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Journal of ISAKOS : Joint Disorders &... Jul 2021Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be... (Review)
Review
Superior labrum, anterior and posterior (SLAP) lesions are common and identified in up to 26% of shoulder arthroscopies, with the greatest risk factor appearing to be overhead sporting activities. Symptomatic patients are treated with physical therapy and activity modification. However, after the failure of non-operative measures or when activity modification is precluded by athletic demands, SLAP tears have been managed with debridement, repair, biceps tenodesis or biceps tenotomy. Recently, there have been noticeable trends in the operative management of SLAP lesions with older patients receiving biceps tenodesis and younger patients undergoing SLAP repair, largely with suture anchors. For overhead athletes, particularly baseball players, SLAP lesions remain a difficult pathology to manage secondary to concomitant pathologies and unpredictable rates of return to play. As a consequence, the most appropriate surgical option in elite throwers is controversial. The objective of this current concepts review is to discuss the anatomy, mechanism of injury, presentation, diagnosis and treatment options of SLAP lesions and to present current literature on outcomes affecting return to sport and work.
Topics: Arthroscopy; Humans; Return to Sport; Shoulder Injuries; Shoulder Joint; Tenodesis
PubMed: 34272296
DOI: 10.1136/jisakos-2020-000537 -
Journal of Orthopaedic Surgery and... Sep 2016Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this... (Review)
Review
Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.
Topics: Ankle Injuries; Ankle Joint; Arthroscopy; Athletic Injuries; Humans
PubMed: 27608626
DOI: 10.1186/s13018-016-0430-x -
International Journal of Surgery... Jul 2020Degenerative meniscal tear is a chronic disorder which presents with knee pain, swelling and loss of motion. It is currently unknown whether arthroscopic partial... (Comparative Study)
Comparative Study Meta-Analysis Review
Arthroscopic partial meniscectomy combined with medical exercise therapy versus isolated medical exercise therapy for degenerative meniscal tear: A meta-analysis of randomized controlled trials.
BACKGROUND
Degenerative meniscal tear is a chronic disorder which presents with knee pain, swelling and loss of motion. It is currently unknown whether arthroscopic partial meniscectomy combined with medical exercise therapy is superior to isolated medical exercise therapy for degenerative meniscal tear.
OBJECTIVE
To determine if medical exercise therapy alone is as effective as arthroscopic partial meniscectomy combined with medical exercise therapy in treating degenerative meniscal tear.
METHOD
Electronic searches were performed using MEDLINE, EMBASE, and the Cochrane Library Databases for all randomized studies. Two reviewers independently completed the literature screening, data extraction, and risk evaluation of bias. The outcome measures were visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion, the Lysholm Knee Scoring Scale (LKSS), Knee injury and Osteoarthritis Outcome Score (KOOS) and postoperative complications. STATA 13.0 software was applied for meta-analysis.
RESULT
Six randomized controlled trials (RCTs) were conducted, with 900 patients included. The present study revealed that there were significant differences between the two groups regarding the VAS at two months, as well as, WOMAC and range of motion. No significant differences were found in terms of LKSS, KOOS or postoperative complications.
LIMITATIONS
(1) Only 6 RCTs were included in our meta-analysis and the sample sizes were small; (2) The follow-up period was too short in some included studies. Long-term follow-up studies should be conducted in the future; (3) Heterogeneity among the included studies was unavoidable due to different grade of degenerative meniscal tear and program of exercise. Heterogeneity was also caused by a variety of other factors. (4) Publication bias that came from the process of literature searching was unavoidable and was hard to overcome. (5) There are many other words which could yielded more studies (Ex. physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis). Implications of key findings: This meta-analysis suggests that doctors can choose arthroscopic partial meniscectomy combined with medical exercise therapy for the treatment of degenerative meniscal tear.
CONCLUSION
Arthroscopic partial meniscectomy combined with medical exercise therapy is effective in reducing pain and improving range of motion in the early postoperative period. Therefore, arthroscopic partial meniscectomy combined with medical exercise therapy may be recommended for the treatment of degenerative meniscal tear. Further research is necessary to determine the type, frequency, and duration of the best exercise program. Systematic review registration number: Reviewregistry884.
Topics: Adult; Arthroscopy; Combined Modality Therapy; Exercise Therapy; Humans; Meniscectomy; Middle Aged; Randomized Controlled Trials as Topic; Tibial Meniscus Injuries
PubMed: 32522685
DOI: 10.1016/j.ijsu.2020.05.035 -
European Review For Medical and... Apr 2019Infection is a rare complication of arthroscopic procedures, with an overall incidence estimated in less than 1%. However, the actual prevalence may be higher as many... (Review)
Review
Infection is a rare complication of arthroscopic procedures, with an overall incidence estimated in less than 1%. However, the actual prevalence may be higher as many cases may go unreported. Despite low incidence, early diagnosis is of outmost importance in order to avoid devastating consequences, such as arthrofibrosis. Clinical presentation is usually not specific and may include, at varying degrees of severity: increasing pain and stiffness, local erythema, swelling, warmth, and fibrinous exudate. High temperature and signs of sepsis are not common but may be present in severe cases. Unfortunately, variable clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Several risk factors have been identified, mainly related to the surgical site, patient characteristics or the surgical procedure. The aim of this paper is to provide an overview on pathogenesis, risk factors, clinical presentation, diagnostic evaluation, and current treatment options of septic arthritis after an arthroscopic procedure. Since no relevant data are available on infections after hip, ankle or elbow arthroscopy, the present review is mainly focused on infections after shoulder and knee arthroscopic procedures.
Topics: Arthritis, Infectious; Arthroscopy; Humans; Postoperative Complications
PubMed: 30977895
DOI: 10.26355/eurrev_201904_17502 -
British Journal of Sports Medicine Nov 2020To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at... (Randomized Controlled Trial)
Randomized Controlled Trial
Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial.
OBJECTIVES
To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up.
DESIGN
Multicentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial.
SETTING
Orthopaedic departments in five public hospitals in Finland.
PARTICIPANTS
146 adults, mean age 52 years (range 35-65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised.
INTERVENTIONS
APM or placebo surgery (diagnostic knee arthroscopy).
MAIN OUTCOME MEASURES
We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale).
RESULTS
There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI -2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), -1.7 (95% CI -7.7 to 4.3) in WOMET, -2.1 (95% CI -6.8 to 2.6) in Lysholm knee score, and -0.04 (95% CI -0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar.
CONCLUSIONS
APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT01052233 and NCT00549172).
Topics: Adult; Aged; Arthroscopy; Disease Progression; Finland; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Meniscectomy; Middle Aged; Osteoarthritis, Knee; Patient Reported Outcome Measures; Postoperative Complications; Radiography; Risk Factors; Tibial Meniscus Injuries
PubMed: 32855201
DOI: 10.1136/bjsports-2020-102813 -
Annals of the Rheumatic Diseases Feb 2018To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.
METHODS
In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35-65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out.
RESULTS
In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, -4.3; 95% CI, -11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (-3.2; -8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (-0.4; -1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups.
CONCLUSIONS
In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.
Topics: Adult; Aged; Arthroscopy; Female; Finland; Follow-Up Studies; Humans; Intention to Treat Analysis; Male; Meniscectomy; Menisci, Tibial; Middle Aged; Patient Satisfaction; Postoperative Complications; Recovery of Function; Tibial Meniscus Injuries; Treatment Outcome
PubMed: 28522452
DOI: 10.1136/annrheumdis-2017-211172 -
International Journal of Surgery... Jun 2018Hip arthroscopy has recently occupied an important place in the armamentarium of General Orthopedic and especially hip surgeons. It is an effective and innovative... (Review)
Review
Hip arthroscopy has recently occupied an important place in the armamentarium of General Orthopedic and especially hip surgeons. It is an effective and innovative procedure with rapidly expanding indications. Advancements in surgical tools and refinement in techniques has revolutionalized modern Hip arthroscopy. Surgeons are now able to address pathology in and around the hip joint that was either misdiagnosed or poorly understood. The procedure allows detailed visualization of acetabular labrum, femoral and acetabular chondral surfaces, fovea, ligamentum teres, synovium and the extra-articular peri-trochanteric space. Minimally invasive surgery is now performed for diagnoses as well as treatment of a variety of Hip disorders. The acceptance and rates of hip arthroscopy are increasing across the board and the associated literature is expanding every day. Increasing surgical experience and improving technology is contributing for more advanced procedures to become popularized, however long-term outcome data about hip arthroscopy is still relatively sparse. We aim to review hip arthroscopy in the light of recent literature and will discuss the current indications, outcomes and complications of the procedure.
Topics: Arthroscopy; Hip Joint; Humans; Treatment Outcome
PubMed: 28823795
DOI: 10.1016/j.ijsu.2017.08.557 -
Sports Health 2020Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft... (Comparative Study)
Comparative Study
CONTEXT
Recent studies examining return to sport after traumatic shoulder instability suggest faster return-to-sport time lines after bony stabilization when compared with soft tissue stabilization. The purpose of the current study was to define variability across online Latarjet rehabilitation protocols and to compare Latarjet with Bankart repair rehabilitation time lines.
EVIDENCE ACQUISITION
Online searches were utilized to identify publicly available rehabilitation protocols from Accreditation Council for Graduate Medical Education (ACGME)-accredited academic orthopaedic surgery programs.
STUDY DESIGN
Descriptive epidemiology study.
LEVEL OF EVIDENCE
Level 3.
RESULTS
Of the 183 ACGME-accredited orthopaedic programs reviewed, 14 institutions (7.65%) had publicly available rehabilitation protocols. A web-based search yielded 17 additional protocols from private sports medicine practices. Of the 31 protocols included, 31 (100%) recommended postoperative sling use and 26 (84%) recommended elbow, wrist, and hand range of motion exercises. Full passive forward flexion goals averaged 3.22 ± 2.38 weeks postoperatively, active range of motion began on average at 5.22 ± 1.28 weeks, and normal scapulothoracic motion by 9.26 ± 4.8 weeks postoperatively. Twenty (65%) protocols provided specific recommendations for return to nonoverhead sport-specific activities, beginning at an average of 17 ± 2.8 weeks postoperatively. This was compared with overhead sports or throwing activities, for which 18 (58%) of protocols recommended beginning at a similar average of 17.1 ± 3.3 weeks.
CONCLUSION
Similar to Bankart repair protocols, Latarjet rehabilitation protocols contain a high degree of variability with regard to exercises and motion goal recommendations. However, many milestones and start dates occur earlier in Latarjet protocols when compared with Bankart-specific protocols. Consequently, variability in the timing of rehabilitation goals may contribute to earlier return to play metrics identified in the broader literature for the Latarjet procedure when compared with arthroscopic Bankart repair.
STRENGTH OF RECOMMENDATION TAXONOMY (SORT)
Level C.
Topics: Arthroscopy; Bankart Lesions; Clinical Protocols; Early Ambulation; Exercise Therapy; Humans; Joint Instability; Muscle Strength; Range of Motion, Articular; Resistance Training; Restraint, Physical; Return to Sport; Shoulder Dislocation; Time Factors
PubMed: 31916920
DOI: 10.1177/1941738119887396 -
Sports Health 2017Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved... (Review)
Review
CONTEXT
Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies.
EVIDENCE ACQUISITION
Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017).
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Initially used as a technique for loose body removal, drainage/debridement of septic arthritis, and treatment of pediatric hip disorders, hip arthroscopy is currently used to treat various hip conditions. The recognition of femoroacetabular impingement (FAI) as a source of hip pain in young adults has rapidly expanded hip arthroscopy by applying the principles of osseous correction that were previously described and demonstrated via an open surgical dislocation approach. Hip pathologies can be divided into central compartment, peripheral compartment, peritrochanteric space, and subgluteal space disorders.
CONCLUSION
Although hip arthroscopy is a minimally invasive procedure that may offer decreased morbidity, diminished risk of neurovascular injury, and shorter recovery periods compared with traditional open exposures to the hip, it is important to understand the appropriate patient selection and indications.
Topics: Arthritis, Infectious; Arthroscopy; Cartilage, Articular; Contraindications; Femoracetabular Impingement; Hip Injuries; Hip Joint; Humans; Joint Loose Bodies; Ligaments, Articular; Osteoarthritis, Hip; Patient Selection; Synovectomy; Synovial Membrane; Tendons
PubMed: 28678628
DOI: 10.1177/1941738117712675 -
Chinese Journal of Traumatology =... Nov 2023Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint.... (Review)
Review
Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.
Topics: Humans; Ankle Joint; Ankle; Joint Diseases; Treatment Outcome; Arthroscopy; Pain
PubMed: 37852876
DOI: 10.1016/j.cjtee.2023.09.006