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Arthroscopy : the Journal of... Dec 2022The debate regarding optimal capsular management during hip arthroscopy has been evolving for over 20 years. Femoroacetabular impingement emerged in the arthroscopic...
The debate regarding optimal capsular management during hip arthroscopy has been evolving for over 20 years. Femoroacetabular impingement emerged in the arthroscopic world in the early 2000s. However, the ability to address osseous deformities and decompress and/or reshape them was limited by the hip capsular structures and small capsulotomies. Some surgeons attempted to arthroscopically manage these deformities with limited capsulotomies, with not surprisingly limited success. Others made larger capsular windows (capsulectomies) to more accurately manage these deformities but potentially left some patients with varying degrees of iatrogenic microinstability or macroinstability. Over time, an increasing awareness of post-arthroscopy instability in the form of case reports, case series, and backroom chatter among the hip arthroscopy thought leaders brought the idea of routine capsular closure to the forefront. Biomechanical studies defined the role of the hip capsular ligaments, the deficits created with various capsulotomies during surgery, and the ability to restore stability after capsular repair. Clinical studies revealed better outcomes and lower revision rates after capsular repair for subtle osseous and soft-tissue instability, revision cases, and athletes compared with unrepaired capsulotomies. Various capsular repair constructs (side-to-side repairs, capsular shifts, and various suture configurations and suture materials) have been proposed, without evidence to support a superior technique or suture material. In the end, capsular management is an evolving art that takes into account various patient-specific factors (i.e., individual activity requirements, soft-tissue and osseous parameters, and intraoperative impressions) with the end goal of achieving a stable, impingement-free joint. There might be various capsular management roads to travel, but the destination remains the same.
Topics: Humans; Femoracetabular Impingement; Arthroscopy; Bone and Bones; Ligaments, Articular; Sutures
PubMed: 36462780
DOI: 10.1016/j.arthro.2022.07.004 -
Arthroscopy : the Journal of... Oct 2021Subscapularis tears can sometimes be difficult to identify arthroscopically. Burkart recognized this and described the "comma sign," an arc formed by a portion of the...
Subscapularis tears can sometimes be difficult to identify arthroscopically. Burkart recognized this and described the "comma sign," an arc formed by a portion of the superior glenohumeral ligament/coracohumeral ligament complex, to help identify the subscapularis when it is torn and retracted. The comma sign marks the superolateral corner of the torn subscapularis tendon. In the majority of cases, the comma sign can be identified on preoperative magnetic resonance imaging. Magnetic resonance imaging findings of a comma sign include a predominantly low T1 and T2 signal intensity band of soft tissue, situated anterior and medial to the anterior glenoid labrum, extending vertically immediately lateral to the base of the coracoid, and bridging the subscapularis and supraspinatus fossa. Knowing that a comma sign is present before an arthroscopic subscapularis repair should help surgeons identify and secure the leading edge of the subscapularis for repair.
Topics: Arthroscopy; Humans; Magnetic Resonance Imaging; Rotator Cuff; Rotator Cuff Injuries; Shoulder Joint
PubMed: 34602148
DOI: 10.1016/j.arthro.2021.07.009 -
Annals of Joint 2023The surgical treatment of anterior cruciate ligament (ACL) injuries dates back over 100 years from the present day [2022]. While open repair of the torn ACL was... (Review)
Review
The surgical treatment of anterior cruciate ligament (ACL) injuries dates back over 100 years from the present day [2022]. While open repair of the torn ACL was popularized in the early 1900s, the first ACL reconstructions utilized the fascia lata as a graft and other extra-articular stabilizing techniques. The first free tendon graft reported for ACL reconstructions was the quadriceps tendon (QT) in the 1930s, followed by the hamstrings tendon (HT), and then the patellar tendon. With improved understanding of the ACL anatomy and biomechanics and the invention of the arthroscope, ACL reconstruction evolved from open procedures to arthroscopic. Similarly, with the help of many surgeon-scientists who reported patient outcomes following ACL reconstruction with various techniques, graft choice evolved with the hamstrings and patellar tendon grafts becoming the dominant and preferred choice of both surgeons and patients. In present day, we see a resurgence of one of the original grafts reported, the QT, as well as primary ACL repair. Future research will result in continued advancements of ACL surgical techniques and graft harvesting, which will allow the orthopedic community (including patients and surgeons) to benefit from such innovations and advanced technologies.
PubMed: 38529255
DOI: 10.21037/aoj-22-39 -
JSES International Nov 2022As the volume and proportion of patients treated arthroscopically for rotator cuff repair increases, it is important to recognize sex differences in utilization and...
BACKGROUND
As the volume and proportion of patients treated arthroscopically for rotator cuff repair increases, it is important to recognize sex differences in utilization and outcomes.
METHODS
Patients who underwent arthroscopic rotator cuff repair between 2010 and 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Baseline demographic and clinical characteristics were collected, and information concerning utilization, operative time, length of hospital stay, days from operation to discharge, readmission, and adverse events were analyzed by sex.
RESULTS
Of 42,443 included patients, 57.7% were male and 42.3% were female. Comparably, females were generally older ( < .001) and less healthy as indicated by American Society of Anesthesiologists class ( < .001) and rates of obesity (52.0% vs. 47.8%, < .001), chronic obstructive pulmonary disease (4.0% vs. 2.7%, < .001), and steroid use (2.7% vs. 1.6%, < .001). Females experienced shorter operative times (mean difference [MD] 11.5 minutes, < .001), longer hospital stays (MD 0.03 days, < .001), longer times from operation to discharge (MD 0.03 days, < .001), and more minor adverse events (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.24-2.47) after baseline adjustment. Conversely, rates of serious adverse events (OR, 0.69; 95% CI, 0.55-0.86) and readmissions (OR, 0.88; 95% CI, 0.66-0.97) were lower among females. Disparities in utilization increased over the study period ( = .008), whereas length of stay ( = .509) and adverse events ( = .967) remained stable.
CONCLUSION
Sex differences among patients undergoing arthroscopic rotator cuff repair are evident, indicating the need for further research to understand and address the root causes of inequality and optimize care for all.
PubMed: 36353439
DOI: 10.1016/j.jseint.2022.07.003 -
Operative Orthopadie Und Traumatologie Aug 2022Open reduction of congenital hip dislocations currently remains the standard treatment for those hip joints which are irreducible by closed means. The open reduction of... (Review)
Review
OBJECTIVE
Open reduction of congenital hip dislocations currently remains the standard treatment for those hip joints which are irreducible by closed means. The open reduction of the dislocated hip joint represents a relatively invasive surgical method. Thus, the goal was to develop a minimally invasive and safe procedure with a lower complication rate as an alternative to open reduction. This work presents the arthroscopically guided reduction of dislocated hip joints, first described in 2009, as a standardized surgical technique.
INDICATIONS
Failed closed reduction for congenital hip dislocation.
SURGICAL TECHNIQUE
Arthroscopic reduction of the dislocated femoral head using an arthroscopic two-portal technique, a high anterolateral and a medial subadductor portal. The arthroscope is inserted through the subadductor portal. The high anterolateral portal serves as working portal. Step-by-step identification and removal of obstacles to reduction such as the ligament of the femoral head, fat tissue, capsular constriction and psoas tendon. Reduction of the femoral head under arthroscopic control.
POSTOPERATIVE TREATMENT
The hip joint is retained in a hip spica cast with the legs in human position.
RESULTS
Arthroscopic hip reduction of 20 congenital hip dislocations: 13 girls and 3 boys with an average age at the time of operation of 5.8 months (3-9 months). All children had multiple, unsuccessful attempts of closed reduction by use of overhead traction, Pavlik harness or closed reduction and hip spica application. According to the Graf classification, there were 20 type IV hips. According to the radiological classification of Tönnis, there were 9 type 4, 7 type 3, and 4 type II grades. The obstacles to reduction were capsular constriction, hypertrophic ligament of the femoral head, and an extensively large pulvinar in the acetabulum. An inverted labrum was not seen in any of the cases. In contrast, in 2/3 of the cases, there was considerable retraction of the dorsal edge of the socket due to the ligament of the femoral head expanding right over it. In all cases, postreduction transinguinal ultrasound and MRI were used to check the femoral head position in the cast postoperatively. In all cases there was a deep reduction of the femoral head in the acetabulum. There were no intra- or postoperative complications such as bleeding, infections or nerve lesions. There were no cases of redislocation or decentering of the femoral head, which was also confirmed after an average follow-up of 15 months. The mean AC angle at follow-up was 24.5°. There was one coxa magna in the series and one avascular necrosis with a fragmented femoral head according to the Salter classification.
Topics: Acetabulum; Child; Female; Hip Dislocation; Hip Dislocation, Congenital; Hip Joint; Humans; Infant; Male; Treatment Outcome
PubMed: 35138416
DOI: 10.1007/s00064-021-00752-5 -
Medicine Jun 2020The clinical effects and safety over the treatment of tibia intercondylar eminence fracture (TIEF) with cannulated screw and suture fixation were evaluated under...
The clinical effect and safety of the treatment of tibia intercondylar eminence fracture with cannulated screw and suture fixation under arthroscope: Protocol for a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
The clinical effects and safety over the treatment of tibia intercondylar eminence fracture (TIEF) with cannulated screw and suture fixation were evaluated under arthroscope systematically, providing evidence-based medical support for the selection of surgical methods in terms of minimally invasive arthroscopic treatment for TIEF.
METHODS
The English databases of PubMed, EMBASE, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang databases were searched by computer. The randomized controlled trials were conducted to compare the clinical effects of TIEF with cannulated screw and suture fixation under arthroscope. The retrieval period is from the beginning of database building to January 2020. There is no language restriction. Chinese databases are searched by keywords, while English databases are searched by the combination of subject words and free words. According to the retrieval strategy, the two evaluators will lead the conforming documents into Note Express for repeated literature screening, and the two evaluators will extract and cross-check the conforming documents according to the pre-designed data extraction table. Two researchers adopted the modified Jadad scale independently to evaluate the quality of the literature. The RevMan 5.3 version software provided by the Cochrane Collaboration Network was adopted for statistical analysis.
RESULTS
The study will strictly review and extract the data included in the literature, and scientifically make statistical analysis for the pre-set outcome indicators. All the research processes will be conducted in strict accordance with the guidance of system evaluation. In this study, the differences between cannulated screw fixation and suture fixation under arthroscopy will be evaluated by comparing the relevant outcome indicators. All the results of this study will be published openly in a highly influential professional academic journal.
CONCLUSION
The paper adopted Cochrane system evaluation method to collect and sort out the published literature about the treatment of tibial eminence fracture between cannulated screw fixation and suture fixation under arthroscopy, and to compare the clinical efficacy and safety of the two fixation methods utilizing meta-analysis and comparison of related outcome indicators. Through this study, we will draw a positive conclusion, which will provide a basis for the better treatment of tibial eminence fracture.
PROSPERO REGISTRATION NUMBER
PROSPERO CRD42020168433.
Topics: Bone Screws; Fracture Fixation, Internal; Humans; Knee Injuries; Meta-Analysis as Topic; Randomized Controlled Trials as Topic; Sutures; Systematic Reviews as Topic; Tibial Fractures
PubMed: 32502035
DOI: 10.1097/MD.0000000000020609 -
Arthroscopy : the Journal of... Mar 2022Isolated patellofemoral osteoarthritis is not uncommon, and treatment remains controversial. Several surgical procedures have been performed to treat this condition. The...
Editorial Commentary: Isolated Patellofemoral Osteoarthritis May Be Treated Arthroscopically: Arthroscopic Partial Lateral Facetectomy Is a Good Alternative to More Aggressive Techniques.
Isolated patellofemoral osteoarthritis is not uncommon, and treatment remains controversial. Several surgical procedures have been performed to treat this condition. The success of surgery highly depends on the technique and the patient selection. The surgeon can choose between a relatively extreme total knee replacement, with predictable results, or operations demanding less surgical dissection and resection, but offering less certainty. Partial lateral facetectomy is a minimally invasive procedure that is simple and effective enough in selected patients with up to 10 years follow-up. An even less aggressive technique, the arthroscopic partial lateral facetectomy in combination with lateral retinacular release, has been shown to be safe, practical, reproducible, and with a low rate of complications and revision surgery at mid-term follow-up. Benefits of arthroscopic techniques include decreased bleeding, less postoperative pain, ability to treat concomitant pathology, and better cosmesis.
Topics: Arthroplasty, Replacement, Knee; Humans; Osteoarthritis, Knee; Pain, Postoperative; Reoperation; Treatment Outcome
PubMed: 35248236
DOI: 10.1016/j.arthro.2021.12.002 -
Journal of Wrist Surgery Jun 2022Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available...
Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO "B3" and "C" DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of "B3" or "C" DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in "B3" and "C" fractures. The dual-window volar approach is very useful when using AARIF for AO "B3" and "C" DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO "B3" or "C" DRF has not previously been reported. Displaced VRF are rare whether they were part of "B3" or "C" fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO "B3" and "C" fractures with VRF. A single anteromedial approach can also be used for isolated "B3" anteromedial DRF.
PubMed: 35837590
DOI: 10.1055/s-0041-1735980 -
Zhongguo Gu Shang = China Journal of... Nov 2019Elbow tuberculosis is a rare disease of infectious osteoarthritis. The aim of operation for elbow tuberculosis is to maintain joint function, ensure stability of joint... (Review)
Review
Elbow tuberculosis is a rare disease of infectious osteoarthritis. The aim of operation for elbow tuberculosis is to maintain joint function, ensure stability of joint and improve quality of life, while there were controversies about the implementation details of different procedures. For elbow tuberculosis at an advanced stage, the clinical effect of forked osteotomy arthroplasty is effective and could meet with most patients without demand of strength. However, arthrodesis is only recommended for heavy manual workers with high demand of strength, and making research on the optimal fusion angle could improve satisfaction of patients. For elbow tuberculosis at the early stage, there were few reports about interposition arthroplasty, which has a recommendation of lower degree. Otherwise, hinged external fixator with arthrolysis is main procedure for its safety, effective clinical effects, and less recurrence of inflammation, the optimal approach of arthrolysis is the research focus at present. Elbow arthroscopic surgery could not only treat the simple synovial tuberculosis of elbow joint under arthroscope, but also improve positive rate under arthroscopic, and it is recommended to be used at the early unclear diagnosis of swelling and pain of chronic elbow joint. In addition, total elbow arthroplasty may be an option for patients with high functional requirements in the future.
Topics: Elbow; Elbow Joint; Humans; Quality of Life; Range of Motion, Articular; Treatment Outcome; Tuberculosis
PubMed: 31870060
DOI: 10.3969/j.issn.1003-0034.2019.11.019 -
Orthopaedic Surgery Aug 2021To explore the development of hip arthroscopy in China through reviewing the change of the application of hip arthroscopy operation on treating femoracetabular... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To explore the development of hip arthroscopy in China through reviewing the change of the application of hip arthroscopy operation on treating femoracetabular impingement (FAI).
METHOD
Papers were retrieved from January 1, 2005 to November 1, 2019, from databases CNKI, Wanfang Data, VIP, PubMed, and Embase. The keywords are Hip Impingement, Femoroacetabular impingement, Hip arthroscopy, Arthroscopic operation, Hip Arthroscopy operation, and Arthroscope, etc. The quality of papers was assessed through MINORS , and statistics and meta-analysis were performed by Word, Excel, and Revman 5.3 Zurich, Switzerland.
RESULTS
From a total of 8,953 papers, 46 review articles without data and 48 articles with data were involved, and 25 papers were included in the Meta-analysis. The twenty-five papers were selected from 48 papers with data, of which 41 were reported in Chinese, 11 were missing complete Harris scores, five did not mention the number of patients who had lost follow-up, three had minors quality scores below 7, one did not have enough FAI cases, and three did not have standard deviations in Harris scores. Overall, in China, the application of hip arthroscopy regarding FAI has flourished while maintaining a high level of treatment and has reached its peak in the past 2 years.
CONCLUSION
With the rapid development of hip arthroscopy in China, hip operation is widely recognized, many reports on its application on FAI have emerged successively, and the scope of application and technical level have been improved.
Topics: Arthroscopy; China; Femoracetabular Impingement; Humans; Surveys and Questionnaires
PubMed: 34664414
DOI: 10.1111/os.13105