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Orthopaedic Journal of Sports Medicine Jun 2022Several classification systems based on arthroscopy have been used to describe lesions of the ligamentum teres (LT) in young active patients undergoing hip-preserving...
Reliability and Reproducibility of a Novel Grading System for Lesions of the Ligamentous-Fossa-Foveolar Complex in Young Patients Undergoing Open Hip Preservation Surgery.
BACKGROUND
Several classification systems based on arthroscopy have been used to describe lesions of the ligamentum teres (LT) in young active patients undergoing hip-preserving surgery. Inspection of the LT and associated lesions of the adjuvant fovea capitis and acetabular fossa is limited when done arthroscopically but is much more thorough during open surgical hip dislocation. Therefore, we propose a novel grading system based on our findings during surgical dislocation comprising the full spectrum of ligamentous-fossa-foveolar complex (LFFC) lesions.
PURPOSE
To determine (1) intraobserver reliability and (2) interobserver reproducibility of our new grading system.
STUDY DESIGN
Cohort study (diagnosis); Level of evidence, 3.
METHODS
We performed this validation study on 211 hips (633 images in total) with surgical hip dislocation (2013-2021). We randomly selected 5 images per grade for each LFFC item to achieve an equal representation of all grades (resulting in 75 images). The ligament, fossa, and fovea were subcategorized into normal, inflammation, degeneration, partial, and complete defects. All surgeries were performed in a standardized way by a single surgeon. The femur was disarticulated using a bone hook, the LT was inspected, documented and resected, then the fossa and fovea were documented with the femoral head in full dislocation using a 70° arthroscope. Six observers with different levels of expertise in hip-preserving surgery independently conducted the measurements twice, and intraclass correlation coefficients (ICC) were calculated to determine (1) intraobserver reliability and (2) interobserver reproducibility of the novel grading system.
RESULTS
For intraobserver reliability, excellent ICCs were found in both the junior and the experienced raters for grading the ligament, fossa, fovea, and total LFFC (ICCs ranged from 0.91 to 0.99 for the LFFC score). We found excellent interobserver reproducibility between raters for all items of the LFFC (all interobserver ICCs ≥ 0.76).
CONCLUSION
Our new grading system for lesions of the LFFC is highly reliable and reproducible. It covers the full spectrum of damage more precisely than arthroscopic classifications do and offers a scientific basis for standardized intraoperative evaluation.
PubMed: 35706555
DOI: 10.1177/23259671221098750 -
Scientific Reports Oct 2022Meniscus horizontal tears are usually degenerative. It could be asymptomatic and unrelated to knee symptoms. Therefore, there are controversies regarding treatment...
Meniscus horizontal tears are usually degenerative. It could be asymptomatic and unrelated to knee symptoms. Therefore, there are controversies regarding treatment choices. The aim of this study was to evaluate factors that affect the results of non-surgical and surgical treatments for meniscus horizontal tears. We retrospectively studied 159 patients with meniscus horizontal tears with a minimum 2-year follow-up period. Patients were treated non-surgically or arthroscopically. The treatment results were dichotomized into success and failure. The factors considered were age, sex, joint line tenderness, mechanical symptoms, widest tear gap width on sagittal MRI, cartilage lesion grade, discoid meniscus, tear site, and joint alignment. Joint alignment and cartilage lesion grade were the factors that significantly influenced non-surgical treatment results. The widest tear gap width and cartilage lesion grade significantly affected arthroscopic surgery results. The mechanical symptoms did not show any significant relationship with either treatment result. In treating patients with meniscus horizontal tears, patients with varus alignment and advanced cartilage lesions should be informed of possible poor outcomes with non-surgical treatment. If the patient has a wide tear gap or minimal cartilage lesion, arthroscopic surgery would be a good treatment choice. The mechanical symptom was not an adequate factor for arthroscopic surgery.
Topics: Arthroscopy; Humans; Magnetic Resonance Imaging; Menisci, Tibial; Meniscus; Prognosis; Retrospective Studies; Rupture; Tibial Meniscus Injuries
PubMed: 36241683
DOI: 10.1038/s41598-022-21599-1 -
Arthroscopy Techniques Mar 2022Posterior hindfoot disorders encompass a spectrum of bony, cartilaginous, and soft-tissue pathology. Traditional open surgical techniques have been increasingly replaced...
Posterior hindfoot disorders encompass a spectrum of bony, cartilaginous, and soft-tissue pathology. Traditional open surgical techniques have been increasingly replaced by less-invasive arthroscopic and endoscopic approaches. Recent innovations such as the advent of the needle arthroscope continue to push the boundary of minimally invasive interventions. This Technical Note highlights our technique for posterior hindfoot needle endoscopy for common posterior hindfoot pathologies in the wide-awake office setting, including indications, advantages, and technical pearls.
PubMed: 35256963
DOI: 10.1016/j.eats.2021.10.018 -
Acta Orthopaedica Et Traumatologica... Oct 2017The aim of this study was to analyse the pattern of portal-tract healing, to compare the healing time of anteromedial and anterolateral portal tracts and to assess the...
OBJECTIVE
The aim of this study was to analyse the pattern of portal-tract healing, to compare the healing time of anteromedial and anterolateral portal tracts and to assess the impact of portal-tract delayed healing on the post-operative sub-acute and chronic anterior knee tenderness.
METHODS
The study included 104 patients (68 males and 36 females; mean age: 49 ± 3.16 years (range; 17-66)) who have undergone knee arthroscopy. Puncture wounds were divided into two groups, (1) anteromedial and (2) anterolateral groups. Each group contained 104 portal-tracts. Healing of portal tracts was evaluated using sequential superficial ultrasonographic examinaitons. Visual analogue scale (VAS) was used to measure pain related to delayed tract healing and its association with the post-operative sub-acute and chronic anterior knee tenderness.
RESULTS
Anteromedial and anterolateral tracts total healing time average values were 47 days and 28 days respectively. The VAS average values of anteromedial tracts after 2 weeks, one month, three months, six months and one year were 8.2, 6.3, 4, 1.9 and 0.6 respectively, and for the anterolateral tracts 7.4, 5.5, 2.8, 1.2 and 0.2 respectively. A statistical significance was detected between the two groups at the first and third months with P values 0.042 and 0.0035 respectively.
CONCLUSIONS
Anteromedial tracts closed later than anterolateral tracts. Both portal-tracts delayed closure is a potential for post-operative sub-acute and chronic anterior knee tenderness after arthroscopic surgery. Four grades of tract healing were recognized. Portal-tract ultrasonography is advised in persistent post-operative sub-acute and chronic anterior knee tenderness.
LEVEL OF EVIDENCE
Level III, Therapeutic study.
Topics: Aged; Arthralgia; Arthroscopes; Arthroscopy; Female; Humans; Knee Joint; Male; Middle Aged; Outcome Assessment, Health Care; Postoperative Complications; Visual Analog Scale; Wound Healing
PubMed: 28596053
DOI: 10.1016/j.aott.2017.05.002 -
Arthroscopy Techniques Sep 2023The diagnosis and treatment of elbow instability can be challenging for surgeons. Although history, physical examination, radiographs, and advanced imaging such as...
The diagnosis and treatment of elbow instability can be challenging for surgeons. Although history, physical examination, radiographs, and advanced imaging such as stress ultrasound scanning and magnetic resonance imaging are helpful, diagnostic arthroscopy is a valuable tool in the armamentarium of an elbow surgeon. Elbow arthroscopy is not only a diagnostic tool but also has the added therapeutic benefits that are not available with other diagnostic modalities. The purpose of this article and associated video is to present 3 arthroscopic techniques to help elbow surgeons arthroscopically recognize and quantify medial and lateral elbow instability.
PubMed: 37780657
DOI: 10.1016/j.eats.2023.04.029 -
Arthroscopy Techniques Nov 2022The advent of arthroscopy in shoulder surgery has allowed for the development of minimally invasive techniques for the treatment of shoulder pathology. Further...
The advent of arthroscopy in shoulder surgery has allowed for the development of minimally invasive techniques for the treatment of shoulder pathology. Further developments in needle arthroscopy have continued this trend toward less invasive shoulder surgery, allowing for decreased pain using smaller portals and decreased fluid irrigation through the shoulder joint during surgery. This technique describes a minimally invasive rotator cuff repair using a dual-lumen cannula that provides both direct visualization and direct instrument access to the pathology. This new cannula has the potential to further refine and to simplify needle arthroscopic techniques about the shoulder. With judicious patient selection, needle arthroscopy is a viable option for the treatment of common shoulder pathology.
PubMed: 36457403
DOI: 10.1016/j.eats.2022.08.012 -
JSES International Sep 2021The rate of complications of open compared to arthroscopic distal clavicle excision remain poorly studied. Therefore, the purpose of this investigation was to (1)...
BACKGROUND
The rate of complications of open compared to arthroscopic distal clavicle excision remain poorly studied. Therefore, the purpose of this investigation was to (1) Identify most recent national trends in the usage of open vs. arthroscopic approaches for distal clavicle excision (DCE) from 2007 to 2017; (2) to identify and compare the complication rates for both approaches, and to identify patient-specific risk factors for complications; (3) to identify and compare the revision rate for both approaches; and (4) to identify and compare the reimbursement of each approach.
METHODS
The PearlDiver database was reviewed for patients undergoing DCE from 2007 to 2017. Patients were stratified into 2 cohorts: those undergoing arthroscopic DCE (n = 8933) and those undergoing open DCE (n = 2295). The rate of postoperative complications within 90 days was calculated and compared. The revision rate and reimbursement of the arthroscopic and open approach were compared. Statistical analysis included chi-square testing to compare the rates of postoperative complications and multivariate logistic regression analysis to identify risk factors for complications within 90 days. Results were considered significant at < .05.
RESULTS
The percentage of DCEs performed arthroscopically has significantly increased from 53.9% in 2007 to 69.8% in 2016, with a concomitant decrease in the use of open DCE from 46.1% in 2007 to 30.2% in 2016. The open approach was associated with significantly more postoperative complications, including a significantly greater incidence of surgical site infection (1.9% vs. 0.3%; < .001), wound disruption (0.3% vs. 0.1%; < .001), hematoma (0.9% vs. 0.2%; = .001), and transfusion (0.6% vs. 0.1%; < .001), than arthroscopic DCE. Several risk factors, including open approach, diabetes, heart disease, tobacco use, chronic kidney disease, and female gender, were identified as independent risk factors for complications after DCE. There was no significant difference in revision rate between open and arthroscopic approaches ( = .126). The reimbursement of open and arthroscopic DCE procedures were comparable, with median reimbursements of $5408 and $5,447, respectively ( = .853).
CONCLUSION
Both arthroscopic and open DCE techniques were found to have similar reimbursement amounts, with a low rate of complications, although the open technique had a higher rate of early complications such as surgical site infection. Over the study period, there was an increase in the utilization of arthroscopic DCE, while the incidence of the open technique remained constant.
PubMed: 34505096
DOI: 10.1016/j.jseint.2021.05.012 -
Indian Journal of Orthopaedics 2016Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay....
BACKGROUND
Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia.
MATERIALS AND METHODS
24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2.
RESULTS
Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference ( < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively.
CONCLUSION
These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.
PubMed: 27904211
DOI: 10.4103/0019-5413.193474 -
JBJS Essential Surgical Techniques 2022Complex intra-articular calcaneal fractures often resulted in secondary pain and deformity, requiring subsequent subtalar arthrodesis. The literature suggests that...
UNLABELLED
Complex intra-articular calcaneal fractures often resulted in secondary pain and deformity, requiring subsequent subtalar arthrodesis. The literature suggests that primary subtalar arthrodesis in the acute period has good functional results. The literature also demonstrates that posterior arthroscopic subtalar arthrodesis for chronic arthritis has favorable results. Thus, we propose an approach to treating these difficult intra-articular calcaneal fractures that utilizes a posterior arthroscopic primary subtalar arthrodesis technique-aptly named Calcaneus Fracture and Posterior Arthroscopic Primary Subtalar Arthrodesis (C-PASTA).
DESCRIPTION
The procedure begins with the patient in the prone position. The subtalar joint is visualized with a 1.9-mm flexible camera through a standard posterior arthroscopic approach. With the help of the C-arm, position in the subtalar joint space is confirmed. The joint space is debrided with use of a 4-0 shaver and then prepared for arthrodesis arthroscopically with use of an osteotome and a burr. Next, we inject allograft demineralized matrix-based bone putty under direct arthroscopic visualization to fill residual gaps or defects. The arthrodesis is performed under fluoroscopic guidance with use of 2 guidewires followed by 2 to 3 titanium compression screws. The first screw is inserted along the posteromedial calcaneus and into the talar dome medially. The second is placed laterally into the head-neck junction of the talus. The third screw is placed distal to proximal from the plantar anterior process to the talar head. Finally, images are obtained in multiple views to ensure proper screw placement, and the screws are tightened sequentially to ensure equal compression across the joint.
ALTERNATIVES
Nonoperative treatment of calcaneal fractures includes cast immobilization with non-weight-bearing, although this treatment is typically reserved for nondisplaced, small extra-articular fractures. Operative treatment of calcaneal fractures includes open reduction and internal fixation, which is traditionally performed via a sinus tarsi approach or extensile lateral approach. Primary subtalar arthrodesis has been utilized primarily for Sanders type-IV fractures.
RATIONALE
Displaced intra-articular calcaneal fractures are associated with alarmingly high rates of posttraumatic arthritis (30% to 70% within 1 year of injury), and surgical outcomes are inversely proportional to the severity of the fracture pattern, with Sanders III and IV having the worst outcomes. Treating these most severe fracture patterns with primary open subtalar arthrodesis has shown favorable results in terms of union rates, pain scores, and functional outcomes throughout the literature. However, some authors have reported rates of revision as high as 60%. Thus, the PASTA procedure has been established, resulting in significantly better time to union, return to work, activities of daily living, and sports activities compared with open techniques. Thus, given the favorable results of primary open subtalar arthrodesis and the proven results with use of an arthroscopic technique in the non-acute setting, we propose that C-PASTA can serve as an alternative treatment option in the acute setting for patients with Sanders type-III and IV calcaneal fractures.
EXPECTED OUTCOMES
We expect the outcomes of this procedure to mirror those found throughout the literature, which shows favorable results for open primary subtalar arthrodesis. With use of an arthroscopic approach, we expect better time to union, return to work, activities of daily living, and sports activities than if the procedure were performed in an open fashion. In addition, minimizing soft-tissue damage through an arthroscopic approach may decrease the risk of infection and stimulate postoperative healing, perhaps accounting for the more favorable postoperative recovery period compared with an open procedure.
IMPORTANT TIPS
In the arthroscopic approach to the subtalar joint, identify the flexor hallucis longus, making sure to stay lateral to that tendon to remain in the "safe zone."Utilizing the TRIMANO device (Arthrex) to distract the ankle longitudinally in addition to a solid bump placed on the anterior aspect of the ankle allows for optimal subtalar joint visualization.Fish-scaling with an osteotome followed by bone grafting allows for a good fill between cancellous fragments to stimulate an optimal environment for fusion.Divergent screws should be placed and tightened sequentially to ensure equal compression across the joint.
ABBREVIATIONS AND ACRONYMS
ADL's = activities of daily livingCT = computed tomographySCD = sequential compression deviceAP = anteroposteriorDVT = deep vein thrombosisBID = twice dailyVit = vitamin.
PubMed: 36816530
DOI: 10.2106/JBJS.ST.21.00057 -
Orthopaedic Journal of Sports Medicine May 2023Latissimus dorsi tendon transfer (LDTT) is increasingly performed with arthroscopic assistance, requiring an open axillary incision, which could increase risks of...
BACKGROUND
Latissimus dorsi tendon transfer (LDTT) is increasingly performed with arthroscopic assistance, requiring an open axillary incision, which could increase risks of infection, hematoma, and lymphoedema. Technological advancements now enable LDTT to be fully arthroscopic, but its benefits and safety have not yet been confirmed.
PURPOSE
To compare the clinical outcomes and complication rates of arthroscopic-assisted versus full-arthroscopic LDTT for irreparable posterosuperior massive rotator cuff tears in shoulders with no surgical antecedents.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
The study included 90 patients who had undergone LDTT over 4 consecutive years by the same surgeon and did not have prior surgery. During the first 2 study years, all procedures were arthroscopically assisted (n = 52), while during the last 2 years, all procedures were fully arthroscopic (n = 38). Procedure duration and all complications were recorded, as well as clinical scores and range of motion at minimum 24-month follow-up. To enable direct comparison between the techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up.
RESULTS
From the initial cohort of 52 patients who underwent arthroscopic-assisted LDTT, 8 had complications (15.4%), of which 3 (5.7%) required conversion to reverse shoulder arthroplasty and 2 (3.8%) required drainage or lavage. From the initial cohort of 38 patients who had full-arthroscopic LDTT, 5 had complications (13.2%), of which 2 (5.2%) required conversion to reverse shoulder arthroplasty but no patients (0%) required other procedures. Propensity score matching resulted in 2 groups, each comprising 31 patients, with similar outcomes in terms of clinical scores and range of motion. The procedure time was about 18 minutes shorter for full-arthroscopic LDTT, which had different complications (2 axillary nerve pareses) as compared with arthroscopic-assisted LDTT (1 hematoma and 2 infections).
CONCLUSION
Equivalent outcomes at minimum 24-month follow-up were found for arthroscopic-assisted and full-arthroscopic LDTT in terms of complications rates (15.4% and 13.2%, respectively), conversion to reverse shoulder arthroplasty (5.7% and 5.2%), clinical scores, and range of motion.
PubMed: 37179711
DOI: 10.1177/23259671231160248