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Medicina (Kaunas, Lithuania) Jun 2024: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic... (Comparative Study)
Comparative Study
: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic modification of the Broström operation (AMBO) was developed; many studies have shown that there are no significant differences in clinical and radiological outcomes between the two surgical methods. However, no studies have been conducted comparing the two surgical methods in terms of return to play (RTP) time. This study assesses the time to RTP and the functional clinical outcomes. : Sixty patients were enrolled from January 2012 to July 2014. They were segregated into two cohorts: the AMBO group comprised 30 patients, while the OMBO group comprised another 30 patients. Each participant underwent standardized treatment and rehabilitation regimens and RTP time was measured using seven questions that explored the times to return of painless walking, running, jumping, squatting, climbing stairs, and rising up on the heels and toes. We compared the time intervals from the onset of instability to the date of surgery. Clinical outcomes were evaluated before the surgery, 6 weeks after surgery, and 6 months after surgery. The assessments included the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the pain visual analog scale (VAS) score, subjective satisfaction with rehabilitation, and activity level. : In terms of RTP, AMBO was associated with a shorter interval to walking without pain (7.07 ± 2.96 weeks) relative to OMBO (11.03 ± 8.58 weeks). No disparities were observed in the time to return to play (RTP) between OMBO and AMBO. While there were no discrepancies in the 6-month postoperative AOFAS or VAS scores, the 6-week postoperative VAS score was notably lower in the AMBO group compared to the OMBO group. AMBO provided a faster RTP in terms of two of the seven questions in a group exhibiting high-level physical activity. The rate of subjective satisfaction with rehabilitation was higher for AMBO than for OMBO. : Aside from walking, the duration to return to play and the clinical outcomes were similar between AMBO and OMBO treatments for lateral ankle instability. AMBO is a good treatment option and should be carefully considered for athletes with lateral ankle instability. AMBO demonstrated positive outcomes in a group with higher activity levels compared to others, particularly in terms of time to RTP, subjective satisfaction, and postoperative pain.
Topics: Humans; Male; Female; Adult; Joint Instability; Arthroscopy; Return to Sport; Treatment Outcome; Ankle Injuries; Time Factors; Ankle Joint; Young Adult; Recovery of Function
PubMed: 38929538
DOI: 10.3390/medicina60060921 -
Frontiers in Surgery 2024Acetabular fractures are among the most challenging injuries in traumatology. The complex anatomy usually requires extensive surgical approaches baring the risk for...
INTRODUCTION
Acetabular fractures are among the most challenging injuries in traumatology. The complex anatomy usually requires extensive surgical approaches baring the risk for iatrogenic damage to surrounding neurovascular structures. As a viable alternative, minimally invasive endoscopic techniques have emerged during the recent years. This paper reports on the feasibility of different coupling mechanisms for a novel suprapectineal plate especially designed for minimally invasive acetabular surgery.
METHODS
A total number of 34 participants contributed to the present study, who differed in their arthroscopic and surgical experience. A laparoscopic model was used to compare four different coupling mechanisms by the number of failed attempts, the time required for plate fixation, the influence of surgical experience as well as the learning success for each individual coupling mechanism. Moreover, the feasibility of each mechanism was evaluated by a questionnaire.
RESULTS
The results demonstrate that plates employing grooved and pressure-sliding coupling mechanisms exhibit fewer failed attempts and reduce trial times, especially in contrast to sole sliding mechanisms. Furthermore, our study revealed that proficiency in endoscopic procedures significantly influenced the outcome. Notably, the subjective evaluation of the participants show that the pressure base and pressure-slide base plate designs are the most supportive and feasible designs.
CONCLUSIONS
In summary, the present study evaluates for the first-time different plate and coupling designs for minimal-invasive surgery, indicating a superior feasibility for plates with a grooved and pressure-sliding mechanism.
PubMed: 38919977
DOI: 10.3389/fsurg.2024.1357581 -
The Iowa Orthopaedic Journal 2024Posterior cruciate ligament (PCL) tears in young children are rare and optimal treatment is poorly described. Diagnosis may prove challenging as young children may not... (Review)
Review
BACKGROUND
Posterior cruciate ligament (PCL) tears in young children are rare and optimal treatment is poorly described. Diagnosis may prove challenging as young children may not be able to verbalize a complete history of injury, may be difficult to examine, and plane film radiographs often appear within normal limits. Surgical treatment carries a risk of physeal arrest, but non-operative treatment may lead to recurrent instability and pain.
METHODS
We present a case report of a fouryear- old child with a PCL avulsion off the femoral insertion who received an open reduction and internal fixation (ORIF) with combined arthroscopic synovial debridement. We performed a literature review which compared the mechanism, location, concomitant injuries, work up and management of PCL injuries in children under the age of ten compared to adolescents and adults.
RESULTS
Nineteen months following surgery, physical examination revealed full knee range of motion and return to baseline function. Imaging studies confirmed there was no evidence of physeal arrest.
CONCLUSION
ORIF with arthroscopy can be an effective method to treat PCL avulsions in children under the age of 10 years. This is similar to other case reports which reported positive outcomes with ORIF in this population. Large studies are needed to best understand optimal treatment modalities for PCL injuries in very young children. .
Topics: Humans; Posterior Cruciate Ligament; Arthroscopy; Child, Preschool; Male; Debridement; Knee Injuries; Range of Motion, Articular; Treatment Outcome; Fracture Fixation, Internal; Female
PubMed: 38919372
DOI: No ID Found -
The Iowa Orthopaedic Journal 2024Determination of need for osteochondroplasty (OCP) during periacetabular osteotomy (PAO) commonly relies on intraoperative assessment of internal rotation at 90°...
BACKGROUND
Determination of need for osteochondroplasty (OCP) during periacetabular osteotomy (PAO) commonly relies on intraoperative assessment of internal rotation at 90° flexion (IRF). Performing an OCP helps decrease the risk of iatrogenic femoroacetabular impingement from PAO reduction. Avoiding impingement helps decrease risks of accelerated secondary osteoarthritis. The literature is limited for factors that predict need for OCPs during PAOs. The purpose of this study was to (1) define the characteristics of patients needing concurrent OCP and provide OCP rate based on IRF and femoral version and (2) identify predictive factors (clinical, radiographic) associated with need for OCP during PAO. As some surgeons determine need for OCP pre-operatively, predictive factors would aid decision making.
METHODS
This was a prospective cohort of 224 hips (207 patients) who underwent PAO for symptomatic acetabular dysplasia, of which 154 hips (69%) underwent OCP between years 2013 and 2017. Patients underwent OCP if they had restrictions in motion or impingement intra-operatively. Pre-operative factors such as age, sex, BMI, and CT findings were recorded that underwent univariate and multivariable analyses. Multivariable analysis found predictors that were described using odds ratios and 95% confidence intervals. IRF>30° and femoral version 10°-25° were used as the reference groups during categorical analysis. P-values ≤0.05 were considered significant.
RESULTS
Alpha angles >55° (OR= 2.20, CI: 1.08-4.52, p= 0.03), IRF≤20° (OR: 9.52, CI: 3.87-23.40, p<0.001), IRF >20°-30° (OR: 2.68, CI: 1.08-6.62, p=0.03), and femoral version <10° (OR: 5.26, CI: 1.09-25.30, p=0.04) were associated with increased odds of OCP. On continuous modeling, decreasing femoral version (OR: 1.07, CI: 1.02-1.12, p=0.002) and IRF (OR: 1.06, CI: 1.03-1.09, p<0.001) were associated with increased chance of OCP. For 5° changes, the chance of OCP increased by 40% (OR: 1.40, CI: 1.13-1.73, p=0.002) and 35% (OR: 1.35, IC: 1.16-1.57, p<0.001), respectively.
CONCLUSION
Awareness of need for OCP may be valuable in peri-operative planning for these patients especially since some surgeons perform this technique arthroscopically before PAO. Factors associated with increased chances of OCP were alpha angles >55°, decreased IRF, and decreased femoral version. More studies in the future would help determine how OCP affects patient outcomes. .
Topics: Humans; Male; Female; Osteotomy; Prospective Studies; Adult; Acetabulum; Femoracetabular Impingement; Femur; Young Adult; Hip Dislocation; Adolescent; Range of Motion, Articular
PubMed: 38919345
DOI: No ID Found -
BMC Sports Science, Medicine &... Jun 2024Extensive research has been conducted to investigate the short-term and long-term outcomes of arthroscopic Bankart repair, yielding varying results across different...
BACKGROUND
Extensive research has been conducted to investigate the short-term and long-term outcomes of arthroscopic Bankart repair, yielding varying results across different populations. However, there remains a dearth of studies specifically focused on evaluating outcomes in recreational athletes.
METHODS
A retrospective case series study was conducted on recreational athletes who underwent isolated arthroscopic Bankart repair between 2013 and 2021. The primary outcome assessed was recurrent instability, defined as dislocation or subluxation. Secondary outcomes included patient satisfaction, rates of returning to the same sports (RTS) and RTS at preinjury level, and patient-reported outcomes. Evaluation of the Rowe score, Constant score, American Shoulder and Elbow Surgeons score, and VAS pain score were performed. Prognostic factors for recurrent instability, including demographic and clinical characteristics, as well as postoperative magnetic resonance imaging (MRI) appearance of the labrum were analyzed.
RESULTS
A total of 191 patients met the selection criteria, with 150 (78.5%) available for the final follow-up. Recurrent instability occurred in 10.7% of patients, with a mean follow-up duration of 4.1 years. Younger age at surgery and more critical glenoid bone loss were significantly associated with recurrent instability (p = .038 and p = .011, respectively). The satisfaction rate regarding surgery was 90.0%. Rates of return to the same sports (RTS) and RTS at preinjury level were 82.0% and 49.3%, respectively. Clinical outcomes measured at the final follow-up were as follows: Rowe score - 92.8; Constant score - 98.0; ASES score - 98.3; VAS pain score - 0.2. Patients with recurrent instability had significantly inferior outcomes in terms of satisfaction rate, RTS at preinjury level rate, Rowe score, and Constant score (p = .000, p = .039, p = .000, and p = .015, respectively). A total of thirty-seven patients underwent MRI examination six months after surgery in our institution. The T2-weighted anterior labrum morphology was found to be poorer in patients with recurrent instability. No significant difference was observed between patients with or without recurrent instability in terms of anterior Slope, anterior labral glenoid height index (LGHI), inferior Slope, inferior LGHI, and T2-weighted inferior labrum morphology.
CONCLUSION
Arthroscopic Bankart repair can yield satisfactory medium-term outcomes for recreational athletes. Younger age at surgery, more critical glenoid bone loss, and poorer T2-weighted anterior labrum morphology assessed six months postoperatively were significantly associated with recurrent instability.
PubMed: 38915076
DOI: 10.1186/s13102-024-00925-2 -
Cureus Jun 2024Articular cartilage defects are common injuries of the knee. The defects often progress in size and produce significant clinical symptoms due to the lack of intrinsic...
Articular cartilage defects are common injuries of the knee. The defects often progress in size and produce significant clinical symptoms due to the lack of intrinsic repair or regenerative capacity of articular cartilage. With the failure of nonoperative treatment options, surgical treatment is indicated and includes palliative, reparative, and regenerative options. For large defects of the femoral condyles, trochlea, or patella, autologous chondrocyte implantation can provide successful and long-lasting results. Presented is the case of a 37-year-old male with an 18-year follow-up to autologous chondrocyte implantation for extensive left knee articular cartilage defects of the medial and lateral femoral condyles. Recovery from articular cartilage defects is shown through both clinical improvement of the patient and arthroscopic photographs of robust autologous articular cartilage on the medial femoral condyle. This case supports the long-term benefits of autologous chondrocyte implantation as a surgical intervention for large, full-thickness articular cartilage defects of the knee.
PubMed: 38912077
DOI: 10.7759/cureus.62913 -
Revista Brasileira de Ortopedia Jun 2024To compare the functional outcomes of anterior cruciate ligament (ACL) reconstruction with hamstring autograft (HA) through the all-inside (AI) technique with...
Comparison of the Functional Outcomes of Arthroscopic Anterior Cruciate Ligament Reconstruction through the All-inside and Outside-in Techniques: A Double-Blinded Randomized Controlled Trial.
To compare the functional outcomes of anterior cruciate ligament (ACL) reconstruction with hamstring autograft (HA) through the all-inside (AI) technique with adjustable-loop cortical Endobutton (Smith & Nephew, Watford, Hertfordshire, England) on the sides of the femur and tibia and through the outside-in (OI) technique using an interference screw on the tibial side and a cortical Endobutton on the femoral side. The present is a double-blinded randomized controlled trial (RCT) of 44 patients undergoing arthroscopic ACL reconstruction from February 2019 to February 2022 in a tertiary care hospital. As per computer-based randomization, the patients were distributed into two groups: the AI and OI groups. Both groups were evaluated for 12 months using the Visual Analog Scale (VAS), the Lysholm Knee Scoring Scale, and part I (pain score) and part II (function score) of the Knee Society Score (KSS). On postoperative day 2, the VAS score was significantly higher in the OI group ( = 0.0001), but insignificant ( = 0.807) at 6 weeks. At 3, 6, and 12 months of follow-up, the score on the Lysholm Knee Scoring Scale was significantly higher ( = 0.001) in the AI group. At 6 months, both parts of the KSS showed a significant difference, with the AI group presenting a better outcome ( = 0.04). However, at 12 months, the AI group presented a better score on part I of the KSS, but no differences were observed regarding part II. In a follow-up of 12 months, the patients submitted to the AI technique presented better outcome scores and pain relief than those submitted to the OI technique.
PubMed: 38911895
DOI: 10.1055/s-0044-1786726 -
Revista Brasileira de Ortopedia Jun 2024To evaluate surgeons' performance in resecting CAM-type deformities using a realistic arthroscopic surgery simulator. An arthroscopic simulator was created using...
To evaluate surgeons' performance in resecting CAM-type deformities using a realistic arthroscopic surgery simulator. An arthroscopic simulator was created using low-cost materials with the help of a GTMax Core A1 3D printer and the programs Invesalius and Meshmixer 2017, which were used to develop femoral head parts in ABS material, with the presence of a CAM-type deformity, to mimic a femoroacetabular impact situation. After the operations were performed by 16 surgeons, the femurs were compared to a previous model with deformity and another without, using Cloudcompare, and parameters such as the volumetric difference between the operated femurs, with and without deformity, the minimum and maximum distance between them, the percentage of the deformity resected, the estimated time for total resection of the deformity, as well as a qualitative analysis based on the images and graphs provided by the program representing the areas of the parts resected, were evaluated at the end. The average resection speed was 34.66 mm /min (SD = 46 mm /min, max = 147.33; min = -2.66). The average resection rate was 26.2% (SD = 34.7%, max = 111; min = -2). Qualitative analysis showed hyporesection of deformities and sometimes hyperresection of nondeformed areas. The simulator was highly rated by the surgeons, with a tactile sensation very similar to real surgery, according to them. Arthroscopic simulators have proved very useful in training less experienced surgeons.
PubMed: 38911881
DOI: 10.1055/s-0044-1785666 -
Revista Brasileira de Ortopedia Jun 2024Wrist and hand arthroscopy, despite being an old tool, has gained popularity and advanced in assisting in the treatment of various injuries and conditions in the region...
Wrist and hand arthroscopy, despite being an old tool, has gained popularity and advanced in assisting in the treatment of various injuries and conditions in the region in recent years. Dorsal, volar, ulnar, and radial accessory portals are used to reach all points of the carpal and hand joints. The minimal tissue damage, lesser injury to the capsule and its mechanoreceptors, the assessment of injuries associated with the reason for surgery, and aesthetically more favorable scars have attracted many doctors and their patients. As a result, there has been an increase in publications and diversifications of arthroscopic techniques. The aim of this update article is to present the advances and the evidence available in the literature to assist readers in their decision on which technique to use in the treatment of wrist and hand conditions.
PubMed: 38911879
DOI: 10.1055/s-0044-1779336 -
Journal of Orthopaedic Case Reports Jun 2024Pan-labral tears, commonly associated with recurrent shoulder dislocations, are a well-documented pathology. However, circumferential pan-labral tears following a...
INTRODUCTION
Pan-labral tears, commonly associated with recurrent shoulder dislocations, are a well-documented pathology. However, circumferential pan-labral tears following a first-time shoulder dislocation represent a rare and scarcely reported entity in the literature. Accurate diagnosis requires a comprehensive clinical history, physical examination, and further evaluation, often involving MRI. Even with advanced imaging, the acute nature of the injury can lead to the oversight of pan-labral tears, necessitating arthroscopic assessment for definitive diagnosis. Repairing such extensive glenoid labral tears presents a challenging task, requiring skilled surgeons to utilize accessory portals and percutaneous techniques for optimal visualization and anchor placement trajectory. To the best of our knowledge, this case report represents the first documentation of a pan-labral tear associated with a 1st-time shoulder dislocation.
CASE REPORT
A 27-year-old Asian male presented with pain and limited range of motion in the left shoulder following a single episode of anterior shoulder dislocation during cricket. Initial X-rays were unremarkable, but subsequent MRI revealed an anteroinferior labral tear with intact rotator cuffs. Arthroscopic evaluation disclosed a pan-labral tear, prompting meticulous repair under general and locoregional anesthesia. The patient achieved full recovery postoperatively.
CONCLUSION
While pan-labral tears are typically linked to recurrent dislocations, this case underscores their occurrence in a 1st-time traumatic shoulder dislocation without overt clinical signs or fractures. Arthroscopic repair demands careful intraoperative planning to achieve optimal tensioning and alignment of labral and capsular tissues. This report contributes to the limited literature on pan-labral tears associated with initial shoulder dislocations, emphasizing the importance of arthroscopic evaluation for accurate diagnosis and successful repair.
PubMed: 38911003
DOI: 10.13107/jocr.2024.v14.i06.4526