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The International Journal of Medical... Sep 2017Shoulder arthroscopy is a minimally invasive surgical procedure for diagnosis and treatment of a shoulder pathology. The procedure is performed with a fiber optic...
BACKGROUND
Shoulder arthroscopy is a minimally invasive surgical procedure for diagnosis and treatment of a shoulder pathology. The procedure is performed with a fiber optic camera, called arthroscope, and instruments inserted through very tiny incisions made around the shoulder. The confined shoulder space, unintuitive camera orientation and constrained instrument motions complicates the procedure. Therefore, surgical competence in arthroscopy entails extensive training especially for psychomotor skills development. Conventional arthroscopy training methods such as mannequins, cadavers or apprenticeship model have limited use attributed to their low-fidelity in realism, cost inefficiency or incurring high risk. However, virtual reality (VR) based surgical simulators offer a realistic, low cost, risk-free training and assessment platform where the trainees can repeatedly perform arthroscopy and receive quantitative feedback on their performances. Therefore, we are developing a VR based shoulder arthroscopy simulation specifically for the rotator cuff ailments that can quantify the surgery performance. Development of such a VR simulation requires a through task analysis that describes the steps and goals of the procedure, comprehensive metrics for quantitative and objective skills and surgical technique assessment.
METHODS
We analyzed shoulder arthroscopic rotator cuff surgeries and created a hierarchical task tree. We introduced a novel surgery metrics to reduce the subjectivity of the existing grading metrics and performed video analysis of 14 surgery recordings in the operating room (OR). We also analyzed our video analysis results with respect to the existing proposed metrics in the literature.
RESULTS
We used Pearson's correlation tests to find any correlations among the task times, scores and surgery specific information. We determined strong positive correlation between cleaning time vs difficulty in tying suture, cleaning time vs difficulty in passing suture, cleaning time vs scar tissue size, difficulty passing vs difficulty in tying suture, total time and difficulty of the surgery.
CONCLUSION
We have established a hierarchical task analysis and analyzed our performance metrics. We will further use our metrics in our VR simulator for quantitative assessment.
Topics: Arthroscopy; Clinical Competence; Computer Simulation; Computer-Assisted Instruction; Humans; Models, Anatomic; Rotator Cuff Injuries; Shoulder Injuries; Task Performance and Analysis; User-Computer Interface; Video Recording
PubMed: 28026107
DOI: 10.1002/rcs.1799 -
Knee Surgery, Sports Traumatology,... Oct 2020Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses....
PURPOSE
Technical innovation now offers the possibility of 2-mm diameter operative arthroscopy: an alternative to conventional arthroscopy that no longer uses inner rod-lenses. The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage.
METHODS
A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh-frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed.
RESULTS
All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage.
CONCLUSION
2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.
Topics: Ankle; Ankle Joint; Arthroscopy; Humans; Peroneal Nerve; Talus; Tibia
PubMed: 32065244
DOI: 10.1007/s00167-020-05889-7 -
Hand (New York, N.Y.) Mar 2017This study addresses the prevalence of discrete pathophysiology accounting for patients' symptoms during diagnostic wrist arthroscopy in individuals with wrist pain...
This study addresses the prevalence of discrete pathophysiology accounting for patients' symptoms during diagnostic wrist arthroscopy in individuals with wrist pain without a specific preoperative diagnosis. Secondarily, we determined the number and type of surgeries subsequent to diagnostic wrist arthroscopy. Between January 2000 and January 2015, 135 diagnostic wrist arthroscopies were performed by 12 surgeons in 3 urban academic hospitals. We recorded the diagnostic findings of diagnostic wrist arthroscopy and any subsequent surgeries. One hundred and five patients had synovitis or a normal wrist (78%), 17 had likely age-appropriate changes (eg, central triangular fibrocartilage complex defects scapholunate changes) (13%), 8 (6%) were given uncommon diagnoses, and 5 (4%) had osteochondral defects. Sixteen patients (12%) had subsequent wrist surgery: 2 were for adverse events, 2 were carpal tunnel releases, and 12 were other surgeries. Diagnostic arthroscopy performed in the setting of an unclear preoperative diagnosis yielded limited diagnostic benefit.
Topics: Adult; Arthralgia; Arthroscopy; Cartilage Diseases; Female; Humans; Male; Middle Aged; Retrospective Studies; Synovitis; Triangular Fibrocartilage; Wrist Joint
PubMed: 28344533
DOI: 10.1177/1558944716661993 -
Orthopaedics & Traumatology, Surgery &... Sep 2012The objectives of surgical treatment of femoroacetabular impingement are to improve the symptoms and to prevent or slow the progression of osteoarthritis by improving... (Review)
Review
The objectives of surgical treatment of femoroacetabular impingement are to improve the symptoms and to prevent or slow the progression of osteoarthritis by improving joint clearance between the acetabular rim and the femoral neck. Arthroscopic correction of bone abnormalities and treatment of articular lesions requires the use of techniques that provide good access to the peripheral and central compartments of the hip joint. Various patient positions and portal placements have been suggested. The sequence used to access the two compartments may differ according to the option chosen. Entering the central compartment first is the most popular technique for arthroscopic hip joint access and requires joint distraction under fluoroscopic monitoring. Accessing the peripheral compartment first can be achieved without distraction and does not always require fluoroscopic guidance. Regardless of the sequence, capsulotomy greatly facilitates the therapeutic procedures that are common to all approaches. Osteoplasties are conducted after careful pre-operative planning based on various visual or fluoroscopic landmarks. Several options are available for treating articular cartilage and labral lesions.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans; Plastic Surgery Procedures
PubMed: 22795065
DOI: 10.1016/j.otsr.2012.06.001 -
British Journal of Sports Medicine Nov 2017The purpose of this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS). (Review)
Review
BACKGROUND
The purpose of this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS).
METHODS
A librarian-assisted computer search of Medline, CINAHL and Embase for studies related to criterion for FAIS surgery was used in this study. Inclusion criteria included studies with the primary purpose of surgery or surgical outcomes for treatment of FAIS with and without labral tear, and reporting criteria for FAIS surgery.
RESULTS
Diagnostic imaging was a criterion for surgery in 92% of the included studies, with alpha angle the most frequently reported (68% of studies) criterion. Reporting of symptoms was a criterion for surgery in 75%, and special tests a criterion in 70% of studies. Range-of-motion limitations were only a required criterion in 30%, only 12% of studies required intra-articular injection and 44% of studies described previously failed treatment (non-surgical or physiotherapist-led rehabilitation) as a criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging combined for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting.
CONCLUSION
Diagnostic imaging evidence of FAIS was the most commonly reported criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting, and only 44% of studies had failed non-surgical treatment (and 18% a failed trial of physiotherapy) as a criterion for surgery.
Topics: Arthroscopy; Femoracetabular Impingement; Humans; Injections, Intra-Articular
PubMed: 28219940
DOI: 10.1136/bjsports-2016-096936 -
Orthopaedics & Traumatology, Surgery &... Dec 2022
Topics: Humans; Arthroscopy; Orthopedics; Clinical Competence
PubMed: 36410929
DOI: 10.1016/j.otsr.2022.103473 -
Knee Surgery, Sports Traumatology,... Feb 2015
Topics: Arthroscopy; Diagnostic Imaging; Humans; Rotator Cuff; Rotator Cuff Injuries; Tendon Injuries
PubMed: 25630276
DOI: 10.1007/s00167-015-3515-x -
Medicine Sep 2020We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and... (Observational Study)
Observational Study
We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment.We retrospectively analyzed the records of 15 patients with chronic wrist pain following DRF, who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment from 2010 to 2017. The average patient age was 44 years (range, 20-68 years), average time from injury to treatment 21 ± 23.46 months (range, 3-96 months) and average follow up period 20.13 ± 8.71 months (range, 12-39 months). The functional outcome was evaluated by comparing the preoperative and final follow up values of the range of motion, grip strength, pinch strength, visual analogue scale for pain and quick disabilities of the arm, shoulder and hand score.Based on the arthroscopic findings, synovitis was found in all cases and the pathologic intra-articular lesions were classified into 4 patterns. Triangular fibrocartilage complex rupture was seen in 14 cases, intercarpal and radiocarpal ligament ruptures in 9 cases, ulnar impaction syndrome in 5 cases, and cartilage lesion in 9 cases. In terms of surgical treatment, 15 patients underwent arthroscopic synovectomy, 7 foveal or capsular repair of TFCC, 7 intercarpal Kirschner wires fixation or intercarpal thermal shrinkage, 1 intercarpal ligament reconstruction, 2 Sauve-Kapandji procedure, and 2 unlar shortening osteotomy. Postoperatively, the average range of motion, grip strength, and pinch strength increased significantly. From preoperative to final follow up values, the average visual analogue scale and quick disabilities of the arm score decreased from 5.93 ± 1.58 (range, 3-8) to 1.33 ± 1.29 (range, 0-3) (P = .001) and from 49.38 ± 19.09 to 12.63 ± 7.63 (P = .001), respectively.Diagnostic arthroscopy and arthroscopically-assisted tailored treatment of chronic wrist pain following DRF can provide an accurate diagnosis, significant pain relief, and functional improvement.
Topics: Adult; Aged; Arthroscopy; Chronic Pain; Female; Humans; Male; Middle Aged; Radius Fractures; Retrospective Studies; Wrist Injuries; Young Adult
PubMed: 32957349
DOI: 10.1097/MD.0000000000022196 -
Journal of Ultrasound Dec 2022The aim of this study is to verify the usefulness of ultrasound-assisted mapping of the vascular and neurological structures in the anterior compartment of the ankle... (Review)
Review
PURPOSE
The aim of this study is to verify the usefulness of ultrasound-assisted mapping of the vascular and neurological structures in the anterior compartment of the ankle just before an anterior arthroscopic procedure to reduce these kinds of complications.
METHODS
Various complications can be present in anterior arthroscopy of the ankle. The structures most prone to iatrogenic damage are vessels and nerves. They are macroscopically visible and palpable in a little more than 50% of cases, but arterial ramifications are not visible because they are located deeper.
RESULTS
The authors have investigated how to reduce potential iatrogenic damage to the complex and variable neuro-vascular network of the anterior aspect of the ankle. They have completed the classic routine marking of the bony and tendinous structures with an ultrasound mapping of the neurovascular structures.
CONCLUSIONS
The authors concluded that ultrasound-assisted mapping is a non-invasive, fast, and safe procedure that can help to reduce potential iatrogenic damage when performing anterior arthroscopic surgery.
Topics: Humans; Arthroscopy; Ankle; Ankle Joint; Ultrasonography; Iatrogenic Disease
PubMed: 35294770
DOI: 10.1007/s40477-021-00611-w -
Clinics in Sports Medicine Oct 1999Complications associated with arthroscopic shoulder stabilization are relatively common. Excluding recurrence, complications are rarely disabling. Current statistics... (Review)
Review
Complications associated with arthroscopic shoulder stabilization are relatively common. Excluding recurrence, complications are rarely disabling. Current statistics undoubtedly underestimate the true incidence of complications. Many complications, including neurovascular injuries and articular damage, are preventable and can be minimized through familiarity with anatomy, proper surgical technique and instrumentation, and clinical experience. Nevertheless, despite these efforts, a few complications, including recurrent instability, persist. Despite careful patient selection and attention to labral pathology and capsular laxity, arthroscopic repairs continue to have success rates lower than those achieved through open means. While cautiously proceeding toward a more complete understanding of the instability continuum, surgeons must maintain a high index of suspicion for new techniques that purport to "solve" the problem of arthroscopic shoulder stabilization, lest the history of enthusiastic but ultimately unsubstantiated claims is repeated. Outcomes must withstand the rigors of scientific scrutiny and the test of time. Without this cautious vigilance, the appeal of today's solutions becomes the fodder of tomorrow's articles about the complications of arthroscopic shoulder stabilization.
Topics: Arthroscopes; Arthroscopy; Blood Vessels; Humans; Incidence; Intraoperative Complications; Joint Capsule; Joint Instability; Patient Selection; Peripheral Nerve Injuries; Postoperative Complications; Recurrence; Shoulder Injuries; Shoulder Joint; Treatment Outcome
PubMed: 10553234
DOI: 10.1016/s0278-5919(05)70183-6