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Hand Clinics Nov 2023With advancements in surgical instrumentation and techniques, the role of arthroscopic and arthroscopic-assisted surgical procedures is ever-growing. Arthroscopy offers... (Review)
Review
With advancements in surgical instrumentation and techniques, the role of arthroscopic and arthroscopic-assisted surgical procedures is ever-growing. Arthroscopy offers direct, magnified visualization of pathology and reductions and is more accurate than relying on intraoperative fluoroscopy alone. It also minimizes soft tissue stripping, which is of particular importance to smaller fracture fragments whose vascularity is precarious and can be injured through open approaches.
Topics: Humans; Arthroscopy; Fractures, Bone; Wrist Injuries; Plastic Surgery Procedures
PubMed: 37827605
DOI: 10.1016/j.hcl.2023.05.003 -
The Journal of Knee Surgery Jan 2024The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has... (Review)
Review
The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has focused on the cruciate ligament injuries, yet there are several other entities that can cause knee pain from within the intercondylar notch. This review focuses on identifying the various diagnostic and treatment options for rare benign and malignant lesions including ganglion cyst formation, mucoid degeneration, benign proliferative conditions, and intra-articular tumors. These entities are most often diagnosed with advanced imaging studies and treated arthroscopically. While rare, these pathologies are important to identify in patients with ongoing vague knee pain.
Topics: Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Joint; Knee; Magnetic Resonance Imaging; Pain
PubMed: 36539213
DOI: 10.1055/a-2001-6764 -
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 -
The Journal of the American Academy of... Dec 2023Arthroscopy is an orthopaedic technique that provides surgical solutions in a minimally invasive fashion. Since its introduction, arthroscopy has become a preferred... (Review)
Review
Arthroscopy is an orthopaedic technique that provides surgical solutions in a minimally invasive fashion. Since its introduction, arthroscopy has become a preferred surgical approach for treating various orthopaedic pathologies, such as meniscal tears, anterior cruciate ligament ruptures, rotator cuff tears, and wrist, elbow, ankle, and hip conditions. Despite its ubiquity, surgical training in arthroscopy poses several challenges for educators and trainees. Arthroscopy involves neuromotor skills which differ from those of open surgery, such as the principles of triangulation, bimanual dexterity, and the ability to navigate a three-dimensional space on a two-dimensional screen. There remains no universally implemented curriculum for arthroscopic education within orthopaedic residency or fellowship training programs, permitting the potential for highly variable training experiences from institution to institution. Therefore, the current review seeks to highlight the history of arthroscopic education, strategies and current teaching modalities in modern arthroscopic education, and avenues for future educational pathways.
Topics: Humans; Arthroscopy; Orthopedics; Rotator Cuff Injuries; Educational Status; Curriculum
PubMed: 37703548
DOI: 10.5435/JAAOS-D-23-00254 -
Hand Clinics Feb 2024Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly... (Review)
Review
Intra-articular malunion of the distal radius represents a difficult clinical problem. While not all patients require treatment, corrective osteotomy may significantly improve motion, grip strength, and patient-reported outcome measures. Meticulous planning and technical precision are required with the possible need for multiple surgical approaches and both volar and dorsal implants. Arthroscopic assistance may be used to visualize the joint and articular reduction. Custom 3-dimensional planning guides are helpful in addressing complex multiplanar deformities. Regardless, intervention may not change the natural history of these injuries and post-traumatic arthritis is to be expected.
Topics: Humans; Radius; Radius Fractures; Treatment Outcome; Fractures, Malunited; Wrist Joint; Range of Motion, Articular
PubMed: 37979992
DOI: 10.1016/j.hcl.2023.08.015 -
Clinics in Shoulder and Elbow Dec 2023Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder...
Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid. Furthermore, patient positioning can have a dramatic effect on visualization with both the beach chair position and lateral decubitus positioning having various strengths and weaknesses depending on the intended procedure being performed. The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy.
PubMed: 37088880
DOI: 10.5397/cise.2022.01291 -
Rhode Island Medical Journal (2013) Oct 2023Surgical simulation has become a commonly utilized and well-researched training adjunct in nearly all surgical specialties. Balancing high-quality orthopaedic surgical...
Surgical simulation has become a commonly utilized and well-researched training adjunct in nearly all surgical specialties. Balancing high-quality orthopaedic surgical training in the face of work hour restrictions and efficiency pressures has become a challenge to educators and trainees alike. Surgical simulation is an opportunity to enhance such training and potentially permit trainees to be better equipped for the operating room. In orthopaedics, various low-fidelity, high-fidelity, and virtual reality simulation platforms are readily available to almost all trainees and permit simulation of a wide array of arthroscopic surgeries. In this review, we seek to highlight the potential utility of simulation-based training in orthopaedic surgery, the various types of available simulators, and review the evidence for simulator use.
PubMed: 37768163
DOI: No ID Found -
The American Journal of Sports Medicine Oct 2023Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after...
BACKGROUND
Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR.
PURPOSE
To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months).
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded.
RESULTS
A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, -10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up ( < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively ( = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; = .035).
CONCLUSION
An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.
Topics: Humans; Adult; Retrospective Studies; Knee Joint; Joint Diseases; Lysholm Knee Score; Tissue Adhesions; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries; Treatment Outcome
PubMed: 37724743
DOI: 10.1177/03635465231195366 -
Arthroscopy Techniques Aug 2023Superior capsular reconstruction is a common treatment option for irreparable rotator cuffs. Arthroscopic surgery procedures mostly use anchor-based methods. However,...
Superior capsular reconstruction is a common treatment option for irreparable rotator cuffs. Arthroscopic surgery procedures mostly use anchor-based methods. However, difficulty in preoperative graft measurement and intra-articular knot-tying present an obstacle for most sport surgeons. Complementing the known advantages of the transosseous technique in rotator cuff repair, a feasible, economical arthroscopic transosseous superior capsular reconstruction technique is described in this Technical Note. This procedure results not only in similar fixation strength and stability and greater bone stock but also in greater cost effectiveness due to using fewer anchors. This Technical Note describes the procedure in detail and compares it with conventional procedures.
PubMed: 37654865
DOI: 10.1016/j.eats.2023.03.022 -
The American Journal of Sports Medicine Nov 2023Arthroscopic techniques aim to reduce complications and accelerate recovery of the elbow after treatments for posttraumatic stiffness, arthritis diseases, lateral...
BACKGROUND
Arthroscopic techniques aim to reduce complications and accelerate recovery of the elbow after treatments for posttraumatic stiffness, arthritis diseases, lateral epicondylitis, ligament reconstruction, and elbow trauma. However, data on the true prevalence and characteristics of heterotopic ossification (HO) formation after elbow arthroscopy are limited.
PURPOSE
To investigate the prevalence, timing, locational distribution, and risk factors of HO after elbow arthroscopy.
STUDY DESIGN
Cohort study; Level of evidence, 4.
METHODS
Data on 205 patients undergoing elbow arthroscopy by a single senior elbow surgeon at a single institution between May 2011 and January 2022 were retrospectively reviewed. The patients were evaluated at 2 weeks, 8 weeks, 6 months, and then annually after surgery or more frequently if HO developed, with a minimum of 1 year of postoperative follow-up. Postoperative anteroposterior and lateral elbow radiographs were taken at 2 weeks to rule out fracture and at 8 weeks to identify HO. The clinical outcomes were evaluated based on the pain visual analog scale; the shortened version of the Disabilities of the Arm, Shoulder and Hand score; Mayo Elbow Performance Score; and the Single Assessment Numeric Evaluation scores before and after surgery. Bivariate logistic regression analyses were used to determine factors affecting HO prevalence.
RESULTS
Thirteen (12 male, 1 female) of 205 (6.3%) patients developed HO, with 10 (76.9%) with HO that formed on the medial compartment of the elbow. Ten (76.9%) patients were diagnosed at 8 weeks after arthroscopic surgery, 1 (7.7%) at 6 months after surgery, and 2 (15.4%) at 12 months after surgery. HO was not found at 2 weeks after surgery in any patient. The mean follow-up time was 3.5 years (range, 1.0-11.8 years). Eleven asymptomatic patients were treated nonoperatively, and 2 symptomatic patients underwent HO excision arthroscopically or had a combination of open surgery and arthroscopy. Age was a protective factor for HO formation (odds ratio [OR], 0.953; 95% CI, 0.910-0.999; = .047). The risk factors for HO formation were tourniquet time (OR, 1.042; 95% CI, 1.019-1.065; < .001) and surgical time (OR, 1.026; 95% CI, 1.011-1.041; < .001).
CONCLUSION
Among 205 patients who underwent elbow arthroscopy, HO was a minor complication of elbow arthroscopy, with a prevalence rate of 6.3%, and was usually located on the medial compartment of the elbow. Although the presence of HO may not affect the clinical outcomes in most patients, it should be carefully monitored for a minimum of 8 weeks postoperatively. Younger age, longer tourniquet time, and longer surgical time contributed to HO formation after elbow arthroscopy.
Topics: Humans; Male; Female; Arthroscopy; Cohort Studies; Retrospective Studies; Elbow; Prevalence; Risk Factors; Elbow Joint; Ossification, Heterotopic; Range of Motion, Articular
PubMed: 37804157
DOI: 10.1177/03635465231198862