-
Zhongguo Gu Shang = China Journal of... Feb 2021To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement.
METHODS
Totally 34 patients (34 hips) with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018, were randomly divided into two groups named as tranexamic acid group and control group, 17 patients in each group. In TXA group, there were 10 males and 7 females, aged from 20 to 49 years old with an average of (32.1±7.6) years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min. In control group, there were 11 males and 6 females, aged from 20 to 49 years old with an average of (30.9±6.2) years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min. Introopertaive and total bloodloss between two groups were compared. Visual analogue scale (VAS) at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint. Modified Harris Hip Score(mHHS) of hip joint at 3, 6, 9 and 12 weeks after oeprtaion were applied to evaluate clinical effects.
RESULTS
All patients were obtained follow up over 12 weeks. Incision healed well without infection and deep vein thrombosis. There were no statistical difference in opertaion time bewteen two groups(>0.05) . Total blood loss and introopertaive blood loss in TXA group were (0.47±0.20) L and (0.18±0.08) L, while (0.66±0.22) L and (0.24±0.01) L in control group;there were statical differences between two groups (<0.05). There were no dierences in VAS before opertaion and 7 days after opertaion between two groups (>0.05);VAS at 3 days after opertaion in TXA group was 2.35±1.12 and 3.12±0.70 in control group, and had difference (< 0.05). There were significance in VAS at 3 and 7 days after opertaion compared with preopertaive between two groups (< 0.05). Postopertaive mHHS in TXA group at 3 and 6 weeks were 87.72±1.95 and 91.92±2.32, respectively;while 84.08±1.21 and 89.77±3.30 in control group;there were difference between two groups at 3 and 6 weeks after operation (<0.05);there were no significant difference in mHHS between two groups at 9 and 12 weeks after operation(>0.05).
CONCLUSION
Preoperative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement, thereby improving surgical field of vision, reducing difficulty of surgical operation, which could promote early and rapid rehabilitation of hip function.
Topics: Adult; Aged; Arthroscopes; Arthroscopy; Blood Loss, Surgical; Female; Femoracetabular Impingement; Hip Joint; Humans; Male; Middle Aged; Tranexamic Acid; Treatment Outcome; Young Adult
PubMed: 33665997
DOI: 10.12200/j.issn.1003-0034.2021.02.005 -
Arthroscopy : the Journal of... Feb 2019Working around the coracoid has now become commonplace in arthroscopic shoulder surgery. No longer is there a safe side and a "suicide"; therefore, it is important to...
Working around the coracoid has now become commonplace in arthroscopic shoulder surgery. No longer is there a safe side and a "suicide"; therefore, it is important to recognize the potential for neurovascular injury when surgery is performed about the coracoid. Although safe zones and distances are important, when more complex procedures are performed arthroscopically, direct visualization and identification of neurovascular structures is critical in avoiding iatrogenic injury.
Topics: Arthroscopy; Cadaver; Coracoid Process; Humans; Shoulder; Shoulder Joint
PubMed: 30712618
DOI: 10.1016/j.arthro.2018.11.007 -
Arthroscopy Techniques Jun 2016Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi...
Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function.
PubMed: 27656385
DOI: 10.1016/j.eats.2016.02.007 -
Orthopaedic Surgery Aug 2021To explore the development of hip arthroscopy in China through reviewing the change of the application of hip arthroscopy operation on treating femoracetabular... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To explore the development of hip arthroscopy in China through reviewing the change of the application of hip arthroscopy operation on treating femoracetabular impingement (FAI).
METHOD
Papers were retrieved from January 1, 2005 to November 1, 2019, from databases CNKI, Wanfang Data, VIP, PubMed, and Embase. The keywords are Hip Impingement, Femoroacetabular impingement, Hip arthroscopy, Arthroscopic operation, Hip Arthroscopy operation, and Arthroscope, etc. The quality of papers was assessed through MINORS , and statistics and meta-analysis were performed by Word, Excel, and Revman 5.3 Zurich, Switzerland.
RESULTS
From a total of 8,953 papers, 46 review articles without data and 48 articles with data were involved, and 25 papers were included in the Meta-analysis. The twenty-five papers were selected from 48 papers with data, of which 41 were reported in Chinese, 11 were missing complete Harris scores, five did not mention the number of patients who had lost follow-up, three had minors quality scores below 7, one did not have enough FAI cases, and three did not have standard deviations in Harris scores. Overall, in China, the application of hip arthroscopy regarding FAI has flourished while maintaining a high level of treatment and has reached its peak in the past 2 years.
CONCLUSION
With the rapid development of hip arthroscopy in China, hip operation is widely recognized, many reports on its application on FAI have emerged successively, and the scope of application and technical level have been improved.
Topics: Arthroscopy; China; Femoracetabular Impingement; Humans; Surveys and Questionnaires
PubMed: 34664414
DOI: 10.1111/os.13105 -
Journal of Children's Orthopaedics Apr 2017pinning of slipped capital femoral epiphysis (SCFE) results in various degrees of deformity of the femoral head-neck junction. Repetitive trauma from cam-type...
BACKGROUND
pinning of slipped capital femoral epiphysis (SCFE) results in various degrees of deformity of the femoral head-neck junction. Repetitive trauma from cam-type femoroacetabular impingement (FAI) can lead to labral tears and injury to the articular cartilage causing loss of function. Arthroscopic osteoplasty is an alternative to open procedure and to Southwick/Imhäuser-type osteotomies in symptomatic selected cases.
SURGICAL TECHNIQUE
The amount of bone to be resected has to be carefully planned pre-operatively. Only gentle traction is applied on a well-padded perineal support. A spherical burr is used to gradually resect the prominence. Intra-operative fluoroscopy is very useful when checking adequate reshaping of the head-neck junction is obtained.
RESULTS
Arthroscopy often reveals acetabular cartilage lesions, labrum hyperhemia and fraying which rarely require repair. Arthroscopic osteoplasty provides satisfactory pain relief and, to a lesser extent, restores hip internal rotation.
CONCLUSION
Arthroscopic osteoplasty is more technically and time-demanding in post SCFE than idiopathic FAI. It requires strong arthroscopic skills and experience in hip arthroscopy. It stands as a reasonable alternative to open procedure or flexion osteotomies in symptomatic FAI post mild to moderate SCFE. It provides pain relief and to a lesser extent restores internal rotation of the hip.
PubMed: 28529661
DOI: 10.1302/1863-2548-11-160281 -
Arthroscopy Techniques Nov 2020Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying...
Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability.
Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying osteochondral lesions is paramount to operative success. To treat these conditions effectively, a comprehensive arthroscopic assessment of the patellofemoral joint as well as dynamic visualization of patella tracking must be achieved. Visualization of the patellofemoral joint-in particular, the articular cartilage of the patella and trochlea morphology-can be difficult when using traditional anteromedial or anterolateral portals and a 30° arthroscope lens. The technique described here uses an accessory superolateral portal and a 70° arthroscope to achieve significantly improved visualization of the patellofemoral articulation, in particular the chondral surfaces. This vantage point aids the surgeon in effectively evaluating patellar tracking, trochlea morphology, and importantly, osteochondral lesion location to help guide treatment algorithms in the patellofemoral joint.
PubMed: 33294334
DOI: 10.1016/j.eats.2020.07.020 -
Arthroscopy : the Journal of... Jul 2021Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging...
Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging (MRI), including time out of work, prolonged diagnostic dilemmas, and finite advanced imaging resources. Improvements in the image quality with the modern needle arthroscope have made it a viable option for use as a diagnostic tool in the operative setting, and eventually, if surgeons are able to create strict criteria for proper diagnostic use of the needle arthroscope, it may become an excellent tool for in-office use despite financial or legal hurdles. Specific clinical scenarios for use of an diagnostic needle arthroscopy instead of an MRI (and typically immediately followed by therapeutic arthroscopy in the same setting) include (1) a patient with a clinically obvious meniscus tear with a locked knee, (2) a patient with an outdated but previously positive MRI with recurrent injury such as a recurrent shoulder or patella dislocations, (3) a patient who is ineligible for an MRI such as those with pacemakers or spinal implants who have clear and obvious clinical findings to suggest intra-articular pathology, and (4) a patient who is over the age of 50 years with positive rotator cuff testing after a shoulder dislocation in which I have a high degree of suspicion of a rotator cuff tear. In the future, we envision using multiple needle arthroscopes to provide simultaneous views from different angles during surgery and giving ourselves a 360° view. I envision an operating room in the future with multiple small needle scopes in joint and multiple viewing monitors providing a new 3-dimensional world of arthroscopy.
Topics: Arthroscopes; Arthroscopy; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Middle Aged; Rotator Cuff; Shoulder Joint
PubMed: 34226002
DOI: 10.1016/j.arthro.2021.04.014 -
Computer Methods and Programs in... Mar 2023Intraoperative joint condition is different from preoperative CT/MR due to the motion applied during surgery, inducing an inaccurate approach to surgical targets. This...
BACKGROUND AND OBJECTIVES
Intraoperative joint condition is different from preoperative CT/MR due to the motion applied during surgery, inducing an inaccurate approach to surgical targets. This study aims to provide real-time augmented reality (AR)-based surgical guidance for wrist arthroscopy based on a bone-shift model through an in vivo computed tomography (CT) study.
METHODS
To accurately visualize concealed wrist bones on the intra-articular arthroscopic image, we propose a surgical guidance system with a novel bone-shift compensation method using noninvasive fiducial markers. First, to measure the effect of traction during surgery, two noninvasive fiducial markers were attached before surgery. In addition, two virtual link models connecting the wrist bones were implemented. When wrist traction occurs during the operation, the movement of the fiducial marker is measured, and bone-shift compensation is applied to move the virtual links in the direction of the traction. The proposed bone-shift compensation method was verified with the in vivo CT data of 10 participants. Finally, to introduce AR, camera calibration for the arthroscope parameters was performed, and a patient-specific template was used for registration between the patient and the wrist bone model. As a result, a virtual bone model with three-dimensional information could be accurately projected on a two-dimensional arthroscopic image plane.
RESULTS
The proposed method was possible to estimate the position of wrist bone in the traction state with an accuracy of 1.4 mm margin. After bone-shift compensation was applied, the target point error was reduced by 33.6% in lunate, 63.3% in capitate, 55.0% in scaphoid, and 74.8% in trapezoid than those in preoperative wrist CT. In addition, a phantom experiment was introduced simulating the real surgical environment. AR display allowed to expand the field of view (FOV) of the arthroscope and helped in visualizing the anatomical structures around the bones.
CONCLUSIONS
This study demonstrated the successful handling of AR error caused by wrist traction using the proposed method. In addition, the method allowed accurate AR visualization of the concealed bones and expansion of the limited FOV of the arthroscope. The proposed bone-shift compensation can also be applied to other joints, such as the knees or shoulders, by representing their bone movements using corresponding virtual links. In addition, the movement of the joint skin during surgery can be measured using noninvasive fiducial markers in the same manner as that used for the wrist joint.
Topics: Humans; Augmented Reality; Wrist; Arthroscopy; Wrist Joint; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 36608430
DOI: 10.1016/j.cmpb.2022.107323 -
Plastic and Reconstructive Surgery Dec 2022Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the...
BACKGROUND
Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the results obtained by reconstructing the scapholunate ligament with a bone-ligament-bone autograft through an arthroscope-assisted minimally invasive approach.
METHODS
Thirty-six patients were enrolled initially but only 31 constituted the final population study (23 male, eight female; median age, 38 years; age range, 18 to 55 years). Radiographic (posteroanterior and true lateral radiographs to assess the scapholunate gap, radiolunate, and capitolunate angles; computed tomographic scan; magnetic resonance images), functional [grip strength (Jamar test and pinch test), active range of motion], and subjective (patient-rated wrist evaluation test) outcome measurements were collected. Minimum follow-up was 50 months.
RESULTS
Grip strength and wrist mobility were significantly improved from the preoperative values and improved over time. No scapholunate synostosis or carpal bone necrosis was observed. No wrist showed any sign of arthrosis or progression towards wrist instability. Only four patients had scapholunate gap greater than 3 mm.
CONCLUSIONS
The proposed technique for scapholunate reconstruction, providing a biologic reconstruction of both the volar and dorsal portion of the scapholunate ligament and avoiding extensive capsulotomy, obtained significant functional outcomes improvement that was maintained over time and prevented degenerative changes to the articular surfaces.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Humans; Male; Female; Adult; Adolescent; Young Adult; Middle Aged; Lunate Bone; Scaphoid Bone; Arthroscopes; Retrospective Studies; Ligaments, Articular; Wrist Joint; Joint Instability; Range of Motion, Articular
PubMed: 36126203
DOI: 10.1097/PRS.0000000000009736 -
JBJS Essential Surgical Techniques Sep 2018The first recorded attempt at arthroscopic visualization of the hip can be attributed to Dr. Michael Burman in 1931. Since then, hip arthroscopy has become widely used...
BACKGROUND
The first recorded attempt at arthroscopic visualization of the hip can be attributed to Dr. Michael Burman in 1931. Since then, hip arthroscopy has become widely used for the management of femoroacetabular impingement (FAI) because of its clear benefits, including a low complication rate and limited patient morbidity as compared with traditional open approaches.
DESCRIPTION
Arthroscopic management of FAI begins with arthroscopy of the central compartment, where the intra-articular damage is identified. Standard portal placement provides optimal access for surveying and accessing intra-articular injury. The pathological findings identified preoperatively and confirmed during diagnostic arthroscopy dictate the necessary arthroscopic procedures. Correction of acetabular overcoverage and repair of the labrum to the acetabular rim can correct pincer lesions. Femoral-sided cam lesions require removal of traction and application of hip flexion in order to perform a femoral osteoplasty to recreate a normal anatomic femoral head-neck offset. Finally, capsular management is performed as clinically indicated.
ALTERNATIVES
Appropriate management of FAI typically begins with nonoperative care consisting of rest, nonsteroidal anti-inflammatory drugs (NSAIDs), activity modification, and physical therapy. Intra-articular corticosteroid injections can also provide relief. Open procedures involving surgical hip dislocation can be utilized to address pathological conditions not accessible arthroscopically. Additionally, a "mini-open" procedure in which intra-articular disorders are treated arthroscopically and cam lesions are resected via a small anterior exposure can be employed.
RATIONALE
Hip arthroscopy offers a minimally invasive technique that can be effective for treating intra-articular hip disorders and is usually favored over open surgical dislocation. Hip arthroscopy has been shown to result in higher functional outcome scores than open procedures, with lower rates of complications. Hip arthroscopy is playing an increasingly important role as an adjunct diagnostic and therapeutic tool in conjunction with open femoral and/or periacetabular osteotomy for complex hip deformities.
PubMed: 30588368
DOI: 10.2106/JBJS.ST.18.00043