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Acta Ortopedica Mexicana 2018There are less and fewer opportunities for residents to learn and develop surgical skills in the operating room. In some parts of the world, the development and... (Review)
Review
BACKGROUND
There are less and fewer opportunities for residents to learn and develop surgical skills in the operating room. In some parts of the world, the development and adaptation of technology for the teaching of psychomotor skills in surgical specialties appears. Arthroscopy is a surgical technique that lends itself to simulation. So far there is no such thing as a structured and validated arthroscopy training program for orthopaedic residents in Mexico.
OBJECTIVE
To propose a structured arthroscopy training plan that incorporates the simulation for orthopaedic residents.
METHOD
A review of the literature on teaching with simulation in orthopaedics and arthroscopy was performed, a study was conducted to establish reference values for arthroscopy exercises in a virtual reality simulator and a training plan was developed with Arthroscopy simulation for orthopaedic residents.
RESULTS
A seven-stage program was developed with theoretical classes and simulation to improve motor skills. The complexity of the procedures increases through the practical modules. It is complemented by a semester evaluation.
DISCUSSION
Currently most of the efforts in teaching with simulators focus on medical students and first-and second-year residents. I believe that efforts should be focused to include residents of higher ranks and surgeons. This design will be proposed to the orthopaedic Unique Medical Education Program (PUEM in Spanish). It is important to develop validated curricula that incorporate the simulation for the development of motor skills in orthopaedic residents.
Topics: Arthroscopy; Clinical Competence; Computer Simulation; Internship and Residency; Knee Joint; Mexico; Orthopedics
PubMed: 30726593
DOI: No ID Found -
Medicine Oct 2016This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials.
METHODS
We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI.
RESULTS
Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence).
CONCLUSION
Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans
PubMed: 27741133
DOI: 10.1097/MD.0000000000005122 -
Journal of the American Academy of... Nov 2023Resilience is a person's capacity to overcome adversity. The purpose was to determine what patient factors correlate with resilience using the Brief Resilience Score. We...
INTRODUCTION
Resilience is a person's capacity to overcome adversity. The purpose was to determine what patient factors correlate with resilience using the Brief Resilience Score. We hypothesize that characteristics of female sex, younger age, Workers' Compensation status, and preoperative opioid use are predictors of a lower preoperative resilience score and that patients with positive psychosocial factors would have higher resilience scores.
METHODS
Eight hundred nine patients undergoing knee or shoulder arthroscopy were preoperatively categorized into low, normal, and high-resilience groups. Preoperative patient-reported outcome measures (PROMs) and demographics were assessed. Statistical analyses evaluated differences in demographics and PROMs between resilience groups.
RESULTS
Analysis disclosed notable differences between low, normal, and high-resilience groups regarding demographics and PROMs. High resilience was seen in older patients, male patients, and patients with positive psychosocial factors. Low resilience scores were discovered in Workers' Compensation patients and those with a history of preoperative opioid use. No difference in resilience scores was observed between smokers and nonsmokers.
DISCUSSION
Preoperative resilience score is associated with age, sex, preoperative opioid use, Workers' Compensation status, and smoking status of patients undergoing knee or shoulder arthroscopy.
Topics: Humans; Male; Female; Aged; Shoulder; Arthroscopy; Analgesics, Opioid; Treatment Outcome; Knee Joint
PubMed: 37967061
DOI: 10.5435/JAAOSGlobal-D-23-00207 -
The Knee Jun 2023The aim was to review the literature regarding needle arthroscopy using the Arthrex NanoScope system and evaluate: (1) the diagnostic indications, utility, and efficacy... (Review)
Review
BACKGROUND
The aim was to review the literature regarding needle arthroscopy using the Arthrex NanoScope system and evaluate: (1) the diagnostic indications, utility, and efficacy compared to conventional methods, and (2) the therapeutic indications, safety, and reported outcomes.
METHODS
Searches of three databases (MEDLINE, Embase and PubMed) were conducted in November 2021 using MeSH terms: 'needle arthroscopy', 'human', 'in office arthroscopy', 'needle arthroscope', 'nanoscopic', 'surgery', 'nanoscope' and 'percutaneous arthroscopy'. The included studies were catalogued, quality-assessed using Methodological Index for Non-Randomised Studies (MINORS), and analysed using the Cochrane data collection templates for randomised control trials (RCT) and non-randomised control trials (non-RCT). The majority of studies were non-numerical and were examined using qualitative analysis.
RESULTS
The search yielded 314 studies, 22 of which were included for analysis. MINORS assessment was applicable to four studies. Mean MINORS was 10.7/16 with the most frequent limitations being lack of unbiased endpoint or sample size calculation. The level of evidence ranged from level IV-V. Diagnostic and therapeutic indications were described in relation to the: knee (n = 10); shoulder (n = 6); foot/ankle (n = 3); elbow (n = 2), and miscellaneous (n = 1).
CONCLUSIONS
Needle arthroscopy can augment the diagnostic process in patients presenting with musculoskeletal complaints, and may provide benefits in terms of diagnostic accuracy, cost efficiency, timeliness of investigation, and a visually impactful patient-centred consultation. Therapeutic interventions are reported by a small number of pioneer groups who report some benefits over conventional arthroscopy. The available literature remains small and of low quality, and more evidence is needed with regards to patient selection, efficacy, safety, and cost.
LEVEL OF EVIDENCE
Level V (based on the weakest study included in the Systematic Review).
Topics: Humans; Arthroscopy; Outpatients
PubMed: 37105012
DOI: 10.1016/j.knee.2023.04.003 -
BMC Musculoskeletal Disorders May 2022Different from arthroscopy in other joints, more perfusion is required for a better access to perform surgical procedures in hip arthroscopic operations. The significant...
BACKGROUND
Different from arthroscopy in other joints, more perfusion is required for a better access to perform surgical procedures in hip arthroscopic operations. The significant fluid perfused may lead to complications of partial tissue injury and electrolyte imbalance. However, there were few studies on the change of serum electrolyte after hip arthroscopy and the influential factors were still unknown.
METHODS
We evaluated consecutive patients who underwent hip arthroscopy in our hospital between October 2021 and February 2022. Age, sex, and BMI matched patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at the same time were also included as the control group. Preoperative and postoperative serum electrolyte of sodium (Na +), potassium (K +), chloride (Cl-), magnesium (Mg2 +), and carbon dioxide capacity (CO2CP) were analyzed. The correlations between influential factors like perfusion volume, operating time, BMI and hip circumference, and changes in serum electrolyte were also analyzed.
RESULTS
A total of 79 patients were involved in this study, including 49 patients who underwent hip arthroscopy and 30 patients who underwent knee arthroscopy. For hip arthroscopy, decrease of potassium levels was observed in 40.8% of the patients, and postoperative hypokalemia was found in 10.2% patients. There were significant variations in postoperative sodium, magnesium, chloride and carbon dioxide capacity in hip arthroscopy (p < 0.05). No correlations were found between each of the electrolyte concentrations and influential factors like perfusion volume, operating time, BMI, sex and hip circumference. The significant variations were found in chloride and carbon dioxide capacity in knee arthroscopy (p < 0.05).
CONCLUSIONS
Hip arthroscopy would significantly influence postoperative serum electrolyte, and hypokalemia could be a postoperative complication. The correlation between serum electrolyte and fluid perfusion volume is remained to be investigated. We therefor advocate that performing a systematic care of preoperative and postoperative serum electrolyte analysis as perioperative management is necessary.
Topics: Anterior Cruciate Ligament Injuries; Arthroscopy; Carbon Dioxide; Chlorides; Electrolytes; Humans; Hypokalemia; Magnesium; Potassium; Retrospective Studies; Sodium; Treatment Outcome
PubMed: 35590402
DOI: 10.1186/s12891-022-05451-1 -
Acta Orthopaedica Et Traumatologica... Sep 2020The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age.
OBJECTIVE
The aim of this study was to evaluate the results of the arthroscopic repair in patients with partial and full thickness rotator cuff tears and less than 45 years of age.
METHODS
Fifty patients (26 women and 24 men; mean age: 41.4±3.96 years; range: 31-45) with rotator cuff tear, and who were treated with the arthroscopic repair, were included in the study. Twenty patients had full thickness and 30 had partial-thickness tears. The final functional evaluation was conducted at a mean of 42.4 months (range, 24 to 95 months; SD:13.3). The American Shoulder and Elbow Surgeon (ASES) self-report score and the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) were used as validated scoring systems.
RESULTS
At the final follow-up, the mean ASES and UCLA scores improved significantly to 72.3 and 26.5, respectively, in the full-thickness group (p<0.01). The mean ASES and UCLA scores improved significantly to 70.7 and 25.3, respectively, in the bursal-side group (p<0.01). The mean ASES and UCLA scores improved significantly to 75.3 and 27.1, respectively, in the joint-side group (p<0.01). There were no significant differences between the groups according to the postoperative ASES score (p>0.06) and UCLA score (p<0.37).
CONCLUSION
The arthroscopic repair of the joint-sided tears and bursal-sided tears has good functional outcomes as full thickness rotator cuff tears, and the surgical option should be considered in younger population if the conservative treatment fails.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
Topics: Adult; Age Factors; Arthroscopy; Female; Humans; Male; Range of Motion, Articular; Recovery of Function; Rotator Cuff Injuries; Shoulder Injuries; Shoulder Joint; Trauma Severity Indices; Treatment Outcome
PubMed: 33155555
DOI: 10.5152/j.aott.2020.19154 -
Journal of Orthopaedic Surgery and... Feb 2016This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments.
METHODS
PubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker's cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥ 16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data.
RESULTS
A total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively.
CONCLUSIONS
Based on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.
Topics: Arthroscopy; Humans; Knee Joint; Popliteal Cyst; Treatment Outcome
PubMed: 26879283
DOI: 10.1186/s13018-016-0356-3 -
Medicina (Kaunas, Lithuania) Apr 2024: The number of hip arthroscopy procedures is on the rise worldwide, and awareness regarding proper management of the hip capsule has increased. No capsulotomy shape is...
: The number of hip arthroscopy procedures is on the rise worldwide, and awareness regarding proper management of the hip capsule has increased. No capsulotomy shape is agreed upon as a standard approach, with literature supporting both isolated interportal and T-shaped capsulotomies. The aim of this retrospective cohort study is to report the clinical results of a standardized extended interportal capsulotomy (EIPC) during hip arthroscopy. : Patients operated on between 2017 and 2020 with a hip arthroscopy were eligible. The inclusion criteria were ages 18-60 years, failed non-operative treatment, and at least a 2-year follow-up. Exclusion criteria were bilateral femoroacetabular impingement syndrome (FAS) cases or labral lesions, ipsilateral knee injury, history of ipsilateral hip surgery, and significant spine lesions. Data regarding demographic characteristics such as age, gender, operation date, BMI, but also Beighton score, presence of postoperative pudendal nerve damage, and revision for any reason were gathered from patients' records. All patients were evaluated preoperatively with a visual analog scale (VAS), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score (mHHS). : Of the 97 patients operated on with a hip arthroscopy between the defined dates, only 90 patients were included. The mean age was 37.9 ± 9.8, and 58.9% of patients were male. The most frequent surgical indication was an isolated FAS lesion (73.3%), followed by FAS associated with a labral tear (12.2%), an isolated labrum tear (10.0%), synovitis (3.3%), and a loose body (1.1%). The mean follow-up for the study cohort was 39.3 months. The majority of the patients had uneventful surgeries (76.7%), while there were three cases of sciatic nerve neuropraxia and 12 cases of pudendal nerve neuropraxia. Two patients underwent revision surgery during the study period. Comparison between preoperative and postoperative clinical scores showed a significant improvement with a final mHHS mean value of 67.7 ± 18.2, an HOOS value of 74.1 ± 13.2, and a low VAS score of 1.3 ± 1.2. : A hip arthroscopy procedure with a standardized and unrepaired, extended interportal capsulotomy is a safe procedure with satisfactory mid-term results and high overall patient satisfaction. At a minimum of 2 years and a mean of 39.2 months, patients showed improved clinical scores and a low revision rate.
Topics: Humans; Adult; Male; Female; Retrospective Studies; Middle Aged; Arthroscopy; Hip Joint; Adolescent; Joint Capsule; Treatment Outcome; Cohort Studies; Young Adult; Femoracetabular Impingement
PubMed: 38792921
DOI: 10.3390/medicina60050738 -
Sports Medicine and Arthroscopy Review Mar 2022Arthroscopy of the shoulder, elbow, hip, and knee has become increasingly utilized due to continued advancements in technique, training, and instrumentation. In... (Review)
Review
Arthroscopy of the shoulder, elbow, hip, and knee has become increasingly utilized due to continued advancements in technique, training, and instrumentation. In addition, arthroscopy is generally safe and effective in the utilization of joint preservation surgical techniques. The arthroscopist must utilize a thorough understanding of the surgical anatomy, detailed care with patient positioning, and safe instrumentation portals to prevent associated neurological injury. In the event of postoperative neurological complications, the physician must carefully document the patient history and physical examination while considering the utilization of additional imaging, testing, or surgical nerve exploration with a specialized team depending upon the severity of neurological injury. In this review, we discuss the prevention, evaluation, and treatment of neurological complications related for arthroscopic procedures of the shoulder, elbow, hip, and knee.
Topics: Arthroscopy; Elbow; Elbow Joint; Humans; Knee Joint; Shoulder
PubMed: 35113840
DOI: 10.1097/JSA.0000000000000322 -
Journal of Orthopaedic Surgery (Hong... 2019Ankle arthroscopy has been used as a standard tool by foot and ankle surgeons. To overcome the narrowness of ankle joint, a noninvasive distraction technique is used for...
PURPOSE
Ankle arthroscopy has been used as a standard tool by foot and ankle surgeons. To overcome the narrowness of ankle joint, a noninvasive distraction technique is used for the successful visualization in ankle arthroscopy. The aim of this study was to investigate the incidence and type of complications associated with ankle arthroscopy using a noninvasive distraction technique and to report a troublesome complication.
METHODS
We reviewed 514 patients' charts from 2003 to 2011. The same noninvasive distraction technique was used. Patients' demography, duration of follow-up, diagnoses, procedures, and complications related to ankle arthroscopy were analyzed.
RESULTS
There were 388 male and 126 female; mean age was 37.2 years; mean follow-up duration was 33 months. The diagnoses were osteochondral lesion of talus, chronic ankle instability, anterolateral soft tissue impingement syndrome, and anterior bony impingement. We performed arthroscopic synovectomy, osteochondral procedure, bony spur excision, and loose body removal. The mean time of arthroscopic procedure was 47 min. There were neurologic complications (eight cases), skin necrosis of posterior thigh (three cases), instrument breakage (two cases), and superficial wound infection (one case). All complications were well resolved. The total duration of distraction plus tourniquet inflation exceeded 120 min in the three cases of skin necrosis. Skin necrosis was deemed to be resulted from the long tourniquet time.
CONCLUSION
The noninvasive distraction technique is safe and effective for ankle arthroscopy. However, the distraction plus tourniquet requires attention because it can cause high pressure on posterior thigh resulting in soft tissue injury.
Topics: Adolescent; Adult; Aged; Ankle Injuries; Ankle Joint; Arthroscopy; Child; Female; Humans; Male; Middle Aged; Postoperative Complications; Young Adult
PubMed: 31359846
DOI: 10.1177/2309499019862502