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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 -
Acta Orthopaedica Belgica Sep 2023Arthroscopic anterior cruciate ligament reconstruction (ACLR) is often performed with the use of a thigh tourniquet. Surgeons believe this helps improve visualisation... (Review)
Review
Arthroscopic anterior cruciate ligament reconstruction (ACLR) is often performed with the use of a thigh tourniquet. Surgeons believe this helps improve visualisation and reduce operative time. However, tourniquet use has been associated with many complications including increased pain, neurovascular injury, venous thromboembolism, haematoma formation, and others. In this article, we describe a method allowing comparable arthroscopic visualisation to be achieved without the aid of a tourniquet for ACLR procedures. The literature evidence relating to this technique as well as tourniquet use for ACLR is also reviewed. Tourniquet-less ACLR can be achieved through the combined application of hypotensive anaesthesia, intravenous tranexamic acid, and use of adrenaline-supplemented irrigation fluid and local anaesthetic. Performing ACLR without a tourniquet avoids the risks associated with its use and reduces the severity of post-operative haemarthrosis which may contribute to the patient's pain and limit their ability to perform their rehabilitation exercises.
Topics: Humans; Tourniquets; Venous Thromboembolism; Anterior Cruciate Ligament Reconstruction; Pain; Postoperative Period; Anterior Cruciate Ligament Injuries
PubMed: 37935228
DOI: 10.52628/89.3.11747 -
Arthroscopy : the Journal of... Apr 2024Subscapularis pathology is difficult to diagnose, in part because of decreased sensitivity and accuracy in identifying tears with magnetic resonance imaging (MRI) when...
Subscapularis pathology is difficult to diagnose, in part because of decreased sensitivity and accuracy in identifying tears with magnetic resonance imaging (MRI) when compared to other cuff tendons. Artificial intelligence evaluation of patient physical examination and MRI data using a machine learning model shows that arthroscopically confirmed partial- or full-thickness subscapularis tears are highly associated with abnormal subscapularis tendon length, long head of the biceps tears, and subscapularis fatty atrophy, and on physical examination, with weakness with internal rotation and positive lift-off, belly press, and bear hug tests. Today, physicians may use machine learning as a tool, but this model may not currently be sufficient to drastically change practice. However, with continued research and development, which is occurring rapidly, similar models could aid physicians in timely identification of pathology and optimization of preoperative planning, as well as physician training and education.
Topics: Humans; Rotator Cuff; Rotator Cuff Injuries; Tendon Injuries; Artificial Intelligence; Magnetic Resonance Imaging; Machine Learning; Arthroscopy
PubMed: 38219107
DOI: 10.1016/j.arthro.2023.10.012 -
Anesthesiology Nov 2023Single-shot suprascapular nerve block and superior trunk block have been reported to provide a noninferior analgesic effect after shoulder surgery with a lesser... (Randomized Controlled Trial)
Randomized Controlled Trial
Comparison of the Analgesic Efficacy between Arthroscopically Placed Continuous Suprascapular Nerve Block and Ultrasound-guided Continuous Superior Trunk Block: A Double-blinded Randomized Controlled Trial.
BACKGROUND
Single-shot suprascapular nerve block and superior trunk block have been reported to provide a noninferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block. This study hypothesized that continuous suprascapular nerve block provides noninferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery.
METHODS
100 patients were randomized undergoing arthroscopic shoulder surgery between December 2020 and October 2021 into continuous suprascapular nerve block and continuous superior trunk block groups. Before the surgery, patients received either a single-shot superior trunk block or subomohyoid suprascapular nerve block. Thereafter, a superior trunk catheter was inserted by anesthesiologists in patients in the continuous superior trunk block group, and a posterior suprascapular nerve catheter was inserted with arthroscopic assistance during the surgery by surgeon in the continuous suprascapular nerve block group. The primary outcome was the postoperative pain score at postoperative 24 h, and the incidence of hemidiaphragmatic paresis was also compared.
RESULTS
Overall, 98 patients were included in the final analysis. The worst and resting pain scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared with those in the continuous superior trunk block group in the test with a noninferiority margin of 1 (worst pain score: mean difference, 0.9; 95% CI, 0.1 to 1.7; resting pain score: mean difference, 0.5; 95% CI, 0.0 to 1.0). However, the continuous suprascapular nerve block group had a significantly lower incidence of hemidiaphragmatic paresis at postoperative 24 h than the continuous superior trunk block group.
CONCLUSIONS
Continuous suprascapular nerve block provides statistically inferior analgesia compared to the continuous superior trunk block; however, the continuous suprascapular nerve block had a minimal effect on the phrenic nerve function.
Topics: Humans; Shoulder; Brachial Plexus Block; Pain, Postoperative; Analgesics; Ultrasonography, Interventional; Paresis; Arthroscopy; Anesthetics, Local
PubMed: 37450621
DOI: 10.1097/ALN.0000000000004691 -
JSES International Sep 2023Periprosthetic joint infection of the shoulder (PJI) is a devastating complication with a reported incidence of 1%-15.4% and is often difficult to diagnose with current... (Review)
Review
BACKGROUND
Periprosthetic joint infection of the shoulder (PJI) is a devastating complication with a reported incidence of 1%-15.4% and is often difficult to diagnose with current diagnostic tools including serologic tests and arthrocentesis. This systematic review evaluates the reliability and validity of arthroscopic biopsy in the current literature for the diagnosis of shoulder PJI.
METHODS
MEDLINE, Scopus, Web of Sciences, Google Scholar, and Cochrane databases were queried electronically from inception to June 2022 for publications reporting diagnostic accuracy of shoulder arthroscopic biopsy for detecting infection after anatomic total shoulder arthroplasty, shoulder hemiarthroplasty, or reverse total shoulder arthroplasty. This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
After exclusion, our meta-analysis consisted of 7 articles with a total of 112 patients. The estimated pooled sensitivity and specificity of arthroscopic biopsy for confirmation of shoulder periprosthetic infection were 0.87 (95% confidence interval [CI]: 0.73-0.95) and 0.79 (95% CI: 0.67-0.88), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.15 (95% CI: 2.57, 6.70) and 0.17 (95% CI: 0.08, 0.36), respectively. The aggregate positive predictive value was 73.58% (95% CI: 63.29%-81.82%), and aggregate negative predictive value was 89.83% (95% CI: 80.59%-94.95%). The diagnostic odds ratio of arthroscopic biopsy was 19.92 (95% CI: 4.96-79.99).
CONCLUSION
Arthroscopic biopsy in patients suspected of shoulder PJI has good diagnostic accuracy, with high sensitivity and specificity. Given the various biopsy protocols (such as devices, numbers, locations, etc.), further prospective studies are necessary to define the future role of arthroscopic biopsy in diagnosis and treatment.
PubMed: 37719814
DOI: 10.1016/j.jseint.2023.05.004 -
The Bone & Joint Journal Oct 2023Arthroscopic microfracture is a conventional form of treatment for patients with osteochondritis of the talus, involving an area of < 1.5 cm. However, some patients have... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness and safety of arthroscopy combined with radial extracorporeal shockwave therapy for osteochondritis of the talus: a prospective, single-centre, randomized, double-blind study.
AIMS
Arthroscopic microfracture is a conventional form of treatment for patients with osteochondritis of the talus, involving an area of < 1.5 cm. However, some patients have persistent pain and limitation of movement in the early postoperative period. No studies have investigated the combined treatment of microfracture and shortwave treatment in these patients. The aim of this prospective single-centre, randomized, double-blind, placebo-controlled trial was to compare the outcome in patients treated with arthroscopic microfracture combined with radial extracorporeal shockwave therapy (rESWT) and arthroscopic microfracture alone, in patients with ostechondritis of the talus.
METHODS
Patients were randomly enrolled into two groups. At three weeks postoperatively, the rESWT group was given shockwave treatment, once every other day, for five treatments. In the control group the head of the device which delivered the treatment had no energy output. The two groups were evaluated before surgery and at six weeks and three, six and 12 months postoperatively. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Secondary outcome measures included a visual analogue scale (VAS) score for pain and the area of bone marrow oedema of the talus as identified on sagittal fat suppression sequence MRI scans.
RESULTS
A total of 40 patients were enrolled and randomly divided into the two groups, with 20 in each. There was no statistically significant difference in the baseline characteristics of the groups. No complications, such as wound infection or neurovascular injury, were found during follow-up of 12 months. The mean AOFAS scores in the rESWT group were significantly higher than those in the control group at three, six, and 12 months postoperatively (p < 0.05). The mean VAS pain scores in the rESWT group were also significantly lower than those in the control group at these times (p < 0.05). The mean area of bone marrow oedema in the rESWT group was significantly smaller at six and 12 months than in the control group at these times (p < 0.05).
CONCLUSION
Local shockwave therapy was safe and effective in patients with osteochondiritis of the talus who were treated with a combination of arthroscopic surgery and rESWT. Preliminary results showed that, compared with arthroscopic microfracture alone, those treated with arthroscopic microfracture combined with rESWT had better relief of pain at three months postoperatively and improved weightbearing and motor function of the ankle.
Topics: Humans; Arthroscopy; Osteochondritis; Talus; Fractures, Stress; Prospective Studies; Double-Blind Method; Extracorporeal Shockwave Therapy; Pain; Edema; Treatment Outcome
PubMed: 37777205
DOI: 10.1302/0301-620X.105B10.BJJ-2023-0152.R2 -
JSES International Nov 2023Introducing and implementing an arthroscopic classification tool for posterolateral elbow instability.
BACKGROUND
Introducing and implementing an arthroscopic classification tool for posterolateral elbow instability.
METHODS
Thirty arthroscopies were performed on 30 patients, and all recordings were collected, blinded, and labeled. Three orthopedic surgeons reviewed and scored all 30 recordings three times with a period of at least seven days in between to analyze the intraobserver and interobserver reliability. The classification consisted of five different grades.
RESULTS
Indications for elbow arthroscopy included impingement (n = 7), osteochondritis dissecans (n = 5), pain (n = 7), osteoarthritis (n = 6), and other (n = 5). The kappa value for intrarater reliability was 0.71, indicating good reliability, while the kappa value for inter-rater reliability was 0.38 indicating fair reliability.
CONCLUSION
This new classification is a tool for an arthroscopic assessment of PLRI and can be used as a standardized grading system for further research and communication between orthopedic surgeons. We demonstrated good intrarater reliability (k = 0.71) with fair inter-rater reliability (k = 0.38). However, further research is necessary to study the clinical significance.
PubMed: 37969525
DOI: 10.1016/j.jseint.2023.02.016 -
International Journal of Rheumatic... Nov 2023To assess the efficacy and safety of arthroscopic surgery associated with platelet-rich plasma (PRP) infusion in treating knee osteoarthritis (KOA). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the efficacy and safety of arthroscopic surgery associated with platelet-rich plasma (PRP) infusion in treating knee osteoarthritis (KOA).
METHODS
PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database, China VIP Database, Wanfang Database, and China Biomedical Literature Database online database were searched for the case-control trial of arthroscopic surgery associated with PRP infusion in patients with KOA. During the search period of January 2010 through May 2022, two researchers independently extracted the data. With RevMan5.3, we performed a meta-analysis on the collected data.
RESULTS
A total of six clinical controlled studies were included, including 333 individuals. Compared with the control group treated only by arthroscopic surgery, the results showed that the visual analogue scores of patients in the arthroscopic surgery and PRP infusion group were significantly lower at 3, 6 and 12 months after operation, and the Western Ontario and McMaster Universities Osteoarthritis Index were significantly lower at 3, 6 and 12 months after operation (p < .05). The meta-analysis of Hospital for Special Surgery (HSS) knee score and Lisum knee score (LKSS) showed that postoperative HSS score, LKSS score at 3, 6, and 12 months after operation, and SF-36 quality of life score at 6 and 12 months after operation were higher (p < .05).
CONCLUSION
Arthroscopic debridement associated with PRP is more successful in relieving knee pain and enhancing knee joint function than arthroscopic debridement in treating KOA. The treatment scheme deserves to be popularized in clinical practice, but further research and longer interventions will be needed to validate it, using high-quality methods.
Topics: Humans; Osteoarthritis, Knee; Arthroscopy; Quality of Life; Knee Joint; Platelet-Rich Plasma; Treatment Outcome; Hyaluronic Acid; Injections, Intra-Articular
PubMed: 37715357
DOI: 10.1111/1756-185X.14921 -
Clinics in Shoulder and Elbow Dec 2023The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid...
The Latarjet procedure is a surgical procedure that can effectively restore glenohumeral stability, especially in patients with anterior shoulder instability and glenoid bone loss. Many studies have shown comparable clinical outcomes between patients undergoing the arthroscopic Latarjet procedure and those undergoing traditional open methods or other glenohumeral joint stabilization procedures. However, the arthroscopic Latarjet procedure is a challenging technique due to the unfamiliar portal placements, proximity of neurovascular structures, and serious postoperative complications. The arthroscopic Latarjet procedure has not yet been widely applied, and a clear understanding of the anatomical structure and the precise methods is required prior to operation performance. Satisfactory clinical outcomes can be achieved by thorough preoperative planning and proper implant fixation methods.
PubMed: 37442776
DOI: 10.5397/cise.2022.01396 -
Arthroscopy Techniques Nov 2023Osteonecrosis of the humeral head is an uncommon condition, and treatment options are controversial. The shoulder is the second most common location for osteonecrosis,...
Osteonecrosis of the humeral head is an uncommon condition, and treatment options are controversial. The shoulder is the second most common location for osteonecrosis, typically presenting between the second and fifth decades of life. Early diagnosis and treatment are essential because osteonecrosis may progress and lead to significant pain and loss of function. Nonoperative options are limited and are based on addressing the cause of the osteonecrosis. Multiple surgical treatments have been described, and these techniques continue to evolve. Open core decompression of the humeral head has been found to be an effective surgical option to restore blood supply and stimulate new bone formation. The evolution of arthroscopic techniques combined with biological adjuncts allows a minimally invasive approach with potential to accelerate revascularization and bone growth. We describe our technique for arthroscopic-assisted intraosseous bioplasty of the humeral head for the treatment of osteonecrosis.
PubMed: 38094945
DOI: 10.1016/j.eats.2023.07.021