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Journal of Bone and Joint Infection 2019Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues.... (Review)
Review
Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt. Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those "sterility mistake" situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope. When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p<0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: "putting a definitive PE one size smaller or bigger with balance adjustment" (31%); and "leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives" (29%) (p<0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p<0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p<0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p<0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error. There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.
PubMed: 31011510
DOI: 10.7150/jbji.30613 -
Arthroscopy Techniques Jul 2022Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure, particularly with respect to tibial footprint debridement and tibial...
Arthroscopic posterior cruciate ligament (PCL) reconstruction is a technically demanding procedure, particularly with respect to tibial footprint debridement and tibial tunnel placement, where iatrogenic damage to anatomic structures is a well reported complication and incorrect tunnel placement can have functional implications. Preparation of the tibial component often involves switching between 30° and 70° arthroscopes and frequent portal swapping and reorientation, which can be inefficient and time-consuming. As the technology and picture resolution of needle arthroscopy has improved, its clinical application has widened. This manuscript describes the use of needle arthroscopy-assisted arthroscopic PCL reconstruction for optimal visualization of the PCL tibial footprint using an accessory posterolateral portal, while obviating the need of both 30° and 70° arthroscopes.
PubMed: 35936863
DOI: 10.1016/j.eats.2022.03.019 -
European Journal of Radiology Open 2019To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist...
OBJECTIVE
To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist pain.
MATERIALS AND METHODS
37 consecutive patients 22 males and 15 females, with age range from 16 to 49 years "mean age 28 years" complaining of unexplained chronic wrist pain were prospectively examined by using MRI and MRA with arthroscopic correlation in 25 of them. Findings were divided into 5 main groups of lesions including triangular fibrocartilage complex (TFCC) lesions, ligamentous injuries, osseous lesions, tendon pathology and ganglion.
RESULTS
MRA picked up more ligamentous injuries and triangular fibrocartilage complex (TFCC) lesions that couldn`t be detected on MRI study while both were equal in detection of other types of lesions. TFCC lesions were the most common pathologic findings in both MRI and MRA. Arthroscopic correlation in 25 suspected TFCC lesions (clinically, radiologically or both) revealed that the sensitivity / specificity / accuracy of MRI and MRA were 87.5% / 100% / 96% and 100% / 100% / 100% respectively for central lesions while were 71.4% / 81.3% / 76% and 100% / 90.9% / 96% respectively For peripheral lesions. Extra-capsular lesions, like tenosynovitis and fracture hook of hamate couldn`t be confirmed arthroscopically.
CONCLUSION
MRA can replace both MRI and diagnostic arthroscopy in detecting causes of chronic wrist pain.
PubMed: 31372370
DOI: 10.1016/j.ejro.2019.06.003 -
Current Reviews in Musculoskeletal... Oct 2020This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs). (Review)
Review
PURPOSE OF REVIEW
This review aims to describe the role of the latissimus dorsi transfer (LDT) for patients with irreparable posterosuperior rotator cuff tears (RCTs).
RECENT FINDINGS
Historically, the LDT has been performed as an open (double-incision) procedure for neurologically intact, relatively young patients with irreparable posterosuperior RCTs with disabling loss of active external rotation with or without impaired active elevation. The transferred tendon reconstitutes the posterior rotator cuff and force couple, respectively and thus has the potential to function effectively as an external rotator and humeral head depressor. Long-term results of the open technique have demonstrated in the majority of patients substantial and durable improvements in shoulder function and pain relief at the 10-year benchmark. With the advancements of arthroscopic surgery, the LDT was expanded to an arthroscopically assisted procedure with promising short-term results. In addition to adequate technical performance, the success of the procedure depends on preoperative factors, such as exclusion of glenohumeral osteoarthritis and acromial acetabularization; intact or reparable subscapularis tendon; intact (or hypertrophic) teres minor muscle; adequate preoperative activity of the latissimus dorsi; and normal or mild impairment of overhead function. The LDT (open or arthroscopically assisted) is a reliable treatment option for patients with massive, irreparable posterosuperior RCTs with disabling loss of active external rotation, with or without diminished overhead function and without advanced glenohumeral osteoarthritis. Precise patient selection is of tremendous importance in the success of the LDT.
PubMed: 32661917
DOI: 10.1007/s12178-020-09659-3 -
Frontiers in Surgery 2022To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) repair and autograft ACL reconstruction for ACL ruptures. (Review)
Review
PURPOSE
To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) repair and autograft ACL reconstruction for ACL ruptures.
METHODS
PubMed, EMBASE, Scopus, Web of Science and The Cochrane Library were searched for relevant studies from 1 January 1990 to 21 March 2022. Two evaluators independently screened the literature, extracted data and assessed the methodological quality of the enrolled studies. Meta-analysis was conducted using RevMan 5.4 software.
RESULTS
Ten studies with mean follow-up periods from 12 to 36 months were included. For 638 patients with ACL ruptures, arthroscopic ACL repair showed statistically comparable outcomes of failure ( = 0.18), complications ( = 0.29), reoperation other than revision ( = 0.78), Lysholm score ( = 0.78), Tegner score ( = 0.70), and satisfaction ( = 0.45) when compared with autograft ACL reconstruction. A significantly higher rate of hardware removal ( = 0.0008) but greater International Knee Documentation Committee (IKDC) score ( = 0.009) were found in the ACL repair group. The heterogeneity of the side-to-side difference of anterior tibial translation (ΔATT) was high ( = 80%). After the sensitivity analysis, the decreased dramatically ( = 32%), and the knees with ACL repair showed significantly greater ΔATT ( = 0.04).
CONCLUSION
For proximal ACL ruptures, arthroscopic ACL repair showed similar clinical outcomes, and even better functional performance when compared to autograft ACL reconstruction. ACL repair has a higher rate of hardware removal, and might be related to greater asymptomatic knee laxity. More high-quality prospective trials are needed to confirm our findings.
PubMed: 35521430
DOI: 10.3389/fsurg.2022.887522 -
Clinical Orthopaedics and Related... Mar 2009Recent developments in hip arthroscopy techniques and technology have made it possible in many cases to avoid open surgical technique for treating pincer-type and... (Review)
Review
Recent developments in hip arthroscopy techniques and technology have made it possible in many cases to avoid open surgical technique for treating pincer-type and cam-type femoroacetabular impingement and rather treating it arthroscopically. Early reports suggest favorable results using arthroscopic techniques. The frequency of complications reported for hip arthroscopy for all indications is generally less than 1.5%, suggesting the procedure is safe. Little information is available on complications directly related to the arthroscopic treatment of femoroacetabular impingement. Failure to recognize and treat or incompletely reshape impingement deformities may be the most frequent cause for a second hip arthroscopy and redébridement of the deformity. There has been no report of avascular necrosis related to the arthroscopic treatment of femoroacetabular impingement; only one femoral neck fracture after arthroscopic cam remodeling has been reported in a large series of patients. Other clinical concerns include hip dislocation secondary to extensive capsulotomies or overresection of the anterior acetabular rim in the case of pincer impingement.
Topics: Acetabulum; Arthroscopy; Femur; Hip Joint; Humans; Joint Diseases; Radiography, Interventional; Reoperation; Treatment Outcome
PubMed: 19018604
DOI: 10.1007/s11999-008-0618-4 -
Orthopaedic Surgery Oct 2020To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic...
OBJECTIVE
To report the clinical and radiological outcomes of arthroscopically assisted surgery for combination of glenoid and greater tuberosity fractures after traumatic shoulder dislocation.
METHODS
From December 2013 to December 2018, patients with concomitant fracture of the greater tuberosity and glenoid who underwent arthroscopically assisted surgery were retrospectively reviewed. Fifteen patients were included. Preoperative computed tomography (CT) scans with 3D reconstruction were performed to evaluate the fracture configuration and associated fractures. All patients underwent arthroscopically assisted surgery under general anesthesia with brachial plexus anesthesia in the lateral position. Under the arthroscopic approach, a comprehensive inspection of the joints was firstly conducted to examine the injury of bones and other tissues. With arthroscopy support, closed reduction and internal fixation of both fractures were performed with suture anchors, with or without additional cannulated screws. At the same time, other injuries were also repaired under the arthroscope. Patients were followed up (6 weeks,8 weeks,3 months,6 months,1 year after surgery) regularly for at least 1 year. At the follow-up, clinical outcomes (Constant score, ASES score, range of motion, and VAS score) and radiological outcomes were analyzed.
RESULTS
Of the 15 patients, there are seven cases of men, eight cases of women; aged 22-66 years, with an average age of 48 years; left shoulder for five cases, 10 cases of the right shoulder. The injury mechanisms were: a simple fall (n = 9), an epileptic seizure (n = 1), a high fall injury (n = 2), and a traffic accident (n = 3). Of the 15 cases of glenoid fracture, 11 cases were type Ia and four cases were type II according to the Ideberg Classification System. The mean size of the glenoid fracture fragment was 28.4% (range, 8.7%-47.2%). According to the Mutch classification system, the fractures of the greater tuberosity were divided into: five cases of avulsion, one case of compression, and nine cases of split. Average time of follow-up was 38.2 months (range, 12-70 months), and one case was lost to follow-up. With fractures healing well, almost all patients had a good joint function. At the final follow-up, mean anterior flexion was 157°; mean external rotation was 40°; mean internal rotation was T level; the mean Constant-Murley score was 94.6 points (range, 70-100 points); the mean ASES score was 94.6 points (range, 79-100 points); and the mean VAS score was 0.4 points (range, 0-2 points). No recurrent instability or re-dislocation occurred. No patient had revision surgery.
CONCLUSION
Arthroscopic management of glenoid and greater tuberosity bipolar fractures was useful and effective with minimal injury, and it achieved satisfactory clinical and radiological outcomes at a mean follow-up time of more than 3 years.
Topics: Adult; Aged; Arthroscopy; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Retrospective Studies; Scapula; Shoulder Fractures; Young Adult
PubMed: 33078582
DOI: 10.1111/os.12786 -
Arthroscopy Techniques Mar 2022There are various technique preferences when performing arthroscopic rotator cuff repair. Currently, most surgeons address all intra-articular pathology as well as...
There are various technique preferences when performing arthroscopic rotator cuff repair. Currently, most surgeons address all intra-articular pathology as well as assess the extent of a rotator cuff tear with the arthroscope in the joint prior to moving to the subacromial space, where they will initiate footprint preparation, anchor placement, and rotator cuff repair. Although this technique often yields good or at least acceptable visualization of the footprint, it does not always provide an optimal view of the medial footprint even when using a "50-yard line view" from a lateral portal. This can particularly be an issue with "cone-shaped" supraspinatus tears in which a smaller full-thickness bursal-sided tear often expands to a much larger articular-sided component. When surgeons are visualizing with the scope in the subacromial space, it is much more difficult to obtain a full appreciation of the extent of the articular-sided tear as well as optimal visualization of the medial footprint right up to the articular margin for both bone preparation and anchor placement. This article describes the benefit of keeping the arthroscope in the joint to facilitate footprint preparation and medial-row suture anchor placement prior to going to the subacromial space. This small technical modification can often offer surgeons far superior visualization of the entire greater tuberosity footprint especially when encountering a cone-shaped tear or high-grade articular-sided tear that requires repair. To further enhance viewing of the footprint with the scope intra-articularly, proficiency in using a 70° scope directed laterally will typically allow surgeons the most ideal view achievable. Once anchors are placed into the medial row, the arthroscope is inserted into the subacromial space to complete the repair.
PubMed: 35256975
DOI: 10.1016/j.eats.2021.10.029 -
Journal of Wrist Surgery Feb 2018Patients with scapholunate instability usually have pain in the dorsal wrist. This pain may occur due to the impingement between the scaphoid and the dorsal rim of...
Patients with scapholunate instability usually have pain in the dorsal wrist. This pain may occur due to the impingement between the scaphoid and the dorsal rim of the radius when the scaphoid is detached from the lunate. This pain appears as the scaphoid is displaced over the dorsal rim of the radius. The arthroscopic scaphoid 3D (dorsal, dynamic, displacement) test is described here to check this pathologic dorsal displacement of the scaphoid. The test should be performed both in the radiocarpal and midcarpal joints. Traction is released and the arthroscope is set under the lunate when tested in the radiocarpal joint and on the lunate when tested in the midcarpal joint. The scaphoid is manually pushed dorsally at the scaphoid tubercle. If there was no scapholunate instability, all the proximal row bones are minimally displaced: a negative test. If there was scapholunate instability, the scaphoid is displaced dorsally while the lunate remains static: evaluated as positive. This test can add information to the arthroscopic classifications of the scapholunate instability, which explore both the proximal to distal displacement of the scaphoid (the step-off) and the ulnar to radial displacement (the gap), as this test explores the volar to dorsal displacement.
PubMed: 29383283
DOI: 10.1055/s-0037-1601578 -
Arthroscopy : the Journal of... May 2019To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients...
PURPOSE
To report the outcomes of all-arthroscopic coracoclavicular (CC) ligament reconstruction and simultaneous diagnosis and treatment of glenohumeral pathologies in patients with symptomatic, chronic (>6 weeks), complete (Rockwood type III-V) acromioclavicular joint (ACJ) separations.
METHODS
We prospectively followed up 57 consecutive patients treated arthroscopically for chronic Rockwood type III (n = 11), type IV (n = 19), and type V (n = 27) ACJ dislocations. Previous ACJ surgery failed in 11 (19%). The mean delay between injury and surgery was 39 months (range, 6 months to 17 years). The mean age at surgery was 42 years (range, 19-71 years). After glenohumeral exploration, an arthroscopic modified Weaver-Dunn procedure with CC suture button fixation (Twinbridge) was performed. The CC reduction and tunnel position were analyzed with radiographs and computed tomography. The mean follow-up period was 36 months (range, 12-72 months).
RESULTS
Intra-articular pathology was treated arthroscopically in 27 patients (48%): 17 labral tears, 8 rotator cuff tears (3 partial and 5 complete), and 15 biceps lesions (4 SLAP lesions and 11 subluxations). At last follow-up, 7 patients (12%) experienced recurrent ACJ instability: 2 frank dislocations (1 trauma and 1 infection) and 5 ACJ subluxations. There was no significant correlation between subluxation and clinical outcome. The rate of recurrent ACJ instability was significantly higher in patients with higher-grade ACJ dislocations (P < .01) and/or previous failed surgery (P < .001). Recurrent subluxation was observed in 3 cases of lateral migration of the coracoid button with lateral tunnel placement, as well as 2 cases of anterior migration of the clavicular button with anterior tunnel placement. The Constant score increased from 67 (range, 28-89) to 85.5 (range, 66-100), and the mean Subjective Shoulder Value increased from 54% to 85% (P < .001). At last follow-up, 95% of patients (54 of 57) were satisfied.
CONCLUSIONS
All-arthroscopic treatment allows successful CC ligament reconstruction and simultaneous diagnosis and treatment of frequently associated (48%) glenohumeral lesions. Higher-grade ACJ dislocations, previous ACJ surgery, and misplacement of bone tunnels are risk factors for recurrent instability.
LEVEL OF EVIDENCE
Level IV, case series.
Topics: Acromioclavicular Joint; Adult; Aged; Arthroscopy; Clavicle; Female; Follow-Up Studies; Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Male; Middle Aged; Prospective Studies; Radiography; Plastic Surgery Procedures; Rotator Cuff; Shoulder; Shoulder Dislocation; Suture Techniques; Young Adult
PubMed: 31054712
DOI: 10.1016/j.arthro.2018.11.058