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Arthroscopic rotator cuff repairs using titanium-alloy suture anchors are a new treatment option for active patients with shoulder injuries. Shoulder arthroscopy and arthroscopicrepair procedures are alternative treatments to traditional open surgical procedures for Bankart lesions and rotator cuff tears. Distinct advantages of arthroscopicrepair techniques include decreased patient tissue trauma and morbidity rates and shortened recovery and rehabilitation periods.
Although open anterior acromioplasty and rotator cuff repair has reliably provided satisfactory results for several decades, efforts are continually being made to improve on these results. Arthroscopically assisted mini-open rotator cuff repair provides the advantages of arthroscopic glenohumeral inspection and identification and treatment of any concomitant lesions, deltoid origin preservation (with the arthroscopic subacromial decompression), decreased surgical morbidity, and improved
The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages ofglenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of the method, which limits its application to surgeons skilled in both
From February 1982 through July 1987, the author studied 87 patients who had a total of 116 meniscus tears, 96 of which were repaired. Seventy patients (79 meniscus repairs) had postoperative followup ranging from 12 months to 5½ years (mean, 39 months). The patients' ages ranged from 14 to 51 years with a mean age of 22. The time from
Rotator cuff repair techniques continue to evolve in an effort to improve repair biomechanics, maximize the biologic environment for tendon healing, and ultimately improve patient outcomes. The arthroscopic transosseous-equivalent technique was developed to replicate the favorable tendon-bone contact area for healing seen in open transosseous tunnel repair. In this technical note and accompanying video, we present our all-arthroscopic transosseous-equivalent rotator cuff repair technique with a focus on technical pearls.
Lavery, Kyle P.; Rasmussen, Jeffrey F.; Dhawan, Aman
Technical advancements in arthroscopic wrist procedures have improved our knowledge of normal and abnormal intraarticular wrist function. Triangular fibrocartilage complex (TFCC) tears from trauma injuries are a common source of ulnar-sided wrist pain. Fortunately, the TFCC is a structure that can be evaluated and treated arthroscopically with results that are comparable to open surgical procedures. Successful arthroscopicrepairs of TFCC tears depend on a coordinated team effort between perioperative nurses, orthopedic surgeons, nurse practitioners, and occupational hand therapists, as well as cooperation from patients and family members. This article reviews the anatomy and physiology of the TFCC, the biomechanics of the wrist and mechanisms of injury, and arthroscopicrepairs of TFCC tears. PMID:9220068
Baehser-Griffith, P; Bednar, J M; Osterman, A L; Culp, R
Peripheral tears to the articular disk of the triangular fibrocartilage complex are fairly common. Patients complain of ulnar-sided wrist pain with ulnar deviation and forearmrotation along the prestyloid recess. The peripheral tears of the articular disk are amenable to arthroscopicrepair due to its blood supply. All-arthroscopic knotless repair of peripheral ulnar-sided tears of the articular disk has several advantages. This technique allows for repair of the superficial and deep layers of the articular disk directly down to bone. In addition, by being knotless, it avoids irritation to the surrounding soft tissues by suture knots. This article describes arthroscopicrepair of peripheral ulnar-sided tears of the articular disk down to bone with a knotless technique. PMID:22281170
The arthroscopic treatment of the “bony Bankart lesion” continues to evolve. We present a novel technique that we developed at Orthopaedic Research of Virginia, the “transosseous bony Bankart repair,” which incorporates several essential concepts to provide for optimal healing and rehabilitation. We promote arthroscopicrepair emphasizing bone preservation, a fracture interface without interposing sutures, the ability to reduce capsular volume, and multiple points of stable glenolabral fixation. Our technique positions suture anchors within the subchondral bone of the intact glenoid to allow for an anatomic reduction of the bony fragment. By use of an arthroscopic drill, spinal needle, and nitinol suture passing wire, the sutures are passed in a retrograde fashion through the bony Bankart fragment and anterior capsule in a mattress configuration. Additional inferior and superior anchors are placed to further provide stability and reduce capsular volume. While maximizing fracture surface area and optimizing bony healing, the end result is an anatomic reduction of the bony fragment and the glenoid articular surface.
Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures\\u000a were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated\\u000a primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance.\\u000a Two centimeter in length meniscal tear 2–3 mm far from
Taner Gunes; Bora Bostan; Mehmet Erdem; Murat Asci; Cengiz Sen; Mehmet Halidun Kelestemur
Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopicrepair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic. PMID:17011216
Lee, Edward; Bishop, Julie Y; Braman, Jonathan P; Langford, Joshua; Gelber, Jonathan; Flatow, Evan L
The arthroscopic treatment of the "bony Bankart lesion" continues to evolve. We present a novel technique that we developed at Orthopaedic Research of Virginia, the "transosseous bony Bankart repair," which incorporates several essential concepts to provide for optimal healing and rehabilitation. We promote arthroscopicrepair emphasizing bone preservation, a fracture interface without interposing sutures, the ability to reduce capsular volume, and multiple points of stable glenolabral fixation. Our technique positions suture anchors within the subchondral bone of the intact glenoid to allow for an anatomic reduction of the bony fragment. By use of an arthroscopic drill, spinal needle, and nitinol suture passing wire, the sutures are passed in a retrograde fashion through the bony Bankart fragment and anterior capsule in a mattress configuration. Additional inferior and superior anchors are placed to further provide stability and reduce capsular volume. While maximizing fracture surface area and optimizing bony healing, the end result is an anatomic reduction of the bony fragment and the glenoid articular surface. PMID:23766995
Joint injuries are a major concern for horses used in athletic and recreational sports. Spontaneous cartilage repair diminishes as horses reach maturity, and surgical measures have been developed to bolster these meager intrinsic responses. Local debridement, joint lavage, and marrow stimulation techniques provide improved symptomatic therapy that may last several years. Subchondral drilling (forage) has largely been superseded by microfracture
Purpose: The purpose of this article is to report the 4- to 10-year results of arthroscopicrepair of full- thickness rotator cuff tears. Type of Study: This is a retrospective study evaluating a series of arthroscopic rotator cuff repairs performed by a single surgeon from February 1990 to February 1996. Methods: Retrospective chart reviews and telephone interviews were performed to
Eugene M. Wolf; William T. Pennington; Vivek Agrawal
We evaluated the arthroscopic meniscal repair using T-fix and present our preliminary results. The series included 47 consecutive patients who underwent meniscal repair using T-fix. Mean follow-up was 26 months (range 12-42 months). The overall number of T-fixes used in the repairs was 163, with a mean of three (range two to five) per patient. Patients were evaluated according to the modified Marshall scoring system. Results were rated as excellent in 32, good in 10, fair in 2, and poor in 3 patients. Second-look arthroscopy was performed in 18 patients as the part of our protocol. In 15 patients meniscal tears were considered to be healed, according to Henning's criteria. Six of those who underwent anterior cruciate ligament reconstruction healed completely. There were no neurovascular complications. Repair of the menisci using T-fix proved successful and reliable. In view of satisfactory functional results and the observation of healing of tears on second-look arthroscopy, we believe that preservation and repair of menisci should be attempted in appropriate cases. PMID:12355302
Arthroscopicrepair of full-thickness rotator cuff tears is currently performed by a number of surgeons. The goals, indications, and postoperative rehabilitation are identical to traditional open repair. The principles of the operative technique are also identical to open repair, with the differences occurring in the manner in which the tendon is repaired to bone. This article describes in detail the
Background: Medial meniscal repairs are commonly performed with inside-out sutures and entirely arthroscopic with arrows, but few comparative evaluations on failures have been performed.Hypothesis: No differences in failure rates exist between medial meniscal repairs performed with inside-out suture or entirely arthroscopic at the time of anterior cruciate ligament reconstruction.Study Design: Prospective cohort study.Materials: A single surgeon performed 47 consecutive inside-out
Kurt P. Spindler; Eric C. McCarty; Todd A. Warren; Clinton Devin; Jason T. Connor
The number of commercially available all-arthroscopic meniscal repair devices has increased in recent years. Although inside-out vertical mattress sutures have been considered the gold standard in the past, recent biomechanical studies have shown that some all-arthroscopicrepair devices provide comparable strength. To successfully use these devices, surgeons must understand proper insertion technique. The purpose of this article is to demonstrate this technique for the Meniscal Cinch (Arthrex, Naples, FL).
Total hip/knee arthroplasty may cause venous thromboembolism (VTE) as a postoperative complication. However, there are few reports on VTE after arthroscopic shoulder surgery. We report a patient who developed pulmonary embolism (PE) 6 days after arthroscopic rotator cuff repair but recovered without sequelae. In this case, the possibility of DVT of the lower limbs was denied by contrast-enhanced CT. Most possibly, the source of PE was deep vein thrombosis (DVT) of the upper limb under Desault fixation which showed arthroscopic surgery-related swelling postoperatively.
The diagnosis and treatment of SLAP tears have improved with the development of arthroscopic shoulder surgery techniques. With types 2 and 4 tears, the goal is to restore stability to the labrum and biceps anchor and achieve healing to the glenoid. Suture repair with anchors is currently the repair technique of choice. The purpose of this article is to report
Edward Yian; Conrad Wang; Peter J Millett; Jon J. P Warner
Purpose: The purpose of this study was to evaluate the outcome of patients who underwent arthroscopicrepair of anterosuperior rotator cuff tears. The null hypothesis, that there was no difference between preoperative scores and postoperative scores, was tested statistically. Type of Study: A cohort study. Methods: The preoperative and postoperative status of patients with anterosuperior rotator cuff tears was analyzed
Patients with massive rotator cuff tears present with pain, weakness, and loss of function. Candidates for arthroscopicrepair include symptomatic, young, active patients; those with an acute tear or tears with early changes of atrophy; and patients willing to comply with recovery and rehabilitation processes after surgery. As massive rotator cuff tears extend, the glenohumeral articulation is destabilized, allowing superior migration. Repair of the force couples and reinforcement of the anterosuperior rotator cuff cable can restore functional elevation via the deltoid. Muscle changes, including rotator cuff atrophy and fatty infiltration, will affect shoulder strength and function. As chronic changes become more extensive (such as the absence of the acromiohumeral interval and degenerative joint changes), other repair options may be more durable. Other arthroscopic options, including partial rotator cuff closure, graft to augment the repair, and use of the long head of the biceps tendon, have been helpful in pain relief and functional gains. PMID:22301227
Background: The impact of a recurrent defect on the outcome after rotator cuff repair has been controversial. The purpose of this study was to evaluate the functional and anatomic results after arthroscopicrepair of large and mas- sive rotator cuff tears with use of ultrasound as an imaging modality to determine the postoperative integrity of the repair. Methods: Eighteen patients
LEESA M. GALATZ; CRAIG M. BALL; SHARLENE A. TEEFEY; WILLIAM D. MIDDLETON; KEN YAMAGUCHI
As experience has been gained in the arthroscopicrepair of small and moderate rotator cuff tears, there has been a natural\\u000a progression toward the repair of larger tears.1–3 There is now considerable experience in the arthroscopicrepair of these larger tears. The most significant advantage of\\u000a an all-arthroscopic approach in the repair of large and massive rotator cuff tears is
Background: Outcomes of arthroscopic type II superior labral anterior posterior (SLAP) repairs have been reported with success. However, published data regarding outcomes of revision arthroscopic type II SLAP repairs are lacking.Hypothesis: Outcomes of revision arthroscopic type II SLAP repairs are inferior to those of primary repairs.Study Design: Case series; Level of evidence, 4.Methods: A retrospective chart review was performed to
Injury to the triangular fibrocartilage complex is the most common cause of ulnar-sided wrist pain. This functionally related complex of anatomic structures can be a source of pain secondary to acute injury or chronic degeneration. Strategies for the treatment of these injuries involve determining the anatomic location of the tear, the presence of associated distal radioulnar joint instability, and the presence of associated degenerative changes. Surgical management with open and arthroscopic techniques have been described, both with successful results. PMID:20951898
Purpose: The clinical results of a single surgeon’s experience with Meniscus Arrows (Bionx, Blue Bell, PA) for meniscal repair are reviewed and reported to determine the safety and efficacy of this device. Type of Study: Consecutive sample. Methods: Over a 3-year period, the senior author has used only Meniscus Arrows for all meniscal repairs. All patients who underwent meniscal repair
Timothy S. Petsche; Harlan Selesnick; Adam Rochman
Background: Controversy remains regarding the results of all arthroscopic rotator cuff repairs compared with the mini-open approach. The purpose of this study was to perform a comprehensive literature search and meta-analysis of clinical trials comparing the results of arthroscopic rotator cuff repairs and mini-open rotator cuff repairs.Hypothesis: There is no difference between the clinical results obtained from all arthroscopic rotator
Kenneth Morse; A. David Davis; Robert Afra; Elizabeth Krall Kaye; Anthony Schepsis; Ilya Voloshin
Background: Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair.Purpose: To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques.Hypothesis: Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to
Augustus D. Mazzocca; Peter J. Millett; Carlos A. Guanche; Stephen A. Santangelo; Robert A. Arciero
The purpose of this study was to compare early postoperative outcomes between arthroscopic and mini-open repair for rotator cuff tears smaller than 3 cm to determine whether arthroscopicrepair causes less postoperative pain and allows for faster recovery of range of motion. Sixty patients scheduled for rotator cuff repair were randomized to either an arthroscopicrepair group (30 patients) or a mini-open repair group (30 patients). Pain level, range of motion, shoulder stiffness, and complications were compared between the 2 groups from immediately postoperatively to 6 months postoperatively. Although no statistically significant difference was found in mean visual analog scale pain scores between the 2 groups during the 6 months postoperatively, mean visual analog scale pain score was significantly lower in the arthroscopicrepair group compared with the mini-open repair group at postoperative days 1 and 2 (P=.02 and P=.04, respectively). No significant difference existed in postoperative range of motion, duration of rehabilitation, shoulder stiffness, or complications between the 2 groups; however, the use of additional analgesics in the arthroscopicrepair group was significantly lower than in the mini-open repair group (P=.03). Arthroscopic and mini-open repair had equivalent clinical outcomes in the early postoperative period. The hypothesis that arthroscopicrepair would cause less postoperative pain and allow faster recovery of range of motion in the early postoperative period compared with mini-open repair was not supported. PMID:22955400
Background: Results of arthroscopicrepair of isolated subscapularis tendon tears have not been widely studied. A detailed evaluation of subscapularis function with subscapularis strength quantification has not been performed to date.Purpose: To evaluate postoperative subscapularis muscle function and to assess the clinical outcome and structural tendon integrity with postoperative magnetic resonance imaging after arthroscopicrepair of isolated subscapularis tears.Study Design:
Christoph Bartl; Gian M. Salzmann; Gernot Seppel; Stefan Eichhorn; Konstantin Holzapfel; Klaus Wörtler; Andreas B. Imhoff
Bankart repair, or one of its modifications, is currently the gold standard procedure for treatment of anterior traumatic shoulder instability. It is now possible to perform the operation arthroscopically with the introduction of suture anchors. As described by Eugene Wolf, arthroscopic shoulder stabilization using the Mitek (Mitek Surgical Products, Ethicon, Edinburgh, U.K.) anchors requires two anterior portals and intra-articular knot tying. However, sliding the anchor on the inside limb of a suture loop could be challenging because the other limb could get tangled in the nitinol arc of the anchor. We describe a modification of the original technique to prevent that possibility and avoid any tension on the repair tissue during anchor passage. The proposed modification involves the use of a cheap, readily available silastic feeding tube to isolate the outside limb of the suture loop and stabilize labral tissues while the anchor is being passed. This tube also serves as a stent for knot tying. By allowing the whole operation to be performed through one anterior portal, the modified technique reduces possible morbidity associated with a second portal and further reduces cost. PMID:15243444
Purpose Both open and arthroscopic Bankart repair are established procedures in the treatment of anterior shoulder instability. While the open procedure is still considered as the "golden standard" functional outcome is supposed to be better in the arthroscopic procedure. The aim of this retrospective study was to compare the functional outcome between open and arthroscopic Bankart repair. Materials and methods In 199 patients a Bankart procedure with suture anchors was performed, either arthroscopically in presence of an detached, but not elongated capsulolabral complex (40) or open (159). After a median time of 31 months (12 to 67 months) 174 patients were contacted and agreed to follow-up, 135 after open and 39 after arthroscopic Bankart procedure. Results Re-dislocations occurred in 8% after open and 15% after arthroscopic Bankart procedure. After open surgery 4 of the 11 re-dislocations occurred after a new adequate trauma and 1 of the 6 re-dislocations after arthroscopic surgery. Re-dislocations after arthroscopic procedure occured earlier than after open Bankart repair. An external rotation lag of 20° or more was observed more often (16%) after open than after arthroscopic surgery (3%). The Rowe score demonstrated "good" or "excellent" functional results in 87% after open and in 80% patients after arthroscopic treatment. Conclusion In this retrospective investigation the open Bankart procedure demonstrated good functional results. The arthroscopic treatment without capsular shift resulted in a better range of motion, but showed a tendency towards more frequently and earlier recurrence of instability. Sensitive patient selection for arthroscopic Bankart repair is recommended especially in patients with more than five dislocations.
The purpose of the study was to compare the recurrence rate of arthroscopic Bankart repair with suture anchors in collision vs noncollision athletes. Sixty-four patients who underwent arthroscopic shoulder stabilization using suture anchors for recurrent anterior dislocation were identified. Forty-three patients (22 collision and 21 noncollision) were evaluated at a minimum 24-month follow-up. The recurrence rate was reported, and functional outcomes (American Shoulder and Elbow Society, Western Ontario Shoulder Index, and Short Form 12) were evaluated. Statistical analysis was performed using chi-square test and Student's t test with a 95% confidence interval and a significance level set at a P value less than .05. The overall dislocation recurrence rate was 4.6% (2 of 43 patients); the dislocation recurrence rate in collision athletes was 9% (2 of 22 patients), and no redislocations occurred in noncollision athletes. No statistical differences existed in Western Ontario Shoulder Index score (73.5% in collision and 73.4% in noncollision athletes; P=.831), American Shoulder and Elbow Society score (91.2 in collision and 80.7 in noncollision athletes; P=.228), and Short Form 12 score (108.5 in collision and 101.2 in noncollision athletes; P=.083). Average external rotation loss was 6.8° in collision and 5.5° in noncollision athletes (P=.864). Ninety percent of collision athletes vs 95% of noncollision athletes were satisfied. Seventy-three percent of collision and 81% of noncollision athletes were able to return to sport at their preinjury levels. Collision athletes had higher recurrence rates after arthroscopic shoulder stabilization compared with noncollision athletes, but no statistical difference was found. Functional outcomes according to American Shoulder and Elbow Society, Western Ontario Shoulder Index, and Short Form 12 were similar. PMID:23672915
Petrera, Massimo; Dwyer, Tim; Tsuji, Matthew R S; Theodoropoulos, John S
Purpose: The purpose of this study was to determine the incidence of clinically significant postoperative stiffness following arthroscopic rotator cuff repair. This study also sought to determine the clinical and surgical factors that were associated with higher rates of postoperative stiffness. Finally, we analyzed the result of arthroscopic lysis of adhesions and capsular release for treatment of patients who developed
David P. Huberty; John D. Schoolfield; Paul C. Brady; Antonio P. Vadala; Paolo Arrigoni; Stephen S. Burkhart
The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm) cannula is placed through 1 of the anchor incisions into the subacromial space. The medial 2 sutures are retrieved, a pair at a time, through the small cannula and are tied according to standard arthroscopic techniques; then, the lateral 2 sutures are retrieved from the anchor. The graft should cover the area of repair completely and should be under slight tension. Additional sutures may be placed to further secure or tension the graft as necessary, with the use of standard suture passing techniques, similar to those used when margin convergence is performed. Passive shoulder motion, pendulum exercises, and active elbow and wrist motion begin 2 days after surgery when the dressing is removed. Active assisted motion and active motion begin at 6 weeks, with integrated periscapular stabilization exercises. Formal cuff strengthening begins no sooner than 12 weeks after surgery for large and massive tears. PMID:17027416
Background: Good functional results have been reported for arthroscopicrepair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Our hypothesis was that arthroscopicrepair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. Methods: Sixty-five consecutive shoulders with a chronic full-thickness
PASCAL BOILEAU; NICOLAS BRASSART; DUNCAN J. WATKINSON; MICHEL CARLES; ARMODIOS M. HATZIDAKIS; SUMANT G. KRISHNAN
The effectiveness of arthroscopicrepair of type II superior labrum anterior–posterior lesion (SLAP) was unclear as previous\\u000a studies examined this treatment with patients of combined types of SLAP lesions. To address this research gap, we evaluated\\u000a the clinical and functional outcomes of arthroscopicrepair for 16 patients (mean = 24.2, SD = 6.5) with clinical evidence\\u000a of isolated type II SLAP lesion. After having
Patrick Shu-Hang Yung; Daniel Tik-Pui Fong; Ming-Fat Kong; Chun-Kong Lo; Kwai-Yau Fung; Eric Po-Yan Ho; Derwin King-Chung Chan; Kai-Ming Chan
Background: Despite advances in arthroscopicrepair of rotator cuff tears, recurrent tears after repair of large and massive tears remain a significant clinical problem. The primary objective of this study was to define the timing of structural failure of surgically repaired large and massive rotator cuff tears by serial imaging with ultrasound. The secondary objective of this study was to
Bruce S. Miller; Brian K. Downie; Robert B. Kohen; Theresa Kijek; Bryson Lesniak; Jon A. Jacobson; Richard E. Hughes; James E. Carpenter
Purpose: The objective of this study is to report on the complete arthroscopicrepair of full-thickness tears of the supraspinatus. Type of Study: Prospective cohort study. Methods: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. Between 1997 and 1999, there were 24 patients who had a complete arthroscopicrepair
Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness.
John N. Trantalis; Richard S. Boorman; Kristie Pletsch; Ian K. Y. Lo
Purpose: The goal of this study is to report on the complete arthroscopicrepair of massive rotator cuff tears. Type of Study: Prospective cohort study. Methods: Between 1997 and 1999, 37 patients underwent complete arthroscopicrepair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow
Arthroscopic rotator cuff repair is a reliable option for symptomatic patients who have failed conservative treatments. Limited evidence exists regarding early rehabilitation time points (less than 1 year) and the influence of tear size. The authors sought to determine whether a difference exists in pre- and postoperative range of motion among small, medium, and large isolated rotator cuff tears treated arthroscopically. Patient- and tear-specific demographics were analyzed in a retrospective series of patients who had undergone arthroscopic rotator cuff repair. Two hundred seventy-four patients (153 [56%] men and 121 [44%] women; mean age, 53 years) were analyzed. Small tears (n=158 [58%]) were more common than medium (n=70 [25%]) and large (n=46 [17%]) tears. Shoulder range of motion was measured preoperatively and at 2 and 6 weeks, 3 and 6 months, and 1 year postoperatively. At nearly all time points pre- and postoperatively, large tears were significantly stiffer than small tears in external rotation and forward elevation (P<.05). It takes 1 year to fully regain external rotation after small and medium tears, whereas mild residual stiffness remains after large tears. Full forward elevation is restored by 3 months for small tears vs 6 months for medium and large tears. Significant tear size-dependent differences exist in shoulder range of motion after arthroscopicrepair of isolated rotator cuff tears. These data can be used to manage patients' expectations for range of motion after arthroscopic rotator cuff repair to improve patient satisfaction. PMID:23380011
Harris, Joshua D; Ravindra, Amy; Jones, Grant L; Butler, R Bryan; Bishop, Julie Y
Full-thickness rotator cuff tears are common. When symptomatic, they can affect quality of life. Surgical repair might improve patients' overall health. We systematically reviewed postoperative outcomes in 10 studies comparing mini-open repair and all-arthroscopicrepair techniques. Data regarding patient demographics, rotator cuff pathology, postoperative rehabilitation protocols, American Shoulder and Elbow Surgeons (ASES) scores, University of California Los Angeles (UCLA) scores, pain scores, and incidence of recurrent defects were extracted. There were no statistically significant differences between groups within each study in terms of these data points. One study found decreased pain 6 months after surgery in the all-arthroscopic group versus the miniopen repair group. This systematic literature review indicates there is no statistically significant difference in postoperative ASES, UCLA, or pain scores or incidence of recurrent rotator cuff tears in rotator cuffs repaired all-arthroscopically versus using the mini-open technique. However, there might be decreased short-term pain in patients who undergo arthroscopicrepairs. PMID:21720577
Background The surgical treatment of massive rotator cuff tears (RCT) is still controversial and can be based on a variety of different\\u000a surgical repair methods. This study investigated the effectiveness of arthroscopic debridement or arthroscopic partial repair\\u000a in patients with massive RCT.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods This prospective, randomized study involved forty-two patients with massive RCT (fatty infiltration stage 3 or 4) treated\\u000a with
Alexander Berth; Wolfram Neumann; Friedemann Awiszus; Géza Pap
Injury to the triangular fibrocartilage complex (TFCC) is a major source of ulnar-sided wrist pain that results in disability with common activities of daily living involving forearm rotation, for which operative management is indicated if conservative management fails. Past results with open repairs have been successful, but recent surgical advances have allowed the development of arthroscopic management. This article describes and reviews an all-arthroscopic technique of repair of Palmer type IB TFCC injuries with FasT-Fix suture technology (Smith and Nephew, Andover, MA, USA), which is advantageous both biomechanically and in terms of decreasing risk of morbidity. PMID:21871346
Objective The purpose of this study was to correlate clinical and radiological results using a 3-T MRI to verify meniscal healing after\\u000a arthroscopic all-inside meniscus repair.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods We selected 27 patients (14 men and 13 women) with an average age of 31?±?9 years and retrospective clinical examinations\\u000a and radiological assessments using a 3-T MRI after all-inside arthroscopic meniscal repair were conducted.
Thomas Hoffelner; Herbert Resch; Rosemarie Forstner; Mayer Michael; Bernd Minnich; Mark Tauber
Minimally invasive arthroscopic techniques for rotator cuff tears have been greatly advanced during the past decade. It is important to review the clinical presentation and common physical findings of a large or massive rotator cuff tear, essential preoperative imaging, and the principles and technical aspects of all-arthroscopicrepair. An anatomic repair of the footprint must begin with an understanding of the three-dimensional morphology of the rotator cuff tear and an accurate reduction of the tear. A contracted, immobile massive rotator cuff tear is challenging. Advanced arthroscopic mobilization techniques and margin convergence principles may allow repair of an otherwise irreparable tear. Failure of tendon healing is common but can be minimized by using dual-row, transosseous-equivalent techniques. A relatively slow rehabilitation program is paramount to protect the repair. The result of using arthroscopic techniques for a large or massive rotator cuff tear is comparable to that of a traditional open repair. Pain relief has been a far more reliable result than gains in function or strength. PMID:20415385
Background To evaluate the clinical results and operation technique of arthroscopicrepair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. Methods From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopicrepair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. Results VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopicrepair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. Conclusions In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopicrepair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.
Cho, Hyung Lae; Lee, Choon Key; Hwang, Tae Hyok; Park, Jong Won
Rotator cuff injury and tears are a common source of shoulder pain, particularly among the elderly. Arthroscopicrepair has now become the mainstay in the treatment of significant injuries that have failed conservative therapy. Compared with the traditional open technique, arthroscopicrepair offers patients smaller incisions and less soft-tissue trauma, which result in improved postoperative pain and rehabilitation. The advances that have made arthroscopicrepairs a reality includes improvement in arthroscopic rotator cuff instrumentation, particularly suture anchors. Suture anchors are used to reattach the torn rotator cuff tissue back onto the bone. Current rotator cuff anchors vary by design, anchor composition and suture materials. A treating physician should be aware of the advantages and limitations of these implants, which may influence the choice of one anchor over another. In addition to anchor variables, other factors that may affect the success of the repair include the local environment and surgical technique. In this article, various aspects of anchor design will be discussed. In addition, a concise review of technical considerations will also be discussed. PMID:21542709
Ma, Richard; Chow, Robert; Choi, Luke; Diduch, David
Background: Early passive motion exercise has been the standard rehabilitation protocol after rotator cuff repair for preventing postoperative stiffness. However, recent approaches show that longer immobilization may enhance tendon healing and quality.Purpose: To elucidate whether early passive motion exercise affects functional outcome and tendon healing after arthroscopic rotator cuff repair.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: One hundred
Yang-Soo Kim; Seok Won Chung; Joon Yub Kim; Ji-Hoon Ok; Joo Han Oh
Hypothesis Arthroscopic acromioclavicular joint (ACJ) resection for asymptomatic ACJ arthritis combined with rotator cuff repair leads\\u000a to more satisfactory pain relief and decrease reoperation rate when inferiorly directed osteophytes present at the undersurface\\u000a of ACJ.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods Between January 2006 and May 2008, a total of 83 patients (83 shoulders), 40 males and 43 females, who were planned to have\\u000a arthroscopic
Arthroscopic rotator cuff repair is a well established surgical technique. Passing sutures through the rotator cuff is a critical-and at times, time-consuming-portion of the procedure. Suture-passing devices have been developed that combine a nitinol needle for pushing sutures through the tissue with a tissue grasper. These devices eliminate multiple steps in the repair process and improve the efficiency of the operation. However, as with any innovation, there is the potential for complications. It is vital that these technical complications be appreciated so that they can be avoided in the future. We report a case in which the needle tip of a suture-passing device broke during arthroscopic rotator cuff repair. The breakage was not recognized until after the operation. The patient was observed for 2 years without migration of the foreign body. To our knowledge, this is the first reported complication associated with the use of this type of suturing device. PMID:19038716
We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery. PMID:23526110
Context: It remains unknown if arthroscopicrepair of recurrent anterior shoulder instability is as effective as open repair. Objective: The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability. Study Design: Systematic review of level I and II studies. Data Sources: PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria. Study Selection: Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations. Data Extraction: Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases. Results: Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings. Conclusions: While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.
There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months’ followup.\\u000a We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three\\u000a cohorts of patients had repair of a symptomatic
Neal L. Millar; Xiao Wu; Robyn Tantau; Elizabeth Silverstone; George A. C. Murrell
We compared the outcomes of arthroscopicallyrepaired rotator cuff tears in 28 patients older than 65 years (the over 65 group:\\u000a median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years).\\u000a The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but\\u000a different in age. After
Background: Hip injuries are common among professional hockey players in the National Hockey League (NHL).Hypothesis: Professional hockey players will return to a high level of function and ice hockey after arthroscopic labral repair and treatment of femoroacetabular impingement.Study Design: Case series; Level of evidence, 4.Methods: Twenty-eight professional hockey players (NHL) were unable to perform at the professional level due to
Marc J. Philippon; Douglass R. Weiss; David A. Kuppersmith; Karen K. Briggs; Connor J. Hay
Summary: Meniscus repair using bioabsorbable devices has become popular in the last few years. Good clinical results have been reported and few complications have been published. This report describes the case of a 37-year-old male patient with a lateral meniscus repair using 4 Meniscus Arrows (Bionx Implants, Blue Bell, PA). Postoperatively, repeated episodes of intra-articular effusions have occurred. A second-look
Romain Seil; Stefan Rupp; Michael Dienst; Bernd Mueller; Helmut Bonkhoff; Dieter M. Kohn
We assessed the results of 198 meniscal tears that had a major segment in the central avascular region repaired with an arthroscopically assisted inside-out technique. There were 177 patients whose mean age was 28 years. Eighty-two percent were injured during sports, and 71% also required anterior cruciate ligament reconstruction. The menisci were evaluated by clinical examination (180 repairs) a mean
Marc H. Rubman; Frank R. Noyes; Sue D. Barber-Westin
The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time. PMID:16858558
Hantes, Michael E; Zachos, Vasilios C; Varitimidis, Sokratis E; Dailiana, Zoe H; Karachalios, Theophilos; Malizos, Konstantinos N
Several surgical approaches have been described for the treatment of recurrent posterior shoulder instability. Many authors have performed posterior bone block procedures with good results not only in the presence of glenoid bone loss or dysplasia but also in the case of capsular hyperlaxity and poor soft-tissue quality. Open techniques often require an extensive approach with the disadvantage of a poor cosmetic result and possible insufficiency of the deltoid muscle. Furthermore, the treatment of concomitant pathologies and the correct placement of the bone graft are difficult. Therefore we describe an all-arthroscopic posterior shoulder stabilization technique with an iliac bone graft and capsular repair that is intended to improve the pre-existing open procedure. The key steps of the operation are the precise placement and screw fixation of the bone block at the posterior glenoid under arthroscopic control and the subsequent posterior capsular refixation and plication using 2 suture anchors to create an extra-articular graft position.
Background: Rotator cuff repair surgery is one of the most commonly performed procedures in the world but limited literature exists for guidance of optimal management of post-operative arthrofibrosis following cuff repair. The purpose of this study is to report the results of arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy in patients with recalcitrant postoperative stiffness after rotator cuff repair. Materials and Methods: Twenty-nine patients who had recalcitrant arthrofibrosis following either an arthroscopic (62%), open (28%), or mini-open (10%) rotator cuff repair were included in study. The average age at the time of index cuff repair surgery was 49.8 years (range 24?70 years). Sixteen patients (55%) were involved in worker's compensation claims. The mean time from the date of index operation to lysis of adhesions was 9.7 months (range 4.2?36.2 months), and the mean time from lysis of adhesion to most recent follow-up 18.2 months (range 4.1?43.7 months). Post-operative evaluation was performed using American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) on 18 (62%), while range of motion (ROM), dynamometer strength testing, and Constant-Murley Scoring were performed on 13 (45%). Statistical analysis was performed using a Student's t-test. Results: Prior to arthroscopic lysis of adhesions, mean forward active elevation (FE) was 103.8°, (range 60-145° (SD 26.3) and external rotation at the side (ERS) was 25.3°, (range 5-70° SD 15.1°). Post-operatively, at the most recent follow-up, FE was significantly improved to 158.3°, (range 110?180° SD 22.3°), and ERS improved to 58.9°, (range 15?90° SD 18.6°) in both cases. Involvement in a worker's compensation claim resulted in a lower ASES, VAS, and SANE score, but there was no statistically significant difference in motion. Conclusion: Arthroscopic capsular release, lysis of adhesions, and manipulation under anesthesia is a safe, reliable method of treating persistent stiffness following rotator cuff repair.
Bhatia, Sanjeev; Mather, Richard C; Hsu, Andrew R; Ferry, Amon T; Romeo, Anthony A; Nicholson, Gregory P; Cole, Brian J; Verma, Nikhil N
Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2 year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2004 - 2008). Each patient was followed-up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a Pre and Post Operative Mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.
Background Arthroscopic rotator cuff repair is described as being a successful procedure. These results are often derived from clinical\\u000a general shoulder examinations, which are then classified as 'excellent', 'good', 'fair' or 'poor'. However, the cut-off points\\u000a for these classifications vary and sometimes modified scores are used.\\u000a \\u000a \\u000a Arthroscopic rotator cuff repair is performed to improve quality of life. Therefore, disease specific health-related
Ronald N Wessel; Tjoan E Lim; Henk van Mameren; Rob A de Bie
Persistent tendon defects after rotator cuff repair are not uncommon. Recently, the senior author has identified a subset of 5 patients (mean age, 52 years; range, 42 to 59 years) after arthroscopic double-row rotator cuff repair who showed an unusual mechanism of tendon failure. In these patients the tendon footprint appears well fixed to the greater tuberosity with normal thickness. However, medial to the intact footprint, the tendon is torn with full-thickness defects through the rotator cuff. All patients were involved in Workers' Compensation claims. Magnetic resonance arthrography showed an intact cuff footprint but dye leakage in all patients. Revision surgery was performed at a mean of 8.6 months after the index procedure and showed an intact rotator cuff footprint but cuff failure medial to the footprint. Four patients had repair of the defects by tendon-to-tendon side-to-side sutures, whereas one did not undergo repair. Medial-row failure of the rotator cuff is a previously unreported mechanism of failure after double-row rotator cuff repair. Given the small number of patients in this study, it is unclear whether these defects are symptomatic. However, repair of these defects resulted in improvement in pain in 4 of 5 patients. PMID:18514118
Trantalis, John N; Boorman, Richard S; Pletsch, Kristie; Lo, Ian K Y
Despite advancements in arthroscopic rotator cuff repair techniques, achieving tendon-to-bone healing can be difficult in the setting of poor-quality tendon. Moreover, medial tendon tears or tears with lateral tendon loss may preclude standard techniques. Rip-stop suture configurations have been shown to improve load to failure compared with simple or mattress stitch patterns and may be particularly valuable in these settings. The purpose of this report is to describe a technical modification of a rip-stop rotator cuff repair that combines the advantages of a rip-stop suture (by providing resistance to tissue cutout) and a double row of load-sharing suture anchors (minimizing the load per anchor and therefore the load per suture within each anchor). PMID:23766972
BACKGROUND: Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopicrepair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. METHODS\\/DESIGN: This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator
Joy C MacDermid; Richard Holtby; Helen Razmjou; Dianne Bryant
Several surgical approaches have been described for the treatment of recurrent posterior shoulder instability. Many authors have performed posterior bone block procedures with good results not only in the presence of glenoid bone loss or dysplasia but also in the case of capsular hyperlaxity and poor soft-tissue quality. Open techniques often require an extensive approach with the disadvantage of a poor cosmetic result and possible insufficiency of the deltoid muscle. Furthermore, the treatment of concomitant pathologies and the correct placement of the bone graft are difficult. Therefore we describe an all-arthroscopic posterior shoulder stabilization technique with an iliac bone graft and capsular repair that is intended to improve the pre-existing open procedure. The key steps of the operation are the precise placement and screw fixation of the bone block at the posterior glenoid under arthroscopic control and the subsequent posterior capsular refixation and plication using 2 suture anchors to create an extra-articular graft position. PMID:23766993
Treatment of patients with meniscal cysts of the meniscus usually requires surgery. Arthroscopic partial meniscectomy of the involved torn meniscus with intra-articular cyst drainage has become the accepted intervention. However, if the meniscal tear is peripheral, a lot of healthy meniscal tissue is needlessly sacrificed with subtotal meniscectomy. Moreover, the meniscal cyst is not a true cyst, so it may be treated more conservatively after the underlying disease has been corrected. We report a case of a meniscal cyst arising from the anterior segment of the lateral torn meniscus that was arthroscopicallyrepaired with an outside-in technique. With the use of a 19-gauge long needle to penetrate the peripheral rim inframeniscally, a nonabsorbable No. 3-0 nylon suture was passed into the joint and brought out suprameniscally to loop the meniscal fragment. The second suture was passed and was used to secure the meniscal rim and fragment by the same means approximately 8 to 10 mm from the first one. Then the cyst was aspirated. A good result was obtained, and no recurrence of the cyst or mechanical problems occurred after a follow-up of 14 months. PMID:17157745
This report presents a method of arthroscopicrepair of the peripheral triangular fibrocartilage tears by using ultrasonic suture welding technique, thus avoiding the need for traditional suture knots. This technique eliminates the potential causes of ulnar-sided wrist discomfort especially during the postoperative period. Twenty-three patients (9 women and 14 men; mean age, 35 years; range, 18-52 years) were operated during a 1-year period in 2001 for Palmer grade 1B triangular fibrocartilage complex tear and followed up for 17 months. At the final follow-up, the average wrist arc of motion was as follows: extension, 65 degrees; flexion, 56 degrees; supination, 80 degrees; pronation, 78 degrees; radial deviation, 12 degrees; and ulnar deviation, 25 degrees. Grip strength measured with a dynamometer (Jamar) averaged 81% of the contralateral side at the final evaluation (range, 53%-105%). PMID:17536524
The study included 100 patients who underwent an arthroscopic rotator cuff repair. All patients suffered about a rotator cuff\\u000a tear that was repairedarthroscopically with a suture anchor technique. Immediately postoperatively, patients were randomly\\u000a allocated to one of two different postoperative physiotherapy regimens: passive self-assisted range of motion exercise (controls:\\u000a 46 patients) versus passive self-assisted range of motion exercise associated
Raffaele Garofalo; Marco Conti; Angela Notarnicola; Leonardo Maradei; Antonio Giardella; Alessandro Castagna
Background: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. Purpose: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. Study Design: Case series. Methods: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. Results: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. Conclusions: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing.
Strickland, Justin P.; Fleckenstein, Cassie M.; Ducker, Al; Hasan, Samer S.
The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients
In recent years several single-stage cartilage repair approaches have been devised to treat focal cartilage lesions. These usually associate microfracture (MFX) and a coverage scaffold. We describe a novel arthroscopic technique that combines MFX, autologous bone marrow concentrate (BMC), and a protective scaffold. Bone marrow aspirate from the iliac crest is centrifuged to obtain BMC. The cartilage defect is debrided, MFX holes are created, and the final defect is measured by use of a bent K-wire. The scaffold is then shaped to match the defect, immersed in BMC, introduced into the joint with a grasper, and fixed in place with a mixture of fibrin glue and BMC. This technique aims to augment the original single-stage procedure with a number of mesenchymal stem cells and growth factors contained in the BMC, to increase the defect filling and the rate of hyaline-like cartilage regeneration. The procedure combining MFX, BMC, and a protective scaffold is inexpensive and reproducible and has already shown the ability to regenerate hyaline-like cartilage. Its use as an alternative to autologous chondrocyte implantation requires further investigation.
The mechanical properties of the repaired meniscus may affect its ability to heal and to protect the articular surface against degenerative changes. We compared the immediate biomechanical consequences of open versus arthroscopicrepair in the human cadaver knee. Additionally, having measured postoperative stresses at various degrees of knee flexion, we have addressed the effect of tethering of the meniscus, a
Mark E. Baratz; David C. Rehak; Freddie H. Fu; M. J. Rudert
Background To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion. Methods The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed. Results The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%). Conclusions The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.
Kim, Do-Young; Lee, Sang-Soo; Seo, Eun-Min; Hwang, Jung-Taek; Kwon, Sun-Chang; Lee, Jae-Won
Advancing technology, improved instrumentation, and a desire to address intra-articular pathology with a minimally invasive approach have driven the expansion of arthroscopic shoulder surgery in the past 2 decades. Proponents cite greatly improved visuali...
A. A. Romeo M. T. Provencher S. J. Nho S. T. Seroyer
Objectives To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. Background Physical therapists provide rehabilitation for patients following arthroscopicrepair of the superior labrum. Little research has been published regarding the short-term results of this procedure while the patient is typically under the direct care of the physical therapist. Methods Charts from 39 patients (7 females and 32 males) with a mean age of 43.4±14.9 years following SLAP repair were reviewed. All patients underwent rehabilitation by the same therapist using a standardized protocol and were operated on and referred by the same orthopaedic surgeon. Retrospective chart review was performed to obtain descriptive profiles of shoulder ROM at 6 and 12 weeks post surgery and isokinetically documented internal and external rotation strength 12 weeks post surgery. Results At 12 weeks post-surgery, involved shoulder flexion, abduction, and external rotation active ROM values were 2-6 degrees greater than the contralateral, non-involved extremity. Isokinetic internal and external rotation strength deficits of 7-11% were found as compared to the uninjured extremity. Patients completed the self-report section of the Modified American Shoulder Elbow Surgeons Rating Scale and scored a mean of 37/45 points. Conclusion The results of this study provide objective data for both glenohumeral joint ROM and rotator cuff strength following superior labral repair at time points during which the patient is under the direct care of the physical therapist. These results show a nearly complete return of active ROM and muscular strength following repair of the superior labrum and post-operative physical therapy.
The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients (N = 19) were satisfied with the results of surgery and 95% (N = 21) had improvement of their symptoms. All patients had a statistically significant improvement in pain and active abduction in the scapular plane and in external rotation. Postoperative strength in external rotation and abduction averaged 95% and 97% of the contralateral shoulder, respectively. Preoperative duration of symptoms, strength, age, and tear size were found to be independent predictors of outcome. The average Constant and Murley score was 84 of 100, the average American Shoulder and Elbow Surgeons score was 81 of 100, and the average University of California, Los Angeles, score was 31 of 35. Our results show that an arthroscopically assisted repair of full-thickness, moderate-to-large rotator cuff tears using uniform surgical technique and rehabilitation protocols provides excellent outcome with regard to function, pain, and activities of daily living. PMID:10843119
In a prospectively randomized study including 68 patients, the results of inside-out horizontal meniscus suturing were compared\\u000a to meniscus repair using the meniscus arrow. 96% of the patients underwent re-arthroscopy after 3–4 months. Only lesions in\\u000a the red\\/red or red\\/white areas were included. Patients were treated with a hinged brace for 9 weeks. 30 patients had an isolated\\u000a bucket-handle lesion.
P. Albrecht-Olsen; G. Kristensen; P. Burgaard; U. Joergensen; C. Toerholm
Partial-thickness articular tears of the supraspinatus represent a not uncommon event in shoulder pathology, but their treatment remains controversial. We believe that these lesions must be treated with surgical repair: we hereby describe our technique of transtendon arthroscopicrepair. We have treated 33 patients with an average age of 53.3 years (range 34-69). The average follow-up was 33 months (range 26-45). The post-operative Constant score values have shown a total increase of 48.2 points (from preoperative 44.4 points to post-operative 91.6 points). In the MRI follow-up assessment no cases of retears have occurred. The use of this technique enables the reconstitution of the tendon with complete reconstruction of its footprint without damaging its intact part. We believe that this can allow a better recovery. PMID:19711170
Castricini, R; Panfoli, N; Nittoli, R; Spurio, S; Pirani, O
Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3?years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. Results The mean follow-up was 40?months in the SR group and 38.9?months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications. Level of evidence III. Treatment study: Case–control study.
We developed an effective arthroscopic pullout technique for repairing complete radial tears of the tibial attachment site of the medial meniscus posterior horn (MMPH). In our technique, the torn meniscus is reattached to the tibial plateau immediately medial or anteromedial to the posterior cruciate ligament (PCL) using two No. 2 Ethibond sutures (Ethicon, Somerville, NJ). After a complete radial tear of the tibial attachment site of the MMPH and its reparability were confirmed, using a Caspari suture loaded with a suture shuttle, one No. 2 Ethibond suture is placed through the meniscus, through the red-red zone, 3 to 5 mm medial to the torn edge of the MMPH, and the other is passed through the meniscocapsular junction 3 to 5 mm medial to the torn edge of the meniscus. Then, a tibial tunnel, 5-mm in diameter, is made from the anteromedial aspect of the proximal tibia to the previously prepared tibial plateau, immediately medial or anteromedial to the PCL, and the two No. 2 Ethibond sutures are pulled out through the tibial tunnel and then fixed to the proximal tibia using a 3.5-mm cortical screw and washer. Firm reattachment of the torn meniscus was confirmed arthroscopically. PMID:16848058
Kim, Young-Mo; Rhee, Kwang-Jin; Lee, June-Kyu; Hwang, Deuk-Soo; Yang, Jun-Young; Kim, Sung-Jae
Posterior root tears of the medial meniscus are frequently encountered and should be repaired if possible to prevent osteoarthritis of the medial compartment. Various surgical techniques have been proposed to repair posterior root tears. The anterior arthroscopic approach can cause an iatrogenic chondral injury due to the narrow medial joint space. The posterior approaches might be technically unfamiliar to many surgeons because they require the establishment of a posteromedial or trans-septal portal. This paper describes the medial collateral ligament pie-crusting release technique for arthroscopic double transosseous pullout repair of posterior root tears of the medial meniscus through the anterior approach to provide the good visualization of the footprint and sufficient working space. PMID:21328071
Park, Young-Sik; Moon, Hong-Kyo; Koh, Yong-Gon; Kim, Yong-Chan; Sim, Dong-Sik; Jo, Seung-Bae; Kwon, Se-Kwang
Purpose Arthroscopic stabilization has become the accepted treatment for type II superior labral anterior and posterior (SLAP) lesions. Short-term results using a variety of techniques were promising, but most reports focus on motivated athletes. The purpose of our report is to evaluate the results of arthroscopic fixation of type II SLAP lesions in 21 patients who suffered a work-related injury and are receiving workers’ compensation. The hypothesis was that in patients with a single event trauma who were receiving workers’ compensation, clinical results would be inferior to those previously reported. Methods Twenty-two consecutive workers’ compensation patients with type II SLAP lesions underwent arthroscopic stabilization between October 1994 and December 1996. All patients received suture anchors with nonabsorbable suture secured around the labrum for definitive fixation. Average age at surgery was 43 and average follow-up time was 27.9 months. Seventeen patients (89%) had an acromioplasty at the time of labral stabilization. Outcome was assessed by analysis of visual analog pain scale, simple shoulder test (SST) and general health status questionnaire (SF-36), subjective patient satisfaction, and ability to return to work. Results Visual analog pain scales improved by an average of 3 points although all patients had significant complaints of pain at follow-up. Simple shoulder test responses showed improvement in 9 out of 12 categories. The SF-36 results showed significant improvements only in the bodily pain category and role: physical category. Five patients required reoperation for persistent pain. However, only seven patients (437%) returned to work at their previous functional level, nine patients (47%) returned to work but at less strenuous jobs, and three patients (16%) did not return to work. Conclusions Currently recommended treatment for type II SLAP lesions is arthroscopic stabilization. When this procedure is performed in workers’ compensation, patients a with single event trauma to the shoulder, objective parameters, and patient self-assessment surveys do show improvement. However, results are inferior to those previously reported in the literature.
Relatively large calcific materials on radiographs of shoulders with persistent symptoms after extended periods of conservative\\u000a treatment are candidates for operative treatment. But complete removal of calcific materials sometimes leaves a large defect\\u000a in the rotator cuff tendon, and tendon repair might be essential if defects are large. We evaluated the clinical results of\\u000a complete removal of calcific deposits with
Jae Chul Yoo; Won Hah Park; Kyoung Hwan Koh; Sang Min Kim
Recently, there has been an increased interest in the normal anatomy of the rotator cuff footprint and the re-establishment of the footprint during rotator cuff repair. Single-row suture anchor techniques have been criticized because of their inability to restore the normal medial-to-lateral width of the rotator cuff footprint. In this report, the authors describe a double-row technique for rotator cuff
Background aims Transplantation of synovial mesenchymal stromal cells (MSCs) may induce repair of cartilage defects. We transplanted synovial MSCs into cartilage defects using a simple method and investigated its usefulness and repair process in a pig model. Methods The chondrogenic potential of the porcine MSCs was compared in vitro. Cartilage defects were created in both knees of seven pigs, and divided into MSCs treated and non-treated control knees. Synovial MSCs were injected into the defect, and the knee was kept immobilized for 10 min before wound closure. To visualize the actual delivery and adhesion of the cells, fluorescence-labeled synovial MSCs from transgenic green fluorescent protein (GFP) pig were injected into the defect in a subgroup of two pigs. In these two animals, the wounds were closed before MSCs were injected and observed for 10 min under arthroscopic control. The defects were analyzed sequentially arthroscopically, histologically and by magnetic resonance imaging (MRI) for 3 months. Results Synovial MSCs had a higher chondrogenic potential in vitro than the other MSCs examined. Arthroscopic observations showed adhesion of synovial MSCs and membrane formation on the cartilage defects before cartilage repair. Quantification analyses for arthroscopy, histology and MRI revealed a better outcome in the MSC-treated knees than in the non-treated control knees. Conclusions Leaving a synovial MSC suspension in cartilage defects for 10 min made it possible for cells to adhere in the defect in a porcine cartilage defect model. The cartilage defect was first covered with membrane, then the cartilage matrix emerged after transplantation of synovial MSCs.
Meniscal repair is common and recommended in young patients. Suture techniques and fixation devices were developed for stronger, more facile repairs. Three devices (T-Fix, Meniscal Staple, Meniscus Arrow) were biomechanically compared to horizontal PDS suture. Peripheral tears were created in porcine menisci and repaired using the manufacturer's technique. An Instron was used to distract the menisci at 50 mm/min in axial-pullout and longitudinal shear loads. Load to failure curves and peak failure loads were noted. Load to failure in axially loaded pull-out mode was: Staple, 4.195+/-3.70 N; Arrow, 39.755+/-11.37 N; T-Fix, 45.892+/-13.99 N; Suture, 107.65+/-22.37 N. Analysis of variance with post hoc testing revealed Staple failure at lower load than all devices and Suture failure at higher loads than all devices; Arrow and T-Fix were similar. The data varied significantly from that obtained in shear. Shear loads to failure were: Staple, 8.39+/-8.62 N; Arrow, 27.67+/-14.33 N; T-Fix, 57.47+/-17.05 N; Suture, 64.15+/-17.05 N. Analysis of variance, power analysis, and pair-wise multiple comparisons revealed significant differences between: Suture and Staple, Suture and Arrow, and T-Fix and Staple. No differences were noted between Suture and T-Fix, T-Fix and Arrow, or Arrow and Staple. In pullout, Suture and T-Fix maintained better apposition at low loads. As load increased, the menisci separated until device failure. Arrows allowed low load separation but held tissue until failure. Staples failed at low load. For shear, the menisci attempted to reorient parallel to the force. The devices failed in a pull-slide pattern. Suture failed by pull-through. Meniscal repair devices are easy to use and may provide resistance to shear and pull out. The resistance to pullout loads was very different than the resistance to longitudinal shear loads. PMID:12355304
Fisher, Stephen R; Markel, David C; Koman, Jon D; Atkinson, Theresa S
We describe the repair of a chronic bony Bankart lesion in a case with recurrent instability using standard techniques and equipment for addressing anteroinferior glenohumeral instability. A 25-year-old man with recurrent instability and a chronic bony Bankart lesion with a Hill-Sachs lesion was treated. The inferior 2 sutures and knotless anchors are placed through a low anterior portal, which improves the angle of approach to the inferior portion of the glenoid that is fractured. The knotless anchors are impacted through the low anterior portal, just superior to the level of the suture, as the fragment tends to retract medially and inferiorly, with the drill guide slightly on the face of the glenoid. The superior-anterior portal adjacent to the biceps tendon gives a better view of the glenoid articular cartilage position of the anchors required to restore the anatomic location of the fracture fragment. The low anterior portal improved and simplified the reduction of the fracture fragment to the glenoid neck by allowing access to the anterior-inferior bony Bankart lesion that was repairable with suture and knotless anchors using standardized techniques.
Background Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopicrepair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair. Methods/Design This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate-sized rotator cuff tears. A national consensus meeting of investigators in the Joint Orthopaedic Initiative for National Trials of the Shoulder (JOINTS Canada) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC)) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, Constant score), secondary dimensions of health (general health status (SF-12) and work limitations), and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12, and 24 months post-operatively by blinded research assistants and musculoskeletal radiologists. Patients (n = 250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to statistically detect a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score (? = 0.05). A central methods centre will manage randomization, data management, and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopicrepair procedures will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. We will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2 years post-operatively. As a secondary analysis, we will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2 years. The trial will commence when funding is in place. Discussion These results will have immediate impact on the practice behaviors of practicing surgeons and surgical trainees at JOINTS centres across Canada. JOINTS Canada is actively engaged in knowledge exchange and will publish and present findings internationally to facilitate wider application. This trial will establish definitive evidence on this question at an international level.
MacDermid, Joy C; Holtby, Richard; Razmjou, Helen; Bryant, Dianne
Background: Rotator cuff tears affect patients' quality of life. The evolution toward less invasive operative techniques for rotator cuff repair requires appropriate comparisons with the standard open procedure, using validated outcomes in a randomized fashion.Hypothesis: There is no difference in disease-specific quality of life outcomes at 2 years between an open surgical repair (open) versus an arthroscopic acromioplasty with mini-open
Nicholas G. Mohtadi; Robert M. Hollinshead; Treny M. Sasyniuk; Jennifer A. Fletcher; Denise S. Chan; Feng X. Li
Osteoarthritis (OA) can cause severe pain and dysfunction of the shoulder. When conservative treatment fails and operative treatments such as shoulder arthroplasty and open glenohumeral resurfacing are not advisable, shoulder arthroscopy may be used to treat shoulder OA. Arthroscopic treatment of concomitant pathology in the shoulder including subacromial decompression, labral repair, capsular release, microfracture, and distal clavicle excision have been shown to yield good results when combined with glenohumeral debridement in the treatment of shoulder OA. Arthroscopic glenohumeral resurfacing has recently been described and has shown encouraging results. Arthroscopic treatment appears to have better results in shoulders with a lesser degree of osteoarthritis.
|Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…
We describe an arthroscopic reconstruction technique for acromioclavicular joint dislocation. Subsequent to Baum’s first repair of the coracoclavicular complex in 1886, over 60 operative procedures have been described in the literature. This procedure is the first described arthroscopic approach used in reconstruction for acromioclavicular dislocation. It provides an anatomically correct and structurally sound reconstruction of the coracoclavicular ligament complex. This
Lesions of the TFCC are more frequently implicated as a cause of ulnar-sided wrist pain. Accurate diagnosis of TFCC pathology must be based on a thorough history and physical examination. Imaging modalities of particular use include plain radiographs, triple compartment arthrography, and MR imaging. The most sensitive and accurate diagnosis of the extent as well as the clinical significance of intra-articular pathology on the ulnar side of the wrist is by means of the arthroscope. With the advent of smaller and more elaborate arthroscopic instrumentation, the ability to perform arthroscopic surgery on the TFCC has dramatically increased over the past decade. The present arthroscopic treatment of traumatic central and radial lesions consists of debridement of unstable flaps, whereas dorsal and ulnar-sided lesions can be directly repaired. Centrally located degenerative perforations can be debrided in conjunction with an arthroscopic wafer procedure on the distal ulna. PMID:7566916
Over the last years treatment of rotator cuff tears is evolving gradually from open to complete arthroscopicrepair. There had been fast developments in arthroscopic techniques and instruments and there is a better understanding of biomechanical backgrounds. For a good clinical outcome it is not necessary to obtain a watertight closure in all cases but to balance the force couples in the coronal and transverse plane. There is recent discussion regarding the optimum techniques and stitches for cuff reconstruction and resulting developments in this field. To determine the individual reconstruction technique it is crucial to recognize the different tear categories. Based on these findings we are now able to treat nearly every cuff tear arthroscopically, even a retracted massive lesion. PMID:16897022
Background: Superior labral anterior posterior tears have been described as symptomatic lesions in shoulders of patients of varying ages. It is unknown if age affects clinical outcome of arthroscopic fixation of type II superior labral anterior posterior repairs.Hypothesis: Clinical outcome of arthroscopic fixation of isolated type II superior labral anterior posterior tears differs between younger (<40 years) and older (?40
With advancements in arthroscopic surgery, arthroscopic biceps tenodesis with suture anchor recently has been reported to be a reasonable option for the treatment of biceps pathologies, especially for those that are symptomatic or accompanied by a rotator cuff tear. We introduce our technique of arthroscopic biceps tenodesis with suture anchor that we call the loop-suture technique, which is constructed with 1 loop strand and another sutured strand. This technique can help to improve biceps grip and simultaneously minimize longitudinal splitting of the tendon. In addition, it is relatively simple and can be performed with the use of conventional devices and arthroscopic portals used for rotator cuff repair, without the formation of additional portals or a separate incision for the tenodesis.
Shon, Min Soo; Koh, Kyoung Hwan; Lim, Tae Kang; Lee, Seung Won; Park, Young Eun; Yoo, Jae Chul
Although soft tissue stabilization procedures in the shoulder yield good results, arthroscopy and radiological investigations have identified more complex soft tissue and bony lesions that can be successfully treated using a Latarjet procedure. The authors have advanced this technique to make it possible arthroscopically, thereby conferring all the benefits that arthroscopic surgery offers. This article describes how and why the arthroscopic Latarjet procedure is a valuable tool in the treatment of complex shoulder instability and how the procedure can be introduced into practice. This technique has shown excellent results at short- to mid-term follow-up, with minimal complications. As such, this procedure is recommended to surgeons with good anatomic knowledge, advanced arthroscopic skills, and familiarity with the instrumentation. PMID:20497814
Rotator cuff tears can be a significant source of shoulder pain and weakness. Repair of full-thickness tears canimprove patient satisfaction and functional outcome. Several repair techniques have been described in the literature; these include arthroscopic and open approaches. Although arthroscopicrepair has been popularized in the recent literature, it may not be optimal for some cases of large or massive
Background: The majority of the literature on surgical outcomes of superior labral anterior posterior (SLAP) repairs has focused on short-term follow-up of 1 to 2 years, not allowing adequate time for full rehabilitation and return to maximum level of competition for all types of athletes. Also, previous studies have concentrated on using questionnaires that primarily evaluate patients’ activities of daily
Brian J. Neuman; C. Brittany Boisvert; Brian Reiter; Kevin Lawson; Michael G. Ciccotti; Steven B. Cohen
Arthroscopic treatment for osteoarthritis of the knee has been widely performed as one of the surgical options, in spite of persisting concerns regarding its efficacy. Arthroscopic debridement is a general term that is used to cover many procedures, including lavage, partial meniscectomy, removal of loose body, synovectomy, chondroplasty, removal of offending osteophytes, and/or microfracture. Recently, the role of arthroscopy in managing the osteoarthritic knee has been challenged by elusive consensus on its usefulness. Therefore, we review the available literatures for the arthroscopic intervention in knee osteoarthritis and summarized evidences for proper patient selection, which is a paramount factor to achieve the surgical goal of the arthroscopic treatment in osteoarthritic knee.
Failure of primary arthroscopic Bankart repair in anterior–inferior glenohumeral instability is low, but in some cases revision surgery is required. Revision procedures show good to excellent results but typically are done open and do not respect the anatomical functionality of the joint capsule. The purpose of this cadaveric study was to explore the feasibility of a completely arthroscopic anatomical reconstruction of the inferior glenohumeral ligament using a hamstring autograft.
Trapeziometacarpal osteoarthritis is a common pathology resulting in severe impairments in daily living activities. Many procedures have been described in the treatment of stages Eaton II, III and IV. Bibliographical research evidences that other techniques could not improve the results of the simple trapeziectomy. A surgical technique with an arthroscopically assisted total resection of the trapezium is described. This technique is carried out with a 2.7-mm arthroscope, using the conventional portals (1R and 1U) and a fluoroscan. Surgery ends with soft dressings and rehabilitation begins immediately. In the last 9 years, we treated more than 70 patients. Video-assisted total trapeziectomy offers a simple technique with sufficient postoperative comfort that allows an early return to the daily living activities. PMID:21107227
Daroda, Sergio; Menvielle, Fernando; Cosentino, Rodolfo; Pereira, Paul
The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients.
Kim, Jong In; Kwon, Jae Ho; Seo, Dong Hyun; Soni, Shaishav M.; Munoz, Michael; Nha, Kyung Wook
The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients. PMID:23875135
Kim, Jong In; Kwon, Jae Ho; Seo, Dong Hyun; Soni, Shaishav M; Muñoz, Michael; Nha, Kyung Wook
Presently, tibiotalar fusion remains a valid treatment option in patients affected by end-stage arthritis of the ankle that is unresponsive to other treatments. Over the years, many different surgical techniques have been described to make this kind of surgery less invasive and invalidating. Consequently, the last two decades have seen arthroscopic ankle fusion gain in popularity with many studies aiming to understand its advantages compared with open surgery, indications, and contraindications. The review of literature revealed a lower rate of complication, faster recovery, and shorter time of hospitalization with arthroscopic arthrodesis, in comparison with open surgery. These characteristics, along with a reduction of costs, will probably increase the use of arthroscopic ankle arthrodesis in the near future. PMID:22430861
Rectus femoris origin injuries in adult athletes are uncommon. In the acute phase, conservative treatment seems to have a favourable outcome, with surgical repair reserved for unsuccessful cases only. However, a group of patients may develop chronic pain and disability after recovery from the acute phase due to heterotopic calcification occurring at the site of injury. Open and arthroscopic excision of such calcifications has been described in the literature although arthroscopic excision of large calcified lesions in the rectus femoris has not been reported previously. A relevant case is presented and discussed.
Arthroscopic examination was performed on 32 wrists of 32 patients with Kienböck's disease to relate the appearance of the intraarticular structures, particularly the articular cartilage, to the radiographic stage. The articular cartilage showed osteoarthritic changes in stage III, although this was not evident on plain radiographs. Cracking in the distal facet and flapping at the proximal facet of the lunate
Historically meniscal cysts have been treated with either an open total menisectomy, isolated cyst excision, or a combination of the two procedures. The advent of arthroscopic techniques has led to innovative treatment options for meniscal cyst management. A review of meniscal cysts and the results of arthroscopic treatment form the basis of this study. From 1986 to 1991, 18 patients with meniscal cysts were treated by arthroscopic cyst decompression. Thirteen men and five women comprised the study group and had an average age of 28 years. The follow-up period ranged from 6 to 60 months (average 26). Eight of the cysts were medial and 10 were lateral. A horizontal cleavage tear was noted in all cases, and 15 partial and three subtotal menisectomies were performed in conjunction with an intraarticular cyst decompression. There have been no recurrences to date, and all patients returned to their previous level of activity. Parameniscal cysts may result from synovial fluid tracking through a horizontal cleavage tear. Successful treatment of the meniscal cyst must include appropriate management of the torn meniscus, which can be entirely arthroscopic, consisting of a partial or subtotal meniscectomy, identification of the cyst opening, and cyst decompression. PMID:8280334
Background The current paradigm of arthroscopic training lacks objective evaluation of technical ability and its adequacy is concerning given the accelerating complexity of the field. To combat insufficiencies, emphasis is shifting towards skill acquisition outside the operating room and sophisticated assessment tools. We reviewed (1) the validity of cadaver and surgical simulation in arthroscopic training, (2) the role of psychomotor analysis and arthroscopic technical ability, (3) what validated assessment tools are available to evaluate technical competency, and (4) the quantification of arthroscopic proficiency. Methods The Medline and Embase databases were searched for published articles in the English literature pertaining to arthroscopic competence, arthroscopic assessment and evaluation and objective measures of arthroscopic technical skill. Abstracts were independently evaluated and exclusion criteria included articles outside the scope of knee and shoulder arthroscopy as well as original articles about specific therapies, outcomes and diagnoses leaving 52 articles citied in this review. Results Simulated arthroscopic environments exhibit high levels of internal validity and consistency for simple arthroscopic tasks, however the ability to transfer complex skills to the operating room has not yet been established. Instrument and force trajectory data can discriminate between technical ability for basic arthroscopic parameters and may serve as useful adjuncts to more comprehensive techniques. There is a need for arthroscopic assessment tools for standardized evaluation and objective feedback of technical skills, yet few comprehensive instruments exist, especially for the shoulder. Opinion on the required arthroscopic experience to obtain proficiency remains guarded and few governing bodies specify absolute quantities. Conclusions Further validation is required to demonstrate the transfer of complex arthroscopic skills from simulated environments to the operating room and provide objective parameters to base evaluation. There is a deficiency of validated assessment tools for technical competencies and little consensus of what constitutes a sufficient case volume within the arthroscopy community.
We report a case of acute laceration of the popliteal artery during an arthroscopic posterior cruciate ligament reconstruction. This injury can occur during the creation of the posteromedial portal, the manipulation of the tissues in the posterior part of the capsule of the knee joint, or when drilling the tibial hole. We recommend that a qualified vascular surgeon should be immediately available at the time of the surgery. In case of suspecting the occurrence of a popliteal artery injury, the vascular surgeon should be immediately consulted and arteriography and vascular repair should be performed. PMID:16325093
Makino, Arturo; Costa-Paz, Matias; Aponte-Tinao, Luis; Ayerza, Miguel A; Muscolo, D Luis
The square knot is the gold standard for open surgical knot tying. One criticism of arthroscopic shoulder surgery is that arthroscopic knots are not as secure as square knots tied during traditional open surgery. In this brief technical note, we describe a simple technique for tying arthroscopic square knots that the senior members of our group have been using in clinical practice for several years with successful results. PMID:19238262
Hammerman, Steven M; Elkousy, Hussein; Edwards, T Bradley; O'Connor, Daniel P; Gartsman, Gary M
The management of patients with a failed rotator cuff repair is challenging. Revision arthroscopicrepairs can be entertained in select patients when realistic outcomes are understood. Complete evaluation of the shoulder is needed to identify and treat potential confounding pain generators. The ability to determine if a recurrent tear is repairable is difficult, because there are no established criteria to make this determination. If a recurrent tear is found to be repairable, the results of the surgery are encouraging, although persistent limitations in shoulder function are common. Strategies to improve the rates of tendon healing should be used and include the use of stronger repair constructs, when possible, and implementation of a slower rehabilitation progression. PMID:23040555
A new method for arthroscopic all-inside repair of vertical meniscus lesions by use of a biodegradable fixation device (“meniscus arrow”) has been developed, including a set of cannulas for easy insertion via standard arthroscopic portals. The technique is described. A study to test the fixation properties was performed in the laboratory. Twenty-four fresh frozen bovine medial menisci were defreezed and
Peter Albrecht-Olsen; Thomas Lind; Gert Kristensen; Boe Falkenberg
Background The aim of our study was to evaluate the results of lateral tibial plateau fractures treated with arthroscopically assisted percutaneous osteosynthesis (AAPO). Methods Twenty-one patients (14 men and 7 women) with a mean age of 41 years underwent AAPO to repair low-energy Schatzker I–III tibial plateau fractures. Under pneumatic tourniquet, we reduced and fixed the fracture with 1 or 2 subchondral cannulated screws. Accompanying lesions included 10 meniscus tears, which we partially excised in 9 patients and repaired in 1 patient. On the second postoperative day, patients began range-of-motion exercises. We encouraged partial and full weight-bearing by the sixth and tenth weeks, respectively. The mean follow-up period was 38 (range 12–96) months, and we evaluated the patients using Rasmussen's clinical and radiologic criteria. We used a t test for statistical analysis. Results There were 13 excellent (62%), 6 good (28%) and 2 fair (10%) clinical results, and 11 excellent (52%), 7 good (33%) and 3 fair (14%) radiologic results. We observed mild or moderate arthritic changes in 5 patients (24%). There were no infection or wound problems, but we removed hardware in 4 patients. Conclusion Arthroscopically assisted treatment of lateral tibial plateau fractures yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.
Inadvertent popliteal artery injury during arthroscopic menisectomy is an unusual occurrence. Prompt diagnosis and treatment are essential to achieve a good outcome, as illustrated in two of the five patients described herein. Pitfalls in diagnosis led to late recognition and therapy in three patients, with subsequent serious complications; namely, arteriovenous fistula, false aneurysm, and amputation. On the basis of this limited but poignant experience, we propose an outline of steps in management to help others avoid similar problems. If popliteal injury is suspected, we advise exploration immediately to avoid a potential limb-loss crisis. Heparin should be given as soon as diagnosis is made. A posterior incision in the knee crease, rather than the conventional medial approach, gives expedient exposure for precise repair. We also advise passing a no. 3 thrombectomy catheter distally to rule out or retrieve any clot that may have embolized. A completion angiogram is also helpful. Compartment pressure may be measured, but if any doubt exists, a three-compartment fasciotomy should be performed. PMID:3400813
Tawes, R L; Etheredge, S N; Webb, R L; Enloe, L J; Stallone, R J
Extrusion of the lateral meniscus has been reported after posterior root tear or radial tear, partial meniscectomy, and meniscoplasty of discoid meniscus. It has also been shown to be associated with the development of osteoarthritis. This technical note describes a new arthroscopic technique to centralize and stabilize the mid body of the lateral meniscus to restore and maintain the lateral meniscus function by repairing/preventing extrusion of the meniscus. A JuggerKnot Soft Anchor (Biomet, Warsaw, IN), loaded with a MaxBraid suture (Biomet), was placed on the lateral edge of the lateral tibial plateau, just anterior to the popliteal hiatus, through a midlateral portal. A Micro Suture Lasso Small Curve with Nitinol Wire Loop (Arthrex, Naples, FL) was used to pass 2 limbs of the MaxBraid suture through the meniscus at the margin between the meniscus and the capsule. Another anchor was inserted on the lateral edge of the lateral tibial plateau, 1 cm anterior to the first anchor, and the same procedure was repeated. The sutures were then tied by use of a self-locking sliding knot, achieving centralization and secure stabilization of the lateral meniscus.
Extrusion of the lateral meniscus has been reported after posterior root tear or radial tear, partial meniscectomy, and meniscoplasty of discoid meniscus. It has also been shown to be associated with the development of osteoarthritis. This technical note describes a new arthroscopic technique to centralize and stabilize the mid body of the lateral meniscus to restore and maintain the lateral meniscus function by repairing/preventing extrusion of the meniscus. A JuggerKnot Soft Anchor (Biomet, Warsaw, IN), loaded with a MaxBraid suture (Biomet), was placed on the lateral edge of the lateral tibial plateau, just anterior to the popliteal hiatus, through a midlateral portal. A Micro Suture Lasso Small Curve with Nitinol Wire Loop (Arthrex, Naples, FL) was used to pass 2 limbs of the MaxBraid suture through the meniscus at the margin between the meniscus and the capsule. Another anchor was inserted on the lateral edge of the lateral tibial plateau, 1 cm anterior to the first anchor, and the same procedure was repeated. The sutures were then tied by use of a self-locking sliding knot, achieving centralization and secure stabilization of the lateral meniscus. PMID:23766997
We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two
Stephen C. Weber; Jeffrey S. Abrams; Wesley M. Nottage
Background: In patients with patellar tendinopathy in whom nonoperative management is unsuccessful, surgery is an option to return to high levels of physical activity. Although open surgery is traditionally advocated, an arthroscopic approach may be safe and effective.Purpose: This study was undertaken to analyze medium- and long-term outcome of 64 patients undergoing arthroscopic surgery for the management of patellar tendinopathy
Antonio Pascarella; Mahbub Alam; Fabio Pascarella; Carmine Latte; Mariano Giuseppe Di Salvatore; Nicola Maffulli
We evaluated 69 arthroscopically assisted anterior cru ciate ligament reconstructions for acute tears at an average followup of 60 months. We used a distally based single semitendinosus and gracilis tendon graft passed over the top and fixed to the femur. Combined medial collateral ligament lesions were seen in 30 knees, and they were repaired when found in the distal third
Paolo Aglietti; Roberto Buzzi; Pier Paolo M. Menchetti; Francesco Giron
Degenerative change involving the acromioclavicular (AC) is frequently seen as part of a normal aging process. Occasionally, this results in a painful clinical condition. Although AC joint symptoms commonly occur in conjunction with other shoulder pathology, they may occur in isolation. Treatment of isolated AC joint osteoarthritis is initially non-surgical. When such treatment fails to provide lasting relief, surgical treatment is warranted. Direct (superior) arthroscopic resection of the distal (lateral) end of the clavicle is a successful method of treating the condition, as well as other isolated conditions of the AC joint. The following article reviews appropriate patient evaluation, surgical indications and technique.
Scaphotrapeziotrapezoid (STT) joint osteoarthritis accounts for 13% of all wrist arthritis cases. The arthroscopic treatment combines radial midcarpal portal and STT portal called 1-2 midcarpal portal. We performed 13 isolated resections from the scaphoid distal pole. Patients were only women (average age, 58 years). Pain, mobility, and muscular strength improved significantly. At the same time, we fitted an interposition pyrocarbon implant after resection in 13 patients (average age, 67 years). We had 2 implant dislocations due to technical errors. Outcome quality optimized by the initial mini-invasive approach and arthroscopy should make selection of some treatment indications possible. PMID:21871354
Background: The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic rotator cuff repair demonstrate lower healing rates than traditional open techniques. Transosseous-equivalent repair techniques (suture bridge) were developed to improve the initial fixation strength.Purpose: To compare the initial in vitro tensile fixation strength of a transosseous-equivalent suture bridge (TOE-SB) rotator cuff repair construct to a
Steve B. Behrens; Benjamin Bruce; Alan J. Zonno; David Paller; Andrew Green
From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 pa tients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent re pair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose
Gregory A. Hanks; Trenton M. Gause; John A. Handal; Alexander Kalenak
The frequent occurrence of degenerative joint disease following complete or partial meniscectomy is well recognized. Meniscal repair has been shown to lead to a lower prevalence of degenerative changes in the knee. Arthroscopically assisted inside-to-outside meniscal repair is a safe, reproducible technique for for salvaging the torn meniscus. PMID:8800529
Pigmented villonodular synovitis (PVNS) is a lesion of benign proliferative synovium that invades joint, tendon sheath, and bursa. It mainly occurs in 1 joint, the knee joint or hand, and multi-joint invasion is reported to be <1%. Rare cases have been reported of PVNS occurring in the shoulder joint. Generally, total synovectomy is a standard treatment of PVNS. However, complete synovectomy is sometimes impossible because of difficulty of visualization and access to the whole joint and subacromial space. Therefore, recurrence of the disease is always of concern. This article presents a case of 64-year-old patient with pain and swelling of bilateral shoulder joints of 4 months' duration. Physical examination showed atrophy of the deltoid and infraspinatus and a mass-like protrusion on the anterior portion of left shoulder. Active forward elevation was limited to 30 degrees on the right and 90 degrees on the left. Overall synovial hyperplasia and nodular mass was observed on magnetic resonance imaging. Massive rotator cuff tear and invasion of the lesion toward the subacromial space and deltoid muscle was noted as well. Arthroscopic examination revealed a typical finding of PVNS: yellowish brown pigmentation over the overall joint capsule and subacromial space. Arthroscopic total synovectomy without rotator cuff repair was performed for both shoulders. Clinical outcomes showed good pain relief and no recurrence of the disease, although range of motion and muscle strength was not significantly improved, possibly due to accompanied massive rotator cuff tear. Arthroscopic total synovectomy in the treatment of PVNS of the shoulder joint is a minimally invasive and effective method, which makes it possible to access the whole joint space and subacromial space. PMID:20806759
Hip arthroscopy has been shown to offer minimally invasive access to the hip joint compared with standard open arthrotomy. The use of arthroscopy for diagnosing and treating disorders about the hip continues to evolve. This study describes a case that involves arthroscopic removal of a bullet from a low-velocity gunshot wound. The patient sustained a gunshot wound that entered the abdomen and traversed the small bowel, sigmoid colon then penetrated the urinary bladder before ending up in the medial wall of the acetabulum. After surgical repair of the viscus, the bullet was retrieved from the hip joint using standard arthroscopic portals and a fracture table. A number of issues led to the decision to use arthroscopy. Most importantly was the need to minimize soft tissue dissection, which was required to access the bullet, without interfering with previous wound at the suprapubic area. The risks of potential bullet fragmentation and migration, as well as a possible abdominal compartment syndrome were considered before proceeding. Arthroscopy allowed adequate inspection of the articular surface, irrigation of the joint, and removal of the foreign body while avoiding an invasive arthrotomy with its associated morbidity and soft tissue disruption. This surgical technique afforded a very satisfactory outcome for this patient and serves as a model for others when encountering a similar injury pattern in a trauma patient. It is a procedure that can be performed safely, quickly, and with minimal complications for surgeons with experience in arthroscopy of the hip joint.
Background: Establishing the validity of classification schemes is a crucial preparatory step that should precede multicenter studies. There are no studies investigating the reproducibility of arthroscopic classification of meniscal pathology among multiple surgeons at different institutions.Hypothesis: Arthroscopic classification of meniscal pathology is reliable and reproducible and suitable for multicenter studies that involve multiple surgeons.Study Design: Multirater agreement study.Methods: Seven surgeons
Warren R. Dunn; Brian R. Wolf; Annunziato Amendola; Jack T. Andrish; Christopher Kaeding; Robert G. Marx; Eric C. McCarty; Richard D. Parker; Rick W. Wright; Kurt P. Spindler
Major advances in MRI and arthroscopy have allowed for enhanced diagnosis and subsequent management of ligamentous and soft tissue injuries of the knee. Recognition of the appearance of acute ACL and PCL injuries on MRI can enhance arthroscopic reconstruction. PCL injuries are often more subtle and can present with indirect signs. T2-weighted MRI imaging can examine which structures have been damaged in the posterolateral corner which may manifest arthroscopically as a drive-through sign. Characterization of PLC, meniscus, MCL injuries and OCD lesions on MRI have remarkable correlation with arthroscopic findings. This article focuses on current understanding of how MRI and athroscopy can enhance treatment of ligamentous and soft tissue injuries of the knee. PMID:23773879
Background: Bone-to-tendon healing in the shoulder can be unpredictable. Biologic augmentation, through the implementation of adult mesenchymal stem cells, may improve this healing process.Purpose: The purpose of this study was to (1) arthroscopically obtain bone marrow aspirates from the proximal humerus during rotator cuff repair, (2) purify and concentrate the connective tissue progenitor cells (CTPs) in the operating room efficiently,
Augustus D. Mazzocca; Mary Beth R. McCarthy; David M. Chowaniec; Mark P. Cote; Robert A. Arciero; Hicham Drissi
Background and Objectives: Administration of analgesic medication before surgery, rather than at the completion of the procedure, may reduce postoperative pain. Similarly, administration of multiple analgesics, with different mechanisms of action, may provide improved postoperative pain control and functional recovery. The purpose of our study was to compare pain scores and intravenous opioid consumption after outpatient anterior cruciate ligament (ACL)
Ola P. Rosaeg; Barbara Krepski; Nicholas Cicutti; Kevin C. Dennehy; Anne C. P. Lui; Donald H. Johnson
Ganglion cysts are the most common tumor in the wrist. Dorsal carpal ganglion cysts represent 60 to 70% of all ganglion cysts in the hand and wrist. Standard treatment has been limited to observation, rest, immobilization, aspiration with or without injection, and surgical excision. Arthroscopic resection of dorsal carpal ganglion cyst have been done since the late 1980s. It has
Arthroscopic resection of the distal clavicle was used to treat 26 patients who had osteoarthritis of the acro mioclavicular joint. Twenty of these patients were avail able for review at a minimum followup of 2 years. The preoperative ratings for pain, activities of daily living, work, and sports improved markedly in 17 patients postoperatively. No intraoperative complications were noted. The
An original technique for the treatment of acute acromioclavicular (AC) joint dislocations is proposed. It consists of a closed reduction and stabilization of the AC joint, positioning a cannulated screw between the clavicle and the coracoid under arthroscopic control, without any exposure to x-rays. The conoid and trapezoid ligaments are not sutured or reconstructed. The screw is finally removed under
Thromboembolic complications after arthroscopic shoulder surgery are very unusual and need thorough investigation of the possible origin. In this case of venous pulmonary thromboembolism after arthroscopy of the shoulder, neither a hint of coagulopathy nor an anatomic abnormality could be found that explains this complication. Therefore, irritation of the subclavian vein caused by compression by the motor-driven shaver is probably
Gert K Polzhofer; Wolf Petersen; Joachim Hassenpflug
Hip arthroscopy has been shown to offer minimally invasive access to the hip joint compared with standard open arthrotomy. The use of arthroscopy for diagnosing and treating disorders about the hip continues to evolve. The authors describe an arthroscopically assisted technique for the removal of a bullet lodged in the acetabulum of a patient who sustained a gunshot wound that
Steven B. Singleton; Atul Joshi; Mark A. Schwartz; Cory A. Collinge
Summary: Twenty-five patients underwent arthroscopic debridement to treat early glenohumeral osteoarthritis. The group consisted of 19 men and 6 women with an average age of 46 years (range, 27 to 72 years.) The operative procedure consisted of lavage of the glenohumeral joint, debridement of labral tears and chondral lesions, loose body removal, and partial synovectomy and subacromial bursectomy. Follow-up averaged
David M. Weinstein; John S. Bucchieri; Roger G. Pollock; Evan L. Flatow; Louis U. Bigliani
The hydraulic resistance R across osteochondral tissue, especially articular cartilage, decreases with degeneration and erosion. Clinically useful measures to quantify and diagnose the extent of cartilage degeneration and efficacy of repair strategies, especially with regard to pressure maintenance, are still developing. The hypothesis of this study was that hydraulic resistance provides a quantitative measure of osteochondral tissue that could be used to evaluate the state of cartilage damage and repair. The aims were to (1) develop a device to measure R in an arthroscopic setting, (2) determine whether the device could detect differences in R for cartilage, an osteochondral defect, and cartilage treated using a hydrogel ex vivo, and (3) determine how quickly such differences could be discerned. The apparent hydraulic resistance of defect samples was ~35% less than intact cartilage controls, while the resistance of hydrogel-filled groups was not statistically different than controls, suggesting some restoration of fluid pressurization in the defect region by the hydrogel. Differences in hydraulic resistance between control and defect groups were apparent after 4 s. The results indicate that the measurement of R is feasible for rapid and quantitative functional assessment of the extent of osteochondral defects and repair. The arthroscopic compatibility of the device demonstrates the potential for this measurement to be made in a clinical setting. PMID:21107696
McCarty, William J; Luan, Anna; Sundaramurthy, Priya; Urbanczyk, Caryn; Patel, Atal; Hahr, Jacob; Sotoudeh, Mohammad; Ratcliffe, Anthony; Sah, Robert L
The primary simultaneous diagnosis and therapy of TFCC tears in distal radius fractures is still the exception. We present our results of arthroscopic treatment of these injuries. From January 1998 until September 1999, we treated 21 patients with a type C fracture (AO classification) of the distal radius and one patient with a scaphoid fracture and TFCC tears. The Palmer 1A (n = 5) and 1 C (n = 4) tears have been arthroscopically shaved as well as the meniscal tear (n = 1). The Palmer 1B tears were refixed either in an outside-inside technique (n = 6) or in a new all-inside technique (n = 6). Palmer 1D tears were refixed in the Fellinger technique (n = 5). In the clinical follow-up examination six to fifteen months later, we saw symptoms of ulnar-sided wrist pain only in one case of a Palmer 1B tear treated in an outside-inside technique. Especially the patients treated by the new all-inside technique were free from symptoms of TFCC instability. We conclude, that arthroscopic treatment of TFCC tears in acute radius fractures is possible with good results. The new technique of all-inside repair is minimally invasive and shows good results. PMID:11518985
Böhringer, G; Schädel-Höpfner, M; Junge, A; Gotzen, L
Rotator cuff tears in individuals under age 40 are uncommon; especially rare is the younger patient with acombination of full thickness rotator cuff tear and a Bankart lesion. Operative management of this challenging patient must provide for a “stable” repair of both lesions to allow for optimal rehabilitation. Our surgical preference includes arthroscopic subacromial decompression, rotator cuff repair, and a
Kenneth Brislin; David Rubenstein; Merrick Wetzler; Christian Subbio
The diagnosis and treatment of superior labrum (SLAP) tears have improved with the development of arthroscopic shoulder surgery techniques. With tears involving detachment of the biceps anchor, the goal is to restore stability to the labrum and biceps anchor and achieve healing to the glenoid. Suture repair with anchors is currently the repair technique of choice. The purpose of this
CONRAD WANG; EDWARD YIAN; PETER J. MILLETT; JON J. P. WARNER
Purpose A double-blind clinical trial was conducted to determine the effect of inflation of a thigh tourniquet during anterior cruciate\\u000a ligament repair on arthroscopic visibility, duration of procedure, postoperative pain and opioid consumption.\\u000a \\u000a \\u000a \\u000a Methods Thirty patients were randomly allocated into two groups; Group I had the thigh tourniquet inflated during surgery whereas\\u000a the tourniquet was not inflated in Group II patients. All
Jon Hooper; Ola P. Rosaeg; Barbara Krepski; Donald H. Johnson
Knee arthroscopy to address meniscus tears is among the most common orthopedic procedures performed, and technical advances in the treatment of meniscus tears have affected the treatment options available to orthopedic surgeons. The purpose of this study was to perform a large cross-sectional analysis of orthopedic patients to investigate trends in arthroscopic meniscectomy and meniscus repair in the United States. Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology codes 29881 and 29880) and arthroscopic meniscus repair (Current Procedural Terminology codes 29882 and 29883) were identified using the PearlDiver Patient Record Database, which is a national database of insurance records. The authors identified 187,607 arthroscopic medial or lateral meniscectomies and repairs performed between 2004 and 2009. Ninety-six percent of patients underwent meniscectomy and 4% underwent repair. No change occurred in the incidence of medial or lateral meniscectomy. The incidence of medial meniscus repair decreased from 5.3 cases per 10,000 patients in 2004 to 3.8 in 2009 (P<.001), although no significant change occurred in the incidence of lateral meniscus repair. Medial meniscectomy was most commonly performed in patients aged 50 to 59 years, whereas lateral meniscectomy demonstrated a bimodal age distribution. Conversely, meniscus repairs were most frequently performed in patients aged 10 to 19 years. Sex differences were more pronounced with meniscus repair (63% male vs 37% female) compared with meniscectomy (53% male vs 47% female). A high frequency of meniscus debridement can be expected in arthroscopic knee surgery. Despite advances in meniscus repair techniques and devices, no increase occurred in the performance of meniscus repair compared with meniscectomy. PMID:23937745
Montgomery, Scott R; Zhang, Alan; Ngo, Stephanie S; Wang, Jeffrey C; Hame, Sharon L
Purpose: We present our preliminary studies using LactoSorb plates (Lorenz\\/Biomet, Warsaw, IN) for rotator cuff repair in humans. The use and application of this plate are described as an adjunct to prevent hole migration in trough-tunnel repairs of rotator cuff tears. Methods: Fifty patients with rotator cuff tears documented by magnetic resonance imaging underwent arthroscopic subacromial decompression followed by a
Kevin J. Kessler; Amy E. Bullens-Borrow; Jesse Zisholtz
We describe two patients who sustained serious vascular complications following arthroscopic lateral meniscectomy. Such injuries are rarely encountered or reported in the literature and, as such, the potential catastrophic sequelae of this particular complication of arthroscopy may be underestimated. Investigation of suspected popliteal artery injuries is outlined and the need for a high index of suspicion and early referral to a vascular surgeon is stressed. PMID:8679036
Posterior glenohumeral instability remains a difficult problem. There are still many controversies regarding surgical treatment, due to a lack of understanding the pathomechanical issues leading to posterior instability. This article presents a new arthroscopic technique of posterior bone block augmentation, which we found to be effective, repeatable and successful. This technique can be used for combined soft tissue and bony defects as well as for revisions after previous soft tissue reconstructions. PMID:22910897
The most common injuries reported in the literature regarding the sport of boxing are to the brain, eyes, kidneys and hands.\\u000a Shoulder injuries have not been fully reported in the literature until recently, as a result we aimed to present our arthroscopic\\u000a findings in amateur boxers. Ten amateur boxers with complaints of pain in the shoulder region and decreased performance
Hüseyin Özkan; ?brahim Yanm??; Mustafa Kürklü; Ali ?ehirlio?lu; Servet Tunay; Mahmut Kömürcü; Mustafa Ba?bozkurt
Objectives The aim of this study was to determine whether there is any significant difference in temporal measurements of pain, function and rates of re-tear for arthroscopic rotator cuff repair (RCR) patients compared with those patients undergoing open RCR. Methods This study compared questionnaire- and clinical examination-based outcomes over two years or longer for two series of patients who met the inclusion criteria: 200 open RCR and 200 arthroscopic RCR patients. All surgery was performed by a single surgeon. Results Most pain measurements were similar for both groups. However, the arthroscopic RCR group reported less night pain severity at six months, less extreme pain and greater satisfaction with their overall shoulder condition than the open RCR group. The arthroscopic RCR patients also had earlier recovery of strength and range of motion, achieving near maximal recovery by six months post-operatively whereas the open RCR patients took longer to reach the same recovery level. The median operative times were 40 minutes (20 to 90) for arthroscopic RCR and 60 minutes (35 to 120) for open RCR. Arthroscopic RCR had a 29% re-tear rate compared with 52% for the open RCR group (p < 0.001). Conclusions Arthroscopic RCR involved less extreme pain than open RCR, earlier functional recovery, a shorter operative time and better repair integrity.
A new method of arthroscopic partial meniscectomy for horizontal tear of discoid lateral meniscus was devised to preserve as much meniscal tissue as possible. To evaluate the clinical result of this method for horizontal tear of discoid lateral meniscus, 31 knees (30 patients) were reviewed at an average follow-up of 35 months (range 14-48 months). Horizontally torn discoid lateral menisci were classified as incomplete (11 cases) or complete (20 cases) by the Watanabe classification; no Wrisberg type was noted. Partial meniscectomy was performed in all cases. For the technique of a new method of partial meniscectomy, the unstable leaf of the horizontally torn meniscus was removed to the peripheral rim, but the stable one was preserved and reshaped to produce the similar appearance to the normal lateral meniscus in terms of width and thickness. It was trimmed to have a balanced rim of meniscal tissue about 6-8 mm in width. Meniscal repair was added to partial meniscectomy in one case. All the cases were rated using the Lysholm Knee Scoring Scale and were reviewed to recognize retear clinically. The scores increased after partial meniscectomy by average 20.7 (from 73.0 to 93.7). Recurrence of tear or aggravation of symptoms was not noted at the final follow-up. PMID:11819016
Bin, Seong-Il; Jeong, Sang-Il; Kim, Jong-Min; Shon, Hyun-Chul
For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopicrepair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471
This study examines the intra-articular anatomy and safe zones for arthroscopic resection of the common extensor origin for the treatment of lateral epicondylitis. The extensor complex was arthroscopically debrided in 7 cadaveric elbows to determine the percentage of each tendinous origin that was resectable. Elbow stability was assessed, and safe zones of resection were determined. The extensor carpi radialis brevis
Resection is the accepted treatment for arthritis of the acromioclavicular joint. It may be performed either open or arthroscopically. During arthroscopic resection, visualizing the superior aspect of the joint and determining the limit of resection can be difficult. We describe a new technique to improve visualization during the procedure.
From 1995 to 1998, 30 patients with dorsal wrist ganglia and four with recurrent dorsal ganglia underwent arthroscopic resection. At a mean follow-up of 16 months, no complications were seen, but minimal pain persisted in three patients. Two recurrences were seen after arthroscopic resection of primary ganglia.
R. LUCHETTI; A. BADIA; M. ALFARANO; J. ORBAY; I. INDRIAGO; B. MUSTAPHA
|Arthroscopic examination of 16 dancers with dance-related knee injuries which defied conservative treatment showed 15 meniscal tears and 4 cases of chondromalacia patellae. Partial arthroscopic meniscectomy was used to treat the tears. The results were excellent, with 13 of the 16 returning to preoperative levels of dance activity. (MT)|
The gold standard of treatment for glenohumeral instability has traditionally been viewed as open shoulder stabilization. With the increased awareness of complex instability patterns and the ability to preoperatively detect concomitant pathology with advanced imaging modalities, an evidence-based shift to an all-arthroscopic approach to shoulder stabilization surgery is occurring. Current data suggest that patients who meet eligibility criteria for arthroscopic stabilization (those without significant bony lesions or significant deformity) can expect equivalent rates of recurrence, better functional outcomes, and less morbidity. Modern arthroscopic techniques using suture anchors and capsular plication have resulted in a significant improvement over previous reports in the orthopaedic literature. An argument is put forth on the benefits of an all-arthroscopic approach to shoulder stabilization in athletes and nonathletes alike based on a review of the current orthopaedic literature comparing the evolved arthroscopic technique with more traditional open methods. PMID:21872422
Elbow arthroscopic surgery can now effectively treat a variety of conditions that affect athletes. Advances in instrumentation, increased surgeon familiarity, and expanded indications have led to significant growth in elbow arthroscopic surgery in the past few decades. While positioning, portal placement, and specific instruments may vary among surgeons, anatomic considerations guide surgical approaches to minimize neurovascular compromise. Arthroscopic procedures vary in difficulty, and surgeons should follow stepwise advancement with experience. Removal of loose bodies, debridement of synovial plicae, and debridement of the extensor carpi radialis brevis for lateral epicondylitis are considered simple procedures for novice elbow arthroscopic surgeons. More advanced procedures include management of osteochondritis dissecans, valgus extension overload in the throwing athlete, and capsular release. With proper technique, a variety of athletic elbow conditions can be treated arthroscopically with predictable results and minimal morbidity. PMID:23572098
Byram, Ian R; Kim, H Mike; Levine, William N; Ahmad, Christopher S
Background: Bennett lesions are often observed in throwing athletes, and, although usually asymptomatic, they can sometimes become painful and disturb an athlete's throwing ability. Because it is clinically difficult to determine whether a Bennett lesion is symptomatic or whether pain is from another lesion, the outcome of surgical treatment is variable.Hypothesis: Arthroscopic resection of Bennett lesions diagnosed according to our
The ulnar impaction syndrome is due to hyperpressure in the ulnocarpal joint. It occurs most frequently following distal radial fractures with shortening, but can also be secondary to a primitive length discrepancy between a short radius and a long ulna (positive ulnar variance). Symptoms and clinical findings, even though characteristic, are not specific. Standard X rays show a positive ulnar variance, and sometimes a hyperpressure cyst in the lunate. CT arthroscan and MRI studies demonstrate indirect signs of hyperpressure. If medical treatment fails to improve the condition, the choice surgical technique is arthroscopic, allowing debridement of the TFCC central tear, and shortening of the horizontal aspect of the ulnar head. PMID:17361891
The ulnar impaction syndrome is due to hyperpressure in the ulnocarpal joint. It occurs most frequently following distal radial fractures with shortening, but can also be secondary to a primitive length discrepancy between a short radius and a long ulna (positive ulnar variance). Symptoms and clinical findings, even though characteristic, are not specific. Standard X rays show a positive ulnar variance, and sometimes a hyperpressure cyst in the lunate. CT arthroscan and MRI studies demonstrate indirect signs of hyperpressure. If medical treatment fails to improve the condition, the choice surgical technique is arthroscopic, allowing debridement of the TFCC central tear, and shortening of the horizontal aspect of the ulnar head. PMID:17349396
A long-term follow-up was performed on 22 patients treated for a posterior glenoid osteophyte and symptomatic posterior shoulder pain during either the late cocking, acceleration, or follow-through phases of throwing. Arthroscopic evaluation of these patients revealed undersurface tearing of the rotator cuff in all but one. Fifteen patients also had tearing of the posterior labrum. Anterior labral fraying was noted in four patients. Treatment consisted of debridement of the rotator cuff and labral tears. The posterior glenoid osteophyte was removed arthroscopically in 11 patients. Eighteen of 22 throwers treated were available for long-term follow-up at a mean of 6.3 years (range, 1 to 12). Only 10 of 18 (55%) throwers evaluated had returned to their premorbid level of throwing. All 10 were asymptomatic and had maintained a high level of performance for a mean of 3.6 years (range, 1 to 8). At the time of latest follow-up, five players were still participating at the major league level and five had retired. One patient had recurrence of the exostosis 8 years after surgery. Among our patients a trend existed toward a poorer result and failure of return to activity with a posterior osteophyte greater than 100 mm2. A posterior glenoid exostosis, when identified in the symptomatic shoulder of the throwing athlete, can be considered a definite marker of internal impingement. PMID:10102090
Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as radial tears or avulsions of the posterior horn attachment to bone. After a root tear, there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. Previous cadaver studies from our institution have shown that root repair of the medial meniscus is successful in restoring joint biomechanics to within normal limits. Indications for operative management of meniscal root tears include (1) a symptomatic medial meniscus root tear with minimal arthritis and having failed non-operative treatment, and (2) a lateral root tear in associated with an ACL tear. In this review, we describe diagnosis, imaging, patient selection, and arthroscopic surgical technique of medial and lateral meniscus root injuries. In addition we highlight the pearls of repair technique, associated complications, post-operative rehabilitation regimen, and expected outcomes. PMID:22555205
Background Arthroscopic surgical training is inherently difficult due to limited visibility, reduced motion freedom and non-intuitive hand-eye coordination. Traditional training methods as well as virtual reality approach lack the direct guidance of an experienced physician. Methods This paper presents an experience-based arthroscopic training simulator that integrates motion tracking with a haptic device to record and reproduce the complex trajectory of an arthroscopic inspection procedure. Optimal arthroscopic operations depend on much practice because the knee joint space is narrow and the anatomic structures are complex. The trajectory of the arthroscope from the experienced surgeon can be captured during the clinical treatment. Then a haptic device is used to guide the trainees in the virtual environment to follow the trajectory. Results In this paper, an experiment for the eight subjects’ performance of arthroscopic inspection on the same simulator was done with and without the force guidance. The experiment reveals that most subjects’ performances are better after they repeated the same inspection five times. Furthermore, most subjects’ performances with the force guidance are better than those without the force guidance. In the experiment, the average error with the force guidance is 33.01% lower than that without the force guidance. The operation time with the force guidance is 14.95% less than that without the force guidance. Conclusions We develop a novel virtual knee arthroscopic training system with virtual and haptic guidance. Compared to traditional VR training system that only has a single play-script based on a virtual model, the proposed system can track and reproduce real-life arthroscopic procedures and create a useful training database. From our experiment, the force guidance can efficiently shorten the learning curve of novice trainees. Through such system, novice trainees can efficiently develop required surgical skills by the virtual and haptic guidance from an experienced surgeon.
The outcome of arthroscopic procedures is related to the surgeon’s skills in arthroscopy. Currently, evaluation of such skills\\u000a relies on direct observation by a surgeon trainer. This type of assessment, by its nature, is subjective and time-consuming.\\u000a The aim of our study was to identify whether haptic information generated from arthroscopic tools could distinguish between\\u000a skilled and less skilled surgeons.
George Chami; James W. Ward; Roger Phillips; Kevin P. Sherman
Two cases are presented that demonstrate the utility of arthroscopic intervention for the management of gunshot wounds to the shoulder. The first report involves a 24-year-old man with a retained bullet in his glenohumeral joint after a drive-by shooting The intra-articular bullet was retrieved arthroscopically avoiding chondral injury from the mechanical effects of a loose body as well as the
Ivan S. Tarkin; Armodios Hatzidakis; Samuel C. Hoxie; Charles E. Giangara; Reginald Q. Knight
We evaluated the results of arthroscopic meniscectomy in patients with discoid lateral menisci of the knee. Discoid lateral menisci were detected in 308 patients, of whom 197 (124 males, 73 females; mean age 34.5 years, range 6-67) were clinically, radiologically, and arthroscopically found to be symptomatic and underwent partial meniscectomy. The average period between injury and operation was 13.2 months
Mehmet Asik; Cengiz Sen; Omer F. Taser; Aziz K. Alturfan; Yunus V. Sozen
The authors report three cases in which cerebral ischemia occurred during arthroscopic shoulder surgery performed in beach chair position under general anaesthesia and interscalene plexus block. Several similar cases have been published in the literature. This rare but extremely severe complication is related to the decrease in cerebral perfusion pressure (CPP). Monitoring of CPP in the beach chair position using the measurement of arterial pressure and taking into account the hydrostatic gradient is essential. Prevention includes correction of preoperative hypovolaemia, treatment of postural arterial hypotension, adequate installation of the patient's head, aggressive treatment of perioperative arterial hypotension (whatever the cause) and avoidance of deliberate perioperative arterial hypotension. Routine use of non-invasive monitoring of cerebral oxygenation has been advocated to avoid this accident but its usefulness has to be confirmed by clinical studies. PMID:23069139
Villevieille, T; Delaunay, L; Gentili, M; Benhamou, D
Ulnar shortening osteotomy was performed in 11 wrists with ulnar abutment syndrome, after failed arthroscopic surgery on the TFCC (ten debridements, one repair). A delayed union was present in three, a non-union occurred in two, of whom one needed a revision and grafting procedure. According to the Mayo wrist score, only four had an acceptable outcome. Patient's satisfaction was higher: seven were satisfied, four were not. The postoperative wrist pain score was good in ten patients. Overall outcome was not very successful. Problems related to the procedure could be avoided by adapting the technique (oblique osteotomy, palmar placement of the plate, and compression devices). The key statement remains however to us; ulnar sided wrist pain thought to be caused by an ulnar abutment is not necessarily resolved by decompressing the ulnocarpal joint. PMID:11723772
A new method for arthroscopic meniscal repair using sutures with multiple knots was developed, and its mechanical strength was evaluated. Sutures are passed arthroscopically through the torn meniscus using a needle with a cleft in its tip, and when the needle is withdrawn, knots are placed both in the meniscus and the joint capsule. Our method does not require additional skin incisions and can be performed for repair of posterior tears. Furthermore, this all-inside technique minimizes the risk of popliteal neurovascular injury. Biomechanical analysis using bovine menisci showed that the maximum frictional force between the suture and meniscus was greater than the maximum strength of a suture itself. Our method is simple and rapid, making it easy to insert multiple sutures to achieve adequate stability. PMID:10355724
Background? Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives? Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy? A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria? Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2?years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40?years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis? Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results? Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P?>?0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions? Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. PMID:21631787
We report a case of aseptic synovitis in a 19-year-old man. The synovitis of the left knee developed 13 months after meniscal repair using the biodegradable Meniscus Arrow (Bionx Inc, Malvern, PA). Histologic examination revealed chronic nonspecific synovitis and birefringent materials. Immunohistochemical tests were positive in lysozyme, ?-1-antitrypsin, and ?-1-antichymotrypsin. After arthroscopic synovectomy, pain and swelling of the knee joint
Arthroscopic rotator cuff repair, once the domain of a select group of surgeons, is quickly becoming the standard of care\\u000a employed by more and more orthopedists. This transformation is due in great part to the advent of improved anchors, stronger\\u000a suture material, and enhanced suture passing devices, resulting in enhanced success rates.1–4 However, the most significant advances have come about
The results of open or arthroscopicrepair of the rotator cuff vary widely in the literature.1–15 The factors that have been shown to affect outcome relate to the technique of surgery,3,9,16–18 the size of the tear,9–11 the quality of the tissue and age of the patient,10,11,15 the chronicity of the tear,9–11,19,20 the degree of muscle atrophy, and the degree of
Joseph P. Iannotti; Michael J. DeFranco; Michael J. Codsi; Steven D. Maschke; Kathleen A. Derwin
Successful techniques for arthroscopicrepair of subscapularis tendon tears have been previously described in the literature. Recommendations regarding portal placement, tissue mobilization, and suture passage have been published. We present a novel technique that uses a shuttle suture passed with the Viper suture passer (Arthrex, Naples, FL) through a standard anterior arthroscopy portal. The described technique easily passes a suture through the subscapularis tendon while the surgeon visualizes suture placement from the posterior portal. PMID:23767007
Nystrom, Stephen; Fagan, Paul; Vedder, Kristin; Heming, James
Successful techniques for arthroscopicrepair of subscapularis tendon tears have been previously described in the literature. Recommendations regarding portal placement, tissue mobilization, and suture passage have been published. We present a novel technique that uses a shuttle suture passed with the Viper suture passer (Arthrex, Naples, FL) through a standard anterior arthroscopy portal. The described technique easily passes a suture through the subscapularis tendon while the surgeon visualizes suture placement from the posterior portal.
Nystrom, Stephen; Fagan, Paul; Vedder, Kristin; Heming, James
Remaining superior osteophytes or osseous spurs after arthroscopic lateral clavicle resection can cause persistent pain and could lead to revision surgery. A new method of intraoperative ultrasonographic imaging of the result of the operation during arthroscopic lateral clavicle resection is presented. In 10 patients with acromioclavicular arthritis, standardized arthroscopic lateral clavicle resection was performed. Intraoperatively, the space between the clavicle
Thomas Dirk Boehm; Thomas Barthel; Ulrich Schwemmer; Frank E Gohlke
Forty patients with traumatic knee hemarthrosis were examined within 1 week after injury and observations made with magnetic resonance imaging, scintigraphy, arthroscopic evaluation, radiography, and physical ex amination were compared. Thirty-four patients (85%) had anterior cruciate ligament injuries according to the arthroscopic findings and 28 (83%) of these had asso ciated meniscal tears. Magnetic resonance imaging confirmed the arthroscopic findings,
Torsten Adalberth; Harald Roos; Marten Laurén; Per Åkeson; Maja Sloth; Kjell Jonsson; Anders Lindstrand; L. Stefan Lohmander
Nonsteroidal antiinflammatory drugs (NSAIDs) provide effective postoperative analgesia after arthroscopic knee surgery. Some investigators have suggested that the pre- emptive administration of NSAIDs may reduce postoper- ative analgesic requirements and hypersensitivity. We evaluated the analgesic effect of administering rofecoxib either before or after surgical incision in patients undergo- ing arthroscopic knee surgery under local anesthesia. Sixty patients undergoing arthroscopic meniscectomy
Scott S. Reuben; Shailesh Bhopatkar; Holly Maciolek; Wanda Joshi; Joseph Sklar
Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically. The primary reason for this restriction in arthroscopic practice is the locality of the posteromedially positioned ulnar nerve in the posterior compartment. Experience and practice with elbow arthroscopic techniques allows surgeons to expand the indications for arthroscopic treatment of an increasing number of elbow pathologies. A philosophy that is routine in open surgery when dealing with pathology that is adjacent to neurovasculature is to identify the neurovasculature and hence reduce the risk of injury. Our aim is to translate this philosophy to arthroscopy by helping define a safe technique for identifying the ulnar nerve in the posteromedial elbow gutter and allowing for a safer performance of procedures in the posteromedial region of the elbow.
In cubarthritis—osteoarthritis of the elbow—surgical procedures may be considered to debride the elbow joint to reduce pain, to increase mobility, and to postpone joint replacement surgery. The ulnohumeral arthroplasty as described by Outerbridge and Kashiwagi was originally introduced to debride both anterior and posterior elbow compartments through a direct posterior mini-open approach. To achieve this, a distal humeral fenestration throughout the humeral fossa is performed. Although with an elbow arthroscopy, a technique that was obviously developed later on, all compartments can be easily visualized. The arthroscopic fenestration of the humerus preserves its advantages, with good clinical results focused on pain relief and gaining mobility. On top, future elbow joint locking based on degenerative loose bodies can be prevented. Therefore, this surgery is often done in young, more active patients and even in sportsmen. These patients, however, need to be prompted to restrict loading on the elbow in the immediate postoperative period, because the elbow is biomechanically weakened and may be prone to a fracture. However, both outcome and postoperative rehabilitation are promising and the arthroscopic Outerbridge procedure is a reliable procedure with an easy rehabilitation. Therefore, the threshold is relatively low in early cubarthritis and recurrent locking of the elbow. In this paper, we present a literature review and the author's experience and own research on the Outerbridge procedure.
We report a case of aseptic synovitis in a 19-year-old man. The synovitis of the left knee developed 13 months after meniscal repair using the biodegradable Meniscus Arrow (Bionx Inc, Malvern, PA). Histologic examination revealed chronic nonspecific synovitis and birefringent materials. Immunohistochemical tests were positive in lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. After arthroscopic synovectomy, pain and swelling of the knee joint were relieved and the patient's range of motion fully recovered. We have found no previous report of aseptic synovitis accompanying meniscal repair using the biodegradable Meniscus Arrow. PMID:11154373
Seventeen patients with recurrent posterior shoulder instability underwent posterior capsular plication with or without suture anchors, between 1990 and 1992. Minimum 2-year follow-up was available for 14 patients (average, 33 months; range, 24 to 45 months). The etiology involved trauma in 9 cases, recurrent microtrauma in 4 cases, and no trauma in 1 case. Posterior capsular laxity was present in all 14 cases and was believed to be the primary pathology, although 12 patients showed some form of labral pathology. The patients were interviewed and assessed in six categories: pain, strength, function, stability, range-of-motion, and satisfaction. Twelve patients had excellent results and 2 had fair results. Nine of 10 patients who participate in recreational or competitive athletics reported full return to their preinjury level of function in their respective sports. There was one recurrence of posterior shoulder instability which was remedied with a second arthroscopic posterior capsular reconstruction. All 14 patients were satisfied with the results of their surgery, and no complications were noted. Capsular plication is a promising technique in the treatment of recurrent posterior shoulder instability. PMID:9531126
Arthroscopic assessment and treatment of tibial plateau fractures has gained popularity in recent years. This article describes some maneuvers to facilitate the management of these fractures with the arthroscope. We use a 14-mm rounded curved periosteal elevator to manipulate fragments within the joint instead of using a probe. To facilitate visualization of fractures, we describe the use of loop sutures around the meniscus to retract the meniscus when there is a tear in the meniscus. We suggest the use of the arthroscope for directly viewing the interosseous space to be sure that any internal fixation devices remain outside the articular space. The use of these tactics will allow a faster, more accurate reduction with less radiation exposure in patients with displaced tibial plateau fractures. PMID:9127091
Aim. To prospectively assess the effectiveness of revision with open subacromial decompression in patients who had a previous unsatisfactory outcome with the arthroscopic procedure. Methods. 11 patients were identified for the study, who did not demonstrate expected improvement in symptoms after arthroscopic acromioplasty. All patients underwent structured rehabilitation. Functional evaluation was conducted using the Hospital for Special Surgery, New York, shoulder rating questionnaire. Results. M?:?F was 7?:?4. The mean age was 57?years. The average shoulder score improved from 49.6 preoperatively to 56 postoperatively at an average followup of 16 months. Two patients showed deterioration in their shoulder scores after revision while the rest showed only marginal improvement. All except one patient stated that they would opt for surgery again if given a second chance. Conclusion. In the group of patients that fail to benefit from the arthroscopic decompression, only a marginal improvement was noted after revision with open decompression.
Studies have demonstrated favorable outcomes of arthroscopic decompression for ganglion cyst in the supraspinous fossa; however, little attention has been paid to the difficulty in detecting these cysts during arthroscopy. In this report, we present 2 cases in which ganglion cysts in the supraspinous fossa were undetectable during arthroscopy. The ganglion cysts were not identified in these cases during surgery despite arthroscopic decompression being performed through the area in which the cyst was expected until the suprascapular nerve was entirely exposed. After surgery, magnetic resonance imaging (MRI) confirmed the disappearance of the ganglion cyst and external rotation strength was fully improved, without shoulder pain. We emphasize here that surgeons should be aware of this difficulty when performing arthroscopic decompression of ganglion cysts in the supraspinous fossa. PMID:23925157
Objective: To assess the accuracy of clinical examination by non-specialist orthopaedic surgeons of patients presenting to a diagnostic and treatment centre (DTC) for arthroscopic shoulder surgery. Methods: A retrospective review of notes of 130 consecutive shoulder arthroscopies performed at a DTC over a 10 month period. Preoperative clinical diagnosis was compared with operative arthroscopic findings. Additional information from preoperative imaging was compared with clinical examination and arthroscopic findings. Preoperative clinical examinations and consent were undertaken by clinical fellows, (SpR level) and non-upper limb consultant orthopaedic surgeons. Consultants specialising in upper limb surgery performed the operations. Results: Six main groups were identified on the basis of clinical examination: impingement 76 cases (58%), instability 22 cases (17%), frozen shoulder 11 cases (8%), rotator cuff tear four cases (3%), non-specific pain eight cases (6%), and normal clinical examination nine cases (7%). Impingement and instability diagnosed clinically strongly correlated with the arthroscopic findings. Clinical diagnosis of frozen shoulder and rotator cuff tears had a weaker correlation with the arthroscopic findings. Of the nine cases of normal clinical examination, abnormality was found at arthroscopy in all cases. Conclusion: There have been very few studies comparing clinical examination of the shoulder with arthroscopic findings. This study emphasises the importance of good clinical examination skills in diagnosing common shoulder abnormalities. The addition of imaging, particularly ultrasound and magnetic resonance imaging further increases the likelihood of an accurate diagnosis. Shoulder examination should be taught with as much emphasis at both undergraduate and postgraduate level as other orthopaedic clinical examinations.
Virtual haptic simulation of minimally invasive arthroscopic surgery becomes an extremely important training tool that allows the medical students to acquire necessary motor skills before they can approach actual patients. Normally, 3D simulation of the interior of a joint requires significant efforts from the software developers but yet remains not always photo realistic. In this paper, we propose a pioneering approach of using augmented real arthroscopic images for realistic and immersive image-driven visualization and haptic interaction within the surgical field as if it were actual three-dimensional scene where body parts displayed in the image act and feel as real 3D objects rather than their images. PMID:23400181
An 86-year-old female with a history of right rotator cuff injury was admitted for arthroscopic shoulder surgery under general anesthesia. There were no remarkable immediate postoperative complications. However, while recovering in the general ward, she developed dyspnea with hypoxia. She was immediately treated with oxygen, and antibiotics after pneumomediastinum was confirmed on both chest x-ray and chest computed tomography. Subcutaneous emphysema on either face or neck followed by arthroscopic shoulder surgery was common, but pneumomediastinum with hypoxia is a rare but extremely dangerous complication. Thus we would like to report our case and its pathology, the diagnosis, the treatment and prevention, with literature review.
Kim, Hae-Kyoung; Ko, Eun-Sung; Kim, Jee-Young; Park, Jung-Min; Kim, Jae-Yun
Introduction This retrospective study presents clinical patient outcomes following meniscal repair using T-Fix devices and a modifiable, progressive rehabilitation program. Materials and methods Fifty-two patients (35 males and 17 females) with a mean age of 26.7 years (range 13–50 years) representing all of the patients who underwent arthroscopic meniscal repair (43 medial meniscus, 12 lateral meniscus) over a 3-year period by the
Yavuz Kocabey; John Nyland; William M. Isbell; David N. M. Caborn
The meniscus plays an important role in the function of the knee. Preservation of the meniscus is preferred if possible when considering treatment of a meniscus tear. A thorough understanding of the anatomy of the meniscus, the structure, the mechanics, and other factors of meniscal healing are critical when evaluating the torn meniscus for a reparative procedure. Many options for meniscus repair exist for the orthopaedist. Options such as open repair or arthroscopically-assisted inside-out techniques have long-term favorable results. The all-inside techniques are attractive because of the decrease in operative time and ease of the technique. Short-term results are positive for the all-inside technique; however, good long-term data on these techniques are lacking. Few well-designed prospective studies exist on any of the meniscus repair techniques. Future directions include the potential use of growth factors and gene therapy to augment meniscus repair. PMID:12218477
McCarty, Eric C; Marx, Robert G; DeHaven, Kenneth E
Nineteen consecutive cases of posttraumatic arthrofi brosis of the elbow secondary to a fracture or fracture- dislocation and treated with arthroscopic debridement and manipulation were retrospectively reviewed. All of the patients had pain and stiffness in their elbows, and all had failed a conservative therapy program. All 19 patients were followed postoperatively for an average of 29 months (range, 12
Surgeons need to know how the material properties of a suture affect the security of a surgical knot. The purpose of this study was to compare the security of some clinically important arthroscopic knots when tied using a braided multifilament suture and to draw comparisons with results of similar knots tied with monofilament suture. Permanent braided polyester suture was used
Different assemblies have endeavored to develop arthroscopic laser surgery. Various lasers have been tried in the treatment of orthopaedic problems, and the most useful has turned out to be the Hol-YAG laser 2.1 nm which is a near- contact laser. By using the laser as a powerful tool, and cutting back on the power level, one is able to better
This is a retrospective study of 46 patients who underwent arthroscopic glenoid labral debridement from June 1988 to June 1990. All patients complained of pain in the involved shoulder and all were active in sports involving overhead use of the shoulder, including 30 baseball players (16 professional, 14 collegiate\\/high school). The average age was 22 years (range 16 to 45)
Pisotriquetral disease is a key element in the differential diagnosis of ulnar-sided wrist pain. A loose body within the pisotriquetral joint is an uncommon entity. After appropriate diagnosis, arthroscopic removal is a feasible alternative to open resection. PMID:18294541
This article presents an arthroscopic inferior capsular shift technique. In this technique, the same type of inferior capsular shift as with the open standard Neer procedure can be performed. After standard diagnostic shoulder arthroscopy, a bone trough is made along the capsular attachment to the humeral head using an abrader. An inverted L-shaped incision is performed in the anterior capsule.
Summary: We performed a chart and radiograph review of 173 patients (183 shoulders) who underwent arthroscopic subacromial decompression between 1991 and 1994 and had preoperative and postoperative radiographs. The study focused on the presence of preoperative acromioclavicular joint pathology, intraoperative violation of the acromioclavicular joint, extent of distal clavicle excision, and subsequent development of acromioclavicular joint symptoms. The 183 surgical
Brett W. Fischer; R. Michael Gross; Jack A. McCarthy; Julian S. Arroyo
This article presents an all-arthroscopic technique for coracoclavicular ligament reconstruction by ligamentoplasty after acute or chronic acromioclavicular joint dislocation. A coracoacromial ligament transfer is done to reconstruct the torn coracoclavicular ligaments, similar to open surgery. The coracoacromial ligament is dissected from the undersurface of the acromion and is reinserted on the inferior clavicle by transosseous suture fixation. Additional wire or
Thirty patients with 31 shoulders underwent clinical and radiologic evaluation 5 to 6 years after arthroscopic acromioplasty. The mean age was 51 years. The acromioclavicular (AC) joint was assessed for tenderness on palpation and pain on horizontal adduction of the shoulder. All patients underwent a radiologic examination consisting of an anteroposterior view of the AC joint and bilateral stress views.
Minimal Invasive Surgery (MIS) techniques are becoming more and more frequent. However these techniques are complex and expensive procedures difficult to master. Current learning methods have a number of limita- tions that can be compensated for and complemented by our virtual reality simulator. Training with simulators considerably improves surgeons' dexterities with the arthroscopic instruments, redu- ces surgery times, increases surgery
Fernández Fernández-Arroyo JM; Potti Cuervo J; Illana Alejandro C; Pastor Pérez L; Rodríguez Martínez de Bartolomé; Bayona Beriso S
We report on 34 knee arthroscopic procedures (of 976 knee procedures performed during a 2-year period) performed on patients with chronic knee symptoms or symptoms mimicking a torn meniscus. All patients had deep articular cartilage lesions over which the superficial cartilage appeared normal. These lesions were not diagnosed on radiographs, magnetic resonance imaging, or bone scintigraphy. Only careful arthroscopic probing disclosed the deep cartilage separation. The treatment consisted of cartilage puncturing with a probe, which in 14 cases led to the evacuation of blood. This simple technique produced resolution of symptoms in 30 (88.2%) patients. This condition affects athletes and soldiers undergoing military training and, in many cases, is an expression of an overuse syndrome. The incidence of these lesions was 3.5% in a series of relatively young patients. The lesion should be suspected in cases of unexplained knee pain in the athlete and soldier and in patients with previous negative arthroscopic examinations or meniscal lesions that were treated but remained unresolved. To our knowledge, bleeding from "closed" cartilage lesions has not been previously described. We raise the question of whether arthroscopic probing and cartilage puncturing is the method of treatment. PMID:10424220
We retrospectively reviewed 117 consecutive patients who underwent arthroscopic acromioclavicular joint (ACJ) arthroplasties. Only patients who underwent ACJ arthroplasties from a bursal approach in conjunction with subacromial decompression were included. Patients with isolated ACJ arthrosis treated with resection of the distal clavicle from a superior approach, isolated impingement with only undersurface distal clavicle debridement, prior surgery, or other shoulder pathology
WN Levine; OA Barron; K Yamaguchi; RG Pollock; EL Flatow; LU Bigliani
Shoulder instability is common in contact and collision athletes. This article discusses the anatomy, pathoanatomy, history, physical examination, imaging, management algorithm, and outcomes of surgical treatment of instability of the shoulder in these patients. This article also presents the authors' recommended arthroscopic technique. PMID:24079430
Background: Acute and chronic cartilage injury of the knee has an important impact on prognosis. The validity of the classification of such injuries is critical for prospective multicenter studies. The agreement among multiple surgeons at different institutions for articular cartilage lesions has not been established.Hypothesis: Arthroscopic classification of articular cartilage lesions is reliable and reproducible and can be used for
Robert G. Marx; Jason Connor; Stephen Lyman; Annunziato Amendola; Jack T. Andrish; Christopher Kaeding; Eric C. McCarty; Richard D. Parker; Rick W. Wright; Kurt P. Spindler
Microfracture is the standard of care for the treatment of small cartilage defects in the hip. Autologous matrix-induced chondrogenesis (AMIC) is a novel, 1-step approach that combines microfracture with a type I/III collagen matrix (Chondro-Gide; Geistlich Pharma AG, Wolhusen, Switzerland) to cover the microfractured defect area. The AMIC procedure has been successfully established for treating cartilage defects in the knee and talus, and we report, for the first time, its application in the hip. More importantly, at our center, we have developed a fully arthroscopic approach for the use of AMIC in the hip. Arthroscopic procedures are more desirable than open surgery because they are less invasive and hence reduce the risk of complications, such as infection or avascular necrosis of the femoral head, and allow for a shorter recovery time, resulting not only in lower overall treatment costs but also higher patient satisfaction. The arthroscopic AMIC procedure as described in this report, though surgically challenging, represents a viable, cost-effective treatment option for the repair of chondral lesions of the hip, especially when compared with autologous chondrocyte implantation.
Injuries and conditions that affect the AC joint are common. Low-grade separations, degenerative conditions, and osteolysis of the distal clavicle are frequently dealt with by the treating physician. Proper assessment requires a thorough history, examination, and radiologic work-up. An injection of bupivicaine into the AC joint can be a very useful test to evaluate the source of pain about the symptomatic shoulder. Most conditions affecting the AC joint can be treated conservatively, but patients who do not respond to these treatments or athletes who do not wish to modify their activities may require resection of the distal clavicle and the AC joint. Operative intervention can be performed as an open procedure with good results. Recent advances in operative arthroscopic procedures allow us to replicate and exceed the results of the open resection. Arthroscopic resection can be undertaken via a direct approach that does not violate the subacromial space or via an indirect or bursal approach. The indirect approach allows you to assess both the subacromial space and the AC joint because impingement pathology and subacromial compromise are frequently associated with AC change. The advantage of an arthroscopic resection is its ability to be performed as an outpatient procedure with less compromise of musculotendinous structures, shorter rehabilitation, and quicker return to activity. The amount of bone resection necessary is less than with the open procedure because of the ability to preserve the stabilizing properties of the superior AC ligaments. Resection of 4 mm to 8 mm of bone is all that may be required to give uniformly good results. Arthroscopic resection of the distal clavicle is technically demanding and requires skill and familiarity with other arthroscopic shoulder procedures. Complications related to this procedure are relatively infrequent and include infection, residual pain, lack of adequate bone resection, and instability, particularly in patients with previous grade 1 and 2 separations. Less commonly noted is the symptomatic development of heterotopic bone. To the accomplished arthroscopic shoulder surgeon, arthroscopic resection of the symptomatic AC joint gives excellent clinical results that allow a compromised athlete a relatively quick return to desired sport activities. PMID:12825532
Meniscal injuries are frequently associated with acute injuries to the anterior cruciate ligament (ACL). With the passage of time, this frequency increases significantly. The management of the torn meniscus varies with the type of lesion and the patient's goals. When possible, meniscus repair combined with ACL reconstruction is recommended in young, athletically active patients. Repair may be accomplished by open or closed techniques. Because of significant risks associated with arthroscopic approaches, an outside-in type of repair has been devised. Overall, the clinical success approaches 90% if the ACL is reconstructed. Failure rates of 30% to 40% ensue if the knee remains unstable. PMID:2302896
Glenohumeral arthrosis frequently results in substantial discomfort and activity limitations. Shoulder arthroplasty has been shown to provide reliable pain relief under these circumstances in older, less active populations. Younger patients, however, who desire to continue participation in high-demand activities, may not be optimal candidates for glenohumeral arthroplasty. Arthroscopic debridement has been reported to provide incomplete symptomatic relief in this cohort
Articular cartilage damage is very common in clinical practices. Due to the low self-healing abilities of articular cartilage, the repair strategies for articular cartilage such as arthroscopic lavage and debridement,osteaochondral or chondrocytes transplantation, tissue engineering and hydrogel based artificial cartilage materials are the primary technologies of repairing articular cartilage defect. In this paper,the main repair strategies for the articular cartilage damage and the advantages or disadvantages of each repair technology are summarized. The arthroscopic lavage and debridement is successful in treating the early stage of osteoarthritis. Osteochondral and chondrocytes transplantation are beneficial to treat small full thickness defects. The technology of tissue engineering becomes a new method to heal articular cartilage damage, but the major problem is the absence of bonding strength between the implants and natural defect surfaces. Hydrogel based artificial cartilage possesses similar bio-mechanical and bio-tribological performances to that of natural articular cartilage. However, both bioactivity and interfacial bonding strength between the implant and natural cartilage could be further improved. How to simultaneously optimize the mechanical and bioactive as well as biotribological properties of hydrogel based materials is a focus problem concerned. PMID:23678772
Osteochondral defects (OCDs) of the talus are a common cause of residual pain after ankle injuries. When conservative treatment fails, arthroscopic debridement combined with drilling/microfracturing of the lesion (bone marrow stimulation [BMS] procedures) has been shown to provide good to excellent outcomes. Not uncommonly, talar OCDs involve the borders of the talar dome. These uncontained lesions are sometimes difficult to visualize with the 30° arthroscope, with potential negative effect on the clinical outcome of an arthroscopic BMS procedure. The use of the 70° arthroscope has been described for a multitude of common knee, shoulder, elbow, and hip procedures. The purpose of this article is to show the usefulness of the 70° arthroscope in arthroscopic BMS procedures, pointing out which kinds of talar OCDs can benefit most from its use. PMID:23875138
Spennacchio, Pietro; Randelli, Pietro; Arrigoni, Paolo; van Dijk, Niek
This paper presents a novel graphical user interface developed for a navigation system for ultrasound-guided computer-assisted shoulder arthroscopic surgery. The envisioned purpose of the interface is to assist the surgeon in determining the position and orientation of the arthroscopic camera and other surgical tools within the anatomy of the patient. The user interface features real time position tracking of the arthroscopic instruments with an optical tracking system, and visualization of their graphical representations relative to a three-dimensional shoulder surface model of the patient, created from computed tomography images. In addition, the developed graphical interface facilitates fast and user-friendly intra-operative calibration of the arthroscope and the arthroscopic burr, capture and segmentation of ultrasound images, and intra-operative registration. A pilot study simulating the computer-aided shoulder arthroscopic procedure on a shoulder phantom demonstrated the speed, efficiency and ease-of-use of the system.
Tyryshkin, K.; Mousavi, P.; Beek, M.; Pichora, D.; Abolmaesumi, P.
The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedure to debride and resurface\\u000a the arthritic glenoid, in a middle-aged population, using an acellular human dermal scaffold. Between 2003 and 2005, thirty-two\\u000a consecutive patients underwent an arthroscopic debridement and biological glenoid resurfacing for glenohumeral arthritis.\\u000a The diagnoses included primary osteoarthrosis (28 patients), arthritis after arthroscopic
Joe F. de Beer; Deepak N. Bhatia; Karin S. van Rooyen; Donald F. Du Toit
PURPOSE: The meniscus plays an important role in the knee joint. Meniscal tears are the most common knee injuries, are seen in all age groups and have several causes. Meniscectomy and meniscal repair, including open or arthroscopic procedures, are common operations for orthopaedic surgeons. The purpose of this meta-analysis was to review published articles that compared meniscal repair (open suture and arthroscopic inside-out procedures) with meniscectomy (arthroscopic partial or total meniscectomy) for short- or long-term outcomes and to determine which procedure leads to a better outcome. METHODS: A search was performed in the MEDLINE, EMBASE and OVID databases. All randomized, quasi-randomized, and observational clinical trials that reported the outcome of meniscal repair and meniscectomy were included in our meta-analysis. The outcomes were International Knee Documentation Committee Score, Lysholm Score, Tegner Score and failure rate. RESULTS: Seven studies were included in this meta-analysis, one of which was a randomized, prospective study. There was a statistically significant difference in favour of meniscal repair for Lysholm Score and Tegner Score. Besides, meniscal repair had a lower failure rate than meniscectomy. CONCLUSION: Meniscal repairs have better long-term patient-reported outcomes and better activity levels than meniscectomy; besides, the former meniscal repairs have a lower failure rate. LEVEL OF EVIDENCE: Meta-analysis, Level III. PMID:23670128
Arthroscopic meniscal repair has been a common procedure for the treatment of a torn meniscus, since the importance of meniscal preservation is widely understood. Over the years, the complications associated with suture material have been reported. Meniscal cyst is also one of those things. But ganglion cyst triggered by non-absorbable suture material was not documented in the literature. We report the case of a 19-year-old boy who underwent arthroscopic ACL reconstruction and repair of the medial meniscus by inside-out technique using 2-0 non-absorbable polyester sutures. The patient returned to our clinic at 4-year F/U with right knee pain due to medial meniscus tear and ganglion cyst. We suspect non-absorbable suture materials itself might have caused soft tissue irritation with repetitive trauma that lead to mucoid degeneration which results in ganglion cyst formation in the end. PMID:22858108
A suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength. In this technique, the suture-bridge creation is adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. This technique could be useful for the repair of subscapularis tears, which are not easily approached using other arthroscopic techniques. From a biomechanical point of view, the subscapularis tendon could be restored more ideally using the suture-bridge technique. PMID:20890701
Park, Jin-Young; Park, Jun-Suk; Jung, Jae-Kyung; Kumar, Praveen; Oh, Kyung-Soo
PURPOSE: The purpose of this retrospective study was to evaluate the early results of arthroscopic treatment in patients with missed occult greater tuberosity (GT) fracture of the humerus using the arthroscopic suture-bridge fixation technique. METHODS: Between January 2007 and August 2010, we used arthroscopic suture-bridge fixation in 15 cases of missed occult GT fractures, which were referred to our department with persistent symptoms following trauma, despite physical therapy. Occult GT fracture was diagnosed with bone marrow edema seen on magnetic resonance imaging in all patients. There were 13 male and 2 female patients with a mean age of 45 years (range 31-67 years). Mean time period until the surgery following the initial trauma was 4 months (1.5-12 months). For the measurement of clinical outcomes, we assessed the range of motion and evaluated the University of California, Los Angeles (UCLA) American Shoulder and Elbow Surgeons (ASES) scores and simple shoulder test (SST). RESULTS: The early clinical results were evaluated in these patients at a mean of 24 months (range 14-36 months) after surgery. All the patients were satisfied with the surgery. The mean UCLA, ASES, and SST scores improved from preoperative 15, 39, and 2 to postoperative 33, 91, and 11, respectively (P < .05). Mean forward flexion, abduction, external rotation at the neutral position, and internal rotation were improved to 159°, 155°, 24°, and L1, respectively, at the final follow-up. CONCLUSION: In the occult GT fracture with persistent shoulder symptoms, arthroscopic suture-bridge fixation and early rehabilitation showed excellent clinical outcomes on a short-term follow-up study. LEVEL OF EVIDENCE: Retrospective review, Level IV. PMID:23558662
Park, Sang-Eun; Ji, Jong-Hun; Shafi, Mohamed; Jung, Jae Jung; Gil, Ho-Jin; Lee, Hwan-Hee
The purpose of this study was to evaluate range of motion and patient-reported outcome after complete arthroscopic release of post-traumatic elbow contracture. Fourteen consecutive patients who underwent elbow arthroscopy and capsular release were reviewed retrospectively at a minimum follow-up of 1 year. Pain and range of motion were measured. Patient outcome was assessed with the American Shoulder and Elbow Surgeons
Craig M Ball; Matthew Meunier; Leesa M Galatz; Ryan Calfee; Ken Yamaguchi
PURPOSE: Painful snapping scapula can be a disabling condition. The object of this prospective study was to assess the efficiency of arthroscopic bone resection of the medial superior corner of scapula, in patients suffering from continuously painful snapping scapula. METHODS: Twenty patients with painful snapping scapula underwent arthroscopic scapulothoracic bursectomi and resection of the hook formation at the medial superior margin of the scapular. Preoperatively, all patients reported temporary relief via a local anesthetic injection and had completed a 3-month rehabilitation program. The Western Ontario Rotator Cuff index (WORC) was used for the assessment of pain and function levels both pre- and postoperatively. RESULTS: Twenty patients (13 women and 7 men) were included. The mean follow-up was 2.9 years (range 2-5 years). The mean age was 40 years (range 19-68 years). The mean duration of symptoms was 4 years (range 4 months-20 years). Seven previously had arthroscopic operations in the affected shoulder with acromioplasty, with or without acromioclavicular joint resection. The median preoperative WORC score was 35.0 (range 18-74) and significantly increased to 86.4 (range 33-100) postoperatively. Out of 20 patients, 18 improved and 19 indicated that they would undergo the surgery again. CONCLUSION: In this study, it was found that, among patients troubled by painful snapping scapula and without relief by exercise-based rehabilitation, arthroscopic resection of the medial superior hook formation in combination with partial bursectomy provides a serious gain in respect to the WORC score and is believed to be an effective treatment in most cases. One patient had a serious complication. PMID:23412302
The treatment of symptomatic chronic acromioclavicular joint dislocations can be challenging. Different surgical procedures\\u000a have been described in the literature. We present an arthroscopically assisted stabilization using a gracilis tendon transclavicular-transcoracoid\\u000a loop technique augmented with a Tight-Rope (Arthrex, Naples, FL, USA). In contrast to the classic Weaver–Dunn procedures this\\u000a technique is designed to stabilize the acromioclavicular joint by recreating the
Markus Scheibel; Adeleke Ifesanya; Stephan Pauly; Norbert P. Haas
Background: There are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning.Hypothesis: Preoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability.Study Design: Case series.Methods: From 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle
In a retrospective study we analysed the results of arthroscopic treatment of anterior synovitis of the ankle in 35 athletes. Five athletes additionally suffered from anterior osteophytes, and three presented with an anterolateral plica. Their average age was 25 years (SD 8.3), and the follow-up interval was 32.4 months (SD 19.4). Eight patients suffered from additional hyperlaxity of the ankle
Surgical training systems based on virtual reality (VR) and simulation techniques offer a cost-effective and efficient alternative to traditional training methods. This paper describes a virtual reality system for training arthroscopic knee surgery. The virtual model used in this system is constructed from the Visual Human Project dataset. The system simulates the real-time deformation of soft tissue with topological change using finite element analysis. To offer the realistic tactile feedback, we construct a specialized force feedback hardware. PMID:15544258
Surgical training systems based on virtual-reality (VR) simulation techniques offer a cost-effective and efficient alternative to traditional training methods. This paper describes a VR system for training arthroscopic knee surgery. Virtual models used in this system are constructed from the Visual Human Project dataset. Our system simulates soft tissue deformation with topological change in real-time using finite-element analysis. To offer
Surgical training systems based on virtual-reality (VR) simulation techniques offer a cost-effective and efficient alternative to traditional training methods. This paper describes a VR system for training arthroscopic knee surgery. Virtual models used in this system are constructed from the Visual Human Project dataset. Our system simulates soft tissue deformation with topological change in real-time using finite-element analysis. To offer realistic tactile feedback, we build a tailor-made force feedback hardware. PMID:15217267
Background The effectiveness of arthroscopic treatment for osteoarthritic knee is a controversy. This study presents the technique of a novel concept of arthroscopic procedure and investigates its clinical outcome. Method An arthroscopic procedure targeted on elimination of focal abrasion phenomenon and regaining soft tissue balance around patello-femoral joint was applied to treat osteoarthritis knees. Five hundred and seventy-one knees of 367 patients with osteoarthritis received this procedure. There were 70 (19%) male and 297 (81%) female and the mean age was 60 years (SD 10). The Knee Society score (KSS) and the knee injury and osteoarthritis outcome score (KOOS) were used for subjective outcome study. The roentgenographic changes of femoral-tibial angle and joint space width were evaluated for objective outcomes. The mean follow-up period was 38 months (SD 3). Results There were 505 knees in 326 patients available with more than 3 years follow-up and the mean follow-up period was 38 months (SD 3). The subjective satisfactory rate for the whole series was 85.5%. For 134 knees with comprehensive follow-up evaluation, the KSS and all subscales of the KOOS improved statistically. The femoral-tibial angle improved from 1.57 degrees (SD 3.92) to 1.93 degrees (SD 4.12) (mean difference: 0.35, SD 0.17). The joint space width increased from 2.02 millimeters (SD 1.24) to 2.17 millimeters (SD 1.17) (mean difference: 0.13, SD 0.05). The degeneration process of the medial compartment was found being reversed in 82.1% of these knees by radiographic evaluation. Conclusions Based on these observations arthroscopic cartilage regeneration facilitating procedure is an effective treatment for osteoarthritis of the knee joint and can be expected to satisfy the majority of patients and reverse the degenerative process of their knees.
This is a retrospective study of 46 patients who underwent arthroscopic glenoid labral debridement from June 1988 to June 1990. All patients complained of pain in the involved shoulder and all were active in sports involving overhead use of the shoulder, including 30 baseball players (16 professional, 14 collegiate/high school). The average age was 22 years (range 16 to 45) and the average follow-up was 2.7 years (range 18 to 50 months). At operation, 35 patients had posterior glenoid lesions, 9 had anterior-superior lesions, and 2 had anterior-inferior lesions. The posterior lesions were further divided into those that involved a horizontal flap tear (n = 19), and those that involved fraying (n = 16). Overall, at an average of 31 months follow-up. 54% (25 of 46) of patients had good to excellent results. Professional baseball players had a statistically significant enhanced outcome with 75% (12 of 16) good-excellent compared with the remaining nonprofessional group, with 43% (13 of 30) good-excellent results. Outcome did not correlate with shoulder laxity, labral lesion location, mechanism of injury, or the presence of a rotator cuff lesion. Conclusions: Arthroscopic debridement of glenoid labral lesions does not yield consistent long-term results. Aggressive, supervised physical therapy in highly motivated individuals may be the most important factors in influencing outcome in patients having arthroscopic labral debridement in the absence of overt shoulder instability. PMID:7727011
Stylocarpal impaction is an uncommon cause of ulnar-sided wrist pain in which the long ulnar styloid affects the triquetrum. Previous authors have described an open excision of the ulnar styloid. We present a new technique for arthroscopic identification and subsequent excision of the ulnar styloid. The diagnosis was suspected on plain radiographs and was confirmed by dynamic fluoroscopy. Four patients with ulnar styloid impaction were successfully managed. A diagnostic arthroscopy was performed. With the arthroscope in the 4-5 portal, a 3.5-mm burr was introduced into the 6 U portal. By palpation, the burr was placed onto the tip of the ulnar styloid and confirmed with fluoroscopy. Sufficient ulnar styloid was removed to prevent impingement; this was confirmed on fluoroscopy. We undertook resection of the ulnar styloid to 3 mm (normal, 3 to 6 mm). Adjacent soft tissue structures were not violated. Arthroscopic ulnar styloid identification and excision is a relatively simple procedure. Disruption of the triangular fibrocartilage, dorsal ulnar capsular ligament, and volar ulnar carpal ligament is avoided. Fluoroscopy is valuable in providing preoperative and intraoperative identification of the ulnar styloid and impingement. Postoperatively, patients can recommence activities of daily living as comfort allows. PMID:16762709
Intraosseous ganglia (IOGs) of the lunate are a relatively rare, but by no means insignificant, condition because treatment by traditional open curettage and bone grafting can lead to ongoing pain and stiffness of the wrist.An arthroscopically assisted minimally invasive technique of debridement and grafting of the lunate IOG is discussed, as well as the history of the condition, indications and contraindications, surgical technique with postoperative rehabilitation, and potential complications.The outcomes of 8 patients with persistent symptoms and typical radiographic and bone scan findings were assessed independently preoperatively and postoperatively by using a modified Green and O'Brien wrist score. The intraosseous cyst was drilled under arthroscopic and fluoroscopic guidance via either a volar or dorsal portal, depending on the position identified on the computed tomography scan. Average follow-up time was 3.8 years (range, 1-5.6 yrs). All patients returned to employment within 4 months. Wrist scores improved 34 points, from 51 to 85 points, by 1 year after surgery, with trabeculation being noted within the grafting lunate. The greatest improvements were seen in visual and analog pain scores, reducing from 68.3 to 11.2, and flexion-extension arcs, which increased from 98 to 114 degrees.The technique of arthroscopically assisted debridement of IOGs of the lunate is safe, with minimal morbidity and recurrence of symptoms during the follow-up period. PMID:19060679
Presented in this report is a modified arthroscopic approach to acromioclavicular joint reconstruction via suture and allograft fixation. An arthroscopic approach is used to expose the base of the coracoid by use of electrocautery. After an open distal clavicle excision is performed, clavicular and coracoid tunnels are created under arthroscopic visualization as previously described by Wolf and Pennington. The myotendinous end of a semitendinosus allograft is sutured to a Spider plate (Kinetikos Medical, San Diego, CA). The tendinous end of the graft is prepared with a running baseball stitch. A Nitinol wire with a loop end (Arthrex, Naples, FL) is used to pass 2 free FiberTape sutures (Arthrex) and the leading sutures from the tendinous end of the graft through the clavicular and coracoid tunnels, exiting out the anterior portal. One of the FiberTape sutures is retrieved with a grasper and passed over the anterior aspect of the distal clavicle. The second FiberTape suture and the allograft are passed over the distal end of the resected clavicle. While the acromioclavicular joint is held reduced, the FiberTape sutures are tied to the plate and the allograft is tensioned medially until the plate is embedded against the superior surface of the clavicle. The tendinous end of the graft is secured to the superior surface of the clavicle with a Bio-tenodesis screw (Arthrex) medial to the clavicular tunnel. PMID:17637416
Pennington, William T; Hergan, David J; Bartz, Brian A
This paper presents a novel ultrasound-guided computer system for arthroscopic surgery of the shoulder joint. Intraoperatively, the system tracks and displays the surgical instruments, such as arthroscope and arthroscopic burrs, relative to the anatomy of the patient. The purpose of this system is to improve the surgeon's perception of the three-dimensional space within the anatomy of the patient in which the instruments are manipulated and to provide guidance towards the targeted anatomy. Pre-operatively, computed tomography images of the patient are acquired to construct virtual threedimensional surface models of the shoulder bone structure. Intra-operatively, live ultrasound images of pre-selected regions of the shoulder are captured using an ultrasound probe whose three-dimensional position is tracked by an optical camera. These images are used to register the surface model to the anatomy of the patient in the operating room. An initial alignment is obtained by matching at least three points manually selected on the model to their corresponding points identified on the ultrasound images. The registration is then improved with an iterative closest point or a sequential least squares estimation technique. In the present study the registration results of these techniques are compared. After the registration, surgical instruments are displayed relative to the surface model of the patient on a graphical screen visible to the surgeon. Results of laboratory experiments on a shoulder phantom indicate acceptable registration results and sufficiently fast overall system performance to be applicable in the operating room.
Tyryshkin, K.; Mousavi, P.; Beek, M.; Chen, T.; Pichora, D.; Abolmaesumi, P.
Purpose: The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity.Patients and Methods: Clinical and arthroscopic diagnoses were established in 126
Howard A Israel; Beverly Diamond; Fatemah Saed-Nejad; Anthony Ratcliffe
Arthroscopic acromioplasty and distal clavicle resection has now become an accepted method of treatment for acromioclavicular (AC) joint arthritis. Complications following arthroscopic acromioplasty are relatively uncommon and include instrument breakage, hematoma, traction neuropathy, infection, acromial fracture, reflex sympathetic dystrophy, and recurrence of symptoms. Although heterotopic ossification within the soft tissues has also been reported, complete reossification of the resected clavicle
Graham Tytherleigh-Strong; Jasper Gill; Giuseppe Sforza; Stephen Copeland; Ofer Levy
Summary: Arthroscopic subacromial decompression is traditionally performed through a posterolateral viewing portal and a lateral working portal. We describe the same procedure by using a posterolateral viewing portal and a posteromedial working portal. Because this portal is in the same sagittal plane as the ipsilateral acromioclavicular joint, it allows performing an arthroscopic excision arthroplasty of this joint.Arthroscopy: The Journal of
There is no report of athroscopic treatment for septic arthritis of the ankle in infants. We report a case of successful management of septic arthritis of the ankle in a three-month-old boy by arthroscopic washout. Arthroscopic washout may be a useful treatment for septic arthritis in young infants when performed early after onset.
We have compared two techniques of arthroscopic surgery for advanced internal derangement of the temporomandibular joint (TMJ). Patients with stage III or above TMJ internal derangement, who had not responded to three months of non-surgical treatment, were prospectively and randomly assigned to one of two types of treatment. One group had arthroscopic lysis and lavage (ALL) and the other had
Purpose: To determine if reducing glenohumeral translation by arthroscopic thermal shrinkage would improve the results of arthroscopic treatment of internal impingement in baseball players. Type of Study: Retrospective review. Introduction: Traditional treatment of internal impingement does not address the pathophysiology. Baseball players’ shoulders routinely have glenohumeral laxity. Addressing this laxity by thermal capsulorrhaphy may improve the results in the treatment
Ankle arthroscopy has been increasingly applied to the diagnostic and therapeutic treatment of ankle disorders. A case of adhesion of the extensor tendons and deep peroneal nerve to the anterior ankle capsule after multiple arthroscopic procedures of the ankle was reported. He was successfully treated by complete anterior ankle arthroscopic capsulotomy.
With the development of hip joint preservation procedures, the use of hip arthroscopy has grown dramatically over the past decade. However, recent articles have reported cases of hip instability after hip arthroscopy. Little is known about the role of static and dynamic stabilizers on hip joint stability, but there are concerns that an extensile capsulotomy or capsulectomy, osteoplasty of the acetabulum and proximal femur, and labral detachment or debridement during hip arthroscopy could potentially compromise hip stability. The safety parameters for arthroscopic hip surgery have not yet been fully established, and techniques are being developed for labral refixation and capsular repair after arthroscopic treatment of femoroacetabular impingement in an attempt to decrease the chance of iatrogenic hip instability or microinstability. The surgical technique presented in this article may provide anatomic repair of both the labrum and capsule using a double-loaded suture anchor technique. We believe that this technique increases both operative efficiency and the strength of the overall repair, which may minimize the risk of iatrogenic hip instability after hip arthroscopy. PMID:23766998
Gastroschisis repair is surgery to correct a birth defect that causes an opening in the skin and muscles covering the belly (abdominal wall). The opening allows intestines and sometimes other organs to bulge outside ...
The stabilizing function of the meniscus and the negative effect of a complete or partial meniscectomy have been demonstrated in many studies. On the other hand, it has also been shown that meniscus tears in certain locations can heal very well. The prerequisite is that the torn meniscus can be revascularized from the capsule. Revascularization can be achieved by stimulating the formation of new vessels, but also by the build-up of collagen after induction of fibrochondrocytes and fibroblasts. The requirements for meniscus reconstruction are: careful preparation of the tear, exact repositioning, and precise placement of the sutures. The additional activation of regenerating processes is promoted by using a fibrin clot. In this study, 54 patients underwent meniscus repair, but the results in this group that also received a fibrin clot are not included. In the case of longitudinal-vertical tears of the meniscus inside the 3-mm zone margin, it was decided that the procedure was indicated when tears longer than 1.5 cm were concerned. The inside-out technique was used. Subjective and objective examination of 52 patients showed that the clinical results were good to very good in 92%. PMID:2193287
Rosenberg, T D; Paulos, L E; Wnorowski, D C; Gurley, W D
Executive Summary Objective The purpose of this review was to determine the effectiveness and adverse effects of arthroscopic lavage and debridement, with or without lavage, in the treatment of symptoms of osteoarthritis (OA) of the knee, and to conduct an economic analysis if evidence for effectiveness can be established. Questions Asked Does arthroscopic lavage improve motor function and pain associated with OA of the knee? Does arthroscopic debridement improve motor function and pain associated with OA of the knee? If evidence for effectiveness can be established, what is the duration of effect? What are the adverse effects of these procedures? What are the economic considerations if evidence for effectiveness can be established? Clinical Need Osteoarthritis, the most common rheumatologic musculoskeletal disorder, affects about 10% of the Canadian adult population. Although the natural history of OA is not known, it is a degenerative condition that affects the bone cartilage in the joint. It can be diagnosed at earlier ages, particularly within the sports injuries population, though the prevalence of non-injury-related OA increases with increasing age and varies with gender, with women being twice as likely as men to be diagnosed with this condition. Thus, with an aging population, the impact of OA on the health care system is expected to be considerable. Treatments for OA of the knee include conservative or nonpharmacological therapy, like physiotherapy, weight management and exercise; and more generally, intra-articular injections, arthroscopic surgery and knee replacement surgery. Whereas knee replacement surgery is considered an end-of-line intervention, the less invasive surgical procedures of lavage or debridement may be recommended for earlier and more severe disease. Both arthroscopic lavage and debridement are generally indicated in patients with knee joint pain, with or without mechanical problems, that are refractory to medical therapy. The clinical utility of these procedures is unclear, hence, the assessment of their effectiveness in this review. Lavage and Debridement Arthroscopic lavage involves the visually guided introduction of saline solution into the knee joint and removal of fluid, with the intent of extracting any excess fluids and loose bodies that may be in the knee joint. Debridement, in comparison, may include the introduction of saline into the joint, in addition to the smoothening of bone surface without any further intervention (less invasive forms of debridement), or the addition of more invasive procedures such as abrasion, partial or full meniscectomy, synovectomy, or osteotomy (referred to as debridement in combination with meniscectomy or other procedures). The focus of this health technology assessment is on the effectiveness of lavage, and debridement (with or without meniscal tear resection). Review Strategy The Medical Advisory Secretariat followed its standard procedures and searched these electronic databases: Ovid MEDLINE, EMBASE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and The International Network of Agencies for Health Technology Assessment. The keywords searched were: arthroscopy, debridement, lavage, wound irrigation, or curettage; arthritis, rheumatoid, osteoarthritis; osteoarthritis, knee; knee or knee joint. Time frame: Only 2 previous health technology assessments were identified, one of which was an update of the other, and included 3 of 4 randomized controlled trials (RCTs) from the first report. Therefore, the search period for inclusion of studies in this assessment was January 1, 1995 to April 24, 2005. Excluded were: case reports, comments, editorials, and letters. Identified were 335 references, including previously published health technology assessments, and 5 articles located through a manual search of references from published articles and health technology assessments. These were examined against the criteria, as described below, which resulted in the in
Orchidopexy; Inguinal orchidopexy; Orchiopexy; Repair of undescended testicle; Cryptorchidism repair ... year of life without medical treatment. Undescended testicle repair surgery is recommended for patients whose testicles do ...
Purpose To describe an all-arthroscopic treatment of acromioclavicular joint (ACJ) dislocation and report the clinical results of\\u000a the procedure.\\u000a \\u000a \\u000a \\u000a \\u000a Methods This study consisted of 54 patients of whom 49 were men and 5 were women. The age of the patients averaged 39 years (range\\u000a 16–69 years). All the symptomatic acute and chronic acromioclavicular joint dislocations classified according to Rockwood\\u000a type III–IV were included in
Jean KanyRajkumar; Rajkumar S. Amaravathi; Regis Guinand; Philippe Valenti
As living beings that encounter every kind of traumatic event from paper cut to myocardial infarction, we must possess ways to heal damaged tissues. While some animals are able to regrow complete body parts following injury (such as the earthworm who grows a new head following bisection), humans are sadly incapable of such feats. Our means of recovery following tissue damage consists largely of repair rather than pure regeneration. Thousands of times in our lives, a meticulously scripted but unseen wound healing drama plays, with cells serving as actors, extracellular matrix as the setting and growth factors as the means of communication. This article briefly reviews the cells involved in tissue repair, their signaling and proliferation mechanisms and the function of the extracellular matrix, then presents the actors and script for the three acts of the tissue repair drama.
By virtue of its anatomy and function, the rotator cuff is vulnerable to considerable morbidity, often necessitating surgical intervention. The factors contributing to cuff disease can be divided into those extrinsic to the rotator cuff (most notably impingement) and those intrinsic to the cuff (age-related degeneration, hypovascularity and inflammation amongst others). In an era of emerging biologic interventions, our interventions are increasingly being modulated by our understanding of these core processes, many of which remain uncertain today. When we do intervene surgically, the techniques we employ are particularly challenging in the context of the tremendous pace of advancement. Several recent studies have shown that arthroscopicrepair gives similar functional results to that of mini-open and open procedures, with all the benefits of minimally invasive surgery. However, the 'best' repair construct remains unknown, with wide variations in surgeon preference. Here we present a literature review encompassing recent developments in our understanding of basic science in rotator cuff disease as well as an up-to-date evidence-based comparison of different techniques available to the surgeon for cuff repair. PMID:19104772
Yadav, Hemang; Nho, Shane; Romeo, Anthony; MacGillivray, John D
Purpose Arthroscopic knee surgery is done in outpatient settings; however, postoperative pain is a major barrier for discharge and\\u000a limits early rehabilitation. The efficacy of intraarticular application of magnesium sulphate, levobupivacaine and lornoxicam,\\u000a with placebo on postoperative pain after arthroscopic meniscectomy was evaluated.\\u000a \\u000a \\u000a \\u000a \\u000a Methods One hundred and twenty ASA status I-II patients undergoing elective arthroscopic meniscectomy were included in this randomized,\\u000a single
Kemalettin KoltkaGul Koknel-Talu; Gul Koknel-Talu; Mehmet Asik; Suleyman Ozyalcin
Purpose: This prospective case series evaluates the outcome, and the return to sports of young overhead athletes with a persistent, symptomatic multidirectional instability (MDI) with hyperlaxity type Gerber B5 treated with an arthroscopic anteroposteroinferior capsular plication and rotator interval closure. Methods: 9 young overhead athletes (10 shoulders) with the rare diagnosis of MDI (Gerber B5) and an indication for operative treatment, after a failed physiotherapy program were physically examined 3, 6 and 12 months postoperatively by a physical examination, and got a final phone interview after median 39 months. Results: At the final follow-up all patients were satisfied; Rowe Score showed 7 “excellent” and “good” results; Constant Score was “excellent” and “good” in 6, and “fair” in 1 patient. 7/9 returned to their previous sports, 3/9 at a reduced level. Conclusion: Symptomatic MDI requires an individual indication for surgical treatment after a primary conservative treatment. The described arthroscopic technique stabilizes glenohumeral joint. A return to overhead sports is possible but often at a reduced level; returning to high-performance sports cannot be recommended because of the high risk of reinstability.
The purpose of this study was to evaluate prospectively the findings during arthroscopy in patients with chronic instability of the ankle joint. One hundred and ten consecutive patients who had suffered at least two ankle sprains and were symptomatic for at least 6 months were included in this study. A complete rupture of the anterior talofibular ligament was found in 64%, of the calcaneofibular ligament in 41% and of the deltoid ligament in 6%. Cartilage lesions of the talus were seen in 54% of the joints, more of them medial (56%) than lateral (15%) or ventral (20%). Other frequently observed findings were synovialitis (38%), rupture of the syndesmosis (7%), and ventral scarring (6%). While cartilage damage was found independently of the lateral ligament injuries, all complete tears of the deltoid ligament were associated with cartilage injury of the talus. Medial instability was assessed in five ankles clinically and found arthroscopically in 23 ankle joints. Our arthroscopic findings show that chronic instability of the ankle joint is associated with various pathological conditions of ligaments, capsule and cartilage. It can therefore give essential information about the status of the chronic unstable joint with regard to the choice of operative or conservative treatment. PMID:8819064
A recent study, based on ex vivo unconfined compression testing of normal, diseased, and enzymatically altered cartilage, revealed that a scanning force microscope (SFM), used as a nano-intender, is sensitive enough to enable measurement of alterations in the biomechanical properties of cartilage. Based on these ex vivo measurements, we have designed a quantitative diagnosis tool, the scanning force arthroscope (SFA), able to perform in vivo measurements during a standard arthroscopic procedure. For stabilizing and positioning the instrument relative to the surface under investigation, a pneumatic system has been developed. A segmented piezoelectric tube was used to perform the indentation displacement, and a pyramidal nanometer-scale silicon tip mounted on a cantilever with an integrated deflection sensor measured the biomechanical properties of cartilage. Mechanical means were designed to protect the fragile cantilever during the insertion of the instrument into the knee joint. The stability of the pneumatic stage was checked with a prototype SFA. In a series of tests, load-displacement curves were recorded in a knee phantom and, more recently, in a pig’s leg.
Osgood-Schlatter disease is a self-limiting condition in most cases. Those with unresolved pain after conservative treatment can obtain relief with surgical debridement of the mobile ossicles and tibial tuberosity. We present an arthroscopic technique for debridement. The location of the inferomedial and lateral parapatella tendon portals can be raised slightly to allow improved instrumentation and visualization in the anterior interval. An anterior interval release is performed with the mechanical shaver and radiofrequency ablation device. Care is taken to visualize the meniscal anterior horns and intermeniscal ligament. By staying anterior to these structures, debridement can be performed aggressively onto the anterior tibial slope. The bony lesions are shelled out from their soft-tissue attachments. Small and loose fragments are removed with a pituitary ronguer, whereas larger lesions are removed with an arthroscopic burr. Working deep along the anterior tibial slope is facilitated by extending the knee and taking tension off the patellar tendon. Postoperatively, patients are allowed full weight bearing and unrestricted range of motion. The advantages of this technique include the avoidance of the patellar tendon longitudinal split required for open procedures and the ability to address concomitant intra-articular pathology. PMID:17916481
DeBerardino, Thomas M; Branstetter, Joanna G; Owens, Brett D
In this online math game from Cyberchase, sneaky Hacker has removed some of the tracks on the Trans-Cyberspace Railroad. Learners must repair the tracks so the Cybertrain can get back to Central Station. Learners add decimals and drag spare tracks to fill the missing spaces.
... is surgery to correct a birth defect in boys in which the urethra (the tube that carries ... Hypospadias repair is usually done when boys are between 6 months and 2 years old. It is done on an outpatient basis. It rarely requires an overnight stay in ...
... operating room under general anesthesia. This means your child will be asleep and will not feel pain. Traditional surgery is called open repair. It includes these steps: The most common place for a surgical cut to be made is over the ...
|This consortium-developed instructor's manual for small engine repair (with focus on outboard motors) consists of the following nine instructional units: electrical remote control assembly, mechanical remote control assembly, tilt assemblies, exhaust housing, propeller and trim tabs, cooling system, mechanical gearcase, electrical gearcase, and…
Internal impingement is a primary cause of shoulder pain in throwers; however, instability, internal rotation deficit, scapula muscle dysfunction, and core muscle dysfunction are also important elements of the internal impingement process. Articular surface rotator cuff tears, posterior superior labrum tears, SLAP lesions, anterior capsular ligament attenuation, and posterior capsular ligament contracture are commonly seen in throwers. Each of these conditions must be recognized and appropriately treated to ensure the best possible outcome. There is little potential for spontaneous healing of rotator cuff tears and SLAP lesions after debridement. PMID:11888139
Background: In a previously published report of the authors' arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients.Hypothesis: Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes.Study Design: Case series; Level of evidence, 4.Methods: Forty patients (42 elbows) with lateral epicondylitis who had
The purpose of this study was to assess qualitatively and quantitatively the MR arthrographic variability of the arthroscopically\\u000a normal glenoid labrum. Form and signal abnormalities of arthroscopically normal labral parts were analyzed on axial and coronal\\u000a MR arthrograms of 55 consecutive patients (mean age 43.8 years, age range 21–76 years) referred mainly for suspected rotator\\u000a cuff lesions. Length and width
M. Zanetti; Thorsten Carstensen; Dominik Weishaupt; Bernhard Jost; Juerg Hodler
The purposes of this study were to establish the technique to arthroscopically identify the resident's ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 x 10 mm was created just behind the ridge. At 3-4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7-10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident's ridge. The resident's ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction. PMID:19915823
Lateral reattachment of the rotator cuff and the more recent introduction of the double-row rotator cuff repair technique require adequate visualization to define the rotator cuff footprint and the greater tuberosity. In many cases extensive debridement in this area is required to remove the overlying subdeltoid bursa, which can impair visualization laterally on the proximal humerus. Inadequate visualization laterally may lead to improper placement of the lateral row of fixation, compromising the reduction and fixation of the repaired rotator cuff tendon. We describe a surgical technique used to improve lateral visualization of the proximal humerus for placement of lateral anchors during arthroscopic rotator cuff repair using a Foley catheter. The end of a 14F-diameter Foley catheter is cut just proximal to the balloon end. One to three catheters are introduced in the subacromial space through small anterolateral or posterolateral portals and inflated with 15 mL of air. Adequate distension of the subacromial space allows better visualization, triangulation of the arthroscopic instruments, and anatomic repair of the rotator cuff tendon. PMID:19664512
Kilinc, Alexandre S; Ebrahimzadeh, Mohammad H; Lafosse, Laurent
Rotator cuff surgery is developing at a fast pace, with progress in arthroscopic techniques driving much of its advance. Overall, functional outcomes are satisfactory. Tendon healing, however, is inconsistently obtained. Tendon healing correlates with better outcomes, most notably greater strength. Therefore, the best candidates for surgery are patients with lesions that are likely to heal. Factors associated with healing are
The initial results of using radiofrequency probes for debridement of a torn triangular fibrocartilage complex were studied in 20 patients with a mean age of 44 (range 27-56) years presenting with ulnar-sided wrist pain. On arthroscopic examination, 18 central and two radial triangular fibrocartilage complex tears were identified and debrided to a stable rim using radiofrequency probes. The mean follow-up was 22 (range 9-35) months. Seventeen patients experienced substantial pain relief. In three, the pain was unchanged. The mean flexion extension arc was 132 degrees , pronosupination arc 155 degrees and mean grip strength was 83% of that of the unaffected side. Using the modified Mayo wrist score, there were ten excellent, seven good and three fair results. No perioperative complications occurred. Radiofrequency probes were found to be safe and effective for use in triangular fibrocartilage complex debridement. These results compare favourably with other standard methods of treatment of this problem. PMID:16111792
Femoroacetabular impingement (FAI) causes pain and chondrolabral damage via mechanical overload during movement of the hip. It is caused by many different types of pathoanatomy, including the cam ‘bump’, decreased head–neck offset, acetabular retroversion, global acetabular overcoverage, prominent anterior–inferior iliac spine, slipped capital femoral epiphysis, and the sequelae of childhood Perthes’ disease. Both evolutionary and developmental factors may cause FAI. Prevalence studies show that anatomic variations that cause FAI are common in the asymptomatic population. Young athletes may be predisposed to FAI because of the stress on the physis during development. Other factors, including the soft tissues, may also influence symptoms and chondrolabral damage. FAI and the resultant chondrolabral pathology are often treated arthroscopically. Although the results are favourable, morphologies can be complex, patient expectations are high and the surgery is challenging. The long-term outcomes of hip arthroscopy are still forthcoming and it is unknown if treatment of FAI will prevent arthrosis.
The advantages of arthroscopic reconstruction of the anterior cruciate ligament tear over arthrotomy are quite obvious: reduced pain and morbidity. Some arthroscopists are performing these procedures on an outpatient basis. The physician can choose from several graft substitutes for anterior cruciate ligament replacement. Autografts consisting of the iliotibial band, semitendinosus, gracilis, and meniscus have been used as grafts. The most common autograft is the bone-patellar tendon-bone, which has been used since 1930 and has been shown to have a tensile strength near that of the anterior cruciate ligament. The state of the art in surgical alternatives for anterior cruciate ligament tears is arthroscopic reconstruction using the midthird of the patellar tendon. Treatment of anterior cruciate ligament injuries requires prompt and adequate evaluation of the laxity of the ligament as well as other structures in the knee, appropriate treatment options offered to the patient with complete descriptions of knee function after each treatment option, and comprehensive rehabilitation program. Patient compliance is an integral part of the success of this procedure. The nurse must include a description of the injury, preoperative testing, surgical intervention, and rehabilitation program when educating the patient. The successful postoperative anterior cruciate ligament rehabilitation program is multifaceted. In general, there must be specific guidelines applied by a physical therapist who has knowledge of the surgical procedure, understands principles of ligament healing, and has the ability to individualize the program as needed. For any level of athlete or active person, there must be achievement of all goals per phase to a high performance level. In addition, there must always be objective measurements to document progress to the physical therapist and physician but, perhaps most importantly, to reassure the patient that normalcy is being restored. PMID:2000316
This article describes the technical setup for stereotaxic telesurgical assistance for arthroscopic procedures. It also outlines the current state, limitations, and feasibility of this technical development. Teleassistance or teleconsultation implemented in endoscopic or arthroscopic procedures have not yet been reported. In this study, 7 computer-assisted arthroscopies of the temporomandibular joint were supported by extramural experts via interactive stereotaxic teleconsultation from distant locations. The external experts were supplied with close to real-time video, audio, and stereotaxic navigation data directly from the operation site. This setup allows the surgeons and external experts to interactively determine portals, target structures, and instrument positions relative to the patient's anatomy and to discuss any step of the procedures. Optoelectronic tracking interfaced to computer- based navigation technology allowed precise positioning of instruments for single or multiple temporomandibular joint punctures. The average error of digitizing probe measurements was 1.3 mm (range, 0.0 to 2.5 mm) and the average standard deviation was 0.7 mm (range, 0.4 to 0.9 mm). Evaluation of the reliability and accuracy of this technique suggests that it is sufficient for controlled navigation, even inside the small temporomandibular joint, a fact that encourages further applications for arthroscopy in general. The minimum requirement for high-quality video transmission for teleassisted procedures are integrated services digital network (ISDN) connections. Conventional ISDN-based videoconferencing can be combined with computer-aided intraoperative navigation. Transmission control protocol/internet protocol (TCP/IP)-based stereotaxic teleassistance data transmission via ATM or satellite seem to be promising techniques to considerably improve the field of arthroscopy. PMID:12426549
... Lazy eye repair - discharge; Strabismus repair - discharge; Extraocular muscle surgery - discharge ... You or your child had eye muscle repair surgery to correct eye ... term for crossed eyes is strabismus. Children usually receive ...
The two broad categories of deposited weld metal repair and fiber-reinforced composite repair technologies were reviewed for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Preliminary test programs were developed for both deposited weld metal repairs and for fiber-reinforced composite repair. To date, all of the experimental work pertaining to the evaluation of potential repair methods has focused on fiber-reinforced composite repairs. Hydrostatic testing was also conducted on four pipeline sections with simulated corrosion damage: two with composite liners and two without.
Robin Gordon; Bill Bruce; Nancy Porter; Mike Sullivan; Chris Neary
BACKGROUND: Osteochondral talar defects usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracturing. Although this is mostly successful, early sport resumption is difficult to achieve, and it can take up to one year to obtain clinical improvement. Pulsed electromagnetic fields (PEMFs) may be effective for talar defects after arthroscopic treatment by promoting tissue healing, suppressing
Christiaan JA van Bergen; Leendert Blankevoort; Rob J de Haan; Inger N Sierevelt; Duncan E Meuffels; Pieter RN d'Hooghe; Rover Krips; Geert van Damme; C Niek van Dijk
Background. Anterior soft tissue impingement is a common cause of chronic pain in the ankle. The preferred method of operative treatment is an arthroscopic excision of hypertrophic fibrous and synovial tissue in the anterior part of the ankle joint. Methods. We present the results of arthroscopic treatment of anterior ankle impingement in group of 14 patients. Results. Subjective improvement after
Arthroscopic treatment of bony Bankart lesions can be challenging. We present a new easy and reproducible technique for arthroscopic reduction and suture anchor fixation of bony Bankart fragments. A suture anchor is placed medially to the fracture on the glenoid neck, and its sutures are passed around the bony fragment through the soft tissue including the inferior glenohumeral ligament complex.
Objective evaluation of surgical skills is essential for an arthroscopic training system. We asked whether a quantitative assessment of arthroscopic skills using scores, time to completion, instrument tip trajectory data, and force data was valid. We presumed more experienced surgeons would perform better on a simulated arthroscopic procedure than novices, therefore validating the quantitative assessment. Surgical trainees (n = 12), orthopaedic residents (n = 12), and experienced arthroscopic surgeons (n = 6) were tested on a Sawbones® knee simulator. Subjects performed a joint inspection and probing task and a partial meniscectomy task. The trajectory data were measured using an electromagnetic motion tracking system and the force data were measured using a force sensor. The experienced group performed both tasks with higher scores and more quickly than the less experienced groups. The path length of the probe and the scissors was substantially shorter and the probe velocity was considerably faster in the experienced group. The trainee group applied substantially stronger forces to the joint during the joint inspection and probing task. Our data suggest a performance assessment using an electromagnetic motion tracking system and a force sensor provides an objective means of evaluating surgical skills in an arthroscopic training system.
Apprenticeship training of surgical skills is time consuming and can lead to surgical errors. Our group is developing an arthroscopic virtual reality knee simulator for training orthopaedic residents in arthroscopic surgery before live-patient operating room experience. The simulator displays realistic human knee anatomy derived from the Visible Human Dataset developed by the National Library of Medicine and incorporates active force-feedback haptic technology. Our premise is that postgraduate year 2 residents completing a formal virtual education program who are trained to reach a proficiency standard in the techniques and protocol for an arthroscopic knee examination will complete a diagnostic arthroscopy on an actual patient in less time with greater accuracy, less iteration of movement of the arthroscope, and less damage to the patient's tissue compared with residents in the control group learning and practicing the arthroscopic knee examination procedures through the residency program's established education and training program. The validation study, done at eight orthopaedic residency programs, will commence in early 2006 and will take one year to complete. We anticipate that proficiency obtained on the simulator will transfer to surgical skills in the operating room. PMID:16394734
Cannon, W Dilworth; Eckhoff, Donald G; Garrett, William E; Hunter, Robert E; Sweeney, Howard J
Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is a less understood entity. The purpose of this study was to diagnose mucoid degeneration of anterior cruciate ligament and to assess the effectiveness of arthroscopic treatment in these patients. Materials and Methods: Between December 2007 and November 2011, 20 patients were diagnosed to be suffering from mucoid degeneration of anterior cruciate ligament (ACL) on the basis of magnetic resonance imaging (MRI), histopathology, and arthroscopy findings. 12 patients were males and 8 patients were females, with mean age of 42.2 years for males (range 28-52 years) and 39.4 years for females (range 30–54 years). They presented with pain on terminal extension (n=10) and on terminal flexion (n=2) without history of significant preceding trauma. MRI showed an increased signal in the substance of the ACL both in the T1- and T2-weighted images, with a mass-like configuration that was reported as a partial or complete tear of the ACL by the radiologist. At arthroscopy, the ACL was homogenous, bulbous, hypertrophied, and taut, occupying the entire intercondylar notch. A debulking of the ACL was performed by a judicious excision of the degenerated mucoid tissue, taking care to leave behind as much of the intact ACL as possible. Releasing it and performing a notchplasty treated impingement of the ACL to the roof and lateral wall. In one patient, we had to replace ACL due to insufficient tissue left behind to support the knee. Results: Good to excellent pain relief on terminal flexion–extension was obtained in 19 of 20 knees. The extension deficit was normalized in all knees. Lachman and anterior drawer test showed a firm endpoint in all, and 85% (n=17) showed good to excellent subjective satisfaction. Conclusions: Mucoid hypertrophy of the ACL should be suspected in elderly persons presenting pain on terminal extension or flexion without preceding trauma, especially when there is no associated meniscal lesion or ligamentous insufficiency. They respond well to a judicious arthroscopic release of the ACL with notchplasty.
Chudasama, Chirag H; Chudasama, Vyoma C; Prabhakar, Mukund M
Surgically repaired rotator cuff repairs may re-tear in the post-operative follow-up phase, and periodic imaging is useful for early detection. The authors describe a simple surgical technique that provides a visible clue to the tendon edge on an anteroposterior radiograph of the shoulder. The technique involves arthroscopic or mini-open radio-opaque tagging of the tendon edge using a metal marker, and followed by a double-row rotator cuff repair using suture anchors. Serial post-operative radiographs may then be used to monitor the position of the marker. Progressive or marked displacement of the marker suggests a failure of cuff repair integrity and should be evaluated further.
This article reports on 7 patients with septic arthritis of the temporomandibular joint (TMJ) who were managed with arthroscopy between 1998 and 2007. The common symptoms were trismus and pain. A series of imaging studies showed widening of joint space in 1 patient with plain film; MRI demonstrated increased joint effusion in 4 patients; accompanying cellulitis in adjacent tissues was discerned by CT in 2 patients. Under the arthroscope, a reddened and swollen synovial membrane was found in 2 patients who were in the acute stage, whereas strong adhesions, destruction of cartilage, and bony defects were discovered in other 5 patients in the chronic stage. Additionally, the disc was ruptured in 3 patients, and fibrosis was confirmed for 2 patients. Lavage, lysis of adhesion, and debridement of articular surface were common procedures for treatments. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proven to be a useful method for management of septic arthritis of TMJ, especially for patients in the chronic stage. PMID:20123377
Cai, Xie-Yi; Yang, Chi; Chen, Min-Jin; Zhang, Shan-Yong; Yun, Bai
Osteoid osteomas (OOs) are benign tumors; intra-articular lesions are rare, and few localizations at the elbow are reported. We present 2 cases of OO in young patients; both described limited motion, and 1 patient reported pain. Diagnosis was suspected on the basis of computed tomography findings. Arthroscopic exploration of the joint was performed, bony biopsy was undertaken, and excision of the lesion was completed. In both cases, pathologic examination confirmed the diagnosis. The first patient had an excellent clinical result and returned to full activity in 2 weeks. The second patient underwent only partial excision of the lesion, probably because of the technical nature of the procedure (use of the shaver is not indicated in optimal treatment of OO). Arthroscopy is a useful and safe technique for OO excision when specific steps are followed: A shaver must be used only for exposition of big or deep lesions--not for treatment; in addition, bony biopsy must be performed, curettage must be completed with a curette, and a burr should be used at the end of the procedure to destroy hyperemic lesions. Elbow contracture does not have to be treated because it is directly related to the osteoma, and excision of the osteoma will restore full mobility. PMID:17637425
Nourissat, Geoffroy; Kakuda, Carlos; Dumontier, Christian
The purpose of this prospective study was the assessment of the chronic unstable ankle joint. With regard to cartilage and ligament lesions this was done arthroscopically. 99 consecutive arthroscopies were performed in patients with symptomatic chronic ankle instability. There were 67 complete ruptures of the anterior talofibular ligament and 45 complete ruptures of the calcaneofibular ligament. A complete rupture of the deltoid ligament was found in 6 cases, always combined with lesions of the lateral ligaments. Cartilage damage of the talus was noted in 51 cases and of the tibial pilon in 12 cases. While all complete lesions of the deltoid ligament were associated with talar cartilage damage, this was different for lateral ligament lesions. 11/22 ruptures of the talofibular ligament were associated with cartilage damage of the talus and 11/22 ruptures presented with an intact talar cartilage. Combined ruptures of the talofibular and the calcaneofibular ligament were associated with talar cartilage damage in 21 cases and presented with intact cartilage in 24 cases. This study demonstrated a near equal distribution of intact and damaged articular cartilage in the presence of lateral ligament lesions indicating that the status of the ligaments allows no conclusion with regard to the cartilage. Arthroscopy therefore can give essential information about the status of the unstable ankle joint concerning operative or conservative treatment. PMID:9005600
Treatment methods for osteonecrosis (avascular necrosis) are wide and varied. When untreated, progression of the disease is common and may dictate femoral head replacement. However, before femoral head collapse, some patients have mechanical joint symptoms (locking, buckling, clicking) that are unaddressed by femoral head drilling alone. Radiographic examinations in these patients usually are nondiagnostic. Patients with these clinical criteria were evaluated arthroscopically. Between 1993 and 2000, seven patients were identified with known documented or radiographic diagnosis of avascular necrosis who had hip arthroscopy. Each patient's preoperative history, physical examination, plain radiographs, magnetic resonance imaging scans, and operative notes were reviewed from a prospectively-derived database. The duration and onset of symptoms were identified carefully. Case histories are presented on five of these patients. Articular cartilage changes were recorded and correlated to the preoperative radiologic studies. Hip arthroscopy is a minimally invasive, highly effective, joint-preserving surgery in the young patient with mechanical symptoms (locking, catching, buckling) and early avascular necrosis. Treatable lesions include loose bodies, synovitis, chondral flaps, and labral tears. In addition, accurate staging can be accomplished through direct observation. PMID:12579001
9 asymptomatic subjects and 6 patients underwent T1? MRI to determine whether Outerbridge grade 1 or 2 cartilage degeneration observed during arthroscopy could be detected noninvasively. MRI was performed 2–3 months post-arthroscopy using sagittal T1-weighted and axial and coronal T1? MRI from which spatial T1? relaxation maps were calculated from segmented T1-weighted images. Median T1? relaxation times of patients with arthroscopically documented cartilage degeneration and asymptomatic subjects were significantly different (p < 0.001) and median T1? exceeded asymptomatic articular cartilage median T1? by 2.5 to 9.2 ms. In 8 observations of mild cartilage degeneration at arthroscopy (Outerbridge grades 1 and 2), mean compartment T1? was elevated in 5, but in all observations, large foci of increased T1? were observed. It was determined that T1? could detect some, but not all, Outerbridge grade 1 and 2 cartilage degeneration but that a larger patient population is needed to determine the sensitivity to these changes.
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas
Bill Bruce; Nancy Porter; George Ritter; Matt Boring; Mark Lozev; Ian Harris; Bill Mohr; Dennis Harwig; Robin Gordon; Chris Neary; Mike Sullivan
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary
ome nerve injuries require repair in order to regain sen- sory or motor function. Although this article focuses pri- marily on trigeminal nerve (TN) injuries and repairs, the facts presented may apply to any peripheral nerve repair. The primary indications for nerve repair or grafting are 1) an injury or continuity defect in a nerve, as a result of trauma,
The purpose of this quasi-experimental study was to examine the effect of acupuncture on postoperative pain in day surgery patients undergoing arthroscopic shoulder surgery. Twenty-two participants scheduled to undergo arthroscopic shoulder surgery were included. The results showed that on postoperative day one pain decreased (-1.1) in patients receiving acupuncture compared to the control group in which pain increased (2.0), p=.014. Sleep quality was also significantly higher in the acupuncture group compared to the control group, p=.042. In conclusions, acupuncture seems to have a reducing effect on postoperative pain as well as increase sleep quality in day surgery patients undergoing arthroscopic shoulder surgery. In regards to application, nurses should be encouraged to use additional nonpharmacologic approaches like acupuncture in postoperative pain management, as this can be a part of the multimodal analgesic regimes to improve patients care. PMID:22843248
Although satisfactory arthroscopic resection of volar wrist ganglia has been reported recently, the risk of damage to arteries, nerves, and tendons remains. Furthermore, ganglia and their stalks cannot be visualized arthroscopically in many cases, and surgeons must perform a blind resection of the joint capsule until ganglion cysts or their stalks appear. Sonography has limited resolution, but recent improvements in hardware and software have made it an excellent noninvasive and dynamic imaging technique for assessing the musculoskeletal system. Ganglia, tendons, nerves, and vessels around the lesion can be clearly observed by sonography. Furthermore, the cyclic motion of the arthroscopic shaver tip makes identification by sonography easy and assists in guiding the surgeon to the lesion.
Pigmented villonodular synovitis (PVNS) is a rare proliferative synovial disorder of uncertain etiology. Two forms of this disorder, a localized (LPVNS) and diffuse (DPVNS) form, are well differentiated. The therapy of choice for LPVNS is arthroscopic partial synovectomy with excision of the lesion. Total synovectomy, whether done arthroscopically or through an open arthrotomy, is the recommended treatment for DPVNS. During an eight-year period 13 patients, six male and seven female, average age 28 years (range, 16 to 60 years) were treated for PVNS of the knee with arthroscopic synovectomy. Average follow-up was 84 months (range, 28 to 127 months). Four patients were affected by localized PVNS and were subjected to partial arthroscopic synovectomy (two to three portals) with a complete lesion excision. The remaining nine patients presented with the diffuse form of PVNS and all of them underwent total arthroscopic synovectomy (five portals). The diagnosis was confirmed by synovial biopsy. Each patient was evaluated before treatment and at final follow-up. Results were assessed clinically, radiographically and subjectively and were rated as excellent, good, fair, or poor. No complications or recurrences were noted in the LPVNS group, and all four patients were rated as excellent. In the DPVNS group, eight patients were rated as excellent and one patient was rated as fair and it was the patient who suffered the only recurrence in our case series. No relevant complications were encountered. No cases of infection, joint stiffness or neurovascular lesions were seen. Arthroscopy has become the golden standard in treatment of LPVNS, and can undoubtedly give results that are as good as with open synovectomy when treating DPVNS, if performed by an experienced arthroscopic surgeon. PMID:21874741
Kubat, Ozren; Mahnik, Alan; Smoljanovi?, Tomislav; Bojani?, Ivan
We present our novel arthroscopic anatomic double-bundle coracoclavicular ligament reconstruction technique using a semitendinosus tendon autograft. The dorsal limb of the graft is positioned around the dorsal edge of the clavicle, re-creating the conoid ligament. The anterior limb proceeds superiorly and re-creates the trapezoid ligament. The solution effectively stabilizes the acromioclavicular joint and prevents anterior posterior translation. This new arthroscopic double-bundle coracoclavicular joint reconstruction is an effective and reliable method in stabilizing the clavicle and neutralizing the anterior-posterior translation, and we find it to be technically practical for the surgeon.
Ranne, Juha O.; Sarimo, Janne J.; Rawlins, Mark I.; Heinonen, Olli J.; Orava, Sakari Y.
Purpose The aim of this study was to compare shoulder manipulation and arthroscopic arthrolysis with glenohumeral steroid injections\\u000a in patients affected by idiopathic adhesive shoulder capsulitis.\\u000a \\u000a \\u000a \\u000a \\u000a Methods In this prospective study we randomly assigned patients to enter group A (23 patients, shoulder manipulation and arthroscopic\\u000a arthrolysis) and group B (21 patients, glenohumeral steroid injections). Patients were followed-up at three, six and 12
Angelo De Carli; Antonio Vadalà; Dario Perugia; Luciano Frate; Carlo Iorio; Mattia Fabbri; Andrea Ferretti
This is a case report of an arthroscopic treatment performed on a patient with piriformis syndrome due to perineural cyst on piriformis muscle and sciatic nerve. Confirmation, incision, and drainage of benign cystic lesion on the sciatic nerve below the piriformis muscle were performed following the release of the piriformis tendon through the posterior and posteroinferior arthroscopic portal. Recurrence of the symptoms has not been observed since postoperative period of 20 months. Nor did the MRI taken after the procedure reveal any such recurrence. PMID:20062971
Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find at the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was not heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past. 2 figs.
Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find an the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was was heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past.
The histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow were studied in cadav eric specimens. The capsule consists of two layers of collagen fibers, with two distinct ligamentous bundles corresponding to anterior and posterior portions of the ulnar collateral ligament. The posterior bundle consists of distinct collagen bundles within the layers of the cap sule ;
Abstract: Background: Anterior Cruciate Ligament (ACL) tearing is a common injury among football players. The present study aims to determine the best single-dose of intra-articular morphine for pain relief after arthroscopic knee surgery that, in addition to adequate and long-term analgesia, leads to fewer systemic side effects. Methods: This clinical trial was conducted on 40 ASA-I athletes. After surgery, all participants received an injection of 20cc of 0.5% intra-articular bupivacaine. In addition, the first control group received a saline injection and 5, 10 and 15 mg of morphine were respectively injected into the joints of the second, third and fourth groups by use of Arthroscopic equipment before the Arthroscopic removal. The amount of pain based on VAS at 1, 2, 4, 6 and 24 hours after surgery, duration of analgesia and the consumption of narcotic drugs were recorded. Results: The VAS scores in the fourth, sixth and twenty-fourth hours after surgery showed a significant difference between the study groups. The average time to the first analgesic request from the bupivacaine plus 15 mg morphine group was significantly longer than other groups and total analgesic requests were significantly lower than other groups. No drowsiness complications were observed in any of the groups in the first 24 hours after injection. Conclusions: Application of 15 mg intra-articular morphine after Arthroscopic knee surgery increases the analgesia level as well as its duration (IRCT138902172946N3).
We describe a new arthroscopic excision technique for a symptomatic os trigonum. With the patient lying in a prone position, a posterolateral portal just lateral to the Achilles tendon, at the 5-mm level proximal to the tip of the fibula, is used for the arthroscope and an accessory posterolateral portal just posterior to the peroneal tendon at the same level is used for instruments. The synovial tissues are then debrided with a power shaver through the accessory posterolateral portal for better visualization. An elevator is used to release the fibrous tissue between the os trigonum and the talus. The os trigonum is completely excised with a grasper to visualize the flexor hallucis longus tendon. Radiographic control is helpful to check the position of the arthroscope if it happens to be inserted into the ankle joint as a result of the reduced subtalar joint space. Postoperatively, no immobilization is necessary, and full weight-bearing is allowed as tolerated. Three of us have performed 11 procedures with excellent results and no cases of complications. This arthroscopic excision technique for the symptomatic os trigonum is a safe and effective procedure. PMID:18182212
Arthroscopic management of lateral epicondylitis is a commonly performed procedure that has a good track record of efficacy and safety based on the current literature. Here, we report 2 cases of nerve injuries resulting from this operation: 1 posterior interosseous nerve transection and 1 partial median nerve laceration. PMID:22459658
Carofino, Bradley C; Bishop, Allen T; Spinner, Robert J; Shin, Alexander Y
Purpose: The purpose of this study was to determine the optimal knot configuration that maximized both knot and loop security when tied with 2 different types of nonabsorbable, braided suture. Type of Study: In vitro biomechanical study. Methods: Six commonly used arthroscopic sliding knots (Duncan loop, Nicky’s knot, Tennessee slider, Roeder knot, SMC knot, Weston knot) with and without a
Ian K. Y. Lo; Stephen S. Burkhart; K. Casey Chan; Kyriacos Athanasiou
Arthroscopic subacromial decompression (ASD) was performed in 88 patients (90 shoulders) with stage II or early III impingement syndrome of the shoulder unresponsive to nonoperative treatment. The purpose of this retrospective study was to evaluate the follow-up an average of 41 months (range 24 to 82 months) after surgery. We wished to compare results in (1) patients with and without
PURPOSE: To report the 10-years' experience of a novel arthroscopic assisted anatomical TFCC reconstruction in treatment of chronic DRUJ instability resulting from irreparable TFCC injuries. MATERIALS AND METHODS: 15 patients (7 males, 8 females) with mean age of 37 (17-49) suffering from irreparable TFCC injuries received arthroscopic assisted reconstruction using palmaris longus graft. Three skin incisions were made with creation of one radial and one ulna tunnel for passage of graft following the path of dorsal and palmar radio-ulnar ligaments under fluoroscopic and arthroscopic guidance. The joint capsule was kept intact. Early mid-range forearm rotation was started since 4th week postoperatively. RESULTS: The mean follow-up was 85.53months (32-138). Mayo wrist score improved from 62.5 to 88(p<0.05). Comparing contralateral side, total prono-supination range increased from 76.6% to 92.1% and grip strength increased from 56.1% to 76.9%. Twelve patients resumed previous jobs. No evidence of DRUJ arthritis was noticed. Complications included 2 late graft ruptures and one unexplained dystonia. CONCLUSIONS: Our arthroscopic assisted approach on TFCC reconstruction is safe, produces comparable results as the standard technique and may achieve better range of motion with less soft tissue dissection and earlier mobilization. PMID:23337702
We describe an arthroscopic technique by which to reconstruct both the calcaneofibular ligament and anterior talofibular ligament anatomically. The ankle joint is examined through the anteromedial portal and a lateral portal close to the talar insertion of the anterior talofibular ligament. The subtalar joint is examined through the anterolateral portal and the middle portal. Associated intra-articular pathology (e.g., osteochondral defect)
Sixty-two consecutive patients with painful limited dor siflexion of the ankle not responding to nonoperative treatment participated in a prospective study. All 42 men and 20 women (average age, 31 years) under went arthroscopic surgery. Preoperative radiographs were graded according to an osteoarthritic and an impingement classification. Standardized followup took place at 4 months and 1 and 2 years after
C. Niek van Dijk; Johannes L. Tol; Cees C. P. M. Verheyen
Foot and ankle surgeons often rely on the medial clear space to evaluate competency of the deep deltoid ligament when evaluating ankle fractures. This investigation assesses the integrity of the deep deltoid ligament after lateral malleolar fracture by using direct arthroscopic visualization and medial clear-space separation on plain film radiographs. The objectives of this study were to test the reliability
John M Schuberth; David R Collman; Shannon M Rush; Lawrence A Ford
Background: Hip arthroscopy represents a new and minimally invasive method of treating patients with femoroacetabular impingement (FAI). However, participation in popular sports after this procedure has not yet been analyzed.Hypotheses: Arthroscopic treatment of FAI increases the level of popular sports activities, and this level of activity correlates with the clinical outcome in terms of pain and function.Study Design: Case series;
Alexander Brunner; Monika Horisberger; Richard F. Herzog
We reviewed 17 patients after arthroscopic resection for anterior impingement in the ankle. All had had painful limitation of dorsiflexion which had failed to respond to conservative treatment. Review at an average of 39 months showed very significant improvements in levels of pain, swelling, stiffness, limping and activity. There was a significant improvement in the range of dorsiflexion but not
Trochanteric bursitis with lateral hip pain is a commonly encountered orthopaedic condition. Although most patients respond to corticosteroid injections, rest, physical therapy (PT), stretching, and anti-inflammatory medications, those with recalcitrant symptoms may require operative intervention. Studies have explored the use of the arthroscope in the treatment of these patients. However, these reports have not addressed the underlying pathology in this
Derek Farr; Harlan Selesnick; Chet Janecki; Daniel Cordas
The purpose of this article is to describe the outcome of an arthroscopic examination and the pathology in symptomatic shoulders of 41 professional overhand throwing athletes. With the arm in the position of the relocation test, 100% of the subjects had either contact between the rotator cuff undersurface and the posterosuperior glenoid rim or osteochondral lesions. Other key findings included
Kevin J. Paley; Frank W. Jobe; Marilyn M. Pink; Ronald S. Kvitne; Neal S. ElAttrache
Background: Symptomatic labral tears of the hip are associated with bony abnormalities of the femoral head and acetabulum, resulting in impingement. These patients have characteristic internal rotation limitations, which can result in compensatory athletic injury patterns around the hip, pelvis, and lumbar spine.Hypothesis: Patients undergoing arthroscopic cam decompression will have improvement in internal rotation after decompression. Patients with decreased femoral
Bryan T. Kelly; Asheesh Bedi; Catherine M. Robertson; Katrina Dela Torre; M. Russell Giveans; Christopher M. Larson
Various methods have been described for the treatment of the acutely infected total knee arthroplasty. These include antibiotic suppression, open debridement and irrigation, exchange arthroplasty, resection arthroplasty, arthrodesis, and amputation. A method not frequently reported is arthroscopic irrigation and debridement. Two cases of acutely infected total knee arthroplasty treated with arthroscopic irrigation and debridement are presented. In both cases there was a benign postoperative course averaging five months. Both infections were secondary to hematogenous seeding from a distant focus of infection. The patients presented within approximately 12 h after the onset of knee symptoms and were taken for arthroscopic irrigation and debridement within 12 h after presentation. Gram-positive organisms sensitive to the antibiotics being used were cultured in both. Postoperative knee function and range of motion returned rapidly and disability was minimal. At average 30-month follow-up both patients were pain free, had full activity of daily living, and had no clinical or radiographic evidence of infection. Arthroscopic irrigation and debridement appears to be an effective method of treatment in select cases of infected total knee arthroplasty. PMID:3166657
We reviewed 100 patients treated arthroscopically for symptoms of chronic ankle pain associated with sprains of the ankle. All had pain that had failed to respond to conservative treatment for at least 6 months. The pathology in 95 of the 100 ankles studied could be categorized into one of three groups: the instabilities (lateral and syndesmotic), the impingements (anterior and
D. J. Ogilvie-Harris; Michael K. Gilbart; Katheryn Chorney
A system for simulating arthroscopic knee surgery that is based on volumetric object models derived from 3D Magnetic Resonance Imaging is presented. Feedback is provided to the user via real-time volume rendering and force feedback for haptic exploration. The system is the result of a unique collaboration between an industrial research laboratory, two major universities, and a leading research hospital.
Sarah F. Frisken Gibson; Joe Samosky; Andrew B. Mor; Christina Fyock; W. Eric L. Grimson; Takeo Kanade; Ron Kikinis; Hugh C. Lauer; Neil Mckenzie; Shin Nakajima; Takahide Ohkami; Randy Osborne; Akira Sawada
Whilst local anaesthesia for daycase arthroscopic knee surgery has been well reported, there are few centres in the United Kingdom performing such a technique. Hyaluronidase has been widely used as an adjunct to local anaesthetic infiltration in the fields of ophthalmic and plastic surgery, but it is rarely used in orthopaedic surgery. We report our technique, which the senior author
Summary: We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was
Jean-François Kempf; Pascal Gleyze; François Bonnomet; Gilles Walch; Daniel Mole; André Frank; Philippe Beaufils; Christophe Levigne; Bruno Rio; André Jaffe
Retinal detachment repair is eye surgery to place a detached retina back into its normal position. A detached ... layers. This article describes the repair of rhegmatogenous retinal detachments -- retinal detachments that occur due to a hole ...
PURPOSE: This study was designed to critically analyze the outcome of sphincter repair and, if possible, to identify high-risk factors. METHODS: Clinical and physiologic assessment was made of all sphincter repairs (42 patients) performed in one unit by two surgeons during five years. RESULTS: Forty-two patients (10 men, 32 women) underwent sphincter repair. Only three of five men with anterior
N. Nikiteas; S. Korsgen; D. Kumar; M. R. B. Keighley
Rotator cuff repair is a type of surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (" ... Surgery to repair a torn rotator cuff is usually very successful at relieving pain in the shoulder. The procedure may not always return ...
Students learn about how biomedical engineers aid doctors in repairing severely broken bones. They learn about using pins, plates, rods and screws to repair fractures. They do this by designing, creating and testing their own prototype devices to repair broken turkey bones.
Integrated Teaching and Learning Program, College of Engineering,
The Donner-Hanna Coke Plant of Buffalo, New York has four coke oven batteries, the oldest being put into operation in 1943. A description is given of a method of repair developed by the company to repair stack waste heat tunnels and coke oven walls using a firesuit that allowed a repairman to work inside these hot areas. The procedure for the repair of coke oven walls is discussed in detail. A high duty castable was found to simulate the qualities of coke oven silica brick. The repair technique is relatively low cost without the attendant loss of production entailed by other methods of oven repair. (CKK)
Laser repair of liver using albumin is a promising method for treating liver trauma. Concentrated human serum albumin is applied to a liver laceration and then denatured using a laser. These repairs were pulled with a material tester to measure the ultimate strength of the laser repair. We show that the ultimate strength of the liver repairs tends to increase with delivered laser energy, that the mode of delivery (pulsed versus continuous) does not matter, that the repair strength correlates with the area of denatured albumin, and that strong welds cause about 1.5 mm of thermal damage.
The human meniscus is important for normal knee function and distributes loads, aids in joint lubrication, congruence, stability, and proprioception. Repair of appropriate meniscal tears is possible and several methods exist to accomplish this including suture repairs and device repairs. Clinical evidence suggests that meniscal repairs can result in acceptable healing rates although adverse events have been reported for some devices. New self-adjusting suture devices have facilitated the accurate and effective repair of the torn meniscus. Technique descriptions for these devices are presented. PMID:18004219
This is the first report to describe a method of arthroscopic osteochondral fixation using absorbable pins to treat osteochondritis\\u000a dissecans (OCD) of the capitellum. Four adolescent baseball players with OCD of the capitellum were treated, and good short-term\\u000a results were obtained. During this arthroscopic procedure, the elbow was maintained in the maximum flexed position, and posterolateral\\u000a portals were used to
Background: Osteochondritis dissecans of the capitellum of the humerus usually occurs in adolescence and is caused by the valgus forces associated with excessive throwing.Hypothesis: Arthroscopic surgery is an appropriate procedure for this condition.Study Design: Retrospective cohort study.Methods: Arthroscopic surgery was performed on 10 baseball players (average age, 13.8 years) with osteochondritis dissecans whose symptoms had been apparent for an average
To counteract the adverse effects of various DNA lesions, cells have evolved an array of diverse repair pathways to restore DNA structure and to coordinate repair with cell cycle regulation. Chromatin changes are an integral part of the DNA damage response, particularly with regard to the types of repair that involve assembly of large multiprotein complexes such as those involved in double strand break (DSB) repair and nucleotide excision repair (NER). A number of phosphorylation, acetylation, methylation, ubiquitylation and chromatin remodeling events modulate chromatin structure at the lesion site. These changes demarcate chromatin neighboring the lesion, afford accessibility and binding surfaces to repair factors and provide on-the-spot means to coordinate repair and damage signaling. Thus, the hierarchical assembly of repair factors at a double strand break is mostly due to their regulated interactions with posttranslational modifications of histones. A large number of chromatin remodelers are required at different stages of DSB repair and NER. Remodelers physically interact with proteins involved in repair processes, suggesting that chromatin remodeling is a requisite for repair factors to access the damaged site. Together, recent findings define the roles of histone post-translational modifications and chromatin remodeling in the DNA damage response and underscore possible differences in the requirements for these events in relation to the chromatin context. PMID:23085398
DNA repair is a collection of several multienzyme, multistep processes keeping the cellular genome intact against genotoxic insults. One of these processes is base excision repair, which deals with the most ubiquitous lesions in DNA: oxidative base damage, alkylation, deamination, sites of base loss and single-strand breaks, etc. Individual enzymes acting in base excision repair have been identified. The recent years were marked with many advances in understanding of their structure and many interactions that make base excision repair a functional, versatile system. This review describes the current knowledge of structural biology and biochemistry of individual steps of base excision repair, several subpathways of the common base excision repair pathway, and interactions of the repair process with other cellular processes. PMID:18259689
The first ever deployed arthroscopic knee surgeries have been performed using a high resolution color head-mounted display (HMD) developed under the DARPA Advanced Flat Panel HMD program. THese procedures and several fixed hospital procedures have allowed both the system designers and surgeons to gain new insight into the use of a HMD for medical procedures in both community and combat support hospitals scenarios. The surgeons demonstrated and reported improved head-body orientation and awareness while using the HMD and reported several advantages and disadvantages of the HMD as compared to traditional CRT monitor viewing of the arthroscopic video images. The surgeries, the surgeon's comments, and a human factors overview of HMDs for Army surgical applications are discussed here.
Nelson, Scott A.; Jones, D. E. Casey; St. Pierre, Patrick; Sampson, James B.
In treating avulsion fracture of the tibial attachment of the anterior cruciate ligament, surgical reduction and fixation of fractured bone is necessary for patients who have a wide displacement of bone fragment (i.e., types III and IV in the Meyers classification). Our arthroscopic technique allows the creation of bone tunnels on the medial and lateral sides of the bone fragment from the medial side of the tibial tubercle without using special equipment. At surgery, fixation wire is prepared into a loop, pulled into the joint space, and the loop is opened within the joint. This makes intra-articular manipulation easy, and the bone can be reduced more accurately. This arthroscopic technique decreases surgical invasion of the joint, allows good postoperative range of motion without problems, and is useful in preventing extension limitation due to dislocation of the anterior portion of the fragment. PMID:11694937
Hara, K; Kubo, T; Shimizu, C; Suginoshita, T; Hirasawa, Y
Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space. PMID:23802093
Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.
This retrospective study was aimed to investigate the epidemiologic, clinical and arthroscopic features of discoid meniscus\\u000a variant in Greek population. We reviewed the cases of 2,132 patients who underwent knee arthroscopy between 1986 and 2004\\u000a and diagnosis of discoid lateral meniscus was established in 39 patients with mean age of 31.7 ± 9.4 years old. Incidence\\u000a of the discoid lateral meniscus variant was
Anestis Papadopoulos; Alexandros Karathanasis; John M. Kirkos; George A. Kapetanos
Background:Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition.Purpose:To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population.Study Design:Case series; Level of evidence, 4.Methods:Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33
David H. Kim; Ralph A. Gambardella; Neal S. Elattrache; Lewis A. Yocum; Frank W. Jobe
Arthroscopy is an accepted technique for the resection of wrist ganglions. The reported complication rate is comparable with open resection at 2%; however, this rate may be underestimated. Most reported complications are relatively benign and self-limited. In this case report, we detail lacerations of multiple digital extensor tendons from arthroscopic resection of a dorsal ganglion and describe our management of this complication. PMID:23993041
Over a 4-year period, 160 wrist arthroscopies were performed at 1 institution. Ninety-seven patients had central or nondetached ulnar peripheral tears of the triangular fibrocartilage complex (TFCC). All these patients underwent debridement with an arthroscopic shaver. Thirteen of the 97 had persistent pain in the TFCC region for more than 3 months after surgery. At an average of 8 months after failed arthroscopic debridement of the TFCC, all 13 patients underwent a 2-mm-long ulna-shortening osteotomy with fixation by a 3.5-mm 6-hole dynamic compression plate. At follow-up examination (an average of 2.3 years later), 12 of the 13 had complete relief of pain at the ulnar side of the wrist. One patient continued to complain of pain with moderate to heavy activity use of her hand. Four of the 13 had postoperative complications: 1 had traumatic pull-out of the screws requiring reinsertion and distal radius bone graft, 1 had nonunion at 4 months after surgery that required iliac crest bone graft, and 2 had pain necessitation hardware removal. All 4 of these patients had no further problems at final follow-up evaluation. There was no statistically significant difference between the arthroscopic debridement alone cohort and the arthroscopy/ulna-shortening subgroup relative to ulnar variance or incidence of associated lunotriquetral ligament tears. On the basis of these findings the authors recommend a 2-mm-long ulna-shortening osteotomy for patients whose previous arthroscopic debridement for central or nondetached peripheral TFCC was unsuccessful in eliminating ulnar-sided wrist pain. PMID:9260628
Background: There has been recent concern about long-term morbidity associated with arthroscopic co-planing of the acromioclavicular joint in the treatment of impingement syndrome. Objective: The purpose of this study was to assess the results of the co-planing procedure, special attention being paid to acromioclavicular joint morbidity. Methods: The study included 56 patients who were operated on by the senior author.
Don Buford; Timothy Mologne; Steven McGrath; Greg Heinen; Stephen Snyder
The ideal treatment for acute acromioclavicular joint dislocation is still controversial, both in terms of indications and\\u000a surgical technique. The clinical and radiographic outcomes of 16 patients affected by acute AC joint dislocation (type III–V)\\u000a and arthroscopically treated with a coracoclavicular double flip button are presented. Despite the excellent clinical results\\u000a both in terms of Constant score (mean 97 points)
L. Murena; Ettore Vulcano; C. Ratti; L. Cecconello; P. R. Rolla; M. F. Surace
While trapeziectomy with or without interposition arthroplasty and ligament reconstruction or suspensionplasty have been demonstrated to have a high rate of satisfactory outcomes, recent interest has focused on arthroscopy because of its perceived limited invasive nature as well as its versatility. In addition, using the arthroscope, other options are available that preserve all or part of the trapezium to limit subsidence of the thumb axis, preserve grip and pinch strength, and retain later options for joint reconstruction, should that become necessary. PMID:21871359
Adams, Julie E; Steinmann, Scott P; Culp, Randall W
Allograft meniscus transplant is considered as a treatment option for meniscus-deficient patients to provide pain relief and\\u000a decrease contact stress. This procedure is now considered as safe and reliable for the treatment for knee pain after total\\u000a menisectomy. This is a new technique that has been developed for arthroscopic meniscus transplant with no bone blocks. It\\u000a anatomically recreates the meniscus–tibial
Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction,\\u000a there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic\\u000a infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined\\u000a the number of procedures performed,
D. Luis Muscolo; Lisandro Carbo; Luis A. Aponte-Tinao; Miguel A. Ayerza; Arturo Makino
Background: Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon.Hypothesis: In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms.Study Design: Case series; Level of evidence, 4.Methods:
Anne M. Kelly; Mark C. Drakos; Stephen Fealy; Samuel A. Taylor; Stephen J. OBrien
We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness\\u000a and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including\\u000a a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically\\u000a intact rotator cuff tendons were
S. Waldt; M. Bruegel; D. Mueller; K. Holzapfel; A. B. Imhoff; E. J. Rummeny; K. Woertler
Intra-articular administration of local anaesthetics such as bupivacaine can produce short-term postoperative analgesia in patients undergoing diagnostic arthroscopy or arthroscopic meniscectomy. A peripheral anti-nociceptive effect may also be induced by the administration of intra-articular opiates interacting with local opioid receptors in inflamed peripheral tissue. In the present study we aimed to study the analgesic effects of intraarticularly given bupivacaine and
J. Karlsson; B. Rydgren; B. Eriksson; U. Järvholm; O. Lundin; L. Swärd; T. Hedner
Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with\\u000a limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. We reviewed 26 (16 male and 10\\u000a female) athletes with a mean age of 27 years treated arthroscopically for symptoms due to soft-tissue (group I, n = 12) and bony
Advanced basal joint arthritis that has failed conservative treatment has traditionally been treated with some type of procedure that encompasses complete trapezial excision. An arthroscopic technique entailing only minimal trapezial debridement coupled with insertion of a synthetic interposition material is described. This provides the implicit benefits of a minimally invasive procedure, with less pain and faster recovery, along with the great advantage of trapezium preservation. The surgical technique is described along with a preliminary clinical series supporting its use. PMID:19060684
The carpometacarpal joint of the thumb is a common site of degenerative arthritis. Several surgical treatments exist, but arthroscopic management offers the potential benefit of earlier recovery. The current study evaluated the early clinical outcomes of a procedure involving arthroscopic hemitrapeziectomy with Artelon spacer (Artimplant, Västra Frölunda, Sweden) interposition arthroplasty into the newly created carpometacarpal space.A chart review of 9 patients treated with thumb carpometacarpal arthroscopic hemitrapeziectomy and Artelon spacer interposition arthroplasty between September 2005 and January 2009 was performed for postoperative complications, range of motion, and pinch strength (percentage of the contralateral limb). Subjective outcomes were analyzed by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Patient-rated Wrist Evaluation. Mean follow-up was 23.4 months (range, 13-33 months). All patients maintained full range of motion. By the 1-year follow-up, mean pinch strength returned to 59%± 19.1% of the contralateral limb strength. The Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-rated Wrist Evaluation scores were 12.3 ± 7.6 and 26.8 ± 23.5, respectively. No significant complications occurred, and 1 patient with symptoms of synovitis was successfully treated with a corticosteroid injection. This study revealed excellent short-term results at the minimum 1-year follow-up for a less invasive treatment option that is appropriate for select patients with moderate thumb carpometacarpal arthritis (Eaton stages 2 and 3). The authors demonstrated a comparably good outcome of arthroscopic hemitrapeziectomy with Artelon spacer interposition arthroplasty with no evidence of foreign-body reaction. The authors also demonstrated the potential role of corticosteroid injections in the setting of a postoperative inflammatory reaction. PMID:23218633
Cartilage repair is required in a number of orthopaedic conditions and rheumatic diseases. From a macroscopic viewpoint, the complete repair of an articular cartilage defect requires integration of opposing cartilage surfaces or the integration of repair tissue with the surrounding host cartilage. However, integrative cartilage repair does not occur readily or predictablyin vivo. Consideration of the ‘integrative cartilage repair process’,
Summary To present the results of arthroscopic treatment of patellar tendinopathy in high-level competition athletes. Eleven high-level athletes presented chronic patellar tendinopathy which did not respond to long term conservative treatment. Average age of the patients was 24.8 ±3.4 years old. All patients received an arthroscopic procedure with osteoplasty of the distal patellar pole, debridement of the underlying Hoffa fat pad and of the degenerated areas of the proximal posterior patella tendon and cauterization of the visible neo-vessels. Mean duration of follow-up was 17.4±4 months. Patients showed a major improvement in the Lysholm score from 49.9±5.2 to 92.5±7 and in the VISA P score from 41.2±5.2 to 86.8±14.9 on tenth post-operative week. All patients had returned to sports activities by the twelfth postoperative week. Arthroscopic treatment of chronic patellar tendinopathy found to be a minimal invasive and safe technique which produced satisfactory results.
Pigmented villonodular synovitis (PVNS) is a proliferative disorder that may lead to joint destruction and activity limitation. We conducted a retrospective study to determine the long-term results of localized PVNS (LPVNS) treated with arthroscopic excision, specifically with respect to postoperative activity level and symptom resolution. We reviewed the cases of 11 patients who had been treated with arthroscopic excision and partial synovectomy of LPVNS and been followed up for a mean of 112 months. Preoperative and postoperative Ogilvie-Harris scores, Tegner activity level scores, and UCLA activity level scores were calculated to determine disease-specific and general functional outcomes, respectively. We noted 2 cases in which posteromedial lesions recurred, moderate resolution of preoperative symptoms in most cases, and 2 cases in which the patient developed secondary osteoarthritis requiring surgical intervention. Arthroscopic excision of LPVNS can improve symptoms with a return to preoperative activity levels, but patients may develop secondary osteoarthritis after treatment, as noted in long-term follow-up. PMID:21290030
Rhee, Peter C; Sassoon, Adam A; Sayeed, Siraj A; Stuart, Michael S; Dahm, Diane L
Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290
Surgical treatment of high-grade acromioclavicular (AC) joint separations has become analogous to ligament reconstructions elsewhere in the body with the goal being restoration of the native anatomy. Circumferential access to the base of the coracoid is essential to reconstruct the coracoclavicular ligament complex. Using some of the traditional open approaches, this access requires detaching the deltoid insertion and performing extensive soft tissue dissection. Also, poor visualization risks injury to nearby neurovascular structures. An arthroscopically assisted reconstruction offers the advantage of less soft tissue dissection and superior visualization to the base of the coracoid. We have developed a unique arthroscopically assisted technique that uses a subacromial approach to pass suture material and a tendon graft around the coracoid to reconstruct the coracoclavicular ligament complex. We describe our technique and preliminary results in 10 patients who have undergone coracoclavicular ligament reconstruction for high-grade AC separation. All patients improved subjectively with regard to pain and function at a minimum followup of 3 months (mean, 5 months; range, 3–18 months). This arthroscopically assisted technique has the potential to allow for safe and at least in the short term reliable restoration of the coracoclavicular ligament complex and provides an alternative technique to treat AC joint separations. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Altchek, David W.; Davila, Jeffrey; Cordasco, Frank A.
A retrospective, average 2-year review of 14 patients with a primary glenoid labral tear treated by arthroscopic debridement was conducted to evaluate the long-term results of labral debridement based on tear location in preoperatively stable shoulders. All patients with concomitant pathology requiring an additional open or arthroscopic procedure were eliminated from this study. Every patient complained of shoulder pain mainly with overhead activities and nine patients (64%) also described "clicking" with shoulder movement. All shoulders were stable to translation in all quadrants during the preoperative examination and examination under anesthesia. The functional results at 6 months' follow-up were 93% excellent or good. However, the results at > 1 year's follow-up (average 2 years) were only 71% excellent or good, with a statistically significant 50% of patients decreased in function. The best results were in the superior and anterior-inferior regions. Three patients with large anterior-superior lesions (60%) developed postoperative instability noted at > 6 months postsurgery, representing a significant difference between groups. One of these patients was able to regain a good functional result with rotator cuff strengthening therapy. Close observation of patients after large anterior-superior labral tear arthroscopic debridement is advised because they are at risk for the delayed onset of instability. PMID:8280328
Background Perioperative hypothermia can develop easily during shoulder arthroscopy, because cold irrigation can directly influence core body temperature. The authors investigated whether active warming and humidification of inspired gases reduces falls in core body temperature and allows redistribution of body heat in patients undergoing arthroscopic shoulder surgery under general anesthesia. Methods Patients scheduled for arthroscopic shoulder surgery were randomly assigned to receive either room temperature inspired gases using a conventional respiratory circuit (the control group, n = 20) or inspired gases humidified and heated using a humidified and electrically heated circuit (HHC) (the heated group, n = 20). Results Core temperatures were significantly lower in both groups from 30 min after anesthesia induction, but were significantly higher in the heated group than in the control group from 75 to 120 min after anesthesia induction. Conclusions In this study the use of a humidified and electrically heated circuit did not prevent core temperature falling during arthroscopic shoulder surgery, but it was found to decrease reductions in core temperature from 75 min after anesthesia induction.
Jo, Youn Yi; Kim, Hong Soon; Chang, Young Jin; Yun, Soon Young
Purpose To introduce and evaluate the clinical results of a new arthroscopic technique for partial meniscectomy of symptomatic lateral discoid meniscus using a knife. Materials and Methods From March 2005 to October 2010, 60 knees of 58 patients underwent arthroscopic partial meniscectomies for lateral discoid meniscus. The average age was 28.9 years (range, 12 to 63 years), and average follow-up was 26 months (range, 8 to 72 years). In this procedure, using a No. 11 knife holder inserted through the high far anteromedial portal, a stab incision on the anterior meniscal horn and following piecemeal meniscal excision were made. Clinical results were assessed using the scale of Ikeuchi and Lysholm score. Results Meniscus shape was complete in 32 knees (53.3%) and incomplete in 28 knees (46.6%). The shape of tears in complete type lesions was horizontal cleavage in 17 knees (53.1%), flap or complex degenerated tears in 10 knees (31.2%) and radial tears in 5 knees (15.6%). Clinical results assessed using the scale of Ikeuchi were excellent in 38 (63.3%), good in 13 (21.6%), fair in 8 (13.3%) and poor in 1 knee (1.6%). The average Lysholm score was improved from 82.8 preoperatively to 95.4 postoperatively. Conclusions Our new arthroscopic technique in lateral discoid partial meniscectomy suggests convenient methods and successful clinical results.
Slipped capital femoral epiphysis (SCFE) is considered to be one of the most common disorders of the hip in children and adolescents. If left untreated, it may lead to progressive deformity, pain and decreased range of motion, and predisposes to early onset degenerative arthritis. Surgical treatment is advised, with in situ pinning across the physis being the gold standard for stable slips. Closed or open reduction can be considered in unstable or severe types. We report the arthroscopically assisted reduction of an unstable severe SCFE, followed by canulated screw fixation. A follow-up of 2.5 years shows an excellent clinical and acceptable radiological outcome. Our case demonstrates that arthroscopically assisted reduction of a slipped capital femoral epiphysis is feasible. Although the technique is technically challenging and requires familiarity with arthroscopy of the hip, it has some clear benefits as compared with both closed and open reduction techniques. Arthroscopically assisted reduction may therefore be a safe and effective treatment in unstable, severe SCFE. PMID:22697001
De Jong, Andy; van Riet, Roger; Van Melkebeek, Jan
The paper provides a simple guide for carrying out preventive maintenance which will eliminate or greatly reduce the need for bicycle repair work. It also covers simple and not-so-simple repair techniques which will allow the reader to fix almost any faul...
The repair of wounds is one of the most complex biological processes that occur during human life. After an injury, multiple biological pathways immediately become activated and are synchronized to respond. In human adults, the wound repair process commonly leads to a non-functioning mass of fibrotic tissue known as a scar. By contrast, early in gestation, injured fetal tissues can
Geoffrey C. Gurtner; Sabine Werner; Yann Barrandon; Michael T. Longaker
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. In lieu of a field installation on an abandoned pipeline, a preliminary nondestructive testing protocol is being developed to determine the success or failure of the fiber-reinforced liner pipeline repairs. Optimization and validation activities for carbon-fiber repair methods are ongoing.
Bill Bruce; Nancy Porter; George Ritter; Matt Boring; Mark Lozev; Ian Harris; Bill Mohr; Dennis Harwig; Robin Gordon; Chris Neary; Mike Sullivan
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. The first round of optimization and validation activities for carbon-fiber repairs are complete. Development of a comprehensive test plan for this process is recommended for use in the field trial portion of this program.
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. Development of a comprehensive test plan for this process is recommended for use in the field trial portion of this program.
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary
Disclosed are improvements to a rapid road repair vehicle comprising an improved cleaning device arrangement, two dispensing arrays for filling defects more rapidly and efficiently, an array of pre-heaters to heat the road way surface in order to help the repair material better bond to the repaired surface, a means for detecting, measuring, and computing the number, location and volume of each of the detected surface imperfection, and a computer means schema for controlling the operation of the plurality of vehicle subsystems. The improved vehicle is, therefore, better able to perform its intended function of filling surface imperfections while moving over those surfaces at near normal traffic speeds.
This is the first report to describe a method of arthroscopic osteochondral fixation using absorbable pins to treat osteochondritis dissecans (OCD) of the capitellum. Four adolescent baseball players with OCD of the capitellum were treated, and good short-term results were obtained. During this arthroscopic procedure, the elbow was maintained in the maximum flexed position, and posterolateral portals were used to visualize the lesion, perform drilling, and insert the pins. This procedure is less invasive and easier to perform than other fixation procedures that require harvesting or production of autologous bone pegs. This is an effective method of fragment fixation with absorbable pins. PMID:19859694
Purpose Both magnesium and morphine provide enhanced patient analgesia after arthroscopic knee surgery when administered separately\\u000a via the intra-articular route. Magnesium sulfate amplifies the analgesic effect of morphine. This study was designed to compare\\u000a the analgesic effects of intra-articular magnesium and morphine, with bupivacaine, when used separately and in combination.\\u000a \\u000a \\u000a \\u000a Methods Eighty patients undergoing arthroscopic menisectomy were randomized blindly into four intra-articular
A neodymium:yttrium aluminum garnet (Nd:YAG) laser beam was introduced by a quartz fiber passed arthroscopically into the superior joint space of the temporomandibular joints (TMJ) of five mongrel dogs, with one joint serving as a control without laser wounds. Immediate postoperative death and examination of the disc grossly and histologically revealed different patterns for contact and noncontact burn wounds. The wounds exhibited signs of thermal coagulation necrosis similar to those reported in other tissues. The potential implications of the adaptation of the Nd:YAG laser to TMJ arthroscopic surgery are discussed.
Bradrick, J.P.; Eckhauser, M.L.; Indresano, A.T. (Case Western Reserve Univ. College of Medicine, OH (USA))
You had a fracture (break) in the femur, also called the thigh bone, in your leg. You may have needed surgery to repair ... surgeon will make a cut to open your fracture. Your surgeon will then use special metal devices ...
This report describes a series of tests to evaluate a system for rapidly repairing airfield pavement using polymer concrete (synthetic polymer plus aggregate), thermally cured by microwave power. The technique, developed by the Syracuse University Researc...
The two broad categories of deposited weld metal repair and fiber-reinforced composite liner repair technologies were reviewed for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Preliminary test programs were developed for both deposited weld metal repair and for fiber-reinforced composite liner repair. Evaluation trials have been conducted using a modified fiber-reinforced composite liner provided by RolaTube and pipe sections without liners. All pipe section specimens failed in areas of simulated damage. Pipe sections containing fiber-reinforced composite liners failed at pressures marginally greater than the pipe sections without liners. The next step is to evaluate a liner material with a modulus of elasticity approximately 95% of the modulus of elasticity for steel. Preliminary welding parameters were developed for deposited weld metal repair in preparation of the receipt of Pacific Gas & Electric's internal pipeline welding repair system (that was designed specifically for 559 mm (22 in.) diameter pipe) and the receipt of 559 mm (22 in.) pipe sections from Panhandle Eastern. The next steps are to transfer welding parameters to the PG&E system and to pressure test repaired pipe sections to failure. A survey of pipeline operators was conducted to better understand the needs and performance requirements of the natural gas transmission industry regarding internal repair. Completed surveys contained the following principal conclusions: (1) Use of internal weld repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling (HDD) when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) Pipe diameter sizes range from 50.8 mm (2 in.) through 1,219.2 mm (48 in.). The most common size range for 80% to 90% of operators surveyed is 508 mm to 762 mm (20 in. to 30 in.), with 95% using 558.8 mm (22 in.) pipe. An evaluation of potential repair methods clearly indicates that the project should continue to focus on the development of a repair process involving the use of GMAW welding and on the development of a repair process involving the use of fiber-reinforced composite liners.
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; Nancy Porter; Mike Sullivan; Chris Neary
... inguinal hernia repairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). If may offer a ...
Patent urachal tube repair ... belly. Next, the surgeon will find the urachal tube and remove it. The bladder opening will be ... surgeon uses the tools to remove the urachal tube and close off the bladder and area where ...
These two diagrams from SpaceTEC National Aerospace Technical Education Center show how to create a PVC foam core sandwich and perform structural scarf repair. The diagrams show the materials to use and the dimensions of each.
Shoulder pain is a common and difficult problem in competitive swimmers due to cumulative loads from repetitive overhead motion. Capsular laxity has been implicated as a potential etiology for shoulder pain in competitive swimmers. No study has examined the role of capsular plication in addressing recurrent shoulder pain in competitive swimmers. The purpose of this study is to retrospectively describe our series of competitive swimmers treated with arthroscopic capsular plication with a primary outcome of return to competitive swimming. Eighteen shoulders in 15 patients underwent arthroscopic capsular plication from 2003 to 2007. Patients were contacted at an average follow-up of 29 months (range, 8–42) and a swimming history, American Shoulder and Elbow (ASES) scores, and L'Insalata scores were obtained. At time of surgery, all patients demonstrated laxity under examination under anesthesia. All patients had a positive drive-through sign. Eighty percent (12/15) of patients returned to competitive swimming although only 20% (3/15) were able to return to their pre-injury training regimen volume. All patients subjectively reported improved pain after surgery. The average ASES score was 78?±?16 (average, standard deviation). The average L'Insalata score was 82?±?11. Although our results demonstrate that arthroscopic capsular plication has utility in the treatment of shoulder pain in swimmers who have failed non-operative treatment, the inability of some athletes to return to pre-injury training volume illustrates the difficult nature of shoulder pain in swimmers. Level of Evidence: Retrospective case series, Level IV
BACKGROUND: Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation. QUESTIONS/PURPOSES: A systematic review was performed to determine the influence of (1) interposition material (manufactured, biological, or none); and (2) patient-related factors (including metacarpophalangeal joint hyperextension, ligamentous laxity, and severity of arthritis) on pain, functional scores, and postoperative complications unique to each approach. METHODS: A systematic review of the English language literature regarding thumb basilar joint arthritis and arthroscopic partial trapeziectomy or débridement was performed. Those procedures including ligament reconstruction or stabilization were excluded. RESULTS: Biological materials and no interposition were both associated with satisfactory improvement and low rates of complications; complication rates with synthetic materials were higher. Eaton Stages I to III were treated successfully with this technique. The effect of scaphotrapeziotrapezoid (STT) changes was variably described across series. In most series, metacarpophalangeal hyperextension did not seem to have an adverse effect on outcomes, although these patients were excluded in some series. CONCLUSIONS: Arthroscopic débridement with or without interposition can be used for treatment of Eaton Stages I to III CMC osteoarthritis with satisfactory outcomes. Some series suggest satisfactory outcomes in the setting of STT changes and metacarpophalangeal hyperextension. PMID:23479236
Because wound infection is a major cause of incisional hernia, the question posed is whether or not repairs of incisional hernias are at a higher risk for wound infection also. To answer this, we analyzed the incidence of wound infection after repair of incisional hernias during a 30 month period and compared it with the infection rate in all other clean procedures performed during the same period. All repairs of incisional hernias were performed upon patients with completely healed incisions without clinical signs of infection. Patients undergoing concomitant procedures upon the gastrointestinal tract were excluded. During the 30 month period, 995 clean operations were performed. In the 80 repairs of incisional hernias, there were 13 infections proved by culture, yielding an over-all infection rate of 16 per cent. In the remaining 915 clean procedures, there were 14 wound infections (1.5 per cent, p less than 0.0001). Of these 915 clean operations, 241 were repairs of inguinal hernias. Two infections occurred in this subgroup (0.8 per cent, p less than 0.0001, compared with repairs of incisional hernias). In patients undergoing repairs of incisional hernias with previously documented wound infections, 41 per cent had infected repairs. By comparison, only 12 per cent of patients without a prior infection had infections develop in the hernial repair (p less than 0.05). The infection rate for patients not receiving prophylactic antibiotics (21 per cent) was almost twice the rate for those receiving antibiotics (11 per cent), p = 0.07. We concluded that repair of incisional hernias has a significantly higher rate of infection than do other clean general surgical procedures. Herniorrhaphy of a wound that was previously infected is at a higher risk for reinfection, despite complete healing of the skin and absence of clinical signs of infection. Perioperative antibiotic prophylaxis may be indicated, but randomized studies are needed. For reporting and surveillance purposes, repairs of incisional hernias should not be classified as clean surgical procedures. PMID:2530641
Houck, J P; Rypins, E B; Sarfeh, I J; Juler, G L; Shimoda, K J
Purpose The purpose of this study was to investigate the relationship between the proximity of neural structures to standard posterior\\u000a portals in different knee positions.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Ten fresh cadaveric knees were used to establish the standard posteromedial and posterolateral portals using an outside-in\\u000a technique with arthroscopic transillumination. The distance from each portal site to the adjacent neurovascular structures\\u000a (infrapatellar branches of the
Jin Hwan Ahn; Sang Hak Lee; Ho Joong Jung; Kyung Hyo Koo; Seong Hwan Kim
Introduction In patients with symptomatic femoroacetabular impingement resection osteochondroplasty of the femoral head–neck junction may\\u000a improve hip pain and range of motion. We evaluated the short-term treatment results of an arthroscopically assisted mini-open\\u000a anterior approach to compare it with the results after surgical dislocation for FAI.\\u000a \\u000a \\u000a \\u000a Methods The clinical and radiographic results of 33 patients were reviewed retrospectively 15 months after the surgery.
Post-surgical seromas and cysts have been reported across many surgical subspecialties including orthopaedics. Treatments include both invasive surgical approaches and more recently reported non-invasive techniques. Non-invasive approaches currently include compressive wrapping, vasopneumatic cryotherapy, and motion exercises. Persistent lesions have been treated with talc or doxycycline sclerodesis. This case presents a patient with a post-arthroscopic seroma that was treated with fibrin glue in an outpatient setting. Fibrin glue has not been reported in the post-arthroscopy outpatient setting to address cystic lesions. This case suggests a viable non-invasive treatment option for these lesions. Level of evidence V. PMID:23579228
Pigmented villonodular synovitis (PVNS) is a rare benign proliferative growth of synovium of obscure etiology with a wide spectrum of clinical presentation. Localized PVNS, also known as giant cell tumor of the tendon sheath, is even more uncommon. Localized PVNS of the knee is a rare, idiopathic condition presenting with symptoms that can mimic other intra-articular pathologies. The condition is usually monoarticular, the knee being the most commonly affected joint. We report a rare case of PVNS arising from the quadriceps tendon sheath. It was successfully treated with arthroscopic intralesional excision. At 18 months' follow-up, there has been no recurrence. PMID:17418347
PURPOSE: The objective of this study was to evaluate the rate, associated risk factors and outcome of insufficiency femoral neck fractures following arthroscopic femoral neck osteochondroplasty for femoroacetabular impingement. METHODS: Between 2005 and 2009, a consecutive series of 376 arthroscopic femoral osteochondroplasties for femoroacetabular impingement were performed and analysed. Seven postoperative fractures were found and comprise the fracture group. The amount of femoral head-neck bone resected as assessed on follow-up cross table lateral views, as well as age, gender, height, weight and BMI, was compared between the fracture group and the entire collective. Subjective outcome was recorded using the WOMAC score. RESULTS: Seven fractures (1.9 %) were identified. All occurred in males at an average of 4.4 weeks postoperatively and were considered insufficiency fractures. The fracture group had a significantly higher mean age (p = 0.01) and height (p = 0.013). Within the fracture group, alpha angles were lower (p = 0.009) and resection depth ratios were higher (p < 0.001). The femoral offset was significantly higher (p = 0.016) in the fracture group and in male patients (p < 0.001). The cut-off value for resection depth ratio on cross table lateral radiograph was 18 % of the femoral head radius. After a mean follow-up of 20 months, an inferior WOMAC (p = 0.030) was recorded in the fracture group. CONCLUSION: Femoral neck insufficiency fractures were identified in 1.9 % of our arthroscopic femoral osteochondroplasty cases. Significant new pain following a period of satisfactory recovery after arthroscopic femoral neck osteochondroplasty should alert the surgeon to the possibility of this complication. If a resection depth ratio of more than 18 % is recognized on the postoperative cross table lateral view, particularly in male patients with a high femoral head-shaft offset, the risk of postoperative insufficiency fracture is increased. This study not only defines the complication rate, but also identifies associated risk factors and determines the influence on the postoperative subjective short-term result. Important information for both the patient and orthopaedic surgeon is provided and may have a direct consequence on the postoperative protocol. LEVEL OF EVIDENCE: IV. PMID:23263229
Purpose One disadvantage of spinal anesthesia using bupivacaine is the relatively short duration of action. Combining it with opioids\\u000a can increase its analgesic effects. It was aimed to analyze the effectiveness and the side effects of bupivacaine alone and\\u000a in combination with sufentanil in arthroscopic knee surgery during unilateral spinal anesthesia.\\u000a \\u000a \\u000a \\u000a \\u000a Methods This is a prospective, randomized, double-blind trial. Fifty patients undergoing
Background There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we\\u000a have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic osteoplasty.\\u000a \\u000a \\u000a \\u000a \\u000a Description of Techniques Surgery was performed using the fracture table. After in situ pinning and diagnostic arthroscopy, peripheral compartment access\\u000a was obtained and head-neck
Michael Leunig; Kevin Horowitz; Hannes Manner; Reinhold Ganz
Post-steroid septic arthritis can be treated with irrigation pump assisted arthroscopic synovectomy. The high-intra-articular\\u000a fluid pressures can force the pyogenic fluid into a pre-existing Baker’s cyst. The cyst can rupture and with the pre-existing\\u000a steroid induced immune-suppression, the calf abscess will be hard to control. Therefore, thorough investigation with an ultrasound-guided\\u000a aspiration followed by an early drainage of the collection
Kristoff Corten; Hilde Vandenneucker; Peter Reynders; Stefaan Nijs; Theo Pittevils; Johan Bellemans
Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteomas. It presents diagnostic and therapeutic challenges since several traumatic or degenerative pathologies of the joint can be simulated with delay in the diagnosis. We report the clinical, radiographic, and histopathological findings in 2 cases of intra-articular osteoid osteoma of the femoral neck and of the acetabulum. Technical aspects of arthroscopic excision and results of surgery are discussed. Arthroscopy allowed complete excision of the osteoid osteomas, with a short postoperative rehabilitation and excellent functional results. PMID:23304593
Nehme, Alexandre H; Bou Ghannam, Alaa G; Imad, Joseph P; Jabbour, Fouad C; Moucharafieh, Ramzi; Wehbe, Joseph
This retrospective study reports on four patients with intra-articular pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) who were managed with arthroscopy between 2002 and 2009. There were three females and one male, with a mean age of 46 years at diagnosis. The common symptoms were trismus and pain. No pre-auricular swelling or mass was detected. Magnetic resonance imaging (MRI) and arthrography showed an anteriorly displaced disc, disc perforation, osteophyte of the condyle, or increased joint effusion. No neoplasm was suspected radiologically. Under arthroscopy, a yellow nodule and loose bodies were found in one patient, and a yellow or brown hyperplasia of the synovial membrane was noted in the other three patients. Degeneration of the articular cartilage was detected in two patients. The arthroscopic procedures used for every patient were partial synovectomy and debridement of articular surfaces with electric shaving and coblation. Arthroscopic disc repositioning was performed for the two young patients. Postoperative histological examination verified the diagnosis of PVNS of the TMJ. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proved to be a useful method for the management of intra-articular PVNS of the TMJ. PMID:20961736
Tenodesis is an accepted treatment option in the management of pathology involving the long head of the biceps (LHB). Among the common causes for revision surgery after tenodesis are residual pain within the bicipital groove, cramping, early biceps fatigue, and biceps deformity. Most technical descriptions of arthroscopic biceps tenodesis involve fixation of the LHB tendon within or proximal to the intertubercular sulcus and thus fail to address the described sources of pain within this proximal anatomic location. Suprapectoral tenodesis offers the surgeon the ability to remove the LHB from within the bicipital groove by fixating the biceps more distally. Cramping, early fatigue, and biceps deformity have been described when the appropriate length-tension relation of the biceps tendon has not been restored after LHB tenodesis. Our described procedure allows for a more consistent restoration of the anatomic length-tension relation of the LHB, therefore reducing the symptoms associated with this variable. This all-arthroscopic, suprapectoral biceps tenodesis with interference fixation addresses the most common causes for revision surgery and offers a comprehensive solution for LHB pathology.
We evaluated the clinical and occupational outcomes of arthroscopic treatment with electrothermal shrinkage for triangular fibrocartilage complex (TFCC) tears. We retrospectively reviewed 162 patients. All patients had ulnar-sided wrist pain that limited their occupational and sporting activities. The surgical technique consisted of electrothermal collagen shrinkage of the TFCC. Pain relief, range of motion, complications, reoperation rate, time to return to work and workers' compensation claims were evaluated. Exclusion criteria were distal radioulnar joint instability and association of other wrist lesions. Complete pain relief was noted in 80.3% of the patients, incomplete pain relief in 14.8%, and only 4.9% required reoperation because of pain-persistence. The average range of motion was over 90% compared to the opposite hand. Worker's compensation claims were introduced by 20 patients, of which 6 did not return to their previous occupation. Electrodiathermy may be a useful option for arthroscopic treatment of TFCC tears in cases without distal radioulnar joint instability. PMID:23409566
Garcia-Lopez, Ignacio; Delgado, Pedro J; Abad, Jose M; Garcia De Lucas, Fernando
Corynebacterium pseudodiphtheriticum is a normal inhabitant of the upper respiratory tract and is rarely thought of as a true pathogen. Although this microorganism has been associated with respiratory complications, a few case reports have demonstrated its ability to cause orthopedic infections. A recent review of the literature was performed regarding this specific bacteria and its association with bone and joint infection. To the author's knowledge, the current case is the first reported case of chronic osteomyelitis from Corynebacterium pseudodiphtheriticum after arthroscopic knee surgery. Isolation of this bacterial species on routine microbial cultures has been proven to be challenging in prior studies. In the current case, difficulty isolating this bacterial species on routine cultures led to a significant delay in diagnosis, which ultimately resulted in end-stage joint destruction. Treatment of the infection was accomplished using a 2-stage total knee arthroplasty technique, with the initial placement of an articulated, antibiotic-loaded spacer followed by a subsequent conversion to total knee arthroplasty. This case serves as a useful reminder that clinically subtle infections can occur after minor orthopedic surgery. Surgeons must remain vigilant to render a timely diagnosis and avoid severe sequelae that can result from an undetected pathogen after arthroscopic surgery. PMID:23276341
The purpose of this study was to compare the stability and force of ultimate failure of the acromioclavicular joint (ACJ) after direct arthroscopic distal clavicle excision (DCE) through superior portals and indirect arthroscopic DCE through inferior portals in paired cadaveric shoulders. Ten paired saline-embalmed cadaveric shoulders were operated alternatively using the indirect and direct technique. Biomechanical testing was performed in the horizontal plane, testing displacement at 15N and 30N and finally failure strength was measured testing the constructs until failure occurred. There was a significant difference in failure strength with the direct DCE being stronger: 766.6 N (SD 233.5) against 5403 N (SD 239.1) for the indirect DCE, p = 0.01334). There was no statistical difference for the displacement measured at 15N and 30N. A direct DCE will result in a postoperative ACJ with greater ultimate failure strength compared to indirect DCE because the inferior ACJ capsule can be better preserved. PMID:23547513
Hardeman, Francois; Van Rooyen, Karin; Somers, Jan; Doll, Stefan; Page, Robert; De Beer, Joe
Objective Traumatic and degenerative meniscal tears have different anatomic features and different proposed etiologies, yet both are associated with development or progression of osteoarthritis (OA). In established OA, synovitis is associated with pain and progression, but a relationship between synovitis and symptoms in isolated meniscal disease has not been reported. Accordingly, we sought to characterize synovial pathology in patients with traumatic meniscal injuries and determine the relationships between inflammation, meniscal and cartilage pathology, and symptoms. Methods Thirty-three patients without evidence of OA undergoing arthroscopic meniscectomy for meniscal injuries were recruited. Pain and function were assessed preoperatively; meniscal and cartilage abnormalities were documented at the time of surgery. Inflammation in synovial biopsies was scored and associations between inflammation and clinical outcomes determined. Microarray analysis of synovial tissue was performed and gene expression patterns in patients with or without inflammation compared. Results Synovial inflammation was present in 43% of patients and was associated with worse pre-operative pain and function scores, independent of age, gender, or cartilage pathology. Microarray analysis and real-time PCR revealed a chemokine signature in synovial biopsies with increased inflammation scores. Conclusion In patients with traumatic meniscal injury undergoing arthroscopic meniscectomy without clinical or radiographic evidence of OA, synovial inflammation occurs frequently and is associated with increased pain and dysfunction. Synovia with increased inflammation scores exhibit a unique chemokine signature. Chemokines may contribute to the development of synovial inflammation in patients with meniscal pathology; they also represent potential therapeutic targets for reducing inflammatory symptoms.
Scanzello, Carla R.; McKeon, Brian; Swaim, Bryan H.; DiCarlo, Edward; Asomugha, Eva U.; Kanda, Veero; Nair, Anjali; Lee, David M.; Richmond, John C.; Katz, Jeffrey N.; Crow, Mary K.; Goldring, Steven R.
The goals of reconstruction in the foot and ankle should be to restore ambulation and enable the patient to use normal footwear. In these wounds, free fasciocutaneous flaps provide pliable protection and gliding of tendons. There can however be problems with contour and bulk. We describe the combined use of liposuction and arthroscopic shaving to achieve effective flap contouring in a single session. We performed the technique in 10 free fasciocutaneous flaps in nine patients. The average interval between the initial reconstructive procedure and flap debulking was 7 months. Complications included two cases of flap superficial epidermal loss and one haematoma. At an average of 8.6 months follow-up, five patients reported that they were very satisfied with the procedure, three were satisfied and one was dissatisfied. Seven of the nine patients were using their original covered footwear at the time of follow-up. In conclusion, the combined use of liposuction and arthroscopic shaving is simple and effective in the contouring of fasciocutaneous flaps leading to good patient satisfaction and enabling the use of normal footwear. PMID:23352375
Tenodesis is an accepted treatment option in the management of pathology involving the long head of the biceps (LHB). Among the common causes for revision surgery after tenodesis are residual pain within the bicipital groove, cramping, early biceps fatigue, and biceps deformity. Most technical descriptions of arthroscopic biceps tenodesis involve fixation of the LHB tendon within or proximal to the intertubercular sulcus and thus fail to address the described sources of pain within this proximal anatomic location. Suprapectoral tenodesis offers the surgeon the ability to remove the LHB from within the bicipital groove by fixating the biceps more distally. Cramping, early fatigue, and biceps deformity have been described when the appropriate length-tension relation of the biceps tendon has not been restored after LHB tenodesis. Our described procedure allows for a more consistent restoration of the anatomic length-tension relation of the LHB, therefore reducing the symptoms associated with this variable. This all-arthroscopic, suprapectoral biceps tenodesis with interference fixation addresses the most common causes for revision surgery and offers a comprehensive solution for LHB pathology. PMID:23766967
From 1996 to 1999, 95 shoulders with calcifying tendinitis of the rotator cuff were treated arthroscopically by the same surgeon and assigned to the same rehabilitation program. The 63 patients matching the inclusion criteria were reviewed after a mean follow-up of 36 months. Preoperative and postoperative clinical functional assessment was performed separately by the same three surgeons using the Constant
Giuseppe Porcellini; Paolo Paladini; Fabrizio Campi; Massimo Paganelli
PURPOSE: The purpose of this study was to present an arthroscopic technique for the treatment for posteromedial and central cartilage defects of the talus using anterior arthroscopic portals and without performing a medial malleolar osteotomy. METHODS: Nine fresh cadavers were dissected. Autografts were implanted under arthroscopy using a retrograde osteochondral transplantation system, and their position was estimated using specific angular calibrators and later confirmed by software analysis of two photographs of the disarticulated ankle joint. RESULTS: In eight cases, the congruence between the surrounding articular cartilage and the cartilage of the graft was high, with differences measuring <1 mm. There were no iatrogenic cartilage lesions of the tibial plafond and no fractures of the talus. All the autografts remained stable during full range of motion cycles of the ankle joint. One failure was reported. CONCLUSION: This cadaveric study showed that the retrograde osteochondral autograft transplantation technique in the talus is feasible. It can be used to restore the posteromedial and central talar articular surfaces using conventional ankle arthroscopic instrumentation and anterior arthroscopic portals without resorting to a medial malleolar osteotomy. Further clinical and biomechanical studies are required to prove the efficacy of this technique and its reproducibility in routine clinical practice. PMID:23579227
We performed a retrospective study on 80 patients who underwent single-incision arthroscopic anterior cruciate ligament reconstruction with patellar tendon autograft and interference fit screw fixation in 1989. Twelve patients were lost to followup, allowing a clinical assessment of 68 patients to be conducted by independent examiners at 1 and 5 years after surgery, with radiographic assessment at 5 years. Thirty-three
David Otto; Leo A. Pinczewski; Amanda Clingeleffer; Ross Odell
Our aim was to identify alternative suture materials that might provide superior knot performance and equivalent ease of manipulation by means of an in vitro experimental study. Although used widely for arthroscopic shoulder stabilisation, absorbable poly( p-dioxanone) (PDS) monofilament sutures can lead to dehiscence and clinical failure due to knot slippage and\\/or loop elongation at low applied loads. With the
Arthroscopic partial menisectomy followed by cyst decompression is currently recommended for treatment of a meniscal cyst. However, it is doubtful whether partial menisectomy should be performed on cysts communicating with the joint in cases without a meniscal tear on its surface since meniscal function will be sacrificed. In this report, a meniscal cyst arising from the posterior horn of the medial meniscus without meniscal tear on its surface was resected using an arthroscopic posterior trans-septal approach. A 59 year-old male presented to our hospital with popliteal pain when standing up after squatting down. Magnetic resonance imaging revealed a multilobulated meniscal cyst arising from the posterior horn of the medial meniscus extending to the posterior septum with a grade 2 meniscal tear by Mink's classification. The medial meniscus was intact on the surface on arthroscopic examination. The meniscal cyst and posterior septum were successfully resected using a posterior trans-septal approach without harming the meniscus. This is the first report on a meniscal cyst being resected using an arthroscopic posterior trans-septal approach with a 9-month follow-up period.
Background: Recent studies have shown that techniques for arthroscopic Bankart reconstruction using suture anchors or tacks can equal the results after an open procedure in the treatment of posttraumatic, recurrent, unidirectional shoulder instability. Which kind of technique and which implants to be used still need further study.Purpose: The aim of this study was to compare the clinical and radiographic results
Anna O. Elmlund; Jüri Kartus; Lars Rostgård-Christensen; Ninni Sernert; Lennart Magnusson; Lars Ejerhed
The aim of this study was to evaluate the analgesic effect of an external cooling system with or without the combined effect of intra-articularly administered bupivacaine\\/morphine after arthroscopic anterior cruciate ligament (ACL) reconstruction. Fifty patients with isolated ACL insufficiency operated on under general anaesthesia were randomized to three different postoperative treatment groups. Group I was treated with the cooling system
Sveinbjörn Brandsson; Bengt Rydgren; Thomas Hedner; Olof Lundin; Leif Sward; Jon Karlsson
Suprascapular nerve entrapment by a ganglion cyst can produce pain and shoulder dysfunction. We report six cases with the associated arthroscopic intraarticular findings of a posterior capsulolabral injury (only the second such description) and review the literature. Based on the current literature and our experience, we document our treatment algorithm for suprascapular nerve entrapment secondary to a ganglion cyst. We
Douglas A. Fehrman; John F. Orwin; Robert M. Jennings
Identifying barriers to recruitment into a randomized clinical trial can help researchers adjust recruitment strategies to maximize enrollment. To determine barriers to enrollment of patients in trials of knee osteoarthritis treatments, we recruited from three centers patients over age 45 who had both knee osteoarthritis and a meniscal tear. We described a hypothetical randomized trial of arthroscopic partial meniscectomy versus
Alisha H. Creel; Elena Losina; Lisa A. Mandl; Robert J. Marx; Nizar N. Mahomed; Scott D. Martin; Tamara L. Martin; Peter J. Millett; Anne H. Fossel; Jeffrey N. Katz
Identifying barriers to recruitment into a randomized clinical trial can help researchers adjust recruitment strategies to maximize enrollment. To determine barriers to enrollment of patients in trials of knee osteoarthritis treatments, we recruited from three centers patients over age 45 who had both knee osteoarthritis and a meniscal tear. We described a hypothetical randomized trial of arthroscopic partial meniscectomy versus
Alisha H. Creel; Elena Losina; Lisa A. Mandle; Robert J. Marxe; Nizar N. Mahomed; Scott D. Martin; Tamara L. Martin; Peter J. Millett; Anne H. Fossela; Jeffrey N. Katz
Arthroscopic lateral retinacular release can be complicated by hemarthrosis in 10 to 18% of cases. The vascular structures involved are the lateral vascular pedicles of the knee. This study examines the topography of these pedicles. Anatomic and radioanatomic studies carried out in 50 specimens defined the route of the vascular pedicles at the lateral aspect of the knee. From the
R. Vialle; J. Y. Tanguy; P. Cronier; H. D. Fournier; X. Papon; P. Mercier
Summary Arthroscopic lateral retinacular release can be complicated by hemarthrosis in 10 to 18% of cases. The vascular structures involved are the lateral vascular pedicles of the knee. This study examines the topography of these pedicles. Anatomic and radioanatomic studies carried out in 50 specimens defined the route of the vascular pedicles at the lateral aspect of the knee. From
R. Viallel; J. Y. Tanguy; P. Cronier; H. D. Fournier; X. Papon; P. Mercier
The mismatch repair (MMR) system detects non-Watson-Crick base pairs and strand misalignments arising during DNA replication and mediates their removal by catalyzing excision of the mispair-containing tract of nascent DNA and its error-free resynthesis. In this way, MMR improves the fidelity of replication by several orders of magnitude. It also addresses mispairs and strand misalignments arising during recombination and prevents synapses between nonidentical DNA sequences. Unsurprisingly, MMR malfunction brings about genomic instability that leads to cancer in mammals. But MMR proteins have recently been implicated also in other processes of DNA metabolism, such as DNA damage signaling, antibody diversification, and repair of interstrand cross-links and oxidative DNA damage, in which their functions remain to be elucidated. This article reviews the progress in our understanding of the mechanism of replication error repair made during the past decade. PMID:23545421
Base excision repair (BER) corrects DNA damage from oxidation, deamination and alkylation. Such base lesions cause little distortion to the DNA helix structure. BER is initiated by a DNA glycosylase that recognizes and removes the damaged base, leaving an abasic site that is further processed by short-patch repair or long-patch repair that largely uses different proteins to complete BER. At least 11 distinct mammalian DNA glycosylases are known, each recognizing a few related lesions, frequently with some overlap in specificities. Impressively, the damaged bases are rapidly identified in a vast excess of normal bases, without a supply of energy. BER protects against cancer, aging, and neurodegeneration and takes place both in nuclei and mitochondria. More recently, an important role of uracil-DNA glycosylase UNG2 in adaptive immunity was revealed. Furthermore, other DNA glycosylases may have important roles in epigenetics, thus expanding the repertoire of BER proteins. PMID:23545420
During repair, many different matrix metalloproteinases are produced by multiple cell types residing in various compartments within the wound environment. This diversity of enzymes, coupled with discreet cellular expression, implies that different matrix metalloproteinases serve different functions, acting on a variety of substrates, during wound healing. With few exceptions, however, the actual function and spectrum of functions of matrix metalloproteinases in vivo is not known. Even with the advent of genetically defined animal models, few studies have rigorously addressed the substrates and role of matrix metalloproteinases in wound repair. Before we can understand the role of matrix metalloproteinases in ulceration and disease, we need to determine the function these enzymes serve in normal tissues and repair. PMID:10633001
Meniscal repair devices not requiring accessory incisions are attractive. Many factors contribute to their clinical effectiveness including their biomechanical characteristics. This study compared several new meniscal repair devices with standard meniscal suture techniques. Using a porcine model, axis-of-insertion loads were applied to various meniscal sutures and repair devices. A single device or stitch was placed in a created meniscal tear and a load applied. Both loads and modes of failure were recorded. The load-to-failure data show stratification into 4 distinct statistical groups. Group A, 113 N for a double vertical stitch; group B, 80 N for a single vertical stitch; group C, 57 N for the BioStinger, 56 N for a horizontal mattress stitch, and 50 N for the T-Fix stitch; and group D, 33 N for the Meniscus Arrow (inserted by hand or gun), 32 N for the Clearfix screw, 31 N for the SDsorb staple, 30 N for the Mitek meniscal repair system, and 27 N for the Biomet staple. The failure mechanism varied. Sutures broke away from the knot. The Meniscus Arrow and BioStinger pulled through the inner rim with the crossbar intact. The Clearfix screw failed by multiple mechanisms, whereas 1 leg of the SDsorb staple always pulled out of the outer rim. The Mitek device usually failed by pullout from the inner rim. The Biomet staple always broke at the crosshead or just below it. Although the surgeon should be aware of the material properties of the repair technique chosen for a meniscal repair, this information is only an indication of device performance and may not correlate with clinical healing results. PMID:10976122
These model repair specifications list the minimum requirements for repair and overhaul of polyphase AC squireel cage induction motors. All power ranges, voltages, and speeds of squirrel cage motors are covered.
Damage recognition is a key initial step in DNA repair. A recent study puts to rest the debate of whether XPD helicase 'verifies' the appropriateness of the DNA damage to be mended by the nucleotide excision repair machinery. PMID:23391386
PURPOSE: The mean reported healing rate after meniscal repair is 60 % of complete healing, 25 % of partial healing and 15 % of failure. However, partially or incompletely healed menisci are often asymptomatic in the short term. It is unknown whether the function of the knee with a partially or incompletely healed meniscus is disturbed in the long term. The purpose of this study was to assess the long-term outcomes of meniscal repairs according to the initial rate of healing. METHODS: Forty-one consecutive meniscal repairs were performed between 2002 and 2003. The median age at the time of surgery was 22 years (9-40). There were 25 medial and 16 lateral menisci. When present, all ACL lesions underwent reconstruction (61.3 % of cases). According to Henning's criteria, by Arthro-CT at 6 months, twenty cases had healed completely, seven partially healed and four cases healed incompletely. RESULTS: At a mean follow-up of 114 ± 10 months, 31 patients were retrospectively followed for clinical and imaging assessments. Objective IKDC score was good in 92 % of the cases (17 IKDC A, 8 B and 2 C). The mean KOOS distribution was as follows: pain 94.3 ± 9; symptoms 90.9 ± 15; daily activities 98.7 ± 2; sports activities 91.1 ± 14; and quality of life 91.5 ± 15. Twenty-three patients displayed no signs of osteoarthritis when compared to the non-injured knee, six patients had grade 1 osteoarthritis and two grade 2. The subjective IKDC score did not decrease with time (ns). Moreover, there were no differences between lateral and medial menisci (ns), in stable or stabilised knees (ns). The initial meniscal healing rate did not significantly influence clinical or imaging outcomes (ns). Four patients with no healing underwent a meniscectomy (12.9 %). CONCLUSION: Arthroscopic all-inside meniscal repair with hybrid devices may provide long-term protective effects, even if the initial healing is incomplete. LEVEL OF EVIDENCE: Case series, Level IV. PMID:23740324
Pujol, Nicolas; Tardy, Nicolas; Boisrenoult, Philippe; Beaufils, Philippe
DNA is under constant attack from intracellular and external mutagens. Sites of DNA damage need to be pinpointed so that the DNA repair machinery can be mobilized to the proper location. The identification of damaged sites, recruitment of repair factors, and assembly of repair "factories" is orchestrated by posttranslational modifications (PTMs). These PTMs include phosphorylation, ubiquitination, sumoylation, acetylation, and methylation. Here we discuss recent data surrounding the roles of arginine and lysine methylation in DNA repair processes. PMID:17306845
Your child had hypospadias repair to fix a birth defect in which the urethra does not end at the tip of the penis. ... Snodgrass WT. Hypospadias. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 130.
|Designed to provide a model curriculum and guidelines, this manual presents tasks that were identified by employers, employees, and teachers as important in a postsecondary auto body repair curriculum. The tasks are divided into ten major component areas of instruction: metalworking and fiberglass, painting, frame and suspension, glass and trim,…
Cell wounding is a common event in the life of many cell types, and the capacity of the cell to repair day-to-day wear-and-tear injuries, as well as traumatic ones, is fundamental for maintaining tissue integrity. Cell wounding is most frequent in tissues exposed to high levels of stress. Survival of such plasma membrane disruptions requires rapid resealing to prevent the loss of cytosolic components, to block Ca2+ influx and to avoid cell death. In addition to patching the torn membrane, plasma membrane and cortical cytoskeleton remodeling are required to restore cell function. Although a general understanding of the cell wound repair process is in place, the underlying mechanisms of each step of this response are not yet known. We have developed a model to study single cell wound repair using the early Drosophila embryo. Our system combines genetics and live imaging tools, allowing us to dissect in vivo the dynamics of the single cell wound response. We have shown that cell wound repair in Drosophila requires the coordinated activities of plasma membrane and cytoskeleton components. Furthermore, we identified an unexpected role for E-cadherin as a link between the contractile actomyosin ring and the newly formed plasma membrane plug.
This note considers a method, recently described by Dykstra, for augmenting existing data in response surface experiments. Examples are given to show how this relatively simple approach can be usefully applied, not only to design repair problems, but to situations in which the experimenter, after reviewing his initial results, decides to change his region of interest, his model, or both.
Exposure of cells to UV light from the sun causes the formation of pyrimidine dimers in DNA that have the potential to lead to mutation and cancer. In humans, pyrimidine dimers are removed from the genome in the form of ~30 nt-long oligomers by concerted dual incisions. Though nearly 50 y of excision repair research has uncovered many details of UV photoproduct damage recognition and removal, the fate of the excised oligonucleotides and, in particular, the ultimate fate of the chemically very stable pyrimidine dimers remain unknown. Physiologically relevant UV doses introduce hundreds of thousands of pyrimidine dimers in diploid human cells, which are excised from the genome within ~24 h. Once removed from the genome, “where do all the dimers go?” In a recent study we addressed this question. Although our study did not determine the fate of the dimer itself, it revealed that the excised ~30-mer is released from the duplex in a tight complex with the transcription/repair factor TFIIH. This finding combined with recent reports that base and oligonucleotide products of the base and double-strand break repair pathways also make stable complexes with the cognate repair enzymes, and that these complexes activate the MAP kinase and checkpoint signaling pathways, respectively, raises the possibility that TFIIH-30-mer excision complexes may play a role in signaling reactions in response to UV damage.
Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome.\\u000a The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and\\u000a outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee’s\\u000a approval and written informed
Ahmet Eroglu; Sebnem Saracoglu; Engin Erturk; Muge Kosucu; Servet Kerimoglu
We assessed the patellar inferior pole (PIP) as a new landmark of the anteromedial (AM) instrumental portal for arthroscopic\\u000a surgery of the posterior horn of the medial meniscus (PHMM). Fifty normal right knees in young adults (group 1) and 50 knees\\u000a from adults of various ages undergoing arthroscopic surgery for relatively simple intra-articular pathologies or diagnosis\\u000a (group 2) were included.
Injury to the ureter is a possible complication of laparoscopic surgery. Traditionally, it is repaired by laparotomy. During laparoscopic surgery for bilateral ovarian remnants in a 29-year-old woman, the left ureter was transected. The ureter was repaired by primary end-to-end anastomosis by laparoscopy. The patient recovered uneventfully, and postoperative intravenous puelogram confirmed the repair to be intact.
Paul K. Tulikangas; Jeffrey M. Goldberg; Inderbir S. Gill
This article discusses a systematic approach to the repair of cystoceles using interposition grafting. Surgeons' opinions vary regarding which graft is most appropriate as there are several varieties for mesh interposition. High-grade cystocele repair using the porcine dermis interposition graft is successful and associated with few complications. Cystocele repair is typically low grade and does not require additional surgery. PMID:21353079
Leu, Patrick B; Scarpero, Harriette M; Dmochowski, Roger R
Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl.
A myriad of techniques for reconstruction of the arthritic thumb carpometacarpal joint have been described. In the modern era, there has been a push, driven by both clinicians and patients, for more rapid rehabilitation after these procedures. A majority of the historically described techniques require pinning of the thumb ray for 4 weeks. Suture button placement between the thumb and index ray metacarpals has been shown in biomechanical studies to effectively resist subsidence of the thumb ray. We describe a novel technique of using a suture button for suspensionplasty of the thumb ray after arthroscopic partial trapeziectomy. This technique allows for early mobilization and may offer a potential improvement on current techniques. Early results of use of this technique are encouraging, but well-conducted follow-up studies are necessary. PMID:20887938
Sudden, profound hypotensive and bradycardic events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. Although HBEs may be associated with the adverse effects of interscalene brachial plexus block (ISBPB) in the sitting position, the underlying mechanisms responsible for HBEs during the course of shoulder surgery are not well understood. The basic mechanisms of HBEs may be associated with the underlying mechanisms responsible for vasovagal syncope, carotid sinus hypersensitivity or orthostatic syncope. In this review, we discussed the possible mechanisms of HBEs during shoulder arthroscopic surgery, in the sitting position, under ISBPB. In particular, we focused on the relationship between HBEs and various types of syncopal reactions, the relationship between HBEs and the Bezold-Jarisch reflex, and the new contributing factors for the occurrence of HBEs, such as stellate ganglion block or the intraoperative administration of intravenous fentanyl. PMID:22474545
Summary Background Osteochondral fracture (OCF) of the lateral femoral condyle has a low incidence and old OCF is even more rarely seen; it is difficult to differentiate from late osteochondritis dissecans (OCD). Case Report In this report, we present the case of a 20-year-old male patient with an old OCF of the lateral femoral condyle. The possible etiology of OCF is discussed, along with its clinical manifestation, diagnosis, and treatment. He underwent arthroscopically-assisted reduction and fixation with cannulated screws. Four months after the surgery, arthroscopy showed good osteochondral healing, and screws were removed. He had achieved good functional recovery by the follow-up visit. Conclusions Old OCF should be distinguished from OCD in clinical practice, and osteochondral bodies should be preserved as much as possible. Osteochondral reduction and fixation under arthroscopy was minimal and the clinical effect was good.
Interpretation of magnetic resonance (MR) arthrography images of the glenohumeral ligaments is made difficult by anatomical variations and by the lack of descriptions of signs of pathology of the ligaments. In this review, we describe the normal and pathologic appearance of the glenohumeral ligaments of the shoulder. These ligaments play an important role in stabilization of the shoulder. Both 1.5 and 3 T MR units were used to acquire the MR images. The principal investigator reviewed the imaging reports and arthroscopic reports. All cases were correlated with arthroscopy. Lesions of the superior glenohumeral, middle glenohumeral, and inferior glenohumeral, including humeral avulsion of the glenoid ligament are discussed. Diagnosis of lesions of the glenohumeral ligaments remains a challenge. PMID:20947292
Boulet, Cedric; De Maeseneer, Michel; Pouliart, Nicole; De Mey, Johan; Handelberg, Frank; Shahabpour, Maryam
The aim of this study was to compare sensitivity of ultrasound and optical coherence tomography (OCT) techniques for the evaluation of the integrity of spontaneously repaired horse cartilage. Articular surfaces of horse intercarpal joints, featuring both intact tissue and spontaneously healed chondral or osteochondral defects, were imaged ex vivo with arthroscopic ultrasound and laboratory OCT devices. Quantitative ultrasound (integrated reflection coefficient (IRC), apparent integrated backscattering coefficient (AIB) and ultrasound roughness index (URI)) and optical parameters (optical reflection coefficient (ORC), optical roughness index (ORI) and optical backscattering (OBS)) were determined and compared with histological integrity and mechanical properties of the tissue. Spontaneously healed tissue could be quantitatively discerned from the intact tissue with ultrasound and OCT techniques. Furthermore, several significant correlations (p?0.05) were detected between ultrasound and OCT parameters. Superior resolution of OCT provided a more accurate measurement of cartilage surface roughness, while the ultrasound backscattering from the inner structures of the cartilage matched better with the histological findings. Since the techniques were found to be complementary to each other, dual modality imaging techniques could provide a useful tool for the arthroscopic evaluation of the integrity of articular cartilage. PMID:22439802
Virén, T; Huang, Y P; Saarakkala, S; Pulkkinen, H; Tiitu, V; Linjama, A; Kiviranta, I; Lammi, M J; Brünott, A; Brommer, H; Van Weeren, R; Brama, P A J; Zheng, Y P; Jurvelin, J S; Töyräs, J
Background: Postoperative pain relief is important in procedures of the lower extremity. Several previous studies have evaluated the efficacy of intra-articular (IA) pethidine as a compound, which has local anesthetic and opioid agonist properties, on postoperative pain relief in arthroscopic knee surgery (AKS). This study compared the postoperative analgesic effect of pre- and post-surgical IA pethidine administration in AKS. Materials and Methods: Seventy-five patients of American Society of Anesthesiologists (ASA) I and II undergoing AKS with general anesthesia were enrolled in this double-blind study. Patients were randomized in three equal groups to receive either 50 mg IA pethidine before surgical incision incision and saline after skin closure (PS), saline before surgical incision and pethedine after skin closure (SP), and only saline at two different times (SS). In each patient with operated knee joint, pain at rest and joint movement was evaluated at 1, 2, 6, 12, and 24 h after surgery completion using Visual Analog Scale (VAS). Data were analyzed using analysis of variance (ANOVA)-repeated measure, t-paired, and Chi-square tests. Results: Postoperative pain score at rest and joint movement in PS group was significantly lower than those in other groups. The time (Mean ± SD) between completion of operation and patient's request for morphine, total morphine consumption (Mean ± SD) in postoperative 24 h, and the numbers of patients requesting analgesic in PS, SP, SS, groups were: 5.2 ± 1.3, 3.3 ± 1.5, and 2 ± 1.3 h (P < 0.05); 4.4 ± 2.4, 8.7 ± 2, and 11.6 ± 4.4 mg (P < 0.05); 11, 18, and 21 persons (P < 0.05), respectively. Conclusion: The present study shows that preemptive intra-articular pethidine 50 mg injection is more effective than preventive injection for postoperative pain relief at rest and joint movement in arthroscopic knee surgery.
Foot and ankle surgeons often rely on the medial clear space to evaluate competency of the deep deltoid ligament when evaluating ankle fractures. This investigation assesses the integrity of the deep deltoid ligament after lateral malleolar fracture by using direct arthroscopic visualization and medial clear-space separation on plain film radiographs. The objectives of this study were to test the reliability of medial clear-space separation and the Lauge-Hansen classification scheme in predicting deep deltoid rupture in displaced lateral malleolar fractures. The medial clear space was measured on injury radiographs of 40 patients with an isolated displaced lateral malleolar fracture who underwent open reduction and internal fixation. Injury radiographs were classified according to the Lauge-Hansen scheme. Direct arthroscopic visualization was used to evaluate the deep deltoid ligament under manual stress before fracture reduction. The mean preoperative medial clear space in patients with a deep deltoid rupture (n = 13) was 6.6 +/- 2.4 mm (range, 4 to 12 mm), and in patients without a deep deltoid rupture (n = 26), it was 4.0 +/- 1.0 mm (range, 2.5 to 6 mm) (P =.002, 2-sample t test). At an injury medial clear space > or =3 mm, the false positive rate for deltoid rupture was 88.5% (P =.54, Fisher's exact test). At > or =4 mm, the false positive rate was 53.6% (P =.007). All fractures were rotational injuries according to the Lauge-Hansen system. Three fractures were not classifiable; another 3 fractures showed deltoid ligament integrity opposite the expected finding. The results indicate that, in isolated displaced fractures of the lateral malleolus, radiographic widening of the medial clear space is not a reliable indicator for deep deltoid rupture. Some fractures considered stable by the Lauge-Hansen classification may require careful scrutiny to rule out deep deltoid injury. PMID:14752760
Schuberth, John M; Collman, David R; Rush, Shannon M; Ford, Lawrence A
BackgroundDiscoid lateral meniscus is more susceptible to tear than normal meniscus. A comparison study for tear types of discoid lateral meniscus between children and adults has not been reported.PurposeTo compare tear type of surgically proven discoid lateral meniscus between adults and children, and to analyze diagnostic performance for tear type of discoid lateral meniscus using magnetic resonance imaging (MRI).Material and MethodsKnee MR examinations of 53 children and 84 adults who had discoid lateral menisci identified at arthroscopic surgery were retrospectively evaluated with consensus by two radiologists for tear type including displacement of torn meniscus. MRI findings were compared with surgery as the reference standard. The difference of tear type and displacement of torn meniscus between children and adults in arthroscopic finding was analyzed using the Fisher's exact test or the Chi-squared test with Bonferroni's correction.ResultsAt arthroscopy, complex tear (children, n = 22; adults, n = 56) and peripheral tear (children, n = 17; adults, n = 8) differed significantly between children and adults (P = 0.006 for complex tear, P = 0.002 for peripheral tear). Displacement of torn meniscus was seen in 28 cases of children and 41 cases of adults, not a statistically significant difference. In children, the positive predictive value (PPV) for horizontal tears was 90%, for peripheral tears 60%, and for complex tears 57%. PPV in adults for horizontal tears was 78%, peripheral tears 25%, and for complex tears 89%.ConclusionComplex tears were more commonly found in adults than children and peripheral tears were more commonly found in children than adults. MRI has a high PPV for diagnosing the type of tear in discoid lateral meniscus for horizontal tears in children and adults and for complex tears in adults. PMID:23463861
Cartilage repair is required in a number of orthopaedic conditions and rheumatic diseases. From a macroscopic viewpoint, the complete repair of an articular cartilage defect requires integration of opposing cartilage surfaces or the integration of repair tissue with the surrounding host cartilage. However, integrative cartilage repair does not occur readily or predictably in vivo. Consideration of the 'integrative cartilage repair process', at least in the relatively early stages, as the formation of a adhesive suggests several biomechanical approaches for characterizing the properties of the repair tissue. Both strength of materials and fracture mechanics approaches for characterizing adhesives have recently been applied to the study of integrative cartilage repair. Experimental configurations, such as the single-lap adhesive test, have been adapted to determine the strength of the biological repair that occurs between sections of bovine cartilage during explant culture, as well as the strength of adhesive materials that are applied to opposing cartilage surfaces. A variety of fracture mechanics test procedures, such as the (modified) single edge notch, 'T' peel, dynamic shear, and trouser tear tests, have been used to assess Mode I, II, and III fracture toughness values of normal articular cartilage and, in some cases, cartilaginous tissue undergoing integrative repair. The relationships between adhesive biomechanical properties and underlying cellular and molecular processes during integrative cartilage repair remain to be elucidated. The determination of such relationships may allow the design of tissue engineering procedures to stimulate integrative cartilage repair. PMID:10367013
Modern meniscal repair incorporates multiple techniques and adjunctive measures. The classic inside-out repair remains the gold standard and is most appropriate for a bucket-handle type tear of the medial or lateral meniscus. The all-inside technique has gained in popularity recently and has outcomes that approach those of the inside-out repair with decreased morbidity but increased cost. The choice of this technique is most appropriate for small tears requiring few sutures to repair. Outside-in repair can also be employed and is preferred for anterior horn tears. Surgeons may use a hybrid technique that incorporates all techniques in some challenging cases. Meniscal debridement is used for degenerative tears that are not amenable to repair. Meniscal transplantation is an option for symptomatic meniscal deficiency in young, active patients. This article discusses the technical considerations for meniscal debridement, repair, and transplantation. PMID:21980876
Burns, Travis C; Giuliani, Jeffrey R; Svoboda, Steven J; Owens, Brett D
Nucleotide excision repair (NER) has allowed bacteria to flourish in many different niches around the globe that inflict harsh environmental damage to their genetic material. NER is remarkable because of its diverse substrate repertoire, which differs greatly in chemical composition and structure. Recent advances in structural biology and single-molecule studies have given great insight into the structure and function of NER components. This ensemble of proteins orchestrates faithful removal of toxic DNA lesions through a multistep process. The damaged nucleotide is recognized by dynamic probing of the DNA structure that is then verified and marked for dual incisions followed by excision of the damage and surrounding nucleotides. The opposite DNA strand serves as a template for repair, which is completed after resynthesis and ligation. PMID:23457260
Kisker, Caroline; Kuper, Jochen; Van Houten, Bennett
The pathogenesis of prolapse and the requirements for a successful surgical outcome vary from one person to another. The importance of traditional risk factors is questionable, but failed previous repair is definitely an adverse prognosticator. An ideal operation should re-attach apical support to the pelvic skeleton, restore integrity within anterior and posterior suspensory hammocks and re-distribute some of the expulsive load back onto the pelvic diaphragm. Reasons for failure are best analysed by location; recurrence within the operated compartment should also be distinguished from recurrence in a different compartment. There is no all-encompassing secret to re-operating on recurrent prolapse. Success depends on sound strategic planning and using tactics to negate the greater technical difficulty and reduced collagen strength in women with prior operative failure. If an augmented repair is to be carried out, choice of biomaterials must reflect surgical objectives, movement dynamics and functional anatomy at the intended implantation site. PMID:21353645
Eukaryotic mismatch repair (MMR) has been shown to require two different heterodimeric complexes of MutS-related proteins: MSH2–MSH3 and MSH2–MSH6. These two complexes have different mispair recognition properties and different abilities to support MMR. Alternative models have been proposed for how these MSH complexes function in MMR. Two different heterodimeric complexes of MutL-related proteins, MLH1–PMS1 (human PMS2) and MLH1–MLH3 (human PMS1)
Occurrence of parastomal hernia is considered a near inevitable consequence of stoma formation, making their management a common clinical dilemma. This article reviews the outcomes of different surgical approaches for hernia repair and describes in detail the laparoscopic Sugarbaker technique, which has been shown to have lower recurrence rates than other methods. Also reviewed is the current literature on the impact of prophylactic mesh placement during ostomy formation. PMID:24035081
The search for safe and effective means of herniorrhaphies has been ongoing for more than a century. Evidence strongly supports tension-free hernia repairs in most patients, which result in a 50% reduction in a ten-year cumulative rate of hernia recurrence compared with tissue repairs. Polypropylene mesh revolutionized the field approximately 50 years ago; however, limitations of traditional polypropylene mesh have fueled the research and development of other prosthetic and biologic mesh products. Newer polyester and expanded polytetrafluoroethylene (ePTFE) products are designed to improve pliability and reduce adhesiogenic potential. Combination meshes capitalize on the ideal properties of biomaterials by strategically positioning particular mesh surfaces to selectively impede or promote tissue ingrowth. The most recent improvement in mesh products is the introduction of "lightweight" meshes. In response to mounting evidence that the traditional formulations of polypropylene meshes are over-engineered, lightweight meshes were designed with less polypropylene per surface area. Future research may prove that most meshes used currently are "mechanical overkill," which may lead to a widespread use of lightweight meshes to provide a durable repair, minimize chronic mesh-related discomfort, and improve the overall quality of life of hernia patients. PMID:17429779
Novitsky, Yuri W; Harrell, Andrew G; Hope, William W; Kercher, Kent W; Heniford, B Todd
Introduction Suprascapular neuropathy is an uncommon cause of shoulder pain and weakness and therefore is frequently misdiagnosed. As a consequence, misdiagnosis can include inappropriate conservative treatment or unsuccessful surgical procedure. Case presentation A rare case is reported of a 54-year-old woman who suffered from suprascapular nerve entrapment syndrome. The patient was subjected to arthroscopy of the left shoulder, where a compression of the suprascapular nerve due to an ossified superior transverse scapular ligament was diagnosed. The arthroscopic release of the suprascapular nerve brought relief from pain, weakness and atrophy of the supraspinatus and infraspinatus muscles. Conclusion Arthroscopic decompression of the entrapped suprascapular nerve is technically challenging, but less invasive and potentially a more effective way to treat suprascapular neuropathy, as it may provide a more rapid recovery, especially in the rare case that the nerve is depressed by an ossified superior transverse scapular ligament.
Sergides, Neoptolemos N; Boukoros, Euangelos; Papagiannopoulos, George
Drilling of femoral tunnel by transtibial technique is widely used in arthroscopic anterior cruciate ligament (ACL) reconstruction. Recent studies suggest in this technique graft is placed in non-anatomical position leading to instability. If the femoral tunnel is drilled through an anteromedial portal (transportal technique), graft can be placed more anatomically leading to better knee stability theoratically. The purpose of this study is to compare the clinical outcome of transtibial technique and transportal technique for drilling of femoral tunnel in arthroscopic ACL reconstruction using hamstring tendon autograft. All patients operated between January 2009 and September 2011 were approached for eligibility. Blinded assessment of IKDC score, Lachman test, pivot shift test, time of recovery from surgery were obtained from both the transtibial and transportal groups. The transportal group shows significantly better IKDC score, higher anteroposterior knee stability by Lachman test and lower recovery time from surgery. PMID:23785908
The authors devised an alternative arthroscopic double bundle ACL reconstruction technique using a bone patellar tendon bone\\u000a (BPTB)–gracilis tendon composite autograft. One tibial and two femoral tunnels were used to reconstruct two bundles of anterior\\u000a cruciate ligaments (ACL) [an anteromedial bundle (AM) and a post-erolateral bundle (PL)]. BTBB was fixed in the tunnels produced\\u000a on the isometric points of the
Kwang Am Jung; Su Chan Lee; Moon Bok Song; Choon Key Lee
Arthroscopic diagnosis was used to determine the incidence of the most frequent injuries to the knee’s internal structures\\u000a associated with ACL tear as well as ones without ACL tear. The most frequent finding associated with a recent ACL tear was\\u000a the LM tear (72.7%). There is a statistically significant incidence of recent LM tear in knees with a recent ACL
Osgood–Schlatter’s disease (OSD) is common and generally treated conservatively. However, surgical treatment is necessary\\u000a for some patients with recurrent or persistent pain that does not respond to conservative treatment. We present a case of\\u000a arthroscopic excision of ossicle associated with OSD that did not respond to conservative treatment. A 30-year-old rugby player\\u000a presented with a 3-year history of anterior knee
Yong Seuk Lee; Jin Hwan Ahn; Dong-Il Chun; Jae Ho Yoo
Background: Lateral ankle sprains account for 85% of ankle lesions.Hypothesis: Combined open and arthroscopic procedures could improve the diagnosis and management of intra-articular lesions and allow surgeons to perform minimally invasive anatomic reconstruction of the lateral ligament complex.Study Design: Case series; Level of evidence, 4.Methods: Forty consecutive patients underwent ankle arthroscopy for recurrent (2 or more episodes) lateral ankle instability
Caio Nery; Fernando Raduan; Angelo Del Buono; Inacio Diogo Asaumi; Moises Cohen; Nicola Maffulli
Background Although arthroscopic shoulder surgery is less invasive and painful than open shoulder surgery, it can often cause intra-operative hemodynamic instability and severe post-operative pain. This study was conducted to investigate the efficacy of the interscalene brachial plexus block (IBPB) on intra-operative hemodynamic changes and post-operative pain during arthroscopic shoulder surgery. Methods After institutional review board approval, 50 consecutive patients that had undergone arthroscopic shoulder surgery under general anesthesia were randomly assigned to one of two groups to evaluate intra-operative hemodynamic changes and post-operative pain control. Group 1 patients received an IBPB with 10 ml of normal saline guided by a nerve stimulator before induction, and Group 2 patients received 10 ml of 0.5% ropivacaine hydrochloride with the same technique. The heart rate and systolic and diastolic blood pressures were recorded before the incision and 1, 3, 5, 10, and 20 minutes after the incision. Pre-operative and post-operative pain was evaluated with a visual analog scale 1, 3, 6, 12, and 24 hours after surgery. The patients were given tramadol as a rescue medication option. The total volume of tramadol that was injected was also evaluated over the same intervals. Results Group 2 showed significantly lower systolic and diastolic blood pressures and heart rates intra-operatively compared to Group 1 (P < 0.05). The visual analog scale pain scores, except at 24 hours after surgery, were significantly lower in Group 2 (P < 0.05). The total tramadol consumption significantly reduced in Group 2 (P < 0.05). Conclusions IBPB effectively controlled the hemodynamic changes that occurred during arthroscopic shoulder surgery as well as post-operative pain.
Knee stiffness due to mismanaged trauma is still common in underdeveloped countries. Many patients with distal femoral fractures, patellar injuries or other local trauma present with intra-articular and extra-articular adhesions between the quadriceps and anterior femur. Nineteen knees with post trauma stiffness due to combined intra- and extra- articular aetiology were taken up for arthroscopic aided release after failing an aggressive physiotherapy protocol. Ultrasound was used to identify the extra-articular adhesions. The intra-articular part of the release was done by a standard protocol involving the release of all infrapatellar, suprapatellar and gutter adhesions, and then the extra-articular proximal adhesions were released by using special long periosteal elevators and arthroscopic scissors. We were able to release the adhesions as high as 9 inches above the patella, and in one case bony ankylosis between the patella and the femur was arthroscopically osteotomised (after 11 years of stiffness). Delay before surgery averaged 2.7 years (6 months-11.3 years). Mean active flexion at one year follow-up improved from 27.3 degrees to 119.3 degrees (average increase: 92 degrees). Mean preoperative extension lag reduced from 6 degrees to 1 degrees postoperatively. No CPM machine was available, and patients had to undergo daily manual and assisted therapy, with appropriate analgesia. Overall patient satisfaction was excellent; one patient developed a supracondylar fracture (infected old fracture with bone loss and severe contracture) and was retrospectively a wrong case selection. Arthroscopic aided quadriceps adhesion release is a good option in cases of neglected trauma; results are excellent even without sophisticated CPM machines, and the periosteal elevators needed are cheap and indigenous. PMID:16152854
. Our objective was to review the MR imaging signs of meniscal bucket-handle tears and assess the relevance of these signs\\u000a to the arthroscopic classification of displaced meniscal tears. Forty-five menisci in 42 patients who had a diagnosis of bucket-handle\\u000a tear either on MR imaging or on subsequent arthroscopy (in which Dandy's classification of meniscal tears was used) were retrospectively
Üstün Aydingöz; Ahmet K. Firat; Ahmet Ö. Atay; Nedim M. Doral
Arthroscopic knee surgery is one of the most common surgeries done in outpatient settings; however, postoperative pain is believed to be the major barrier for discharge and early rehabilitation. In this study we evaluated and compared the efficacy of intraarticular application of long-lasting non-steroidal analgesic drug tenoxicam, a long-lasting local anaesthetic bupivacaine and combination of the two on postoperative pain
Gül K. Talu; Süleyman Özyalç?n; Kemallettin Koltka; Engin Ertürk; Özkan Ak?nc?; Mehmet A??k; Kamil Pembeci
Severe joint inflammation following trauma, arthroscopic surgery or infection can damage articular cartilage, thus every effort\\u000a should be made to protect cartilage from the catabolic effects of pro-inflammatory cytokines and stimulate cartilage anabolic\\u000a activities. Previous pre-clinical studies have shown that pulsed electromagnetic fields (PEMFs) can protect articular cartilage\\u000a from the catabolic effects of pro-inflammatory cytokines, and prevent its degeneration, finally
Pre-clinical studies have shown that treatment by pulsed electromagnetic fields (PEMFs) can limit the catabolic effects of\\u000a pro-inflammatory cytokines on articular cartilage and favour the anabolic activity of the chondrocytes. Anterior cruciate\\u000a ligament (ACL) reconstruction is usually performed by arthroscopic procedure that, even if minimally invasive, may elicit\\u000a an inflammatory joint reaction detrimental to articular cartilage. In this study the
Francesco Benazzo; Giacomo Zanon; Luigi Pederzini; Fulvio Modonesi; Carlo Cardile; Francesco Falez; Luigi Ciolli; Filippo La Cava; Sandro Giannini; Roberto Buda; Stefania Setti; Gaetano Caruso; Leo Massari
We report our experience using the Leeds-Keio artificial ligament for anterior cruciate ligament (ACL) reconstruction. The study relates the results of the first 40 patients subjected to arthroscopic reconstruction of the ACL with a Leeds-Keio ligament, with a mean follow-up of 73 months. No associated peripheral procedures were carried out on any patient. The average age of the patients at
M. Marcacci; S. Zaffagnini; A. Visani; F. Iacono; M. P. Neri; A. Petitto
Background: The RapidLoc is an all-inside, self-adjusting, flexible meniscal repair device that combines a suture with an anchor component and, by using a reinforced sliding knot, allows for tightening to compress and hold the repaired meniscal segments. The purpose of this study was to evaluate the clinical success of the RapidLoc device. Methods: A prospective consecutive series of meniscal repairs
F. Alan Barber; David A. Coons; Michell Ruiz-Suarez
Athletes with superior labral tear from anterior to posterior (SLAP) lesions place large demands on their rotator cuff and often have partial articular-sided rotator cuff tears as part of an internal impingement process. A percutaneous technique that facilitates SLAP repair may decrease the rotator cuff morbidity associated with establishment of the standard Wilmington portal. The current study reports the clinical outcome of patients with SLAP lesions treated with a percutaneous repair technique. Twenty-two patients with SLAP lesions underwent percutaneous repair. Mean patient age was 26.9 years. Standard posterior viewing and anterior working portals were used. Anchor placement and suture passing were performed with a 3-mm percutaneous and transtendinous approach to the superior labrum. Knot tying was performed via the standard anterior working portal. Clinical outcomes were assessed with validated shoulder evaluation instruments. Mean follow-up was 31.1 months (±6.6 months). Improvement of shoulder evaluation scores from pre- to postoperative were as follows: American Shoulder and Elbow Surgeons score improved from 49.5 to 83.6, visual analog scale improved from 5.4 to 1.5, and Simple Shoulder Score improved from 6.4 to 11.0. All were significant improvements (P<.05). There was no significant difference in functional scores between Type II lesions versus combined lesions, or between patients with or without a concurrent low-grade rotator cuff tear. Ninety percent of athletes were able to return to sport at pre-injury level of function. Percutaneously-assisted arthroscopic SLAP lesion repair may minimize surgical morbidity to the rotator cuff and provides excellent results. PMID:21053881
Galano, Gregory J; Ahmad, Christopher S; Bigliani, Louis; Levine, William
Meniscus injury is common in today's active society. Despite the frequent presentation of meniscus injury, the decision to repair or resect a torn meniscus is not always straightforward. Current repair techniques are effective in the peripheral vascularized meniscus, but their success is not dependable in the avascularized zone. Tissue engineering, a discipline that combines the technologies of cell culture and biodegradable scaffolds to deliver a cellular repair, may be one future answer to this problem. The concept of using cell-based repair for torn menisci could improve healing of lesions in the avascular zone and broadly expand the indication for repair rather than removal, obviating the need for meniscectomy. This article reviews current advances in the relatively new field of tissue engineering toward the development of a tissue-engineered meniscal repair technique. PMID:15742594
Most of our understanding of DNA repair mechanisms in human cells has come from the study of these processes in cultured fibroblasts. The unique properties of keratinocytes and their pattern of terminal differentiation led us to a comparative examination of their DNA repair properties. The relative repair capabilities of the basal cells and the differentiated epidermal keratinocytes as well as possible correlations of DNA repair capacity with respect to age of the donor have been examined. In addition, since portions of human skin are chronically exposed to sunlight, the repair response to ultraviolet (UV) irradiation (254 nm) when the cells are conditioned by chronic low-level UV irradiation has been assessed. The comparative studies of DNA repair in keratinocytes from infant and aged donors have revealed no significant age-related differences for repair of UV-induced damage to DNA. Sublethal UV conditioning of cells from infant skin had no appreciable effect on either the repair or normal replication response to higher, challenge doses of UVL. However, such conditioning resulted in attenuated repair in keratinocytes from adult skin after UV doses above 25 J/m2. In addition, a surprising enhancement in replication was seen in conditioned cells from adult following challenge UV doses.
Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large registries have confirmed its efficacy. Randomised controlled trials have shown that although endoluminal repair may not be as cost effective as open repair, it can be performed with a lower mortality in patients fit for open repair.
Tendon connects muscle to bone and functions to transmit muscular forces across joints to stabilize or move those joints. Tendons in the foot and ankle are subject to enormous loads and consequently make up a substantial portion of the body's tendon injuries. Understanding the mechanisms of these injuries requires an understanding of the relative rates of muscle, tendon, osteotendinous junction, and myotendinous junction adaptation. This article provides the practitioner with an overview of tendon anatomy, physiology, healing, and repair and correlates didactic and clinical aspects so that practitioners can better treat patients and get them back to normal functioning as quickly and as close to anatomic and physiologic capabilities as possible. PMID:16213379
We describe an arthroscopic technique by which to reconstruct both the calcaneofibular ligament and anterior talofibular ligament anatomically. The ankle joint is examined through the anteromedial portal and a lateral portal close to the talar insertion of the anterior talofibular ligament. The subtalar joint is examined through the anterolateral portal and the middle portal. Associated intra-articular pathology (e.g., osteochondral defect) is evaluated and addressed. The calcaneofibular ligament is an extracapsular structure that can be examined arthroscopically through the anterolateral portal in the extra-articular plane. The peroneal tendon sheath is stripped with a small periosteal elevator through the middle subtalar portal, and the calcaneal insertion of the calcaneofibular ligament is identified. The plantaris tendon is identified and freed through multiple small wounds at the medial calf, and the tendon is cut proximally and retrieved to its calcaneal insertion. A calcaneal bone tunnel (tunnel 1) is created between the plantaris tendon and the calcaneofibular ligament insertions by use of a 3.5-mm drill bit. The tendon graft is then looped onto a suture, and the suture is passed through the tunnel to the calcaneofibular ligament insertion and retrieved to the middle subtalar portal. Through the anterolateral subtalar portal, the fibular insertion of the calcaneofibular ligament is identified. Another bone tunnel is created from this point to the posterior edge of the fibula (tunnel 2) with a 3.5-mm drill through the middle subtalar portal. The fibular insertion of the anterior talofibular ligament is identified on ankle arthroscopy. Tunnel 3 is created from this point to the exit point of tunnel 2 through the lateral ankle portal. The tendon graft is retrieved to the lateral ankle joints through the second and third tunnels and is pierced through the lateral ankle capsule and course from intracapsular to extracapsular. The tendon graft loop is anchored to the insertion point of the anterior talofibular ligament by a 4.0-mm cancellous screw with a spiked washer. The tendon graft is tensioned by pulling the free end of the tendon graft while tightening the screw. The free end of the tendon graft and the stay stitch are sutured to surrounding soft tissue or anchored with another 4.0-mm cancellous screw and spiked washer. The procedure is then completed, and a short leg cast is applied. The patient is advised to perform non-weight-bearing walking for 6 weeks. PMID:17478288
This paper describes British Airways experience with composite repairs since 1970. It includes the use of composite materials to repair metal structures such as Concorde wing leading edges and traces the repair of composite parts from Radomes starting in ...