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PloS One 2019We have developed a new arthroscope with a field of view of 150°. This arthroscope requires less motion to maneuver and exhibits reduced optical error. It also improves... (Comparative Study)
Comparative Study
BACKGROUND
We have developed a new arthroscope with a field of view of 150°. This arthroscope requires less motion to maneuver and exhibits reduced optical error. It also improves how novices learn arthroscopy. We hypothesized that the surgical performance with this arthroscope is superior to that with a conventional arthroscope. This study tested the hypothesis by using motion analysis and a new validated parameter, "dimensionless squared jerk" (DSJ).
METHODS
We compared the surgical performance between the use of the wide-angle arthroscope and that of the conventional arthroscope among 14 novice orthopedic residents who performed 3 standardized tasks 3 times with each arthroscope. The tasks simulated the surgical skills in arthroscopic rotator cuff repair. The arthroscope motion was analyzed using an optical tracking system. The differences in performance parameters, such as the time taken to complete the tasks, average acceleration of the hands (m/s2), number of movements, and total path length (m) including DSJ between the 2 arthroscopes were investigated using paired t-tests.
RESULTS
All estimated values for the tasks using the 150° arthroscope were lower than those for the tasks using the 105° arthroscope. Statistically significant differences in performance between the 2 arthroscopes were observed only for DSJ (p = 0.014) and average acceleration (p = 0.039).
CONCLUSIONS
DSJ and average acceleration are reliable parameters for representing hand-eye coordination. The surgical performance of novice arthroscopists was better with the new wide-angle arthroscope than with the conventional arthroscope.
Topics: Arthroscopes; Arthroscopy; Clinical Competence; Computer Simulation; Equipment Design; Humans; Internship and Residency; Models, Anatomic; Motor Skills; Movement; Republic of Korea; Task Performance and Analysis
PubMed: 30856176
DOI: 10.1371/journal.pone.0203578 -
EFORT Open Reviews Dec 2017Tears of the subscapularis tendon have been under-recognised until recently. Therefore, a high index of suspicion is essential for diagnosis.A directed physical...
Tears of the subscapularis tendon have been under-recognised until recently. Therefore, a high index of suspicion is essential for diagnosis.A directed physical examination, including the lift-off, belly-press and increased passive external rotation can help identify tears of the subscapularis.All planes on MR imaging should be carefully evaluated to identify tears of the subscapularis, retraction, atrophy and biceps pathology.Due to the tendency of the tendon to retract medially, acute and traumatic full-thickness tears should be repaired. Chronic tears without significant degeneration should be considered for repair if no contraindication exists.Arthroscopic repair can be performed using a 30-degree arthroscope and a laterally-based single row repair; one anchor for full thickness tears ⩽ 50% of tendon length and two anchors for those ⩾ 50% of tendon length.Biceps pathology, which is invariably present, should be addressed by tenotomy or tenodesis.Timing of post-operative rehabilitation is dictated by the size of the repair and the security of the repair construct. The stages of rehabilitation typically involve a period of immobilisation followed by range of movement exercises, with a delay in active internal rotation (IR) and strengthening in IR. Cite this article: 2017;2:484-495. DOI: 10.1302/2058-5241.2.170015.
PubMed: 29387471
DOI: 10.1302/2058-5241.2.170015 -
Arthroscopy : the Journal of... Mar 2021The pros and cons of open and arthroscopic shoulder stabilization procedures have been studied exhaustively. Yet, in many situations, the rates of recurrent instability...
Editorial Commentary: Arthroscopic Glenoid Reconstruction With Subscapularis Tenodesis Results in Promising Clinical Outcomes, but Concerns Regarding Graft Resorption Rates Persist: A Long Way Toward a More Perfect Union.
The pros and cons of open and arthroscopic shoulder stabilization procedures have been studied exhaustively. Yet, in many situations, the rates of recurrent instability and overall complications associated with these techniques remain unacceptably high. Perhaps paradoxically, the refinement of arthroscopic shoulder stabilization techniques has only intensified the debate between proponents of either open or arthroscopic approaches, and although significant (however "significant" is defined), anteroinferior glenoid bone loss has historically been thought to constitute a relatively strong indication for an open bone augmentation procedure, surgeons, to their great credit, continue to push the limits of what can be accomplished arthroscopically. Arthroscopic glenoid reconstruction has emerged as a viable option that may represent "the best of both worlds." Although modifications to the originally described arthroscopic glenoid reconstruction technique are promising, concerns persist regarding the fate of the graft and the durability of the procedure beyond short-term follow-up.
Topics: Allografts; Arthroscopy; Humans; Ilium; Joint Instability; Rotator Cuff; Shoulder; Shoulder Dislocation; Shoulder Joint; Tenodesis
PubMed: 33673965
DOI: 10.1016/j.arthro.2021.01.009 -
Orthopaedics & Traumatology, Surgery &... May 2022Ramp lesions are found in 16% to 40% of patients undergoing anterior cruciate ligament reconstruction. The repair technique traditionally involves using a suture hook...
BACKGROUND
Ramp lesions are found in 16% to 40% of patients undergoing anterior cruciate ligament reconstruction. The repair technique traditionally involves using a suture hook through a posteromedial portal, with the arthroscope positioned in the intercondylar view via an antero-lateral portal. Ramp lesions may be difficult to visualize and repair, even with a 70° arthroscope. The objective of this study was to assess the feasibility of suturing ramp lesions via dual posteromedial portals for the arthroscope and instruments.
HYPOTHESIS
Dual posteromedial arthroscopic portals allow good visualisation and high-quality suturing of ramp lesions, without inducing specific iatrogenic injuries.
MATERIAL AND METHODS
We used 11 fresh cadaver knees. Two posteromedial portals were created under visualisation via an arthroscope introduced through an antero-lateral portal: one was the traditional instrumental portal and the other, located more proximally, was the optical portal. A 2-cm long ramp lesion was created. A suture hook was used to place one or two stitches of PDS n°0 suture. A probe was used to test the quality and stability of the suturing. The posteromedial plane was then dissected to evaluate the anatomical relationships of the portals.
RESULTS
The dual posteromedial approach allowed the visualisation and hook suturing of the ramp lesions in all 11 cases. A single stitch was placed in 4 cases and two stitches in 7 cases. The suture was always of good quality and stable when tested with the probe. The dissection found no injuries to nerves, blood vessels, or tendons.
CONCLUSION
Ramp lesions can be repaired through a dual posteromedial arthroscopic approach. This surgical technique provides good visibility of these lesions and allows high-quality suturing, with no specific iatrogenic injuries. It is an alternative to ramp lesion repair via a single posteromedial portal, which can be challenging.
LEVEL OF EVIDENCE
IV, experimental study with no control group.
Topics: Anterior Cruciate Ligament Injuries; Arthroscopy; Cadaver; Feasibility Studies; Humans; Iatrogenic Disease; Menisci, Tibial; Tibial Meniscus Injuries
PubMed: 34906726
DOI: 10.1016/j.otsr.2021.103175 -
JBJS Essential Surgical Techniques Mar 2016Knee arthroscopy is the most commonly performed orthopaedic procedure in the United States. Indications have grown exponentially since the procedure was first...
Knee arthroscopy is the most commonly performed orthopaedic procedure in the United States. Indications have grown exponentially since the procedure was first popularized by Watanabe and Jackson. Treatment of meniscal tears is the most common reason for knee arthroscopy, with approximately 700,000 arthroscopic partial meniscectomies performed annually. Other indications include assistance for cruciate ligament reconstruction, osteochondral lesions, removal of loose bodies, synovectomy, and septic arthritis. Arthroscopy is accomplished with the use of two small incisions on either side of the patella at the anterior aspect of the knee. An arthroscope is inserted through one incision and used to view the image on a monitor, while the second incision is employed for instrumentation. An examination with the patient under anesthesia should always be performed prior to the initiation of the procedure. The patient is positioned with the knee flexed and a lateral post secured to the side of the bed. Standard anteromedial and anterolateral portals are made, and an arthroscope is introduced through the anterolateral portal. Diagnostic arthroscopy is performed in a systematic fashion. Meniscal tears and other pathology are identified. With use of an arthroscopic probe, the features of the meniscal tear are determined. Arthroscopic punches and shavers are used to debride torn portions back to a stable rim. Knee arthroscopy is a highly effective procedure. Outcomes after partial medial meniscectomy are good to excellent in 80% to 100% of patients. A recent cost-effectiveness analysis demonstrated that knee arthroscopy is more cost-effective than coronary artery bypass surgery or total knee arthroplasty.
PubMed: 30237917
DOI: 10.2106/JBJS.ST.N.00095 -
Orthopaedics & Traumatology, Surgery &... May 2017Arthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar...
BACKGROUND
Arthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar fusion, foreign body removal, and ankle instability. Injuries to the vessels and nerves may occur during these procedures.
OBJECTIVE
To determine whether ultrasound topographic identification of vulnerable structures decreased the risk of iatrogenic injuries to vessels, nerves, and tendons and influenced the distance separating vulnerable structures from the arthroscope introduced through four different portals.
HYPOTHESIS
Ultrasonography to identify vulnerable structures before or during arthroscopic surgery on the ankle may be useful.
MATERIAL AND METHOD
Twenty fresh cadaver ankles from body donations to the anatomy institute in Strasbourg, France, were divided into two equal groups. Preoperative ultrasonography to mark the trajectories of vessels, nerves, and tendons was performed in one group but not in the other. The portals were created using a 4-mm trocar. Each portal was then dissected. The primary evaluation criterion was the presence or absence of injuries to vessels, nerves, and tendons. The secondary evaluation criterion was the distance between these structures and the arthroscope.
RESULTS
No tendon injuries occurred with ultrasonography. Without ultrasonography, there were two full-thickness tendon lesions, one to the extensor hallucis longus and the other to the Achilles tendon. Furthermore, with the anterolateral, anteromedial, and posteromedial portals, the distance separating the vessels and nerves from the arthroscope was greater with than without ultrasonography (P=0.041, P=0.005, and P=0.002), respectively; no significant difference was found with the anterior portal.
DISCUSSION
Preoperative ultrasound topographic identification decreases the risk of iatrogenic injury to the vessels, nerves, and tendons during ankle arthroscopy and places these structures at a safer distance from the arthroscope. Our hypothesis was confirmed.
LEVEL OF EVIDENCE
IV, cadaver study.
Topics: Achilles Tendon; Anatomic Landmarks; Ankle; Ankle Joint; Arthroscopy; Blood Vessels; Cadaver; Humans; Muscle, Skeletal; Peripheral Nerve Injuries; Tendon Injuries; Ultrasonography
PubMed: 28259751
DOI: 10.1016/j.otsr.2016.09.026 -
Arthroscopy Techniques Apr 2024Tendinopathy of the long head of biceps is a relatively common pathology that we usually see in most of our shoulder arthroscopy procedures. Surgical treatment for long...
Tendinopathy of the long head of biceps is a relatively common pathology that we usually see in most of our shoulder arthroscopy procedures. Surgical treatment for long head of biceps tendinopathies ranges from simple biceps tenotomy to biceps tenodesis depending on many factors, two of which are the age and the patient's level of activity. Various techniques in the literature for biceps tenodesis have been described, such as whether to do it open or arthroscopically, suprapectoral or subpectoral, as well as the type of fixation to be used. However, the optimal option is still debatable. In this Technical Note, we describe an arthroscopic technique for distal suprapectoral biceps tenodesis using a knotless corkscrew anchor that has many advantages, such as being an all-arthroscopic with the ability to retension the tendon after implantation. We support our technique with photos and videos with detailed explanations of the technique.
PubMed: 38690349
DOI: 10.1016/j.eats.2024.102922 -
Sports Medicine and Arthroscopy Review Mar 2016Rerupture of the extensor hallucis longus tendon after primary repair and neglected rupture of the tendon poses surgical challenges to orthopedic surgeons. Open... (Review)
Review
Rerupture of the extensor hallucis longus tendon after primary repair and neglected rupture of the tendon poses surgical challenges to orthopedic surgeons. Open exploration and repair of the tendon ends usually requires large incision and extensive dissection. This may induce scarring and adhesion around the repaired tendon. Endoscopic-assisted repair has the advantage of minimally invasive surgery including less soft tissue trauma and scar formation and better cosmetic result. The use of Krackow locking suture and preservation of the extensor retinacula allow early mobilization of the great toe.
Topics: Arthroscopes; Endoscopy; Humans; Rupture; Tendon Injuries; Toes
PubMed: 26752777
DOI: 10.1097/JSA.0000000000000087 -
Osteoarthritis and Cartilage May 2017We investigate the potential of a prototype multimodality arthroscope, combining ultrasound, optical coherence tomography (OCT) and arthroscopic indentation device, for... (Comparative Study)
Comparative Study
OBJECTIVE
We investigate the potential of a prototype multimodality arthroscope, combining ultrasound, optical coherence tomography (OCT) and arthroscopic indentation device, for assessing cartilage lesions, and compare the reliability of this approach with conventional arthroscopic scoring ex vivo.
DESIGN
Areas of interest (AIs, N = 43) were selected from equine fetlock joints (N = 5). Blind-coded AIs were independently scored by two equine surgeons employing International Cartilage Repair Society (ICRS) scoring system via conventional arthroscope and multimodality arthroscope, in which high-frequency ultrasound and OCT catheters were attached to an arthroscopic indentation device. In addition, cartilage stiffness was measured with the indentation device, and lesions in OCT images scored using custom-made automated software. Measurements and scorings were performed twice in two separate rounds. Finally, the scores were compared to histological ICRS scores.
RESULTS
OCT and arthroscopic examinations showed the highest average agreements (55.2%) between the scoring by surgeons and histology scores, whereas ultrasound had the lowest (50.6%). Average intraobserver agreements of surgeons and interobserver agreements between rounds were, respectively, for conventional arthroscope (68.6%, 69.8%), ultrasound (68.6%, 68.6%), OCT (65.1%, 61.7%) and automated software (65.1%, 59.3%).
CONCLUSIONS
OCT imaging supplemented with the automated software provided the most reliable lesion scoring. However, limited penetration depth of light limits the clinical potential of OCT in assessing human cartilage thickness; thus, the combination of OCT and ultrasound could be optimal for reliable diagnostics. Present findings suggest imaging and quantitatively analyzing the entire articular surface to eliminate surgeon-related variation in the selection of the most severe lesion to be scored.
Topics: Animals; Arthroscopy; Cadaver; Cartilage, Articular; Finland; Foot Injuries; Foot Joints; Horses; Injury Severity Score; Multimodal Imaging; Observer Variation; Reproducibility of Results; Tomography, Optical Coherence; Ultrasonography, Doppler
PubMed: 27965140
DOI: 10.1016/j.joca.2016.12.007 -
Arthroscopy Techniques Sep 2023Surgeons are increasingly treating Hill-Sachs lesions arthroscopically by suturing the posterior rotator cuff and capsule into the defect, a procedure known as...
Surgeons are increasingly treating Hill-Sachs lesions arthroscopically by suturing the posterior rotator cuff and capsule into the defect, a procedure known as "remplissage." A number of remplissage techniques have been described in the literature, and these often vary by the number and location of suture anchors. The "triple-double" technique of arthroscopic Hill-Sachs remplissage can be used for larger lesions. This technique utilizes a three-anchor configuration secured by interconnected double-mattress sutures to provide durable fixation through a large contact area between the capsulotenodesis tissue and the prepared bone bed to theoretically optimize healing.
PubMed: 37780661
DOI: 10.1016/j.eats.2023.04.024