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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 -
Journal of Orthopaedics 2020The purpose of this study was to systematically review the literature to gain a greater understanding of the role and usage of arthroscopy in removal of retained bullet... (Review)
Review
PURPOSE
The purpose of this study was to systematically review the literature to gain a greater understanding of the role and usage of arthroscopy in removal of retained bullet fragments. Secondarily, we intend to examine the level of evidence and methodologic quality of studies reporting on this topic.
METHODS
A search of PubMed, MEDLINE, and Cochrane Database of Systematic Reviews was performed using the search terms ("Arthroscopic" OR "Arthroscopy") AND ("Bullet" OR "Gunshot" OR "Ballistic" OR "Removal"). Inclusion criteria included articles published in English reporting on arthroscopic or arthroscopically-assisted bullet removal. Studies lacking sufficient data to separate arthroscopic and open procedures were excluded. Level of evidence, study information (i.e., country, journal, etc.), and patient data was collected from each eligible article. The methodological index for non-randomized studies (MINORS) score were assigned to each article.
RESULTS
A total of 2676 studies were identified in the initial search with 31 studies meeting criteria for inclusion in the study. Twenty-eight of the 31 studies were case reports. The MINORS score averaged 8.8 ± 1.5 (range 5-10) for included studies. Sixty-two patients were identified, the majority (94%) of whom were male with an average age of 36.2 ± 12.3 years. All 62 patients underwent successful arthroscopic bullet removal. One patient was reported to have a complication (compartment syndrome). Outcome measures were underreported in the majority of studies.
CONCLUSIONS
Our study found that very little literature exists on the role of arthroscopy in bullet removal. Of this literature, no high-quality studies exist. Based on the limited existing literature, arthroscopy appears to be a safe, reliable alternative to open surgery for bullet removal. Potential benefits of arthroscopic bullet removal exist and warrant further investigation to further define the role of arthroscopy.
LEVEL OF EVIDENCE
Level V.
PubMed: 33088076
DOI: 10.1016/j.jor.2020.09.019 -
Acta Orthopaedica Apr 2023Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures.
METHODS
We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention.
RESULTS
Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise.
CONCLUSION
The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.
Topics: Humans; Wrist; Arthroscopy; Wrist Joint; Wrist Injuries; Joint Instability; Radius Fractures; Treatment Outcome
PubMed: 37114362
DOI: 10.2340/17453674.2023.11957 -
Muscles, Ligaments and Tendons Journal 2016Hip arthroscopy has gained popularity among the orthopedic community and a precise assessment of indications, techniques and results is constantly brought on.
BACKGROUND
Hip arthroscopy has gained popularity among the orthopedic community and a precise assessment of indications, techniques and results is constantly brought on.
METHODS
In this chapter the principal standard entry portals for central and peripheral compartment are discussed. The description starts from the superficial landmarks for portals placement and continues with the deep layers. For each entry point an illustration of the main structures encountered is provided and the principal structures at risk for different portals are accurately examined. Articular anatomical description is carried out from the arthroscope point of view and sub-divided into central and peripheral compartment. The two compartments are systematically analyzed and the accessible articular areas for each portal explained. Moreover, some anatomical variations that can be found in the normal hip are reported.
CONCLUSION
The anatomical knowledge of the hip joint along with a precise notion of the structures encountered with the arthroscope is an essential requirement for a secure and successful surgery. Level of evidence: V.
PubMed: 28066735
DOI: 10.11138/mltj/2016.6.3.309 -
Journal of Bone and Joint Infection 2019Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues.... (Review)
Review
Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt. Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those "sterility mistake" situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope. When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p<0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: "putting a definitive PE one size smaller or bigger with balance adjustment" (31%); and "leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives" (29%) (p<0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p<0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p<0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p<0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error. There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.
PubMed: 31011510
DOI: 10.7150/jbji.30613 -
Journal of Surgical Case Reports Nov 2022We experienced a case of humeral head impression fracture accounting for approximately 20% of the anterior articular surface. Open reduction and internal fixation of the...
We experienced a case of humeral head impression fracture accounting for approximately 20% of the anterior articular surface. Open reduction and internal fixation of the proximal humeral fracture combined with arthroscope-assisted reduction and internal fixation of the humeral head impression fracture were performed, and good clinical and radiographic outcomes were obtained. Untreated impression fracture may be a potential risk for subluxation or osteoarthritis. However, our arthroscopic approach is minimally invasive and allows for the prevention of these risks.
PubMed: 36452285
DOI: 10.1093/jscr/rjac476 -
JBJS Essential Surgical Techniques Jun 2016Arthroscopic subacromial decompression with acromioplasty is among the most commonly performed arthroscopic shoulder procedures and is an important aspect of any...
Arthroscopic subacromial decompression with acromioplasty is among the most commonly performed arthroscopic shoulder procedures and is an important aspect of any orthopaedic surgeon's armamentarium. This procedure is indicated for refractory subacromial bursitis and subacromial impingement. It is also a routine portion of rotator cuff repair exposure. The procedure aims to remove the subacromial bursa, which can serve as a pain generator, as well as any osteophytes on the undersurface of the acromion, which can lead to impingement and, in some circumstances, bursal-sided rotator cuff tears. Multiple randomized clinical trials have demonstrated no benefit for this procedure as an initial treatment in patients with subacromial bursitis, and thus this procedure is indicated only for patients with refractory subacromial bursitis. The steps of this procedure include (1) placement of the arthroscope in the subacromial space and establishment of a lateral working portal, (2) performance of a thorough subacromial bursectomy, (3) achievement of hemostasis and subperiosteal exposure of the undersurface of the acromion, and (4) smoothing of the undersurface of the acromion and removal of any anterolateral osteophytes. Outcomes after this procedure have shown significant increases in UCLA (University of California at Los Angeles), Constant, visual analog pain scale, and Simple Shoulder Test scores over the preoperative status. Complications, while infrequent, are mostly related to overresection or underresection of the acromion.
PubMed: 30237923
DOI: 10.2106/JBJS.ST.O.00011 -
JBJS Essential Surgical Techniques Mar 2017Acute acromioclavicular (AC)-joint dislocations are common injuries of the shoulder girdle. Surgical repair is indicated for acute high-grade (Rockwood types IV, V, and...
Acute acromioclavicular (AC)-joint dislocations are common injuries of the shoulder girdle. Surgical repair is indicated for acute high-grade (Rockwood types IV, V, and VI) AC-joint injuries. The best treatment for type III is still controversial, but young and active patients with this type of injury might benefit from a surgical AC-joint stabilization. Surgery should be performed within the first 3 weeks after the injury since the biological healing potential decreases with time. Acute AC-joint separation is diagnosed by clinical examination and radiography. Vertical translation anteroposterior stress views with a 10-kg load are used to grade the injuries. Bilateral lateral stress (Alexander) views are used to evaluate dynamic horizontal translation qualitatively. Arthroscopic techniques for AC reconstruction have become more popular in recent years because they are minimally invasive; they allow treatment of concomitant glenohumeral lesions; and they can be performed in one step, with insertion of implants that do not have to be removed later. The arthroscopically assisted double-button technique with an additional AC cerclage was developed to stabilize the AC joint by internal bracing of the torn ligaments. The procedure consists of the following steps. Step 1: With the patient in the beach-chair position, a 2-cm incision is made on top of the clavicle and posterior and lateral viewing portals as well as an anteroinferior working portal are created. Step 2: With the arthroscope in the lateral portal, the subcoracoid bursa and the base of the coracoid are dissected with a radiofrequency ablation device through the anteroinferior portal. Step 3: Coracoclavicular drilling is done with use of a drill guide and under arthroscopic and image-intensifier control. After overdrilling of the Kirschner wires, Nitinol suture passers are introduced and retrieved via the anteroinferior portal. Step 4: Transclavicular and transacromial drill-holes are established for the AC cerclage. Step 5: The 2 double-button devices are attached to the Nitinol suture passers, and the inferior buttons are shuttled through the clavicle and coracoid and then placed parallel to the coracoid base. Step 6: The sutures are tightened, and an anatomical vertical reduction of the AC joint is achieved. Step 7: A triangular acromioclavicular nonabsorbable cerclage tape is used for horizontal stabilization. Step 8: The clavicular incision is closed in 2 layers, including the repair of the deltotrapezoidal fascia and the arthroscopic portals, in a standard fashion. The combined arthroscopically-assisted and image-intensifier-controlled double-button technique with an additional AC cerclage is a safe procedure that enables an anatomical reduction of the AC joint and yields good to excellent clinical results.
PubMed: 30233942
DOI: 10.2106/JBJS.ST.16.00063 -
Arthroscopy Techniques Jul 2022Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure, particularly with respect to tibial footprint debridement and tibial...
Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure, particularly with respect to tibial footprint debridement and tibial tunnel placement, where iatrogenic damage to anatomic structures is a well reported complication and incorrect tunnel placement can have functional implications. Preparation of the tibial component often involves switching between 30° and 70° arthroscopes and frequent portal swapping and reorientation, which can be inefficient and time-consuming. As the technology and picture resolution of needle arthroscopy has improved, its clinical application has widened. This manuscript describes the use of needle arthroscopy-assisted arthroscopic PCL reconstruction for optimal visualization of the PCL tibial footprint using an accessory posterolateral portal, while obviating the need of both 30° and 70° arthroscopes.
PubMed: 35936863
DOI: 10.1016/j.eats.2022.03.019 -
Arthroscopy Techniques Apr 2017The fabella is an anatomic variant not seen in all individuals and can potentially be a source of chronic knee pain due to chondromalacia, osteoarthritis, fractures, or...
The fabella is an anatomic variant not seen in all individuals and can potentially be a source of chronic knee pain due to chondromalacia, osteoarthritis, fractures, or biomechanical pressure against the lateral femoral condyle. It is situated intra-articular, close to the lateral femoral condyle, the lateral gastrocnemius head tendon, and the fabellofibular ligament. Given its rarity, the diagnosis of a symptomatic fabella is often overlooked when evaluating patients with persistent posterolateral knee pain. However, this diagnosis should always be considered, especially in high-performance runners, bikers, and triathletes. Although nonoperative management can potentially resolve symptoms associated with this condition, fabella excision via arthroscopically assisted surgery is a reliable and safe alternative to treat patients who do not benefit from nonsurgical treatment. We present our technique detailing fabella excision for treatment of posterolateral knee pain, which includes an arthroscopic evaluation of the fabella to assess damage to the femoral condyle and minimize over-resection and potential damage to surrounding structures.
PubMed: 28580255
DOI: 10.1016/j.eats.2016.10.011