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International Journal of Rheumatic... Oct 2021Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's... (Review)
Review
Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. The post-War father of modern arthroscopy, Watanabe, found rheumatologists among his early students, who took back the technique to their home countries, teaching orthopedists and rheumatologists alike. Rheumatologists described and analyzed the intra-articular features of their common diseases in the '60s and '70s. A groundswell of interest from academic rheumatologists in adapting arthroscopy grew considerably in the '90s with development of "needle scopes" that could be used in an office setting. Rheumatologists helped conduct the very trials the findings of which reduced demand for their arthroscopic services by questioning the efficacy of arthroscopic debridement in osteoarthritis (OA) and also developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is now imaged mainly by magnetic resonance imaging, some OA features - such as a high prevalence of visible calcinosis - beg further arthroscopy-directed investigation. A new generation of "needle scopes" with far superior optics awaits future investigators, should they develop interest.
Topics: Arthroscopes; Arthroscopy; Diffusion of Innovation; Forecasting; History, 20th Century; History, 21st Century; Humans; Joint Diseases; Practice Patterns, Physicians'; Rheumatologists
PubMed: 34323382
DOI: 10.1111/1756-185X.14184 -
Harefuah Aug 2022Acute septic arthritis of the knee joint is an orthopedic emergency, potentially devastating, which can lead to high morbidity and may even be life-threatening. While... (Review)
Review
Acute septic arthritis of the knee joint is an orthopedic emergency, potentially devastating, which can lead to high morbidity and may even be life-threatening. While any synovial joint can be infected, the knee is the most often affected joint and is involved in about 50 % of the cases. The infection is usually caused by a gram-positive bacteria. The diagnosis is made by synovial fluid aspiration, microbiological analysis and hematological investigations of inflammatory measures. Treatment requires emergency irrigation and debridement of the joint, and intravenous antibiotics. Surgical debridement can be performed either arthroscopically or via open arthrotomy. In recent years, arthroscopic treatment demonstrated more favorable outcomes with better functional outcomes, shorter operative time and hospital stays.
Topics: Arthroscopy; Debridement; Humans; Knee Joint; Retrospective Studies; Therapeutic Irrigation
PubMed: 35979567
DOI: No ID Found -
Operative Orthopadie Und Traumatologie Aug 2022Minimally invasive arthroscopically assisted reconstruction of scaphoid nonunions. (Review)
Review
OBJECTIVE
Minimally invasive arthroscopically assisted reconstruction of scaphoid nonunions.
INDICATIONS
Delayed union or nonunion of the scaphoid with sclerosis and with indication for bone transplantation. Limited arthritic changes at the radial styloid.
CONTRAINDICATIONS
Severe humpback deformity with dorsal intercalated segment instability. Midcarpal arthritic changes.
SURGICAL TECHNIQUE
Supine position with the forearm upright and in neutral position, the elbow flexed by 90°, axial traction of 3 to 4 kg. Standard wrist arthroscopy via the 3-4 and the 4-5 portal and the midcarpal joint via the radial and ulnar portal, respectively, with sodium chloride as arthroscopy medium. Change of the optic to the ulnar midcarpal portal and opening of the nonunion with an elevator via the radial midcarpal portal. Resection of the sclerosis with a 3.0 mm burr while irrigating the joint. Harvesting of cancellous bone via the second extensor compartment. On the hand table, closed reduction by joy-stick K‑wires if needed and insertion of K‑wires for the scaphoid screw. Insertion of the screw without entering of the distal thread into the bone. Arthroscopic insertion of the bone transplant by a blunt drill sleeve via the radial portal with steady compression by the obturator. Complete insertion of the screw under arthroscopic control of the compression of the nonunion space with arthroscopic control of stability with the probe.
POSTOPERATIVE MANAGEMENT
Six weeks forearm cast including the thumb metacarpophalangeal joint, radiographic control and non-load bearing movements for two more weeks, CT scan in the oblique sagittal plane after 8 weeks, and increase of load, as well as physiotherapy on demand depending on the radiographic results.
RESULTS
To date, 17 patients with a mean age of the nonunion of 18 months were treated. In 14 patients, bony union was achieved after 8 weeks. In one patient, an extraosseous screw placement was corrected. In another patient with extraosseous screw placement, persisting nonunion was treated with an angular stable plate. One scaphoid demonstrated an asymptomatic tight nonunion after 14 months, while one scaphoid with sclerosis of the proximal pole did not heal.
Topics: Bone Screws; Bone Transplantation; Fracture Fixation, Internal; Fractures, Ununited; Humans; Infant; Retrospective Studies; Scaphoid Bone; Sclerosis; Treatment Outcome
PubMed: 35394136
DOI: 10.1007/s00064-022-00765-8 -
Arthroscopy : the Journal of... Aug 2022Three goals are at the top of our minds when achieving optimal outcomes for the arthroscopic treatment of femoroacetabular impingement syndrome in the primary setting:...
Three goals are at the top of our minds when achieving optimal outcomes for the arthroscopic treatment of femoroacetabular impingement syndrome in the primary setting: (1) accurate bony correction, (2) labral function restoration-typically with labral repair-and (3) comprehensive capsular management-which involves capsular preservation and closure. Notwithstanding, additional intra-articular concomitant conditions require our attention as well. Central acetabular impingement is characterized by the presence of central acetabular osteophytes at the cotyloid fossa. It has been proposed that central acetabular osteophytes lead to lateralization of the femoral head with relative femoroacetabular incongruency that increases contact force and mechanical cartilage abrasion.
Topics: Acetabulum; Arthroscopes; Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans; Osteophyte; Treatment Outcome
PubMed: 35940741
DOI: 10.1016/j.arthro.2022.03.020 -
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 -
Arthroscopy : the Journal of... Feb 2021Arthroscopic treatment of femoroacetabular impingement is increasingly common with established clinical success. As with other chronic injuries, there is an emotional...
Arthroscopic treatment of femoroacetabular impingement is increasingly common with established clinical success. As with other chronic injuries, there is an emotional impact that can affect recovery, particularly in competitive athletes. As this emotional aspect of injury is more recognized, it will be important to determine comprehensive means of treating both an athlete's physical and mental health. It is important to establish preoperative expectations. For certain patients, psychological evaluation and treatment is indicated early in the diagnosis and recovery to ensure mental fitness, and this may be especially true for adolescents. A comprehensive and personalized approach to injury recovery is optimal.
Topics: Adolescent; Arthroscopes; Arthroscopy; Athletes; Femoracetabular Impingement; Hip Joint; Humans; Male; Mental Health
PubMed: 33546795
DOI: 10.1016/j.arthro.2020.12.193 -
International Journal of Oral and... Sep 2020Operative arthroscopy of the temporomandibular joint requires the insertion of an arthroscope and a working cannula. The surgical instruments are introduced into the...
Operative arthroscopy of the temporomandibular joint requires the insertion of an arthroscope and a working cannula. The surgical instruments are introduced into the joint space via the working cannula, and are visualized by the arthroscope. While the insertion of the arthroscope is relatively easy as anatomical landmarks such as the tragus-canthus line aid the surgeon, the insertion of the working cannula requires the use of advanced techniques and demands higher levels of surgical expertise. Following is a description of a novel guide device that enables the surgeon to introduce the working cannula into the desired location relative to the arthroscope, and maintains optimal spatial relations between them throughout the procedure.
Topics: Arthroscopes; Arthroscopy; Cannula; Humans; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 32171619
DOI: 10.1016/j.ijom.2020.02.013 -
Arthroscopy Techniques Apr 2022Acromioclavicular joint pathology such as osteoarthritis has historically been treated with either an open or arthroscopic distal clavicle resection. Over the years the...
Acromioclavicular joint pathology such as osteoarthritis has historically been treated with either an open or arthroscopic distal clavicle resection. Over the years the trend has been toward more minimally invasive treatment options with the arthroscope. In this article we highlight the use of the nanoscope to visualize the resection which can be performed through a small percutaneous incision. The advantages of this technique include the use of smaller portals, which should lead to improved earlier outcomes, and less iatrogenic damage to the shoulder.
PubMed: 35493033
DOI: 10.1016/j.eats.2021.12.006 -
Rheumatology (Oxford, England) Feb 2021The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to... (Review)
Review
The aim of our manuscript is to illustrate the past, present and future role of rheumatologists performing arthroscopy. Doctors first began adapting endoscopes to inspect joints to assess synovial conditions that concern rheumatologists. Rheumatologists were among the pioneers developing arthroscopy. Students of the father of modern arthroscopy, Watanabe, included rheumatologists, who taught others once home. Rheumatologists assessed the intra-articular features of their common diseases in the 60s and 70s. Improvements in instrumentation and efforts by a few orthopaedists adapted a number of common joint surgical procedures for arthroscopy. Interest from rheumatologists in arthroscopy grew in the 90s with 'needle scopes' used in an office setting. Rheumatologists conducting the first prospective questioning arthroscopic debridement in OA and developing biological compounds reduced the call for arthroscopic interventions. The arthroscope has proven an excellent tool for viewing and sampling synovium, which continues to at several international centres. Some OA features-such as calcinosis-beg further arthroscopic investigation. A new generation of 'needle scopes' with far superior optics awaits future investigators.
Topics: Arthritis, Rheumatoid; Arthroscopy; Humans; Rheumatology; Synovectomy
PubMed: 33257961
DOI: 10.1093/rheumatology/keaa560 -
Arthroscopy Techniques Oct 2021The Latarjet procedure is a method for treating complicated glenohumeral joint dislocation that is often associated with a bone defect in the anterior glenoid. The...
The Latarjet procedure is a method for treating complicated glenohumeral joint dislocation that is often associated with a bone defect in the anterior glenoid. The Latarjet procedure addresses both soft-tissue and bone deficiencies by creating a biceps tendon sling and through bone reconstruction of the anterior glenoid defect. The arthroscopic Latarjet procedure provides good visual control in the structures and eliminates the need for an arthrotomy. We present an arthroscopy-assisted Latarjet technique where the coracoid is temporarily exteriorized to facilitate shaping and preparation for subsequent fixation to the glenoid. Coracoid debridement, anterior glenoid preparation, and the subscapular split are conducted arthroscopically. Cutting the coracoid process is also conducted under arthroscopic control, and the coracoid is exposed through the anteroinferior portal. Once the coracoid is openly shaped and the drill-holes are made, the coracoid is resituated and fixed to the glenoid edge in arthroscopic visual control. The purpose of this technique is to combine favorable elements of the open and arthroscopic procedures. Additionally, the instrumentation is simple, which makes the operation safe and practical to perform.
PubMed: 34754748
DOI: 10.1016/j.eats.2021.07.016