posterior OCLs and removal of anterior distal tibial edge bony impediments. Levels of evidence: Level IV, Anatomic study
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Desai, Sanjay S. "History and evolution of shoulder arthroscopy." Journal of Arthroscopic Surgery and Sports Medicine 1 (July 15, 2020): 11–15. http://dx.doi.org/10.25259/jassm_9_2020.
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The invention of the incandescent light bulb by Edison in 1879, led to the introduction of the laparo-thoracoscope in 1910. Attempts were made to use this device in the knee joint as well. Development of the arthroscope really took off after the introduction of “cold-light” and rod lens optical system by Hopkins in 1960. Kenji Takagi and later Masaki Watanabe get the credit for developing the modern form of arthroscopy. The spillover of knee arthroscopy into the shoulder was inevitable and began in 1980’s. Shoulder arthroscopy started with instability repair, followed by subacromial decompression. Through the 1980’s and 1990’s, with the development in biotechnology, more sophisticated tools and anchors became available leading to refinement of instability repair procedures. The 2000’s saw improvement in arthroscopic rotator cuff repair techniques including the double- row and trans-osseous equivalent. The last decade has witnessed the development of more complex arthroscopic procedures such as Latarjet and Superior Capsule Reconstruction. However, arthroscopic surgery continues to be equipment intensive and we need to remind ourselves that the arthroscope is no “magic wand” and good clinical evaluation continues to prevail.
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Viswanath, Aparna, and Sumedh Talwalkar. "Recent advances and future trends in wrist arthroscopy." Journal of Arthroscopic Surgery and Sports Medicine 1 (July 15, 2020): 65–72. http://dx.doi.org/10.25259/jassm_14_2020.
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For a long time, wrist arthroscopy has languished behind that of shoulder and elbow arthroscopy. However, over the past two decades, there has been a steady increase in therapeutic wrist procedures undertaken using the arthroscope. While diagnostic wrist arthroscopy is still a useful tool, its therapeutic advantages are starting to stack up against the risks of open wrist surgery – mainly stiffness. It remains a technically demanding procedure, but is clearly in the armamentarium of orthopedic hand and wrist surgeons. Recent advances of dry arthroscopy, arthroscopic reduction and internal fixation, and arthroscopic fusion procedures have changed the face of minimally invasive wrist surgery. The new NanoScope™ along with wide-awake, local anesthetic, and no tourniquet techniques, means that we now can dynamically assess and treat wrist pathology without even encountering the risk of anesthesia. Wrist surgery is evolving, and arthroscopy is right at the forefront.
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Shukla, Shivani, Matthew Pettit, Karadi Hari Sunil Kumar, and Vikas Khanduja. "History of hip arthroscopy." Journal of Arthroscopic Surgery and Sports Medicine 1 (July 15, 2020): 73–80. http://dx.doi.org/10.25259/jassm_21_2020.
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Hip arthroscopy is a minimally invasive therapeutic and diagnostic procedure appropriate for an evolving list of conditions. It is routinely used for the treatment of intra- and extra-articular pathology of the hip joint. The development of endoscopy paved the way for the development of arthroscopy. Hip arthroscopy was first described in 1931 by Michael Burman, and its widespread adoption was only achieved some 60 years later during the 1990s. Dr. Watanabe, from Japan, has been credited with the development of modern arthroscopy for his work in developing a practical arthroscope and advancement of both explorative arthroscopy and surgical arthroscopic techniques. More recently, the use of distraction proved as a significant step in the utility of hip arthroscopy and paved the way for future innovations in the procedure. The authors provide a brief overview of the history hip arthroscopy, relevant developments which have paved the way for this procedure and the current state of arthroscopy as a diagnostic and therapeutic procedure.
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Souza, Eduardo Dias de, Joao Luiz Vieira da Silva, Lucas Antônio Ferraz Marcon, and João Elias Ferreira Braga. "Technical description of a low-cost ankle arthroscopy simulator." Journal of the Foot & Ankle 14, no. 2 (August 30, 2020): 173–77. http://dx.doi.org/10.30795/jfootankle.2020.v14.1135.
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Objective: To describe a low-cost, accessible, reproducible ankle arthroscopy simulator model which, after validation, will allow the development and improvement of technical skills required in arthroscopic surgical practice. Methods: This study describes the production of an ankle arthroscopy model that simulates camera, arthroscope, and ankle joint. Results: The simulator works properly when connected to a monitor, television, computer, or cell phone. Conclusion: A reproducible, accessible, low-cost ankle arthroscopy simulator can be developed using components available from local and online stores, with an approximate cost of R$232.00. Level Evidence V; Economic and Decision Analyses – Development of an Economic or Decision Model; Expert Opinion.
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Vangsness, C. Thomas, David B. Thordarson, and Kwan Park. "A Disposable Fiberoptic Arthroscope: A Cadaver Study." Foot & Ankle International 15, no. 9 (September 1994): 502–4. http://dx.doi.org/10.1177/107110079401500909.
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Nine fresh cadaver ankle joints underwent arthroscopy to determine effectiveness of a small diameter, disposable, fiberoptic arthroscope. A sequential examination of the joint was performed through routine anteromedial and anterolateral portals. The anterior aspect of the joint with all anatomical structures was well visualized via the two anterior portals. The posterior aspect of the joint was also well visualized via anterior portals without distraction due to the flexibility of the scope and its small diameter. The quality of the visualization of the posterior joint from the anterior portals alone was comparable to that from the posterior approach. The results of this study indicate that diagnostic arthroscopy of the ankle joint with this disposable 1.6-mm arthroscope is comparable to the standard 2.7-mm to 5mm arthroscopes. The size, flexibility, and 30° viewing angle of this scope allow excellent and thorough joint visualization by routine anterior portals and minimize the need for joint distractors and posterior portals during routine diagnostic ankle arthroscopy.
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Abd-Elnaeim, M., and M. M. Ali. "Arthroscopy of the fetlock joint of the dromedary camel." Veterinary and Comparative Orthopaedics and Traumatology 25, no. 03 (2012): 192–96. http://dx.doi.org/10.3415/vcot-10-11-0154.
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SummaryObjectives: To describe a technique for arthroscopy of the fetlock joint of the dromedary camel, and the problems that could occur during and after arthroscopy.Methods: Seven animals (4 cadaveric limbs and 3 living camels) were used in this study. Two dorsal arthroscopic portals (lateral and medial) and one palmaro-lateral portal were used. Distension of the joint capsule was effected by injecting Ringer's lactate solution into the joint cavity. Landmarks for the dorsal arthroscopic portals were located at the centre of the groove bounded by the lateral branch of the suspensory ligament and the large metacarpus at a point 1 cm proximal to the joint. The palmaro-lateral portal was located in a triangular area between the branch of the suspensory ligament, the large metacarpus, and the sesamoid bone, with insertion of the arthroscope in a 45° joint flexion angle.Results: Arthroscopy of the fetlock joint via the dorso-lateral portal allowed examination of the distal end of the large metacarpus and the proximal end of the first phalanx of the fourth digit. Arthroscopy via a dorso-medial approach allowed examination of the distal end of the large metacarpus and the proximal end of the first phalanx and the distal end of the third digit. The palmaro-lateral portal allowed examination of the sesamoid bones, the synovial membrane, and the synovial villi. The main complications recorded during arthroscopy were iatrogenic articular surface injury as well as obstruction of vision with the synovial villi.Clinical significance: This is the first work to describe the normal arthroscopy of the fetlock joint in the dromedary camel, the arthroscopic portals, and the complications that could occur during and after arthroscopy. Further studies are required for diagnosis of pathological changes in the fetlock joint of the dromedary camel and for arthroscopy of other joints in the dromedary camel.
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Shimozono, Yoshiharu, Yoshiharu Ito, Hayato Ryoki, Sayako Sakai, Shinichiro Ishie, Ryuzo Arai, Yutaka Kuroda, and Shuichi Matsuda. "Posterior Hindfoot Endoscopy Using 1.9-mm Diameter Needle Arthroscopy: A Cadaveric Study." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0045. http://dx.doi.org/10.1177/2473011421s00451.
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Category: Ankle; Arthroscopy; Hindfoot; Sports Introduction/Purpose: Posterior hindfoot endoscopy is a safe and effective treatment for posterior ankle impingement syndrome (PAIS) and flexor hallucis longus (FHL) tendon disorders. As frequent coexistence of PAIS and FHL tenosynovitis has been reported, it is important to investigate FHL tendon pathology concomitantly when treating PAIS. However, the visualization of FHL tendon distal to the retinaculum is limited when using conventional rigid arthroscopy. Additionally, wound-healing problems following hindfoot endoscopy have been still reported. Recently, a novel 1.9-mm diameter needle-arthroscopic system has been introduced. Its small and semirigid features can help reduce the risk of wound complications and can make it easier to perform FHL tendoscopy. The purpose of this study was to assess whether 1.9-mm diameter needle-arthroscopy was useful for hindfoot endoscopy in a cadaveric model. Methods: A 1.9-mm diameter arthroscopic system (NanoScopeTM, Arthrex) was used to perform a hindfoot endoscopy in 6 human donor ankles (3 pairs). The arthroscope tube is 9.5-cm long and semi-rigid, and has a 1.9-mm outer diameter. The scope's direction of view is 0°, with a 120° field of view. Posteromedial and posterolateral portals were established. Visualization and operative reach with tailored arthroscopic instruments were recorded, including posterolateral talar process, posterior talofibular ligament, intermalleolar ligament, subtalar joint, ankle joint, and flexor hallucis longus (FHL) tendon. Finally, a conventional 4.0-mm diameter arthroscope with a 30° angle was used to compare the visualization of FHL tendon. Results: All significant structures were successfully visualized and reached in all specimens. In ankle joint, all of the tibial surface was visualized, but visualization of talar surface was limited. Due to its wide 120° field of view, there was no difficulty obtaining sufficient visualization in any structures. As this needle-arthroscopic system has the semirigid frame, FHL tendoscopy was easily performed via the posterolateral portal. In all specimens, the FHL tendon was visualized from the level of ankle joint to the Knot of Henry (Zone 1 and 2), and the flexor digitorum longus tendon crossing obliquely over the FHL tendon was observed (Figure). The conventional arthroscope could not be inserted into the tunnel underneath the sustentaculum tali in any specimens. Conclusion: Posterior hindfoot endoscopy using a 1.9-mm diameter needle-arthroscopy provides effective visualization and surgical reach of all significant structures for the treatment of PAIS. Its small and semirigid features also make the FHL tendoscopy less invasive and more accessible than conventional rigid arthroscope.
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Uchida, Soshi, Yohei Yukizawa, Hirotaka Nakashima, Dean K. Matsuda, and Akinori Sakai. "Cystoscopy as a tool for hip arthroscopy for treating morbidly obese patients: a case report of treating a Sumo wrestler." Journal of Hip Preservation Surgery 7, no. 2 (July 1, 2020): 345–50. http://dx.doi.org/10.1093/jhps/hnaa029.
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Abstract Sports medicine surgeons sometimes encounter morbidly obese athletes with femoroacetabular impingement, such as Sumo wrestlers. In such cases, traditional arthroscopic equipment will not reach the joint. This case report describes the use of a cystoscope to perform arthroscopy to treat borderline developmental dysplasia of the hip combined with cam impingement in a morbidly obese athlete. The cystoscope enables hip arthroscopy to be performed when traditional instruments are not of sufficient length to access the hip and/or an extra-long arthroscope is not available. The use of the cystoscope provides a practical, feasible and minimally invasive option to treat non-arthritic intraarticular hip pathology in the morbidly obese or extremely muscular athletes.
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Ridge, P. "Feline shoulder arthroscopy using a caudolateral portal, a cadaveric study." Veterinary and Comparative Orthopaedics and Traumatology 22, no. 04 (2009): 289–93. http://dx.doi.org/10.3415/vcot-08-10-0100.
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SummaryThe aim of this cadaveric study was to determine the normal arthroscopic anatomy of the feline shoulder from a caudolateral arthroscope portal, to compare this with the gross anatomy evident upon dissection, and to determine the degree of iatrogenic trauma caused by the arthroscopy. A 1.9 mm, 30° fore oblique arthroscope via a caudolateral portal, and a 21-gauge needle via a cranio-lateral egress portal were used to assess intra-articular structures in eight feline cadaveric shoulders. The medial glenohumeral ligament was shown to be a single banded structure in the craniomedial compartment, and the subscapularis muscle tendon of insertion was visible in all eight shoulders. The biceps brachii tendon and sheath could be examined, although the transverse humeral ligament was not evident arthroscopically from this portal. The lateral glenohumeral ligament was not demonstrated arthroscopically, although a well-defined capsular thickening was present on dissection. No significant neurovascular trauma was evident after arthroscopy.
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Shultz, Christopher L., Samuel N. Schrader, Benjamin D. Packard, Daniel C. Wascher, Gehron P. Treme, and Dustin L. Richter. "Is Diagnostic Arthroscopy at the Time of Medial Patellofemoral Ligament Reconstruction Necessary?" Orthopaedic Journal of Sports Medicine 8, no. 8 (August 1, 2020): 232596712094565. http://dx.doi.org/10.1177/2325967120945654.
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Background: Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined. Purpose: To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded. Results: Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy. Conclusion: Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.
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Ellis, Henry, Eric Edmonds, Yi-Meng Yen, Philip Wilson, Emily Tran, Peter Cannamela, and Kevin Shea. "CHALLENGES IN SMALL KNEE ARTHROSCOPY: A QUALITATIVE AND QUANTITATIVE PEDIATRIC CADAVERIC EXPERIENCE." Orthopaedic Journal of Sports Medicine 8, no. 4_suppl3 (April 1, 2020): 2325967120S0026. http://dx.doi.org/10.1177/2325967120s00267.
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Background: Arthroscopy may be utilized for treatment of septic arthritis of the pediatric knee, with success reported in ages from 3 months to 12 years. There is limited data on the ability to arthroscopically assess articular structures and ensure adequate evaluation without arthrotomy. Hypothesis/Purpose: The purpose of this study is: (1) utilize arthroscopy in small cadaveric knees to improve qualitative and quantitative knowledge of pediatric articular structures and (2) to obtain pilot data for common procedures performed in pediatric patients Methods: Five small pediatric cadaveric specimens (1-4 years) underwent arthroscopy (2.7 mm Stryker arthroscope). Medial and lateral compartments were assessed for meniscus size/mobility/height, compartmental joint space, ACL insertion, patellar chondral height and length, and position of the medial patellofemoral ligament were recorded. Utilizing standard anterior medial and lateral portals, the ability to visualize the structures of the posteromedial and posterolateral compartments was recorded. Procedures pertinent to immature ACL reconstruction and meniscal repair (unstable discoid) were critically evaluated to provide source data for future work. Results: Prior to arthroscopy, all specimens underwent volume-assessed knee insufflation (average 11.4 cc normal saline). Arthroscopic visualization of the menisco-capsular attachment was possible posteromedially in 4/6, and posterolaterally in 5/6 knees. Qualitative arthroscopic relationships were similar to adult references; including patellar-trochlear articulation and lateral meniscal positional relationship to the ACL insertion (see Figure 1). The ACL center was within 2 mm of the posterior aspect of the anterior horn of the lateral meniscus in all specimens. The average height of the medial compartment space under valgus load was 1.5 mm (1 – 2 mm), and lateral space under varus was 2.2 mm (2-3 mm); further emphasizing the need for small joint instruments. The width of the medial and lateral menisci are noted in Table 1. All-inside meniscal devices designed for skeletally mature specimens should be used with caution (Figure 1). Traditionally described inside-out technique for immature ACL reconstruction with an iliotibial band demonstrated significant proximity of the passing device to the neurovascular bundle (Figure 1). Conclusion: The entirety of the small knee is assessable via standard diagnostic arthroscopy, when a 2.7mm arthroscope is utilized. These findings suggest that intra-articular pathology can be reliably identified utilizing this surgical technique. However, the ability to work on the infant meniscus and cartilage with standard arthroscopic instruments is likely limited given the constraints of joint height. [Table: see text][Figure: see text]
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Baker, Andrew, Terry L. Whipple, Gary G. Poehling, and Gregory I. Bain. "History of wrist arthroscopy." Journal of Arthroscopic Surgery and Sports Medicine 1 (July 15, 2020): 44–64. http://dx.doi.org/10.25259/jassm_29_2020.
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The history of wrist arthroscopy is a global one, founded on the development of the arthroscope in Japan in the first half of the 20th century. Japanese surgeons Kenji Takagi and Masaki Watanabe helped develop the arthroscope and the techniques and concepts of arthroscopy, with a focus on the knee. With the improvement in optics, lighting. and miniaturization, arthroscopy of the wrist could be more safely performed. In the 1980’s Terry Whipple, Gary Poehling and James Roth brought a standardized, safe, and reproducible approach to wrist arthroscopy. They conducted courses, revolutionized teaching, and added publications. This led to an explosion in the clinical utilization of wrist arthroscopy and further development of new techniques. In 2005, Christophe Mathoulin created the European Wrist Arthroscopy Society (EWAS) which conducted cadaveric workshops, initially in Europe and then throughout the world. In 2015, PC Ho created the Asia Pacific Wrist Association, which has provided meetings and workshops throughout Asia. Recently, EWAS became International Wrist Arthroscopy Society, truly providing an international approach. This article brings these periods together and presents a thorough picture of the development of wrist arthroscopy.
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Carender, Christopher N., Alan G. Shamrock, Kyle R. Duchman, Natalie A. Glass, T. Sean Lynch, and Robert W. Westermann. "Arthroscopy Volume in United States Residency Programs: Are New Trainees Prepared?" Journal of Hip Surgery 03, no. 03 (August 7, 2019): 124–29. http://dx.doi.org/10.1055/s-0039-1694766.
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AbstractArthroscopy is a technically demanding procedure with a prolonged learning curve. The purpose of this study is to determine if current arthroscopic case volume over the course of an orthopaedic surgery residency is sufficient to meet the number of cases required to achieve competence and/or mastery in complex arthroscopic tasks as well as hip arthroscopy. Publicly available Accreditation Council for Graduate Medical Education case log data for arthroscopic procedures from accredited orthopaedic residencies were reviewed from 2007 to 2017. Linear and segmental regression analyses were used to identify temporal trends, with significance set to p < 0.05. From 2007 to 2013, there was a significant increase in the median number of shoulder and knee arthroscopy case logs (p < 0.001). A sharp decline in the median number of shoulder and knee arthroscopy case logs was seen in 2013 to 2014 (p < 0.001), and the number remained low from 2014 to 2017 (p = 0.02, p = 0.03). The median number of hip arthroscopy procedures logged increased significantly from zero cases in 2012 (range: 0–48 cases) to five cases in 2017 (range: 0–76 cases) (p = 0.02). Over the study period, the median number of total arthroscopic procedures decreased from 301 to 186 (p = 0.01). In the United States, the majority of orthopaedic surgery residents graduate with case log numbers that meet theoretical minimum requirements for competence in basic diagnostic arthroscopy of the shoulder, hip, and knee. Resident experience with hip arthroscopy has increased; however, the majority of residents are graduating with little to no hip arthroscopy experience. Moreover, the median number of total arthroscopic procedures has declined to the point where the average graduate may not be able to perform complex hip or shoulder arthroscopy tasks based on previously published data. These findings support the need for further investigation into the best methods for training residents interested in performing arthroscopy as part of their careers. This was a level of evidence III, retrospective cohort study.
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Cheong, Wei Lun, and Kinjal V. Mehta. "Ultrasound Guidance vs Anatomical Landmark for Ankle Arthroscopic Portal Insertions: A Cadaveric Study." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0061. http://dx.doi.org/10.1177/2473011421s00617.
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Category: Arthroscopy Introduction/Purpose: Ankle arthroscopy can be used for a variety of ankle pathology including soft tissue and bony impingement, loose bodies, osteochondral defects, ankle fractures, osteoarthritis and instability. However, complication rates associated with ankle arthroscopy range from 3.4 to 9%, with half of them consisting of neurovascular and tendon injuries due to arthroscopic portal placement. The purpose of the study is to determine the safety and efficacy of using ultrasound in topographic marking of the neurovascular structures and tendons in the foot and ankle and identification of a safe zone for arthroscopic portal creation, compared to using anatomical landmarks. Methods: Twelve cadaveric samples were divided into two groups of six. The first group underwent ultrasound assessment by a board certified radiologist, who identified zones of safety for ultrasound guided insertion of anteromedial, anterolateral and posteromedial arthroscopic portals. Ankle arthroscopy was then performed. The other group underwent similar ankle arthroscopy assessment utilizing conventional anatomical landmarks. Straws were used to delineate arthroscopy portal tracts. The cadaveric samples were then dissected. The following distances were measured between the portals and important anatomical structures: the anterolateral portal and superficial peroneal nerve (SPN) as well as extensor digitorum longus (EDL); anteromedial portal and the great saphenous vein (GSV) as well as tibialis anterior (TA); and the posteromedial portal and the flexor hallucis longus (FHL). Results: No neurovascular structures or tendons were injured in all twelve cadaveric samples. Compared with the non- ultrasonography group, the group that underwent ultrasonography assessment had statistically significant larger distance of the SPN, EDL and TA from the anterolateral and anteromedial arthroscopic portals (p values = 0.045, 0.046 and 0.025 respectively). No difference was found between the distance of the GSV from the anteromedial arthroscopic portal, as well as the distance of the FHL from the posteromedial arthroscopic portal. Conclusion: Ultrasound assessment and topographic identification of the safe zone for ankle arthroscopic portal creation is a safe and effective process that may reduce the risk of iatrogenic injury to neurovascular structures and tendons in anterior and posterior ankle arthroscopy.
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Heenan, G. Matthew, Kisan Parikh, Armin Tarakemeh, J. Paul Schroeppel, Scott Mullen, and Bryan G. Vopat. "Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0020. http://dx.doi.org/10.1177/2473011419s00206.
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Category: Ankle, Arthroscopy Introduction/Purpose: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,428) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,236) or lateral ankle ligament reconstruction (n=1,211). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=314), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=473), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Cost was higher for arthroscopy groups: repair with arthroscopy ($5,991.32) versus repair without arthroscopy ($3,677.11; p<0.001); reconstruction with arthroscopy ($5,744.83) versus reconstruction without arthroscopy ($4,601.13; p=0.001). Proportionately more patients had complications in the repair without arthroscopy group than in the repair with arthroscopy group (9.87%, 5.41%; p=0.013). Proportionately more patients had newly-diagnosed intra-articular defects in arthroscopy groups: repair with arthroscopy (57.0%) versus repair without arthroscopy (35.6%; p<0.001); reconstruction with arthroscopy (63.0%) versus reconstruction without arthroscopy (39.8%; p<0.001). Proportionately more patients underwent reoperation for intra-articular defects in the combined arthroscopy group (6.89%) than in the combined non-arthroscopy group (4.18%; p=0.006). The average time until reoperation for intra-articular defects was shorter in the combined arthroscopy group (302.536 days) than in the combined non-arthroscopy group (473.886 days; p=0.045). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was over 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.
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Balglei, Aleksandr G., Aleksandr N. Tkachenko, Valerii M. Khaydarov, Dzhalolidin S. Mansurov, and Irina L. Urazovskaya. "Frequency and structure of arthroscopy complications in patients with knee joint osteoarthritis." HERALD of North-Western State Medical University named after I.I. Mechnikov 14, no. 2 (September 8, 2022): 35–47. http://dx.doi.org/10.17816/mechnikov108370.
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BACKGROUND: Arthroscopy is one of the most popular techniques in traumatology and orthopedic practice. The development of the criteria for selection of patients and indications for knee arthroscopy should be carried out for the improvement of arthroscopic technology. It is important to develop safe and informative surgical access to intra-articular structures, optimize stages and techniques, minimize the complications of arthroscopic surgery.
AIM: The publications describing results of knee arthroscopy in patients with knee osteoarthritis have been analyzed in the study.
MATERIALS AND METHODS: A systematic literature review has been conducted by searching in the Pub-Med/MEDLINE database and eLibrary. The search depth was 20 years; a keyword searching has been performed (including the keywords complications, indications/contraindications for arthroscopy). Possible relevant peri-, intra- and postoperative complications of knee arthroscopy are discussed.
RESULTS: Knee joint arthroscopy is the treatment of choice for trauma, injury and orthopedic disease. However, arthroscopy of the knee joint does not always bring a positive effect. The number of negative consequences of this surgical intervention, according to the statistics, range from 0.1 to 2.6% of all cases of knee joint arthroscopy. Complications can be local and systemic and develop both in the early postoperative and in the long-term period after the operation. The review is devoted to the analysis of the data concerning the frequency and structure of knee arthroscopy complications in patients with osteoarthritis of knee joints.
CONCLUSIONS: Intra- and postoperative complications of arthroscopic surgery of the knee joint include nerve and vascular lesions, port disposition, thrombosis, pulmonary embolism, instrument breakage, and compartment syndrome associated with a defect in the joint capsule and leakage of irrigation fluid. In the postoperative period, complications such as hemarthrosis, thrombosis, pulmonary embolism, infection and synovial fistulas are possible. Complications of the late postoperative period of arthroscopic interventions are arthrofibrosis, Ahlbacks disease or aseptic osteonecrosis of the femur or tibia, as well as complex regional pain syndrome.
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Ilyin, A. S., V. N. Merkulov, A. K. Morozov, and N. A. Eskin. "Arthroscopic diagnosis and treatment of intra-articular injuries of the elbow joint in children." N.N. Priorov Journal of Traumatology and Orthopedics 9, no. 2 (February 2, 2022): 26–29. http://dx.doi.org/10.17816/vto99643.
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Experience in elbow arthroscopy in children (36 patients, 5-16 years) was presented in native literature for the first time. Diagnostic arthroscopy was performed in 4 cases, diagnostic arthroscopy + miniarthrotomy in 3 cases, diagnostic and operative arthroscopy in 29 cases. Comparative assessment of radiologic, ultrasound, CT and arthroscopic data showed evident preference of arthroscopy for the diagnosis of intra-articular elbow injuries in children. Main and additional portals decreasing the probability of neurovascular structure injury were suggested. The technique of diagnostic and operative arthroscopy was determined. The indications for the elbow arthroscopy in children were defined. In 91.7% of patients the positive outcomes with complete or almost complete restoration of elbow function were achieved.
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Burnikel, Andrew P., Jonathan B. Goodloe, Joseph Cutrone, Weston McDonald, Alexander S. Guareschi, Caroline P. Hoch, Walker M. Heffron, Christopher E. Gross, and Daniel J. Scott. "Determining the Operative Efficiency of Ankle Arthroscopy with a Standard Arthroscope vs Nanoscope." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0060. http://dx.doi.org/10.1177/2473011421s00601.
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Category: Arthroscopy; Ankle Introduction/Purpose: Ankle arthroscopy is a commonly performed surgical procedure. Needle arthroscopy - performed with a nanoscope (Arthrex, Naples, FL) - has recently been introduced as an alternative to traditional arthroscopy, with goals of reducing pre-procedure set-up time, size of incisions, and minimizing soft tissue injury. To date, the efficiency of nanoscope use in ankle arthroscopy has not been investigated. The purpose of this study is to use time-driven activity-based costing (TDABC) to compare the single-use nanoscope to the reusable 2.7-millimeter small joint arthroscope in performing ankle arthroscopy procedures to understand cost and efficiency. We hypothesize that the nanoscope is the more cost-effective approach because it is not associated with the costs of reprocessing and allows for quicker operating room (OR) setup time. Methods: This is a prospective study of hand-timed collection of procedure times and a retrospective review of procedure costs. Four authors directly hand-timed ankle arthroscopy procedure setup and operative cases performed by one of two fellowship- trained foot and ankle surgeons at a single academic medical center. In total, 21 procedures were timed (arthroscope=10, nanoscope=11). Furthermore, using TDABC, we calculated procedure costs with each device. Costs of reprocessing reusable equipment, operating room time per minute (mean, $36.14/min), sterile processing, department and operating room labor, and maintenance were gathered from literature values and facility accounting systems. These direct and indirect costs were summed into the total cost for each of the surgical techniques, and a sensitivity analysis was performed to determine which of the variables had the most significant effect on overall procedure cost. Results: There was a statistically significant difference in OR opening time (arthroscope=10.28 minutes, nanoscope=4.83 minutes; p=.021) and incision to joint space time (arthroscope=2.19 minutes, nanoscope=1.26 minutes; p=.007) between devices, but no difference concerning set-up or total case intraoperative times. (Table 1) There was no difference in total OR time cost, though the nanoscope group was lower than the arthroscope group (arthroscope= $1,171.48, nanoscope=$916.60; p=.066). With regard to the costs of instrument cleaning, OR turnover, and device setup, the total cost for standard arthroscope use was $1,265.73, as compared to $968.28 for the nanoscope (p=.038). However, the use of the standard arthroscope was less costly when the OR turnover time was less than 24.18 minutes or the OR time costs were less than $26.96 per minute. Conclusion: Overall, the nanoscope was significantly more efficient than the 2.7-millimeter reusable scope regarding opening time and incision to joint space time in the OR. Ankle arthroscopy utilizing a traditional arthroscope is 30.7% more expensive than with the use of a nanoscope and takes longer to set up. Operating room cost per minute and room turnover time are the primary factors driving procedural cost. Given the similar clinical indications of both devices, understanding the cost differences between devices may assist in clinician decision-making to guide the optimization of facility procedures in the operating room.
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Mirkovic, Milan, Aleksandar Crnobaric, Sanja Mirkovic, Andreja Baljozovic, Vladan Stevanovic, Miodrag Glisic, Aleksandar Jevtic, Nemanja Slavkovic, and Zoran Bascarevic. "Magnetic resonance imaging vs. Arthroscopy in diagnosing anterior cruciate ligament and meniscus injuries - is there a difference." Srpski arhiv za celokupno lekarstvo, no. 00 (2022): 90. http://dx.doi.org/10.2298/sarh220524090m.
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Introduction/Objective. The knee joint is prone to injuries caused by direct or indirect trauma. The meniscus and ligament injuries, cannot be completely diagnosed with clinical examination, therefore we use additional non-invasive and invasive diagnostic methods such as magnetic resonance imaging (MRI) and arthroscopy. The aim was to compare the accuracy of MRI and objective knee findings based on arthroscopic examination in case of meniscus and anterior cruciate ligament injuries. Methods. The study involved 50 patients treated with elective surgery which mandatory involved arthroscopic visualization of the knee structures. We compared the MRI findings, obtained from different institutions, and arthroscopic knee findings for all the patients involved in the study. Results. There were 50 patients included in the study with mean age of 31 years. MRI showed that Anterior cruciate ligament was damaged in 41 patients, while arthroscopy confirmed damage in 43 patients. Medial meniscus was damaged in 31 patients on MRI and in 27 on arthroscopic examination. Lateral meniscus was injured in 35 patients on MRI and arthroscopy showed damage in 32 patients. Using ?2 test we found no significant difference between MRI and arthroscopy as diagnostic methods. Wilcoxon Signed Rank Test shows similar results between MRI and arthroscopy findings. Conclusion. A comparative analysis of MRI and arthroscopy diagnostic value in case of anterior cruciate ligament, medial meniscus and lateral meniscus injuries have shown that there is no significant difference between these two methods.
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Shim, Jae Woo, Joo Whan Kim, and Min Jong Park. "Comparative study between open and arthroscopic techniques for scaphoid excision and four-corner arthrodesis." Journal of Hand Surgery (European Volume) 45, no. 9 (March 10, 2020): 952–58. http://dx.doi.org/10.1177/1753193420908820.
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This study presents our technique of arthroscopic scaphoid excision and four-corner arthrodesis and compares the clinical and radiological outcomes with those achieved with the open method. Twenty-seven patients (14 in arthroscopy group and 13 in open group) were included. Bone union was achieved in 13 of 14 patients in the arthroscopy group and in all 13 patients in the open group. In the open group, severe stiffness (flexion–extension arc was 10°) occurred in one patient after surgery. The mean postoperative flexion–extension arc was 75° and 51° in the arthroscopy group and open group, respectively. The pain, clinical scores, and radiological indices were improved in both arthroscopy and open groups. Arthroscopic and open scaphoid excision and four-corner arthrodesis did not show significant differences in clinical outcomes and bone union rates. The arthroscopic method provided a superior range of motion. Level of evidence: III
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Heenan, G. Matthew, Kisan B. Parikh, Armin Tarakemeh, Scott M. Mullen, John Paul Schroeppel, and Bryan George Vopat. "Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations." Orthopaedic Journal of Sports Medicine 7, no. 7_suppl5 (July 2019): 2325967119S0032. http://dx.doi.org/10.1177/2325967119s00325.
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Objectives: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,188) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,141) or lateral ankle ligament reconstruction (n=1,063). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=219), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=325), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Average cost per patient was higher for both arthroscopy groups: repair with arthroscopy ($6,207.78) versus repair without arthroscopy ($3,677.11; p < 0.0001); reconstruction with arthroscopy ($5,758.21) versus reconstruction without arthroscopy ($4,601.13; p = 0.0039). There was a significantly higher proportion of patients with complications in the reconstruction without arthroscopy group than in the reconstruction with arthroscopy group (7.59%, 4.31%; p = 0.0431), but the difference between repair groups was insignificant (p = 0.0626). The proportion of patients with newly diagnosed intra-articular defects was significantly higher in both arthroscopy groups: repair with arthroscopy (53.0%) versus repair without arthroscopy (35.6%; p < 0.0001); reconstruction with arthroscopy (56.0%) versus reconstruction without arthroscopy (39.8%; p < 0.0001). There was a significantly higher proportion of patients who underwent reoperation for intra-articular defects in the combined (repair plus reconstruction) arthroscopy group (7.18%) than in the combined non-arthroscopy groups (4.91%; p = 0.049). Most importantly, the average time until reoperation for intra-articular defects was significantly shorter in the combined arthroscopy group (271.923 days) than in the combined non-arthroscopy group (411.473 days; p = 0.024). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was nearly 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.
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Han, Seung Woo, Jung Ho Park, Dong Hun Suh, Hak Jun Kim, Young Hwan Park, Jung Heum Baek, and Gi Won Choi. "Compartment Syndrome After Ankle Arthroscopy in an Atraumatic Patient." Journal of the American Podiatric Medical Association 109, no. 4 (July 1, 2019): 312–16. http://dx.doi.org/10.7547/17-219.
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Compartment syndromes associated with arthroscopy have been rarely reported. Compartment syndrome after knee arthroscopy has been reported in some case reports, whereas we could find only one case report of acute compartment syndrome following ankle arthroscopy after Maisonneuve fracture. However, there has been no previous report of a case of acute compartment syndrome after ankle arthroscopy in an atraumatic patient. In this article, we present a case of acute compartment syndrome during ankle arthroscopic procedures in an atraumatic patient.
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Rajan, David V., Munis Ashraf, Navya Challumuri, and S. K. Sahanand. "History of arthroscopy in India: Origins and evolution." Journal of Arthroscopic Surgery and Sports Medicine 1 (July 15, 2020): 5–10. http://dx.doi.org/10.25259/jassm_22_2020.
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The practice of arthroscopy in India had started as early as 1978; and during the same year, the Indian chapter of the International Arthroscopy Association was drafted alongside other countries such as Australia and Brazil. The subspecialty of arthroscopy has been a boon to both; the orthopedic surgeon and the patient. The advent of arthroscopy has enabled the orthopedic surgeon to clearly visualize and delineate the extent of disease, with minimal invasion. Moreover, the patient is benefited with rapid recovery and an early return to activities. The present-day arthroscopic surgeries include diagnostic arthroscopy, ligament reconstruction, cartilage repair, and labral repairs and have undoubtedly evolved into a glamorous subspecialty in orthopedics. However, before the technological advancements, the technique of arthroscopy had modest origins. This review traverses through the history of arthroscopy with special emphasis on the advances of arthroscopy in India.
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Bonilla, Alvaro G. "Standing Needle Arthroscopy of the Metacarpophalangeal and Metatarsophalangeal Joint for Removal of Dorsal Osteochondral Fragmentation in 21 Horses." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 05 (May 24, 2019): 420–26. http://dx.doi.org/10.1055/s-0039-1688984.
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Abstract Objective The aim of this study was to report the technique, experience and outcome of standing arthroscopic removal of dorsal osteochondral fragmentation of the metacarpophalangeal and metatarsophalangeal joint using a 1.2-mm needle arthroscope. Study Design This was a prospective clinical study. Materials and Methods All horses referred for standing arthroscopic removal of dorsoproximal first phalanx fragments or fragments embedded in the distal aspect of the synovial plica were included. Relevant information from the cases was recorded. Follow-up was obtained by a telephone questionnaire. Results Twenty-one horses with a mean age of 4.5 years old were included. Osteochondral fragments removed were from the proximal margin of first phalanx in 18 horses (24 joints), in the synovial plica in 2 horses (2 joints) or free-floating fragment in 1 horse (1 joint). Fifteen out of twenty-one horses were unilaterally affected and 6/21 bilaterally. Fifteen out of twenty-seven affected joints were forelimbs and 12/27 hindlimbs. All articular structures within the dorsal recess of the joint were visible. The arthroscope was deemed easy to use and manoeuvre. Only minor complications occurred during the procedure. Surgery time was 15 to 20 minutes for most patients. Conclusions All fragments were successfully removed and needle arthroscopy allowed a thorough evaluation of the dorsal aspect of the joint. The technique offers an alternative for standing fetlock arthroscopy for surgeons concerned about equipment damage or portability.
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Kim, Tae Kyun, Richard M. Savino, Edward G. McFarland, and Andrew J. Cosgarea. "Neurovascular Complications of Knee Arthroscopy." American Journal of Sports Medicine 30, no. 4 (July 2002): 619–29. http://dx.doi.org/10.1177/03635465020300042501.
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During the last 3 decades, arthroscopy has revolutionized the way knee surgery is performed. The indications and the applications of arthroscopic procedures in the knee joint have enormously increased with the improvement in surgical technique and advent of new arthroscopic equipment. The use of arthroscopic techniques has led to a significant decrease in morbidity for the patient with intraarticular abnormalities, in terms of both diagnosis and surgical correction. Even though knee arthroscopy is a minimally invasive procedure with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. The reported incidence of neurovascular complication is low, but it may be underestimated. Many neurovascular complications that occur are preventable with a thorough understanding of neurovascular anatomy, good preoperative and intraoperative planning, and attention to the details of basic techniques and the equipment used for the procedure. It is imperative that the surgeon who is performing arthroscopy be aware of these neurovascular complications, recognize them as early as possible, and initiate further evaluation and treatment as expeditiously as possible. In this article, the causes, management, prevention, and medicolegal implications of neurovascular complications of knee arthroscopy are reviewed.
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Kim, Jeon-Gyo, Heuichul Gwak, and Sangmyung Roh. "Second-Look Arthroscopic Findings and Clinical Outcomes After Management of Intra-Articular Lesions in Acute Ankle Fractures with Arthroscopy." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000054.
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Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: Anatomically successful surgical reduction of ankle fractures does not always result in a clinically favorable outcome. The purpose of the present study was to compare initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes. Methods: A total of 39 patients (40 ankles, 20 male, 20 female) who underwent surgery for ankle fracture between March 2009 and August 2016 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Intra-articular lesions (osteochondral lesion, loose body, injury of ligaments and fibrosis) were evaluated via ankle arthroscopy. Arthroscopic finding of osteochondral lesion were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the international Cartilage Repar System (ICRS). Clinicial outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Visual Analogue Scale (VAS) Results: Chondral lesions were found in 26 ankles (65%) with initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in second-look arthroscopy was 15 cases. Accoding to the Ferkel and Cheng staging at second-look arthroscopy, 4 of 23 ankles with chondral lesions of talus was getting worse (more than stage D). In terms of ICRS overall repair grades, 4 ankle (15%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles respectively in second-look arthroscopy. Correlation were found between AOFAS scores, VAS and intra-articular lesions with second-look arthroscopy. Conclusion: Second-look arthroscopic examination combined with treatment of intra-articular lesion arising from ankle fracture surgery may consider to improve clinical outcomes.
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Bain, Gregory I., Andrew Baker, Terry L. Whipple, Gary G. Poehling, Christophe Mathoulin, and Pak-Cheong Ho. "History of Wrist Arthroscopy." Journal of Wrist Surgery 11, no. 02 (April 2022): 096–119. http://dx.doi.org/10.1055/s-0041-1740304.
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AbstractWrist arthroscopy has a rich history, drawing on contributions from around the world. Its foundation was laid in Japan with Kenji Takagi and Masaki Watanabe, who developed the arthroscope and the techniques for arthroscopy. Across several decades they advanced the optic and lighting technology, allowing the miniaturization which made wrist arthroscopy technologically feasible. A safe and standardized technique for wrist arthroscopy was evolved by Terry Whipple, Gary Poehling, and James Roth in the 1980s, and they shared this with their fellow surgeons through courses and publications. The techniques then spread across the world, leading to widespread uptake and exploration of new therapeutic possibilities. The worldwide spread of wrist arthroscopy was accelerated by the European Wrist Arthroscopy Society (EWAS), founded in 2005 by Christophe Mathoulin. The Asia Pacific Wrist Association (APWA), founded by PC Ho in 2015, also extended the progression of wrist arthroscopy. This article brings together this history and tells the global story of its development through the recollections of those involved. The manuscript includes some amazing videos of the early historical arthroscopy. There are also videos of Gary and Terry describing some of their special memories of the early politics, developments, and evolution of wrist arthroscopy.
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Chiang, Chao-Ching, Chien-Fu Jeff Lin, Yun-Hsuan Tzeng, Ming-Hung Teng, and Tzu-Cheng Yang. "Arthroscopic Quantitative Measurement of Medial Clear Space for Deltoid Injury of the Ankle: A Cadaveric Comparative Study With Stress Radiography." American Journal of Sports Medicine 50, no. 3 (March 2022): 778–87. http://dx.doi.org/10.1177/03635465211067806.
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Background: The deltoid ligament (DL) is an important stabilizer of the ankle. DL injury of varying severity can occur alone or with syndesmotic injury and fibular fracture. Limited diagnostic tools are available to assess DL injury quantitatively. Purpose: To establish an arthroscopic quantitative assessment of DL injury and to compare its performance with that of external rotation stress (ERS) and gravity stress (GS) radiography. Study Design: Controlled laboratory study. Methods: In total, 24 cadaveric lower extremities were divided into 4 groups: group 1 consisted of intact DL, group 2 of superficial DL disruption, group 3 of deep DL disruption, and group 4 of complete DL (superficial and deep) disruption. All specimens underwent sequential sectioning of syndesmotic ligaments, and medial clear space (MCS) was measured with ankle arthroscopy, ERS radiography, and GS radiography at different stages of syndesmotic sectioning. Results: For noninjured deltoid (group 1) and injured deltoid (groups 2-4), area under the receiver operating characteristic curve (AUC) of measurement of MCS was 0.939 for arthroscopy, 0.932 for ERS radiography, and 0.874 for GS radiography, with a significant difference between arthroscopy and GS radiography ( P = .014). For incomplete deltoid injury (groups 1-3) and complete deltoid injury (group 4), the AUC of MCS was 0.811 for arthroscopy, 0.656 for ERS radiography, and 0.721 for GS radiography, with a significant difference between arthroscopy and ERS radiography ( P < .001) and between arthroscopy and GS radiography ( P = .035). For all stages of syndesmotic sectioning, cutoff values of arthroscopic MCS with intact fibula were ≤2.5 mm for intact DL, between 2.5 and 3.5 mm for partial DL injury (superficial or deep), and ≥3.5 mm for complete DL injury. Arthroscopy was unable to detect a difference between superficial deltoid injury (group 2) and deep deltoid injury (group 3) in partial DL injury, with a measured MCS between 2.5 and 3.5 mm. The intraclass correlation coefficient of interrater reliability was 0.975 for arthroscopy, 0.917 for ERS radiography, and 0.811 for GS radiography. Conclusion: Arthroscopic MCS measurement can differentiate intact DL, partial DL injury, and complete DL injury. Compared with ERS and GS radiography, arthroscopic MCS measurement has greater accuracy with excellent interrater reliability. Clinical Relevance: For patients with suspected DL injury, arthroscopic MCS is useful for determining deltoid lesion severity based on defined cutoff values for consideration in preoperative planning to improve surgical outcomes.
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Hulse, D. A., K. S. Schulz, and W. B. Saunders. "Evaluation of portal locations and periarticular structures in canine coxofemoral arthroscopy: a cadaver study." Veterinary and Comparative Orthopaedics and Traumatology 17, no. 04 (2004): 184–88. http://dx.doi.org/10.1055/s-0038-1632818.
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SummaryThe objectives of this study were to determine the optimum limb position for the creation of safe arthroscopy portals for coxofemoral arthroscopy, to determine anatomical landmarks for arthroscopy portals, and to determine distances of portals to periarticular neurovascular structures. Eight hemipelves were harvested from adult dogs that died for reasons unrelated to this project and were free of joint pathology as determined by gross examination at the conclusion of the study. The results suggest that the ideal limb position for canine coxofemoral arthroscopy was slight limb adduction, thirty degrees of hip flexion, with the stifle in a neutral position. With the limb in the ideal position, the arthroscope portal was 5 mm cranial (range 0 mm 10 mm) and 15 mm proximal (range 12 mm 18 mm) to the greater trochanter. The instrument portal was 10.2 mm cranial (range 5 mm 18 mm) and 14 mm proximal (range 7 mm 20 mm) to the greater trochanter. The sciatic nerve and the caudal gluteal artery were 9 mm caudal (range 6 mm 15 mm) to the arthroscope portal. This is the first study to evaluate the location of both arthroscopy portals and periarticular neurovascular structures in relation to surrounding surgical landmarks.
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ADOLFSSON, L. "Arthroscopy for the Diagnosis of Post-Traumatic Wrist Pain." Journal of Hand Surgery 17, no. 1 (February 1992): 46–50. http://dx.doi.org/10.1016/0266-7681(92)90010-y.
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30 patients with post-traumatic wrist pain were investigated by arthroscopy. The clinical findings and type of injury were compared to the pathological morphology seen at arthroscopy. In 21 (70%) of the patients, arthroscopic findings gave a plausible explanation for the symptoms.
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Rog, Dominik, Tuna Ozyurekoglu, and Kumar K. Karuppiah. "Arthroscopic Abrasion Arthroplasty Is Not Superior to Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Arthritis." HAND 14, no. 6 (May 25, 2018): 791–96. http://dx.doi.org/10.1177/1558944718778405.
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Background: A few arthroscopic options have been proposed for the treatment of early stages of the arthritis of the thumb carpometacarpal (CMC) joint. The purpose of this study was to compare the results of arthroscopic abrasion arthroplasty with ligament reconstruction and tendon interposition (LRTI). Methods: In this retrospective cohort study, 11 patients who underwent thumb CMC joint arthroscopic abrasion arthroplasty were compared with 15 patients who were randomly selected from a group of 80 LRTI arthroplasty patients during the same study period, with a minimum 1 year follow-up. Preoperative and postoperative evaluations included radiographs and measurements of grip strength, visual analog scale (VAS) pain scores, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The mean preoperative VAS score in both groups was 6.8. Mean preoperative DASH scores were 61.1 in the arthroscopy group and 67.4 in the LRTI group. Postoperative VAS score at final follow-up was 4.8 in the arthroscopy group and 1.2 in the LRTI group ( P < .05). Postoperative DASH scores 9 months after surgery were 23 for the LRTI group and 55.2 for the arthroscopy group ( P < .05). Eight patients in the arthroscopy group had a second surgery due to persistent pain. Conclusions: Patients undergoing arthroscopic abrasion arthroplasty had high revision rates, higher postoperative pain, and lower patient-rated outcomes than patients undergoing LRTI procedure. The poor results in the arthroscopy group may be secondary to the inherent instability of the CMC joint and lack of use of any biological or artificial interposition material.
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Steed, Jeremiah T., Kathlyn Drexler, Adam N. Wooldridge, and Matthew Ferguson. "Anterior Interosseous Nerve Neuropraxia Secondary to Shoulder Arthroscopy and Open Subpectoral Long Head Biceps Tenodesis." Case Reports in Orthopedics 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/7252953.
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Arthroscopic rotator cuff tendon repair is a common elective procedure performed by trained orthopaedic surgeons with a relatively low complication rate. Specifically, isolated neuropraxia of the anterior interosseous nerve (AIN) is a very rare complication of shoulder arthroscopy. An analysis of peer-reviewed published literature revealed only three articles reporting a total of seven cases that describe this specific complication following standard shoulder arthroscopic procedures. This article reports on three patients diagnosed with AIN neuropraxia following routine shoulder arthroscopy done by a single surgeon within a three-year period. All three patients also underwent open biceps tenodesis immediately following completion of the arthroscopic procedures. The exact causal mechanism of AIN neuropraxia following shoulder arthroscopy with biceps tenodesis is not known. This case report reviews possible mechanisms with emphasis on specific factors that make a traction injury the most likely etiology in these cases. We critically analyze our operating room setup and patient positioning practices in light of the existing biomechanical and cadaveric research to propose changes to our standard practices that may help to reduce the incidence of this specific postoperative complication in patients undergoing elective shoulder arthroscopy with biceps tenodesis.
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Xiao, Ryan, Carl Cirino, Christine Williams, and Michael Hausman. "Arthroscopy of the Pediatric Elbow: Review of the Current Concepts." Revista Iberoamericana de Cirugía de la Mano 49, no. 01 (May 2021): 056–65. http://dx.doi.org/10.1055/s-0041-1730394.
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AbstractAs surgeons have become more familiar with elbow arthroscopy, the indications for arthroscopy of the pediatric elbow have expanded to include contracture releases, fracture fixation, treatment of osteochondritis dissecans (OCD) lesions, correction of elbow deformity, and debridement of soft tissue and bony pathologies. The treatment of various pathologies via an arthroscopic approach demonstrates equal, if not better, efficacy and safety as open surgery for the pediatric elbow. Arthroscopy provides the unique advantage of enabling the performance of extensive surgeries through a minimally-invasive approach, and it facilitates staged interventions in cases of increased complexity. For fracture work, arthroscopy enables direct visualization to assess reduction for percutaneous fixations. While future research is warranted to better evaluate the indications and outcomes of pediatric elbow arthroscopy, this update article presents a review of the current literature, as well as several innovative cases highlighting the potential of arthroscopy.
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Sherman, William F., Nathan P. Verzeaux, Christina Freiberger, Olivia C. Lee, J. Heath Wilder, Travis R. Flick, and Wendell M. R. Heard. "Local and Systemic Complications of Knee and Hip Arthroscopy: A Matched-Cohort Study." Orthopaedic Journal of Sports Medicine 10, no. 11 (November 1, 2022): 232596712211310. http://dx.doi.org/10.1177/23259671221131059.
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Background: Surgeons are familiar with the complication rates and risks of knee arthroscopy, but comparative data between hip arthroscopy and knee arthroscopy are lacking. Purpose: To compare complications in knee arthroscopy, the most common arthroscopic procedure, with those in hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective matched-cohort study analyzing patients who received a primary hip or knee arthroscopy was performed using the PearlDiver database. A total of 19,735 patients were identified for each cohort. Systemic complications and readmissions were assessed at 3 months postoperatively. Local complications and reoperations were assessed at 6 months, 12 months, and 24 months postoperatively. All categorical variables were compared using chi-square analysis. Results: Hip arthroscopy had significantly higher rates of nerve injury, stiffness, heterotopic ossification, and avascular necrosis (all P < .001) than knee arthroscopy at all observed time periods postoperatively. Hip arthroscopy also had a greater rate of all local joint complications than knee arthroscopy (16.79% vs 11.80%; P < .001). Knee arthroscopy was found to have higher incidences of deep vein thrombosis (0.98% vs 0.66%; P < .001) and myocardial infarction (0.06% vs 0.00%; P < .001) as well as a higher overall systemic complication rate (3.93% vs 3.44%; P = .013). Hip arthroscopy was found to have higher rates of subsequent arthroscopy, arthroplasty, and overall reoperation when compared with knee arthroscopy (11.99% vs 14.99%; P < .001) at all time periods up to 24 months postoperatively. Conclusion: Although the systemic complication rate was higher in knee arthroscopy, local joint complications, reoperation, and total complication rates were higher for hip arthroscopy. Surgeons should be aware of these potential differences to best discuss and mitigate risks with this expanding patient population.
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Sun, Wei-Chien, Liang Tseng Kuo, Pei-An Yu, Cheng-Pang Yang, Huan Sheu, Hao-Che Tang, Yi-Sheng Chan, et al. "Pneumothorax, an Uncommon but Devastating Complication following Shoulder Arthroscopy: Case Reports." Medicina 58, no. 11 (November 5, 2022): 1603. http://dx.doi.org/10.3390/medicina58111603.
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Shoulder arthroscopy is a mature and widely used treatment to deal with various shoulder disorders. It enables faster recovery and decreases postoperative complications. However, some complications related to shoulder arthroscopy cannot be neglected because they could be life threatening. We presented three cases of various clinical manifestations of pneumothorax after shoulder arthroscopy. The first case was a 65-year-old female who underwent arthroscopic rotator cuff repair under general anesthesia and interscalene nerve block in the beach-chair position. The second case was a 58-year-old male undergoing arthroscopic rotator cuff repair and reduction in glenoid fracture under general anesthesia in the lateral decubitus position. The third case was a 62-year-old man receiving arthroscopic rotator cuff repair under general anesthesia in the lateral decubitus position. Each case’s operation time was 90, 240, and 270 min. The pressure of the irrigation pumping system was 30, 50, and 70 mmHg, respectively. The second and third cases did not undergo interscalene nerve block. Although the incidence of pneumothorax following shoulder surgery and interscalene nerve block was only 0.2%, it is one of the most life-threatening complications following shoulder arthroscopy. In these cases, multifactorial factors, including patient positioning, interscalene nerve block, long surgical time, size of rotator cuff tears, and the pressure of the irrigation and suction system, can be attributed to the occurrence of pneumothorax. It is crucial to fully comprehend the diagnosis and management of pneumothorax to reduce the risk for patients receiving shoulder arthroscopy.
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Mekhail, Anis O., Bruce E. Heck, Nabil A. Ebraheim, and William T. Jackson. "Arthroscopy of the Subtalar Joint: Establishing a Medial Portal." Foot & Ankle International 16, no. 7 (July 1995): 427–32. http://dx.doi.org/10.1177/107110079501600709.
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One of the recently introduced procedures for studying the posterior subtalar joint is subtalar arthroscopy. There is no reference in the literature to the possibility of a medial portal that might be used either for arthroscopic insertion, probing, or instrumental manipulation. The two portals mentioned in the literature are the anterolateral and the posterolateral portals. For evaluating the possibility of establishing a medial portal, six embalmed adult cadaver feet were used to study the anatomical relations to the proposed medial portal. The subtalar joints of another six fresh adult cadaver feet were then arthroscoped, after distraction of the joint, using the anterolateral, posterolateral, and medial portals. Findings indicated that the medial portal gives good visualization of the posterior subtalar joint. Clinical application has not yet been assessed.
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Desai, Mihir J., Hari Ramalingam, and David S. Ruch. "Heterotopic Ossification After the Arthroscopic Treatment of Lateral Epicondylitis." HAND 12, no. 3 (April 28, 2017): NP32—NP36. http://dx.doi.org/10.1177/1558944716668844.
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Background: Heterotopic ossification (HO) is a well-known complication following the surgical treatment of fractures and dislocations about the elbow but it is not commonly discussed as a complication following arthroscopy. We present a case of a young athlete who developed HO after the arthroscopic treatment of lateral epicondylitis. Methods: This is a case report chart review of a 24 year old male with lateral epicondylitis. After failing conservative measures, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) origin ensued. The treatment and patient’s final disposition were reported. Results: The patient developed heterotopic ossification of the elbow follow arthroscopic debridement of the ECRB origin. Further surgery was required to excise the heterotopic ossification. Good recovery of motion was achieved. Conclusion: To our knowledge, we present the first case of HO development after elbow arthroscopy for lateral epicondylitis. As the use of elbow arthroscopy continues to grow, there is a need for identification of the risk factors and primary prophylaxis for HO.
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Panjwani, Taufiq, Keng Lin Wong, Si Heng Sharon Tan, Glen Liau, Narendra Vaidya, and Lingaraj Krishna. "Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis." Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 4, no. 6 (September 18, 2019): 307–12. http://dx.doi.org/10.1136/jisakos-2018-000269.
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ImportanceSeptic arthritis of the native knee joint is the most common bacterial joint infection. The management involves prompt surgical debridement and joint irrigation by arthroscopy or arthrotomy. This is the first systematic review and meta-analysis to compare arthroscopic debridement with arthrotomy for septic arthritis of native knee joint.ObjectiveThe purpose of this systematic review and meta-analysis is to compare re-operation rates, length of inpatient hospital stay (LOS) and functional outcome between arthroscopy and arthrotomy in the treatment of acute septic arthritis of the native knee joint.Evidence reviewThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched from database inception to 31 May 2019. All original studies that compared re-operation rates and LOS between arthroscopy and arthrotomy for septic arthritis of knee were included. The research question and eligibility criteria were established a priori. Pertinent data were extracted and random-effects model was used to pool the data where possible.FindingsA total of seven studies with 1089 knees were included, of which 723 underwent arthroscopic surgery and 366 knees underwent arthrotomy. The relative risk of re-operation was significantly lower in the arthroscopy group with a pooled relative risk of 0.69 (95% CI 0.56 to 0.86; p=0.0006). All studies reported shorter LOS and one study reported better functional outcomes in the arthroscopy group as compared with arthrotomy. However, the data could not be quantitatively synthesised due to variation in reporting among the studies included.Conclusions and relevanceBased on the available evidence, we conclude that arthroscopy for the treatment of septic arthritis of the knee results in a lower re-operation rate than arthrotomy. It cannot be concluded whether arthroscopic treatment results in shorter LOS or better functional outcome as compared with arthrotomy.Level of evidenceIV
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Ercin, Ersin, Mustafa Bilgili, Halil Ones, and Cemal Kural. "Postoperative pectoral swelling after shoulder arthroscopy." Joints 03, no. 03 (July 2015): 158–60. http://dx.doi.org/10.11138/jts/2015.3.3.158.
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Fluid extravasation is possibly the most common complication of shoulder arthroscopy. Shoulder arthroscopy can lead to major increases in the compartment pressure of adjacent muscles and this phenomenon is significant when an infusion pump is used. This article describes a case of pectoral swelling due to fluid extravasation after shoulder arthroscopy. A 24-year-old male underwent an arthroscopic Bankart repair for recurrent shoulder dislocation. The surgery was performed in the beach chair position and lasted two hours. At the end of the procedure, the patient was found to have left pectoral swelling. A chest radiography showed no abnormality. Pectoral swelling due to fluid extravasation after shoulder arthroscopy has not previously been documented.
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Fernandes, Carlos Henrique, Lia Myiamoto Meirelles, Jorge Raduan Neto, João Baptista Gomes dos Santos, Flavio Faloppa, and Walter Manna Albertoni. "CHARACTERISTICS OF GLOBAL PUBLICATIONS ABOUT WRIST ARTHROSCOPY: A BIBLIOMETRIC ANALYSIS." Hand Surgery 17, no. 03 (January 2012): 311–15. http://dx.doi.org/10.1142/s0218810412500232.
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The objective of this study was to provide an assessment of published studies on the wrist arthroscopy. The search was performed from the "Web of Science (WoS) Science Citation Expanded Database" with studies published between January 1, 1990 and March 31, 2011. For research we used the following terms: "Wrist arthroscopy" and "Arthroscopy of the wrist". We located a total of 426 studies about wrist arthroscopic, published in 89 journals over the study period. Of all the publications retrieved (426), original articles were 387 (90.84%), but only two (0.47%) were randomised controlled trials, level 1 of evidence. This study showed there are a large number of studies on wrist arthroscopy, but the level of methodological evidence is low.
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Wininger, Austin E., Sherif Dabash, Thomas J. Ellis, Shane J. Nho, and Joshua D. Harris. "The Key Parts of Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Implications for the Learning Curve." Orthopaedic Journal of Sports Medicine 9, no. 6 (June 1, 2021): 232596712110187. http://dx.doi.org/10.1177/23259671211018703.
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Background: Hip arthroscopy is a rapidly growing surgical approach to treat femoroacetabular impingement (FAI) syndrome with a significant learning curve pertaining to complication risk, reoperation rate, and total hip arthroplasty conversion. Hip arthroscopy is more frequently being taught in residency and fellowship training. The key, or critical, parts of the technique have not yet been defined. Purpose: To identify the key components required to perform arthroscopic treatment of FAI syndrome. Study Design: Consensus statement. Methods: A 3-question survey comprising questions on hip arthroscopy for FAI was sent to a convenience sample of 101 high-volume arthroscopic hip surgeons in the United States. Surgeon career length (years) and maintenance volume (cases per year) were queried. Hip arthroscopy was divided into 10 steps using a Delphi technique to achieve a convergence of expert opinion. A step was considered “key” if it could (1) avoid complications, (2) reduce risk of revision arthroscopy, (3) reduce risk of total hip arthroplasty conversion, or (4) optimize patient-reported outcomes. Based on previous literature, steps with >90% of participants were defined as key. Descriptive and correlation statistics were calculated. Results: A total of 64 surgeons (63% response rate) reported 5.6 ± 2.1 steps as key (median, 6; range, 1-9). Most surgeons (56.3%) had been performing hip arthroscopy for >5 years. Most surgeons (71.9%) had performed >100 hip arthroscopy procedures per year. Labral treatment (97% agreement) and cam correction (91% agreement) were the 2 key steps of hip arthroscopy for FAI. Pincer/subspine correction (86% agreement), dynamic examination before capsular closure (63% agreement), and capsular management/closure (63% agreement) were selected by a majority of respondents but did not meet the study definition of key. There was no significant correlation between surgeon experience and designation of certain steps as key. Conclusion: Based on a Delphi technique and expert opinion survey of high-volume surgeons, labral treatment and cam correction are the 2 key parts of hip arthroscopy for FAI syndrome.
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Stornebrink, Tobias, J. Nienke Altink, Daniel Appelt, Coen A. Wijdicks, Sjoerd A. S. Stufkens, and Gino M. M. J. Kerkhoffs. "Two-millimetre diameter operative arthroscopy of the ankle is safe and effective." Knee Surgery, Sports Traumatology, Arthroscopy 28, no. 10 (February 17, 2020): 3080–86. http://dx.doi.org/10.1007/s00167-020-05889-7.
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Abstract Purpose Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.
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Karthik, Karuppaiah, Zaid Ali, Toby Colegate-Stone, Adel Tavakkolizadeh, and Jonathan Compson. "Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion." Journal of Hand and Microsurgery 12, no. 02 (July 7, 2019): 100–106. http://dx.doi.org/10.1055/s-0039-1692929.
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Abstract Introduction Patients with scaphoid nonunion and wrist pain may have a wide spectrum of potential concomitant pathologies that may be diagnosed and potentially managed arthroscopically. The aim of this study is to assess the usefulness of wrist arthroscopy in the assessment and treatment of scaphoid nonunion and any associated injuries. Materials and Methods We retrospectively reviewed 34 consecutive patients with established scaphoid nonunion between January 2006 and December 2012 who had undergone arthroscopic assessment. The average age of the patients was 40 years (range: 25–64), and all the patients had arthroscopic assessment of the wrist joint before definitive surgery. The patients with associated intra-articular problems, which could be addressed along with the scaphoid open reduction internal fixation (ORIF) and bone grafting (BG), had definite procedure in the same sitting. However, if the patients had major intra-articular pathology that needed change in the management plan, they had staged definitive treatment after discussing with them about the arthroscopic findings. Results Arthroscopic assessment of the 34 joints showed varying degrees of arthritis affecting radioscaphoid joint (41%) followed by injuries to the triangular fibrocartilage complex (TFCC) (35%), lunotriquetral ligament (LTL) tears (32%), and scapholunate ligament (SLL) injuries (26%). Concomitant procedures performed during the wrist arthroscopy included debridement of synovitis (62%), TFCC debridement (32%), loose body removal (17%), and DRUJ stabilization and TFCC repair (3%). Twenty-nine patients had arthroscopy and definitive procedure in the same sitting, and the remaining had staged or delayed definitive treatment. Conclusion Our study highlights the usefulness of wrist arthroscopy in assessment and management of the scaphoid nonunion and associated pathologies. Besides in 18% of our patients, the initial management plan changed after arthroscopy. Level of Evidence This is a Level IV study.
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Nurm, Triin, Paulo Torres, and Jayasree Ramas Ramaskandhan. "Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Osteochondral Lesions (OCL’s)?" Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000064.
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Category: Ankle, Arthroscopy Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL’s in symptomatic patients. Methods: A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results: Between April 2012 and July 2016, 48 patients who fulfilled the criteria were included. There were 27 male and 21 female patients, the average age was 43.4. Average time interval between MRI and arthroscopy was 9 months. There was a significant negative relationship between OCL’s reported as stable on MRI to arthroscopic findings, r=-.31, p=0.03. Of the 21 patients who had OCL’s reported as stable on the MRI, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI and it was also unstable arthroscopically. In 27 patients, there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on arthroscopic findings. Conclusion: This study demonstrates that MRI has a poor predictive value for the stability of OCL’s of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings.
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Wilkens, Suzanne C., Frederique L. Vissers, Adam Nazzal, and Neal Chen. "The Incidence of Arthroplasty After Initial Arthroscopy for Trapeziometacarpal Arthrosis." HAND 13, no. 5 (August 20, 2017): 600–605. http://dx.doi.org/10.1177/1558944717725382.
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Background: It remains unclear how many patients undergo secondary surgery after initial arthroscopy for trapeziometacarpal (TMC) arthrosis. We studied the factors related to secondary TMC arthroplasty after TMC arthroscopy. We also examined secondary questions of: (1) what percentage of patients underwent secondary TMC arthroplasty; and (2) how much time elapsed from initial arthroscopy to arthroplasty. Methods: In this retrospective study, we included all adult patients who were treated with arthroscopy of the TMC joint at 2 level I hospitals and affiliates. Factors were assessed for their independent association with secondary TMC arthroplasty using bivariate and multivariable analyses. Results: Fourteen of 84 (17%) thumbs underwent secondary TMC arthroplasty an average of 11 months after the initial arthroscopy. Synovectomy alone and smoking tobacco were independently associated with secondary TMC arthroplasty when compared with arthroscopic (partial) trapeziectomy with additional tendon interposition or allograft. Conclusions: This study demonstrated that 1 in 6 thumbs underwent secondary TMC arthroplasty, an average of 11 months after the initial arthroscopy. Coupling arthroscopy with partial trapeziectomy, interposition, or extension osteotomy may be a preferable strategy to isolated synovectomy. In addition, smoking tobacco is associated with inferior outcomes regardless of surgical procedure.
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Smith, Kenneth S., Katherine D. Drexelius, Shanthan C. Challa, Daniel K. Moon, Joshua A. Metzl, and Kenneth J. Hunt. "Patient Outcomes Differences Following Ankle Fracture Fixation with or without Ankle Arthroscopy." Foot & Ankle Orthopaedics 5, no. 2 (April 1, 2020): 2473011420S0001. http://dx.doi.org/10.1177/2473011420s00013.
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Category: Arthroscopy; Ankle; Trauma Introduction/Purpose: Ankle fractures are one of the most common types of fractures, yet there is currently no consensus about how best to treat these patients. The treatment approach typically includes open reduction-internal fixation (ORIF), but not all patients have a good clinical outcome. Intra-articular injuries have been suggested as one potential cause of these sub-optimal outcomes. Use of arthroscopy at the time of surgery is useful in identifying intra-articular lesions in acute ankle fractures, however, there is no evidence that arthroscopic intervention changes the patient’s outcome. Ankle arthroscopy increases the duration and potential complications of anesthesia administration and also increases cost. Our study assesses the clinical impact of arthroscopy accompanying an ankle fracture ORIF, which is essential to promote positive outcomes, while decreasing unnecessary complications and costs. Methods: This is a retrospective chart review. We queried all patients that underwent operative fixation of a bimalleolar or trimalleolar ankle fracture at our institution from January 1, 2014 through November 1, 2018. From this list, we excluded patients less than 18 years old and patients that had concomitant injuries to other body parts that required surgery. In addition, we only included Weber B and Weber C fibula fracture to homogenize the data. We then performed a chart review to extract all demographic data, fracture pattern, surgical procedures performed, tourniquet times, any revision surgeries, arthroscopic findings and any interventions performed due to the arthroscopic portion of the procedure. We then conducted a phone and email survey utilizing the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form and the two question Patient Acceptable Symptom State (PASS). Results: Our study included 213 total patients (142 traditional ORIF, 71 ORIF plus arthroscopy) with an average age of 40 (standard deviation 14.2). The average follow up was 32.4 (13.1) months with a survey follow up rate of 50.7%. The demographic information between the two cohorts was statistically similar. The average tourniquet time for the arthroscopy cohort is 10 minutes longer (89 minutes versus 79 minutes). During the arthroscopy, there was a 28.2% rate of full thickness osteochondral lesions, 33.8% rate of loose bodies, and a 49.2% rate of small cartilage injury not requiring intervention. The mean PROMIS physical function score amongst Weber B fibula fractures was 45.8 and 42.3 in the arthroscopy and non-arthroscopy groups respectively (P value 0.012). In addition, the patient satisfaction rate in Weber B fibula fractures was higher in those patients that underwent arthroscopy as compared to ORIF alone (93.1% versus 75.5%, P value of 0.05). Patients that suffered a tibiotalar joint dislocation at the time of the ankle fracture had a significantly higher PROMIS physical function score (46.6 versus 40.2, P value 0.005) when their surgery included arthroscopy. Conclusion: Ankle arthroscopy at the time of ORIF led to higher mean patient reported outcomes for every tested metric but this reached statistical significance only when looking at the Weber B fibula fractures and ankle dislocations. There was no increase in complication rate and the arthroscopy took only 10 minutes longer on average. [Table: see text]
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Raj, D., S. Iyer, and CM Fergusson. "Methicillin-Resistant Staphylococcus Aureus Infection Following Arthroscopy of the Knee Joint." Annals of The Royal College of Surgeons of England 88, no. 7 (November 2006): 675–76. http://dx.doi.org/10.1308/003588406x149345.
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Arthroscopic surgery of the knee is considered to be a safe procedure. We had a microbiologically confirmed infection of methicillin-resistant Staphylococcus aureus (MRSA). Although various rare infective cases are reported following arthroscopy of the knee joint, to the best of our knowledge there is no previous report of MRSA infection following arthroscopy of the knee joint.
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Beale, B., and J. Miller. "Tibiotarsal arthroscopy." Veterinary and Comparative Orthopaedics and Traumatology 21, no. 02 (2008): 159–65. http://dx.doi.org/10.3415/vcot-07-03-0025.
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SummaryThe objective of this retrospective article was to describe the use of, and to determine long-term outcome of, tibiotarsal arthroscopy in dogs. The medical records of 20 client-owned dogs with tibiotarsal joint disease with arthroscopic treatment were reviewed. Long-term follow-up evaluation of lameness, force plate gait analysis, and radiographs to assess progression of degenerative joint disease (DJD) were performed. Arthroscopy was utilized in the diagnosis of talar osteochondritis dissecans (OCD), collateral ligament injury, septic arthritis, immune mediated arthritis, and a distal talar fragment. Sixteen joints with OCD treated resulted in 10/14 dogs with lameness after exercise only, progression of DJD in most cases, and chronic lameness when comparing operated to unoperated limbs with force plate evaluation at a mean follow-up of 35 months. Following treatment, three dogs with collateral ligament injury had reduced weight bearing on the operated limb, radiographic progression of DJD, and minimal lameness at a mean follow-up of 27 months. Tibiotarsal arthroscopy can be successfully used to help diagnose, and often to treat: OCD, collateral ligament injury, fractures, septic and non-septic arthritis in the dog. The minimally invasive nature of arthroscopy preserved joint stability while allowing complete examination of the articular cartilage. In most cases long term tibiotarsal DJD advancement was the rule.