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Foot & Ankle International Nov 2020Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely... (Comparative Study)
Comparative Study
BACKGROUND
Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques.
METHODS
Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded.
RESULTS
In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( < .001) with no difference ( > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( < .05).
CONCLUSION
Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
Topics: Adolescent; Adult; Arthroscopy; Female; Humans; Joint Instability; Lateral Ligament, Ankle; Male; Middle Aged; Pain Measurement; Plastic Surgery Procedures; Retrospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 32660270
DOI: 10.1177/1071100720938672 -
Arthroscopy : the Journal of... Dec 2023Anterior shoulder instability surgery has evolved over the decades, including both anatomic and nonanatomic repairs and reconstructions. Surgeons are continually...
Editorial Commentary: Both Bristow and Latarjet Procedures Result in Low Rates of Recurrent Shoulder Instability Despite Potential for Bone Resorption and Lack of Graft Healing.
Anterior shoulder instability surgery has evolved over the decades, including both anatomic and nonanatomic repairs and reconstructions. Surgeons are continually advancing their skills and performing more of these procedures using arthroscopic as opposed to open techniques in patients with and without glenoid bone loss. However, there is a steep learning curve and increased technical demands when performing these procedures arthroscopically. Despite high success rates, bone graft resorption or lack of healing after Latarjet and Bristow procedures is well documented, and it is possible that patients develop enough scarring that their shoulders remain stable. Osteoarthritis after these nonanatomic procedures can occur making shoulder arthroplasty and reconstruction technically more challenging because of scarring and the altered anatomy. It remains to be seen whether these arthroscopic techniques as opposed to open surgery lessen the scarring and thus the technical demands of shoulder reconstruction in the small subset of patients who unfortunately develop symptomatic shoulder osteoarthritis. Therefore, in my practice, these techniques are carefully chosen for select patients. My indications for use of the Bristow procedure as a primary procedure for anterior shoulder instability are in patients who perform mixed martial arts fighting and high-level wrestlers without significant glenoid or humeral bone loss. My indications for the Latarjet procedure are in patients with chronic anterior instability and associated anterior glenoid bone loss 15% to 30%, off-track Hill-Sachs lesions, and revision surgery, particularly in high-demand contact and collision athletes. These 2 arthroscopic procedures, despite being nonanatomic, provide surgeons with excellent treatment options for those difficult patients with anterior shoulder instability. Despite high success rates with these arthroscopic procedures, patients should be counseled on the risks of graft resorption, graft nonunion, and possible shoulder osteoarthritis. The appropriate indications for these arthroscopic procedures can enhance the successful outcomes for high-risk patients with shoulder instability while also considering the possible long-term impacts of altering shoulder anatomy and scarring in the rare patient who develops shoulder osteoarthritis.
Topics: Humans; Joint Instability; Shoulder; Cicatrix; Shoulder Joint; Osteoarthritis; Bone Resorption
PubMed: 37981386
DOI: 10.1016/j.arthro.2023.07.025 -
Arthroscopy Techniques Apr 2024The Latarjet procedure is a proven and effective operation to treat anterior shoulder instability. Especially in cases with anterior glenoid bone loss, the Latarjet...
The Latarjet procedure is a proven and effective operation to treat anterior shoulder instability. Especially in cases with anterior glenoid bone loss, the Latarjet operation is the most popular procedure to restore glenoid anatomy and avoid further dislocations. Next to the re-creation of the missing glenoid bone, the sling effect of the conjoint tendon transferred between a split in the subscapularis muscle is an important "soft tissue stabilizer" of the humeral head. However, it has been shown that the inferior part of the subscapularis muscle tends to degenerate, leading to fatty infiltration of the muscle itself. Also, exposure through the subscapularis split is technically demanding, and there is a risk of nerve damage due to the pulling forces of the retractors during open surgery. When performing the procedure arthroscopically, extremely low and medial portals are necessary to find a correct angle for the glenoid drilling when approaching from anterior. Neurovascular structures may be at risk during these surgical steps. The aim of the flipped Latarjet procedure is to facilitate a safe and reliable arthroscopic operation to anteriorly stabilize the shoulder by transferring the coracoid to the deficient glenoid without splitting the subscapularis muscle while keeping the benefits of a sling effect of the conjoined tendon.
PubMed: 38690334
DOI: 10.1016/j.eats.2023.102899 -
Knee Surgery, Sports Traumatology,... May 2023To investigate the clinical characteristics of intratendinous subscapularis (inSSC) tears.
PURPOSE
To investigate the clinical characteristics of intratendinous subscapularis (inSSC) tears.
METHODS
Retrospectively, 69 patients with arthroscopically confirmed inSSC tears were identified from 2018 to 2019. Preoperatively and at final follow-up, thorough physical examination was performed and clinical outcomes (American Shoulder and Elbow Surgeons [ASES] score; University of California, Los Angeles [UCLA] score; visual analogue scale [VAS] for pain; and Simple Shoulder Test [SST]) were recorded. Features of pre-operative magnetic resonance image (MRI) such as high signalling within the tendon substance, communication to the bicipital groove and long head of biceps tendon (LHBT) lesions were investigated. Characteristics of arthroscopic view were investigated. Bear-hug and internal rotation resistance test at 90° abduction and external rotation (IRRT90°) test were used to assess the SSC strength.
RESULTS
The mean follow-up was 2.4 (2-3) years. The prevalence of arthroscopically confirmed inSSC tears was 69/675 (10.2%) among arthroscopic rotator cuff repairs. Pre-operative physical examination found positive IRRT90° and bear-hug test in 41/60 (68.3%) and 42/69 (60.8%) patients, respectively. The Cohen kappa coefficient was interpreted to be substantial for the evaluation of all MRI parameters. According to the conditions of LHBT, inSSC tears were classified into 3 types: type I: without LHBT subluxation and tear; type II: with LHBT subluxation or tears and type III: with LHBT dislocation. At final follow-up, mean ASES, UCLA, VAS, and SST scores improved significantly from mean of 50.6 ± 14.7, 19.4 ± 3.07, 6.2 ± 2.0, and 6.1 ± 2.5 to mean of 90.7 ± 9.5, 32.2 ± 1.8, 1.4 ± 1.2 and 9.8 ± 2.2, respectively (P < 0.001). Bilateral symmetric strength was found by bear-hug and IRRT90° test in all patients postoperatively.
CONCLUSION
Understanding features of pre-operative MRI, physical examination and arthroscopic view is helpful to identify inSSC tears. Arthroscopic repair yielded satisfactory clinical outcomes in patients with inSSC tears.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Animals; Rotator Cuff; Rotator Cuff Injuries; Prevalence; Retrospective Studies; Ursidae
PubMed: 36454292
DOI: 10.1007/s00167-022-07262-2 -
Arthroscopy : the Journal of... Apr 2020Historically described as the "dark side of the knee," the posterolateral corner of the knee has been a significant focus of anatomic, biomechanical, and clinical...
Historically described as the "dark side of the knee," the posterolateral corner of the knee has been a significant focus of anatomic, biomechanical, and clinical outcomes research due to poor treatment outcomes for these injuries before improvements over the past 2 decades. These research efforts have resulted in significant improvements in the understanding, diagnosis, and surgical treatment of these injuries. Perhaps most importantly, improved understanding of the anatomy and biomechanics has led to the development of anatomic-based reconstructions, which have been subsequently validated with both biomechanical and clinical outcomes. Due to the complex anatomy and proximity of neurovascular structures, reconstructions have historically used large "hockey stick" incisions to provide adequate visualization to identify the anatomic insertions of the static stabilizers and ensure adequate protection of neurovascular structures. These anatomic-based techniques have significantly improved the clinical and objective outcomes of the surgical treatment of posterolateral knee injuries. However, as techniques have evolved and the clinical outcomes have improved, clinicians have attempted to develop and employ less-invasive and arthroscopically assisted techniques. Specifically, given the steep learning curve, paucity of clinical outcomes, increased operative time, and the limited view of the anatomy, which may increase the risk of nonanatomic tunnel placement, and injuries to surrounding structures, we cannot support an arthroscopic approach at this time.
Topics: Cadaver; Humans; Knee Injuries; Knee Joint
PubMed: 32247409
DOI: 10.1016/j.arthro.2020.01.030 -
Frontiers in Surgery 2023The management of proximal tibial fractures has evolved significantly in recent years. While the main goals of treatment - stability, restoration of the mechanical axis,... (Review)
Review
The management of proximal tibial fractures has evolved significantly in recent years. While the main goals of treatment - stability, restoration of the mechanical axis, and smooth articular surfaces - remain the same, methods have advanced substantially. In diagnostics, technical progress in CT and MR imaging has led to a better three-dimensional understanding of the injury. Newly developed classification systems such as the three-column concept of Luo et al. and the 10-segment concept of Krause et al. take this into account. Accordingly, there is a trend towards tailored approaches for particular fracture localizations. Parallel to this development, there is increasing evidence of the advantages of arthroscopically assisted surgical procedures. This Current Concepts article reviews classifications, diagnostics, treatment options as well as complications in fractures of the proximal tibia.
PubMed: 37035564
DOI: 10.3389/fsurg.2023.1138274 -
Arthroscopy Techniques Apr 2020The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability in the setting of significant or irreparable rotator cuff tears in elderly...
The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability in the setting of significant or irreparable rotator cuff tears in elderly patients. The procedure comprises an inferior closing wedge partial osteotomy of the coracoid process with fixation to the glenoid neck. This results in a lowered and medialized coracoid process that acts as a bone block and the conjoint tendon is brought closer to the glenohumeral joint, thus closing the subcoracoid space, which blocks humeral dislocation. We describe an arthroscopic step-by-step guided Trillat technique that is simple, efficient, and reproducible, while minimizing risk in the extra-articular subcoracoid space. Our technique does not require the release of the pectoralis minor tendon from the coracoid process, which reduces the risk of damaging the brachial plexus. We use a tight-rope fixation construct that allows progressive transfer of the coracoid process, limiting fracture risk and the risk of overtightening of the subscapularis muscle. Because there is a trend for more complex procedures being performed arthroscopically, it is important to develop and simplify operative techniques, aiding surgeons in achieving reproducible and reliable patient outcomes.
PubMed: 32368472
DOI: 10.1016/j.eats.2019.12.004 -
Arthroscopy Techniques Nov 2020Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying...
Use of a Superolateral Portal and 70° Arthroscope to Optimize Visualization of Patellofemoral Tracking and Osteochondral Lesions in Patients With Recurrent Patellar Instability.
Surgical treatment of patellofemoral instability and associated cartilaginous lesions can be technically challenging. Visualization of patellar tracking and underlying osteochondral lesions is paramount to operative success. To treat these conditions effectively, a comprehensive arthroscopic assessment of the patellofemoral joint as well as dynamic visualization of patella tracking must be achieved. Visualization of the patellofemoral joint-in particular, the articular cartilage of the patella and trochlea morphology-can be difficult when using traditional anteromedial or anterolateral portals and a 30° arthroscope lens. The technique described here uses an accessory superolateral portal and a 70° arthroscope to achieve significantly improved visualization of the patellofemoral articulation, in particular the chondral surfaces. This vantage point aids the surgeon in effectively evaluating patellar tracking, trochlea morphology, and importantly, osteochondral lesion location to help guide treatment algorithms in the patellofemoral joint.
PubMed: 33294334
DOI: 10.1016/j.eats.2020.07.020 -
Arthroscopy : the Journal of... Jul 2021Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging...
Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging (MRI), including time out of work, prolonged diagnostic dilemmas, and finite advanced imaging resources. Improvements in the image quality with the modern needle arthroscope have made it a viable option for use as a diagnostic tool in the operative setting, and eventually, if surgeons are able to create strict criteria for proper diagnostic use of the needle arthroscope, it may become an excellent tool for in-office use despite financial or legal hurdles. Specific clinical scenarios for use of an diagnostic needle arthroscopy instead of an MRI (and typically immediately followed by therapeutic arthroscopy in the same setting) include (1) a patient with a clinically obvious meniscus tear with a locked knee, (2) a patient with an outdated but previously positive MRI with recurrent injury such as a recurrent shoulder or patella dislocations, (3) a patient who is ineligible for an MRI such as those with pacemakers or spinal implants who have clear and obvious clinical findings to suggest intra-articular pathology, and (4) a patient who is over the age of 50 years with positive rotator cuff testing after a shoulder dislocation in which I have a high degree of suspicion of a rotator cuff tear. In the future, we envision using multiple needle arthroscopes to provide simultaneous views from different angles during surgery and giving ourselves a 360° view. I envision an operating room in the future with multiple small needle scopes in joint and multiple viewing monitors providing a new 3-dimensional world of arthroscopy.
Topics: Arthroscopes; Arthroscopy; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Middle Aged; Rotator Cuff; Shoulder Joint
PubMed: 34226002
DOI: 10.1016/j.arthro.2021.04.014 -
JBJS Reviews Aug 2020Arthroscopy may be used to diagnose symptomatic glenoid loosening following anatomic total shoulder arthroplasty (aTSA), and arthroscopic glenoid component removal may... (Review)
Review
Arthroscopy may be used to diagnose symptomatic glenoid loosening following anatomic total shoulder arthroplasty (aTSA), and arthroscopic glenoid component removal may suffice as treatment for some patients. Arthroscopy may be used to diagnose shoulder prosthetic joint infection (PJI) following aTSA and reverse shoulder arthroplasty (RSA). Tissues are biopsied from multiple sites within the joint and the subdeltoid or subacromial space, and they are cultured for a minimum of 14 days. Postoperative adhesions arising after prosthetic shoulder arthroplasty (PSA) may be released arthroscopically. However, other problems contributing to shoulder stiffness such as component malpositioning or shoulder PJI require additional intervention. Arthroscopy may be used to repair select rotator cuff tears that arise acutely following aTSA, but chronic attritional tears do not heal after repair; therefore, revision to RSA often is needed. Many complications following PSA, such as infection, fixed instability, humeral component loosening, and major humeral or glenoid bone loss, are not adequately treated using arthroscopic techniques. However, arthroscopy following PSA may help to diagnose and treat other complications, even as the precise indications following aTSA and RSA remain unclear.
Topics: Arthroplasty, Replacement, Shoulder; Arthroscopy; Humans; Prosthesis Failure; Prosthesis-Related Infections; Rotator Cuff Injuries; Shoulder Impingement Syndrome
PubMed: 32960026
DOI: 10.2106/JBJS.RVW.20.00020