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Sample records for femoroacetabular impingement arthroscopic

  1. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Frank, Rachel M.; Pulido, Luis

    2015-01-01

    Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI. PMID:26697431

  2. The pathoanatomy and arthroscopic management of femoroacetabular impingement

    PubMed Central

    Tibor, L. M.; Leunig, M.

    2012-01-01

    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. PMID:23610655

  3. Femur-mounted navigation system for the arthroscopic treatment of femoroacetabular impingement

    NASA Astrophysics Data System (ADS)

    Park, S. H.; Hwang, D. S.; Yoon, Y. S.

    2013-07-01

    Femoroacetabular impingement stems from an abnormal shape of the acetabulum and proximal femur. It is treated by resection of damaged soft tissue and by the shaping of bone to resemble normal features. The arthroscopic treatment of femoroacetabular impingement has many advantages, including minimal incisions, rapid recovery, and less pain. However, in some cases, revision is needed owing to the insufficient resection of damaged bone from a misreading of the surgical site. The limited view of arthroscopy is the major reason for the complications. In this research, a navigation method for the arthroscopic treatment of femoroacetabular impingement is developed. The proposed navigation system consists of femur attachable measurement device and user interface. The bone mounted measurement devices measure points on head-neck junction for registration and position of surgical instrument. User interface shows the three-dimensional model of patient's femur and surgical instrument position that is tracked by measurement device. Surgeon can know the three-dimensional anatomical structure of hip joint and surgical instrument position on surgical site using navigation system. Surface registration was used to obtain relation between patient's coordinate at the surgical site and coordinate of three-dimensional model of femur. In this research, we evaluated the proposed navigation system using plastic model bone. It is expected that the surgical tool tracking position accuracy will be less than 1 mm.

  4. Hip impingement: beyond femoroacetabular

    PubMed Central

    Bardakos, Nikolaos V.

    2015-01-01

    In the last 20 years, femoroacetabular impingement has been at the forefront of clinical practice as a cause of hip pain in young adults. As arthroscopic techniques for the hip continue to evolve, the possible presence of a new group of conditions creating mechanical conflict in and around the hip joint (ischiofemoral, subspine and iliopsoas impingement) has recently been elucidated whilst interest in already known ‘impingement’ syndromes (pelvic-trochanteric and pectineofoveal impingement) is now revived. This article attempts to increase awareness of these relatively uncommon clinical entities by describing their pathomorphology, contact mechanics, treatment and published results available to present. It is hoped that such knowledge will diversify therapeutic options for the clinician, thereby improving outcomes in a small but not negligible portion of patients with previously unexplained persistent symptoms. PMID:27011843

  5. Pre-operative Thresholds for Achieving Meaningful Clinical Improvement after Arthroscopic Treatment of Femoroacetabular Impingement

    PubMed Central

    Nwachukwu, Benedict U.; Fields, Kara G.; Nawabi, Danyal H.; Kelly, Bryan T.; Ranawat, Anil S.

    2016-01-01

    Objectives: Knowledge of the thresholds and determinants for successful femoroacetabular impingement (FAI) treatment is evolving. The primary purpose of this study was to define pre-operative outcome score thresholds that can be used to predict patients most likely to achieve meaningful clinically important difference (MCID) after arthroscopic FAI treatment. Secondarily determinants of achieving MCID were evaluated. Methods: A prospective institutional hip arthroscopy registry was reviewed to identify patients with FAI treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) tools were administered at baseline and at one year post-operatively. MCID was calculated using a distribution-based method. A receiver operating characteristic (ROC) analysis was used to calculate cohort-based threshold values predictive of achieving MCID. Area under the curve (AUC) was used to define predictive ability (strength of association) with AUC >0.7 considered acceptably predictive. Univariate and multivariable analyses were used to analyze demographic, radiographic and intra-operative factors associated with achieving MCID. Results: There were 374 patients (mean + SD age, 32.9 + 10.5) and 56.4% were female. The MCID for mHHS, HOS activities of daily living (HOS-ADL), HOS Sports, and iHOT-33 was 8.2, 8.4,14.5, and 12.0 respectively. ROC analysis (threshold, % achieving MCID, strength of association) for these tools in our population was: mHHS (61.6, 78%, 0.68), HOS-ADL (83.8, 68%, 0.84), HOS-Sports (63.9, 64%, 0.74), and iHOT-33 (54.3, 82%, 0.65). Likelihood for achieving MCID declined above and increased below these thresholds. In univariate analysis female sex, femoral version, lower acetabular outerbridge score and increasing CT sagittal center edge angle (CEA) were predictive of achieving MCID. In multivariable analysis

  6. Femoroacetabular impingement with chronic acetabular rim fracture - 3D computed tomography, 3D magnetic resonance imaging and arthroscopic correlation

    PubMed Central

    Chhabra, Avneesh; Nordeck, Shaun; Wadhwa, Vibhor; Madhavapeddi, Sai; Robertson, William J

    2015-01-01

    Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement (FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI. PMID:26191497

  7. Postoperative imaging in femoroacetabular impingement.

    PubMed

    Dietrich, Tobias J; Dora, Claudio; Pfirrmann, Christian W A

    2013-07-01

    Femoroacetabular impingement (FAI) has been recognized as a common cause of pain, limited range of motion, and development of early osteoarthritis of the hip in adolescents and adults. Current surgical approaches include femoral osteochondroplasty, acetabular rim resection, and reattachment of torn labrum as either open surgical or arthroscopic techniques as well as periacetabular osteotomy. Conventional radiographs are routinely obtained in the postoperative setting. In addition, MRI serves for work-up in patients with persistent or recurrent groin pain after surgery. Inappropriate correction of the underlying femoral or acetabular osseous abnormality, insufficiency fractures of the femoral neck due to bone resection, intra-articular adhesions, ongoing joint degeneration including advanced cartilage damage, iatrogenic cartilage injury, retear of the labrum, rarely avascular necrosis of the femoral head, defects of the hip joint capsule, or heterotopic ossification might be observed after surgery for FAI. PMID:23787981

  8. Efficacy of a physiotherapy rehabilitation program for individuals undergoing arthroscopic management of femoroacetabular impingement – the FAIR trial: a randomised controlled trial protocol

    PubMed Central

    2014-01-01

    Background Femoroacetabular impingement is a common cause of hip/groin symptoms and impaired functional performance in younger sporting populations and results from morphological abnormalities of the hip in which the proximal femur abuts against the acetabular rim. Many people with symptomatic femoroacetabular impingement undergo arthroscopic hip surgery to correct the bony abnormalities. While many case series over the past decade have reported favourable surgical outcomes, it is not known whether formal rehabilitation is needed as part of the management of patients undergoing this surgical procedure. This randomised controlled trial will investigate the efficacy of a progressive physiotherapist-supervised rehabilitation program (Takla-O’Donnell Protocol) in improving health-related quality of life, physical function and symptoms in individuals undergoing arthroscopic management of femoroacetabular impingement. Methods/design 100 people aged 16–35 years undergoing hip arthroscopy for symptomatic femoroacetabular impingement will be recruited from surgical practices in Melbourne, Australia and randomly allocated to either a physiotherapy or control group. Both groups will receive written information and one standardised post-operative physiotherapy visit whilst in hospital as per usual care. Those in the physiotherapy group will also receive seven individual 30-minute physiotherapy sessions, including one pre-operative visit (within 2 weeks of surgery) and six post-operative visits at fortnightly intervals (commencing two weeks after surgery). The physiotherapy intervention will incorporate education and advice, manual techniques and prescription of a progressive rehabilitation program including home, aquatic and gym exercises. The control group will not receive additional physiotherapy management. Measurements will be taken at baseline (2 weeks pre-operatively) and at 14 and 24 weeks post-surgery. Primary outcomes are the International Hip Outcome Tool and

  9. The Horsens-Aarhus Femoro Acetabular Impingement (HAFAI) cohort: outcome of arthroscopic treatment for femoroacetabular impingement. Protocol for a prospective cohort study

    PubMed Central

    Kierkegaard, Signe; Lund, Bent; Dalgas, Ulrik; Sørensen, Henrik; Søballe, Kjeld; Mechlenburg, Inger

    2015-01-01

    Introduction During the past decade, it has become increasingly more common to offer hip arthroscopic surgery when treating people with femoroacetabular impingement (FAI). Nevertheless, the latest reviews conclude that it still remains to be properly investigated how surgery affects the patients. Specifically, detailed information on the functional, muscular and mechanical impact of surgery in larger groups is lacking. Furthermore, the long-term outcome of the surgery is still to be investigated. Methods and analysis In this prospective cohort study, a total of 60 patients with FAI scheduled for arthroscopic surgery will be followed and tested preoperatively, and again after 3, 6, 9 and 12 months. Assessment includes isokinetic dynamometry evaluating hip flexion and extension; evaluation of functional capacity in a three-dimensional motion laboratory; pain assessment; self-reported function, quality of life, expectation and satisfaction with the surgery; recording of previous and present sporting activities and accelerometry. In addition, data on surgical procedure, rehabilitation progress, adverse events and failure will be recorded. Patients will be compared with an age-matched and gender-matched reference group of 30 persons with no hip, knee, ankle or back problems. Long-term follow-up of this cohort may evaluate possible reoperations and development of hip osteoarthritis. Furthermore, analysis on how subgroups respond to the treatment could be performed together with identification of possible “non-responders”. Ethics and dissemination The study is approved by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 1-10-72-239-14). The results from this study will be presented at national and international congresses and published in peer-reviewed journals. Trial registration number NCT02306525. PMID:26346877

  10. Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN)

    PubMed Central

    Griffin, D R; Dickenson, E J; Wall, P D H; Donovan, J L; Foster, N E; Hutchinson, C E; Parsons, N; Petrou, S; Realpe, A; Achten, J; Achana, F; Adams, A; Costa, M L; Griffin, J; Hobson, R; Smith, J

    2016-01-01

    Introduction Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. Methods We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). Ethics and dissemination Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer

  11. Arthroscopic Technique for Treatment of Combined Pathology Associated With Femoroacetabular Impingement Syndrome Using Traction Sutures and a Minimal Capsulotomy

    PubMed Central

    Thakral, Rishi; Ochiai, Derek

    2014-01-01

    The use of hip arthroscopy is gaining popularity for diagnostic and therapeutic purposes. With our increasing understanding of hip biomechanics and pathophysiology, our techniques for treatment are evolving as well. The main aim is to preserve the joint and prolong the degenerative process associated with femoroacetabular impingement (FAI). In general, combined pathology is encountered when a diagnosis of FAI is established. In our experience, we have seen large number of patients with a combination of cam and pincer lesions with or without associated labral tears. It is optimal to address all symptomatic pathology with one surgical intervention. The described technique shows the feasibility of dealing with the hip FAI pathology by using traction sutures on the capsule through a 2-portal technique. PMID:25264515

  12. Editorial Commentary: Radiographic Inclusion and Exclusion Diagnostic Criteria for Femoroacetabular Impingement Require Confirmation.

    PubMed

    Lubowitz, James H

    2015-07-01

    Femoroacetabular impingement radiographic diagnosis is a hot topic because sensitivity and specificity, and intraobserver and interobserver observational consistency, require confirmation. As a result, hip arthroscopic surgeons must rely on expert clinical examination.

  13. Femoroacetabular Impingement (FAI)

    MedlinePlus

    ... FAI. Because athletically active people may work the hip joint more vigorously, they may begin to experience pain ... the impingement can prevent future damage to the hip joint. However, not all of the damage can be ...

  14. Femoroacetabular impingement: a review of current concepts.

    PubMed

    Sangal, Rohit B; Waryasz, Gregory R; Schiller, Jonathan R

    2014-11-01

    Femoroacetabular impingement is becoming an increasingly more common diagnosis in the orthopaedic community for hip pain in the younger population. Variations in the femoral head and acetabulum can lead to a sequelae of changes to the cartilage that can lead to osteoarthritis. Diagnosis is made through a combination of patient history, physical examination, and diagnostic imaging. Plain radiographs are a very useful tool for evaluating the bony anatomy, while CT scan and MRI have roles for surgical planning and more definitive diagnosis. Most patients should trial physical therapy prior to consideration for any arthroscopic or open procedures. Long-term outcome studies are being performed to determine if surgical intervention has any impact on quality of life and development of osteoarthritis.

  15. Treatment of cam-type femoroacetabular impingement

    PubMed Central

    FIORENTINO, GENNARO; FONTANAROSA, ALBERTO; CEPPARULO, RICCARDO; GUARDOLI, ALBERTO; BERNI, LUCA; COVIELLO, GIANLUCA; GUARDOLI, ALDO

    2015-01-01

    Purpose the aim of this study was to evaluate preliminary clinical and radiographic results of arthroscopic treatment of cam-type femoroacetabular impingement (FAI). Methods thirty-eight patients underwent hip arthroscopy for cam-type FAI between 2009 and 2012. Preoperative assessment was based on clinical examination, modified Harris Hip Score (mHHS) and radiographic examination with anteroposterior pelvis, frog-leg and Lequesne views. The patients’ clinical conditions at follow-up were assessed using the mHHS administered as a telephone survey. Radiographic outcome measurements evaluated pre and postoperatively were the alpha angle and femoral head-neck offset. Results the patients were clinically evaluated at a mean follow-up of 36 months. Radiographic follow-up was performed at an average of 12.7 months. Thirty of the 38 patients (79%) were satisfied with the results of the arthroscopic procedure. A total of nine patients subsequently underwent a total hip replacement. All 30 patients who declared themselves satisfied recorded an mHHS increase; in particular, the mHHS increased from a mean of 52.9 preoperatively (range: 27.5–82.5) to a mean of 85.6 postoperatively (range: 45.1–100.1). Three significant differences between the two groups of patients (satisfied and not satisfied) were recorded: mean age, alpha angle and BMI were all significantly greater in the patients who were not satisfied with the treatment. Conclusions a crucial aspect in order to obtain good clinical outcomes of arthroscopic treatment of cam-type impingement is correct selection of patients who are likely to benefit from this kind of surgery. Hip arthroscopy should be avoided in patients aged over 50 years with risk factors for early osteoarthritis (high BMI and a significantly increased alpha angle). Level of evidence Level IV, therapeutic case series. PMID:26605253

  16. Anterior femoroacetabular impingement: an update.

    PubMed

    Lequesne, Michel; Bellaïche, Laurence

    2012-05-01

    Anterior femoroacetabular impingement can cause early hip osteoarthritis. The typical patient is an adult younger than 50 years of age, often with a history of sporting activities. The main symptom is intermittent pain triggered by static flexion (low seats) or dynamic flexion (during sporting or occupational activities that require repeated hip flexion). The characteristic physical finding is pain triggered by placing the hip in internal rotation and 70 to 110° of flexion. In additional to anteroposterior and false-profile radiographs, lateral Dunn or Ducroquet views should be obtained on both sides to visualize the anterior part of the head-neck junction. Instead of being concave, the head-neck junction is either flat or convex, causing a cam effect that damages the labrum and anterosuperior cartilage. Non-sphericity of the femoral head with an anterior ovoid bulge induces a similar cam effect. In pincer impingement, which is less common, over-coverage by the anterosuperior acetabular rim pinches the labrum between the rim and the femoral head-neck junction when the hip is flexed. Pincer impingement is related to acetabular retroversion or protrusion. Arthrography coupled with computed tomography or magnetic resonance imaging visualizes the morphological abnormalities (e.g., ovoid shape of the femoral head or retroversion of the acetabulum) and detects secondary lesions such as labral tears or separation or damage to the anterosuperior cartilage. Arthroscopy allows removal of the damaged labrum and correction of the morphological abnormalities via femoroplasty to restore the normal concave shape of the neck and/or acetabuloplasty to eliminate over-coverage. Short- or mid-term results are satisfactory in 75 to 80% of patients. However, the presence of degenerative lesions in about two-thirds of patients at the time of arthroplastic surgery limits the probability of achieving good long-term results. PMID:22281229

  17. Femoroacetabular impingement: biomechanical and dynamic considerations.

    PubMed

    Dall'Oca, C; Maluta, T; Micheloni, G M; Romeo, T; Zambito, A; Malagò, R; Magnam, B

    2014-01-01

    Femoroacetabular impingement (F.A.I.) is a pathologic process caused by an abnormal shape of the acetabulum, of the femoral head, or both. F.A.I., often referred to as idiopathic, may be secondary to slipped capital femoral epiphysis, congenital hypoplasia of the femur, Legg-Calvé Perthes disease, post-traumatic mal-union and protrusio acetabuli. From 2009 to 2012 we studied 21 patients (14 males), with a mean age of 52 (33 y - 75 y), affected by idiopathic F.A.I. Every patient underwent pelvic and hip joint X-rays and CT scan with 3D reconstructions, in order to evaluate the morphology of the pelvis and the hip joint and the torsion of the lower limbs (Femoroacetabular ante-retroversion). Our results show an average femoral ante-version angle of 12,4° (15°-20° physiological range) in patients affected by CAM impingement and an average acetabular ante-version angle of 13,5° (15°-20° physiological range) for those with PINCER impingement. These values, in patients affected by F.A.I., are probably related to morphologic and biomechanical features that may lead to the onset of idiopathic femoroacetabular impingement. In the literature, other studies partially support our findings, suggesting a more critical approach to a patient with idiopathic F.A.I. extending evaluations to nearby articulations. PMID:25409718

  18. Femoroacetabular impingement and osteoarthritis of the hip

    PubMed Central

    Zhang, Charlie; Li, Linda; Forster, Bruce B.; Kopec, Jacek A.; Ratzlaff, Charles; Halai, Lalji; Cibere, Jolanda; Esdaile, John M.

    2015-01-01

    Objective To outline the clinical presentation, physical examination findings, diagnostic criteria, and management options of femoroacetabular impingement (FAI). Sources of information PubMed was searched for relevant articles regarding the pathogenesis, diagnosis, treatment, and prognosis of FAI. Main message In recent years, FAI has been increasingly recognized as a potential precursor and an important contributor to hip pain in the adult population and idiopathic hip osteoarthritis later in life. Femoroacetabular impingement is a collection of bony morphologic abnormalities of the hip joint that result in abnormal contact during motion. Cam-type FAI relates to a non-spherical osseous prominence of the proximal femoral neck or head-neck junction. Pincer-type FAI relates to excessive acetabular coverage over the femoral head, which can occur owing to several morphologic variants. Patients with FAI present with chronic, deep, or aching anterior groin pain most commonly in the sitting position, or during or after activity. Patients might also experience occasional sharp pains during activity. A thorough history should be taken that includes incidence of trauma and exercise frequency. A physical examination should be performed that includes a full hip, low back, and abdominal examination to assess for alternate causes of anterior groin pain. Diagnosis of FAI should be confirmed with radiography. Femoroacetabular impingement can be managed conservatively with rest, modification of activities, medications, and physiotherapy, or it can be treated surgically. Conclusion Femoroacetabular impingement is an important cause of anterior groin pain. Early recognition and intervention by the primary care provider might be critical to alleviating morbidity and preventing FAI progression. PMID:26668284

  19. Closed Intramedullary Derotational Osteotomy and Hip Arthroscopy for Cam Femoroacetabular Impingement From Femoral Retroversion

    PubMed Central

    Matsuda, Dean K.; Gupta, Nikhil; Martin, Hal D.

    2014-01-01

    Femoral retroversion is an uncommon cause of cam femoroacetabular impingement that may require surgical treatment beyond arthroscopic or open femoroplasty. We present the case of a young adult with bilateral severe femoral retroversion in whom such treatment failed. We discuss the rationale, surgical technique, and outcome of this patient, who underwent bilateral closed intramedullary derotational proximal femoral osteotomies and interlocked nailing with adjunctive pre- and post-osteotomy hip arthroscopies. Clinical improvement with normal foot progression angles, radiographic union, and resolution of bilateral cam femoroacetabular impingement from femoral retroversion was achieved. This surgery permits rapid institution of weight-bearing ambulation and an early rehabilitative program. Femoral retroversion may be an underappreciated and insufficiently treated cause of cam femoroacetabular impingement that may be readily detected and successfully remedied with this less invasive procedure. PMID:24749047

  20. The Natural History of Femoroacetabular Impingement

    PubMed Central

    Kuhns, Benjamin D.; Weber, Alexander E.; Levy, David M.; Wuerz, Thomas H.

    2015-01-01

    Femoroacetabular impingement (FAI) is a clinical syndrome resulting from abnormal hip joint morphology and is a common cause of hip pain in young adults. FAI has been posited as a precursor to hip osteoarthritis (OA); however, conflicting evidence exists and the true natural history of the disease is unclear. The purpose of this article is to review the current understanding of how FAI damages the hip joint by highlighting its pathomechanics and etiology. We then review the current evidence relating FAI to OA. Lastly, we will discuss the potential of hip preservation surgery to alter the natural history of FAI, reduce the risk of developing OA and the need for future arthroplasty. PMID:26636088

  1. Statistical Shape Modeling of Cam Femoroacetabular Impingement

    SciTech Connect

    Harris, Michael D.; Dater, Manasi; Whitaker, Ross; Jurrus, Elizabeth R.; Peters, Christopher L.; Anderson, Andrew E.

    2013-10-01

    In this study, statistical shape modeling (SSM) was used to quantify three-dimensional (3D) variation and morphologic differences between femurs with and without cam femoroacetabular impingement (FAI). 3D surfaces were generated from CT scans of femurs from 41 controls and 30 cam FAI patients. SSM correspondence particles were optimally positioned on each surface using a gradient descent energy function. Mean shapes for control and patient groups were defined from the resulting particle configurations. Morphological differences between group mean shapes and between the control mean and individual patients were calculated. Principal component analysis was used to describe anatomical variation present in both groups. The first 6 modes (or principal components) captured statistically significant shape variations, which comprised 84% of cumulative variation among the femurs. Shape variation was greatest in femoral offset, greater trochanter height, and the head-neck junction. The mean cam femur shape protruded above the control mean by a maximum of 3.3 mm with sustained protrusions of 2.5-3.0 mm along the anterolateral head-neck junction and distally along the anterior neck, corresponding well with reported cam lesion locations and soft-tissue damage. This study provides initial evidence that SSM can describe variations in femoral morphology in both controls and cam FAI patients and may be useful for developing new measurements of pathological anatomy. SSM may also be applied to characterize cam FAI severity and provide templates to guide patient-specific surgical resection of bone.

  2. What’s New in Femoroacetabular Impingement Surgery

    PubMed Central

    Gupta, Anil K.; Abrams, Geoffrey D.; Nho, Shane J.

    2014-01-01

    Context: Femoroacetabular impingement (FAI) has been described as a common cause of hip pain in young adults. This leads to abnormal hip joint mechanics and contact pressures. The associated pathomechanics can lead to the development of early osteoarthritis. Better understanding of the anatomy and pathophysiology, biomechanics, and diagnostic and therapeutic advances has led to improved clinical outcomes. A growing body of evidence has set the foundation for future progress in the treatment of this commonly encountered condition. Evidence Acquisition: The PubMed database was searched for English-language articles pertaining to FAI over the past 15 years (1998-2013). Study Design: Retrospective literature review. Level of Evidence: Level 4. Results: The authors evaluated and discussed the current evidence regarding the anatomy, physiology, biomechanics, imaging, and clinical outcomes of surgical intervention for FAI. Based on this information, future directions for improving the diagnosis and management of FAI are proposed. Conclusion: There remains a diverse approach to the diagnosis and management of cam- and/or pincer-type FAI. Recent advances in clinical diagnosis, imaging, indications, and arthroscopic techniques have led to improved outcomes and have set the foundation for future progress in the management of this condition. Strength of Recommendation Taxonomy (SORT): B PMID:24587868

  3. The arthroscopic treatment of subacromial impingement.

    PubMed

    Mendoza, F X; Nicholas, J A; Rubinstein, M P

    1987-07-01

    In order to effectively employ arthroscopic techniques for a subacromial decompression, a thorough understanding of the impingement syndrome and its clinical manifestations is necessary. The authors' preliminary experience with the arthroscopic subacromial decompression suggests excellent results with early return to competitive athletics.

  4. Open-configuration MRI study of femoro-acetabular impingement.

    PubMed

    Yamamura, Mitsuyoshi; Miki, Hidenobu; Nakamura, Nobuo; Murai, Masakazu; Yoshikawa, Hideki; Sugano, Nobuhiko

    2007-12-01

    Femoro-acetabular impingement has been proposed as a causative factor of primary hip osteoarthritis. However, primary osteoarthritis of the hip is infrequent in Japan and other Asian countries, even though the hips of Asians frequently sustain impingement, since the Asian lifestyle commonly requires a larger range of hip motion than the Western lifestyle. Therefore, using open-configuration MRI, we investigated whether impingement actually occurs during some traditional Japanese hip positions. The hips of 5 healthy Japanese females were examined in 5 sitting postures: 1) sitting straight; 2) bowing while sitting straight; 3) sitting cross-legged; 4) W-sitting; and 5) squatting. The impingement point was detected by multiple plane reconstructed (MPR) views along with the acetabular rim depicted circumferentially. Impingement was considered to have occurred when, on MRI, the anterior femoral head-neck junction approached the acetabular rim and the femoral head was seen to float from the bottom of the acetabulum with the acetabular rim acting as a fulcrum. Impingement was observed in all volunteers in the W-sitting position, and in 2 of 5 volunteers during squatting. These findings show that impingement occurs frequently during daily Japanese activities. Thus, depending on race, femoro-acetabular impingement might not always cause primary osteoarthritis of the hip. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1582-1588, 2007. PMID:17600811

  5. Can Bracing Affect Altered Gait Patterns in Femoroacetabular Impingement

    PubMed Central

    Safran, Marc R.; Rylander, Jonathan; Shu, Beatrice; Andriacchi, Thomas P.

    2013-01-01

    Objectives: Altered gait patterns have been identified in patients with Femoroacetabular impingement (FAI), a 2nd order reversal in mid stance, that has been shown to be corrected with arthroscopic FAI surgery. Currently, most feel there is no adequate conservative treatment for this malady. The goal of this study is to determine if the gait abnormalities seen with femoroacetabular impingement (FAI) can be modified with bracing. Methods: Eight individuals (4 Male, 34.5 ± 12.8 y.o., 24.0±2.3 BMI) who were diagnosed with FAI after reporting to clinic with groin pain were enrolled in this study. The study was approved by the University Internal Review Board before participants were enrolled. History, clinical exam, and imaging including an AP pelvis and cross table lateral radiograph of the affected hip and MR-arthrogram of the affected hip were utilized to make the diagnosis. Participants who enrolled had primarily unilateral hip symptoms, had positive impingement and labral stress tests on the affected side and were free of other lower extremity, back, and spine disorders. Three dimensional lower limb kinematics were collected using a camera and forceplate system with the subjects wearing reflective markers on anatomical landmarks. Participants were tested prior to surgery. Hip kinematics were collected for the symptomatic limb while the patients walked at a self selected normal walking speed, slowly jogged, and ascended a two stair setup. Three trials for each activity were completed with and without wearing a brace that was designed to externally rotate the femur in the treatment of patellofemoral disorders for a total of 6 trials per activity. Peak hip flexion, extension, abduction, adduction, internal rotation, and external rotation were calculated over the stance phase for each trial. Averages were calculated over the 3 trials for each activity both with and without the brace. Intra-subject differences were compared between the braced and unbraced trials

  6. Surgical hip dislocation for treatment of cam femoroacetabular impingement

    PubMed Central

    Chaudhary, Milind M; Chaudhary, Ishani M; Vikas, KN; KoKo, Aung; Zaw, Than; Siddhartha, A

    2015-01-01

    Background: Cam femoroacetabular impingement is caused by a misshapen femoral head with a reduced head neck offset, commonly in the anterolateral quadrant. Friction in flexion, adduction and internal rotation causes limitation of the hip movements and pain progressively leading to labral and chondral damage and osteoarthritis. Surgical hip dislocation described by Ganz permits full exposure of the hip without damaging its blood supply. An osteochondroplasty removes the bump at the femoral head neck junction to recreate the offset for impingement free movement. Materials and Methods: Sixteen patients underwent surgery with surgical hip dislocation for the treatment of cam femoroacetabular impingement by open osteochondroplasty over last 6 years. Eight patients suffered from sequelae of avascular necrosis (AVN). Three had a painful dysplastic hip. Two had sequelae of Perthes disease. Three had combined cam and pincer impingement caused by retroversion of acetabulum. All patients were operated by the trochanteric flip osteotomy with attachments of gluteus medius and vastus lateralis, dissection was between the piriformis and gluteus minimus preserving the external rotators. Z-shaped capsular incision and dislocation of the hip was done in external rotation. Three cases also had subtrochanteric osteotomy. Two cases of AVN also had an intraarticular femoral head reshaping osteotomy. Results: Goals of treatment were achieved in all patients. No AVN was detected after a 6 month followup. There were no trochanteric nonunions. Hip range of motion improved in all and Harris hip score improved significantly in 15 of 16 cases. Mean alpha angle reduced from 86.13° (range 66°–108°) to 46.35° (range 39°–58°). Conclusion: Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term. PMID

  7. Advanced hip joint degeneration associated with femoroacetabular impingement in a retired chiropractor

    PubMed Central

    Emary, Peter C.; Taylor, John A.

    2016-01-01

    Femoroacetabular impingement is a relatively new clinical entity only recently described in the orthopedic literature. In this report, we document a severe case of hip joint osteoarthritis associated with cam-type impingement in a retired chiropractor.

  8. Femoroacetabular impingement mimicking avascular osteonecrosis on bone scintigraphy

    PubMed Central

    Suarez, Juan Pablo; Domínguez, María Luz; Nogareda, Zulema; Gómez, María Asunción; Muñoz, Jose

    2016-01-01

    Femoroacetabular impingement (FAI) is a structural abnormality of proximal femur and/or acetabulum. It has been recently described, and there are limited reports in nuclear medicine literature because bone scintigraphy is not listed in its diagnostic protocol, but it should be included on differential diagnosis when evaluating patients, with hip-related symptoms because it may be misinterpreted as degenerative changes or avascular necrosis, and its early treatment avoid progression to osteoarthritis. We describe the case of a male who suffered from hip pain. Bone planar scintigraphic appearance mimicked avascular necrosis, but single photon emission computed tomography (CT) imaging and CT examination confirmed the diagnosis of FAI. PMID:27095871

  9. SURGICAL TREATMENT FOR FEMOROACETABULAR IMPINGEMENT IN A GROUP THAT PERFORMS SQUATS

    PubMed Central

    Polesello, Giancarlo Cavalli; Cinagawa, Eduardo Hitoshi Tsuge; Cruz, Paulo Daniel Sousa Santa; de Queiroz, Marcelo Cavalheiro; Borges, Cristian Jandrey; Junior, Walter Ricioli; Daniachi, Daniel; Guimarães, Rodrigo Pereira; Honda, Emerson Kiyoshi; Ono, Nelson Keiske

    2015-01-01

    Objective: Describe the results from arthroscopic surgical treatment on a group of patients who developed symptoms after repetitive physical activity of moving their hips in a position of hyperflexion, as in leg presses and squats. Methods: The study group comprised 47 individuals (48 hips) who developed the onset of painful symptoms associated with hip hyperflexion exercises (leg presses or squats) and underwent arthroscopic treatment. The patients were evaluated radiographically and clinically according to the “Harris Hip Score", as modified by Byrd (MHHS), pre and postoperatively, and were asked about their return to sports activities and the surgical findings. Results: The mean preoperative and postoperative MHHS, respectively, were 60 points (SD 11.0, range 38.5 to 92.4) and 95.9 points (SD 7.7, range 63.8 to 100), with an increase of 35.9 points (P < 0.001). Regarding physical activity, 30 individuals (71.5%) resumed sports activities after surgery, and 25 of them (83.4%) at the previous level. Six patients (12.8%) did not resume activities because of persistent pain. During arthroscopy, 48 hips (100%) presented lesions of the acetabular labrum, and 41 hips (85.4%) had acetabular chondral lesions. Conclusion: The patients with painful symptoms after hip hyperflexion exercises associated with femoroacetabular impingement presented improvements after arthroscopic treatment. PMID:27047856

  10. Editorial Commentary: Ligamentum Teres Tears and Femoroacetabular Impingement: Complex Coexistence of Impingement and Instability.

    PubMed

    Larson, Christopher M

    2016-07-01

    In a large Level IV case series of 2,213 hip arthroscopies with the diagnosis of femoroacetabular impingement, the intraoperative status of the ligamentum teres (LT) was recorded as normal in 11%, frayed and/or partially torn in 88%, and completely torn in 1.5% of hips. Although specific physical examination maneuvers for detecting LT tears were not available early in the study period, thus limiting a detailed assessment of such tests, the authors identified that female gender, a lower lateral center edge angle, a higher Tonnis angle, and capsular laxity were all associated with complete LT tears. This study further supports the complex coexistence of impingement and instability.

  11. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes.

  12. Arthroscopic Approach to Posterior Ankle Impingement.

    PubMed

    Theodoulou, Michael H; Bohman, Laura

    2016-10-01

    Posterior ankle pain can occur for many reasons. If it is produced by forced plantarflexion of the foot, it is often a result of impingement from an enlarged posterior talar process or an os trigonum. This condition may present in an acute or chronic state. Management is initially nonoperative, but surgical treatments are available. This condition is often seen in athletes, so procedures that limit surgical trauma and allow early return to activity are ideal. An arthroscopic approach for this disorder produces good outcomes with limited complications. Understanding the indications, local anatomy, and surgical technique, allows good, reproducible outcomes. PMID:27599438

  13. The etiology of primary femoroacetabular impingement: genetics or acquired deformity?

    PubMed

    Packer, Jonathan D; Safran, Marc R

    2015-10-01

    The etiology of primary femoroacetabular impingement (FAI) remains controversial. Both genetic and acquired causes have been postulated and studied. While recent studies suggest that genetic factors may have a role in the development of FAI, there is no conclusive evidence that FAI is transmitted genetically. Currently, the most popular theory for the development of cam-type deformities is that a repetitive injury to the proximal femoral physis occurs during a critical period of development. There is a correlation between a high volume of impact activities during adolescence and the development of cam-type deformities. Multiple studies have found a high prevalence of FAI in elite football, ice hockey, basketball and soccer players. In this article, we review the current literature relating to the etiology of primary FAI.

  14. The etiology of primary femoroacetabular impingement: genetics or acquired deformity?

    PubMed

    Packer, Jonathan D; Safran, Marc R

    2015-10-01

    The etiology of primary femoroacetabular impingement (FAI) remains controversial. Both genetic and acquired causes have been postulated and studied. While recent studies suggest that genetic factors may have a role in the development of FAI, there is no conclusive evidence that FAI is transmitted genetically. Currently, the most popular theory for the development of cam-type deformities is that a repetitive injury to the proximal femoral physis occurs during a critical period of development. There is a correlation between a high volume of impact activities during adolescence and the development of cam-type deformities. Multiple studies have found a high prevalence of FAI in elite football, ice hockey, basketball and soccer players. In this article, we review the current literature relating to the etiology of primary FAI. PMID:27011846

  15. The etiology of primary femoroacetabular impingement: genetics or acquired deformity?

    PubMed Central

    Packer, Jonathan D.; Safran, Marc R.

    2015-01-01

    The etiology of primary femoroacetabular impingement (FAI) remains controversial. Both genetic and acquired causes have been postulated and studied. While recent studies suggest that genetic factors may have a role in the development of FAI, there is no conclusive evidence that FAI is transmitted genetically. Currently, the most popular theory for the development of cam-type deformities is that a repetitive injury to the proximal femoral physis occurs during a critical period of development. There is a correlation between a high volume of impact activities during adolescence and the development of cam-type deformities. Multiple studies have found a high prevalence of FAI in elite football, ice hockey, basketball and soccer players. In this article, we review the current literature relating to the etiology of primary FAI. PMID:27011846

  16. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

    PubMed

    Griffin, D R; Dickenson, E J; O'Donnell, J; Agricola, R; Awan, T; Beck, M; Clohisy, J C; Dijkstra, H P; Falvey, E; Gimpel, M; Hinman, R S; Hölmich, P; Kassarjian, A; Martin, H D; Martin, R; Mather, R C; Philippon, M J; Reiman, M P; Takla, A; Thorborg, K; Walker, S; Weir, A; Bennell, K L

    2016-10-01

    The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise

  17. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

    PubMed

    Griffin, D R; Dickenson, E J; O'Donnell, J; Agricola, R; Awan, T; Beck, M; Clohisy, J C; Dijkstra, H P; Falvey, E; Gimpel, M; Hinman, R S; Hölmich, P; Kassarjian, A; Martin, H D; Martin, R; Mather, R C; Philippon, M J; Reiman, M P; Takla, A; Thorborg, K; Walker, S; Weir, A; Bennell, K L

    2016-10-01

    The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise

  18. Utility of Intra-articular Hip Injections for Femoroacetabular Impingement

    PubMed Central

    Khan, Wahab; Khan, Moin; Alradwan, Hussain; Williams, Ryan; Simunovic, Nicole; Ayeni, Olufemi R.

    2015-01-01

    Background: Femoroacetabular impingement (FAI) is a condition that is becoming increasingly recognized as a common etiology of hip pain in athletes, adolescents, and adults. However, history and clinical examination are often inconclusive in reaching a diagnosis, while imaging often detects asymptomatic abnormalities. Treatment has traditionally been limited to surgery, with the role of conservative management remaining unclear. Purpose: To evaluate the utility of the intra-articular hip injection in the diagnosis and management of FAI. Study Design: Systematic review; Level of evidence, 4. Methods: MEDLINE, EMBASE, and PubMed databases were screened in duplicate for studies published between January 1946 and January 2014. Search terms included femoroacetabular impingement, hip impingement, and intra-articular injection. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Data evaluated included study design, study objectives, number of hips, injected product, duration of pain relief, and outcomes measured. Results: Our search yielded 8 studies involving 281 hips. Studies were categorized into diagnostic (4 studies), therapeutic (3 studies), and prognostic (1 study) applications. Patients with FAI and its degenerative sequelae obtained greater relief from diagnostic intra-articular hip injection than those without (P < .05). The diagnostic intra-articular injection performed under ultrasound guidance was better tolerated than injections performed under fluoroscopic guidance (pain rating, 5.6 vs 3.0; P < .1). Intra-articular injection of hyaluronic acid was the most effective at providing pain relief (in 23 patients), with significant improvements of functional outcome measures (Harris Hip Score, visual analog scale) present at 12 months. Pooled results with corticosteroid injection resulted in improvement in only 15% (9/60) of patients at 6 weeks. A negative response to intra

  19. Technique of Arthroscopic Treatment of Impingement After Total Ankle Arthroplasty.

    PubMed

    Gross, Christopher E; Neumann, Julie A; Godin, Jonathan A; DeOrio, James K

    2016-04-01

    Rates of medial and/or lateral gutter impingement after total ankle replacement are not insignificant. If impingement should occur, it typically arises an average of 17 months after total ankle replacement. Our patient underwent treatment for right ankle medial gutter bony impingement with arthroscopic debridement 5 years after her initial total ankle replacement. Standard anteromedial and anterolateral portals and a 30° 2.7-mm-diameter arthroscope were used. An aggressive soft-tissue and bony resection was performed using a combination of curettes, a 3.5-mm shaver, a 5.5-mm unsheathed burr, a drill, and a radiofrequency ablator. This case shows that arthroscopic treatment is an effective and potentially advantageous alternative to open treatment of impingement after total ankle replacement. In addition, symptoms of impingement often improve in a short amount of time after arthroscopic debridement of the medial and/or lateral gutter.

  20. Editorial Commentary: Ligamentum Teres Tears and Femoroacetabular Impingement: Complex Coexistence of Impingement and Instability.

    PubMed

    Larson, Christopher M

    2016-07-01

    In a large Level IV case series of 2,213 hip arthroscopies with the diagnosis of femoroacetabular impingement, the intraoperative status of the ligamentum teres (LT) was recorded as normal in 11%, frayed and/or partially torn in 88%, and completely torn in 1.5% of hips. Although specific physical examination maneuvers for detecting LT tears were not available early in the study period, thus limiting a detailed assessment of such tests, the authors identified that female gender, a lower lateral center edge angle, a higher Tonnis angle, and capsular laxity were all associated with complete LT tears. This study further supports the complex coexistence of impingement and instability. PMID:27373179

  1. Fifty Most Cited Articles for Femoroacetabular Impingement and Hip Arthroscopy.

    PubMed

    Lee, Simon; Shin, Jason; Haro, Marc; Khair, Michael; Riboh, Jonathan C; Kuhns, Benjamin D; Bush-Joseph, Charles A; Nho, Shane J

    2015-01-01

    Growing awareness of femoroacetabular impingement (FAI) and recent innovations in management have resulted in hip arthroscopy becoming one of the fastest-growing orthopedic subspecialties. The purpose of this study was to identify the 50 most cited articles related to the topic of FAI and hip arthroscopy and to analyze their characteristics. The overall number of citations within these articles ranged from 99 to 820. Citation density ranged from 4.41 to 74.55. Seven countries produced these articles with the majority attributed to the United States (n = 26) and Switzerland (n = 18). Clinical studies made up more than half of the top articles (n = 27). The Journal of Bone and Joint Surgery level of evidence most commonly encountered was level IV (n = 24), while the remaining articles were level III (n = 3). No randomized controlled trials or non-randomized controlled trials were encountered in this search. The level of evidence was not significantly correlated with the overall number of citations, publication year, or citation density. The current top 50 list provides orthopedic surgeons interested in hip arthroscopy with an up-to-date core list of the most cited articles in the scientific literature and represents a foundation to use to develop their knowledge regarding hip arthroscopy and FAI.

  2. Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Hesper, Tobias; Tiderius, Carl Johan; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined. PMID:26258129

  3. Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement

    PubMed Central

    Zhang, Dagang; Chen, Long; Wang, Guanglin

    2016-01-01

    Abstract Background: This meta-analysis aims to evaluate the efficacy and safety of hip arthroscopy versus open surgical dislocation for treating femoroacetabular impingement (FAI) through published clinical trials. Methods: We conducted a comprehensive literature search using PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases for relevant studies on hip arthroscopy and open surgical dislocation as treatment options for FAI. Results: Compared with open surgical dislocation, hip arthroscopy resulted in significantly higher Nonarthritic Hip Scores (NAHS) at 3- and 12-month follow-ups, a significant improvement in NAHS from preoperation to 3 months postoperation, and a significantly lower reoperation rate. Open surgical dislocation resulted in a significantly improved alpha angle by the Dunn view in patients with cam osteoplasty from preoperation to postoperation, compared with hip arthroscopy. This meta-analysis demonstrated no significant differences in the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, or Hip Outcome Score-Sport Specific Subscale at 12 months of follow-up, or in complications (including nerve damage, wound infection, and wound dehiscence). Conclusion: Hip arthroscopy resulted in higher NAHS and lower reoperation rates, but had less improvement in alpha angle in patients with cam osteoplasty, than open surgical dislocation. PMID:27741133

  4. Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects

    PubMed Central

    Bittersohl, Bernd; Hosalkar, Harish S.; Hesper, Tobias; Tiderius, Carl Johan; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Symptomatic femoroacetabular impingement (FAI) is now a known precursor of early osteoarthritis (OA) of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT) are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI) techniques include magnetic resonance arthrography and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), T2/T2* mapping, and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1ρ mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined. PMID:26258129

  5. Sports hernia and femoroacetabular impingement in athletes: A systematic review

    PubMed Central

    Munegato, Daniele; Bigoni, Marco; Gridavilla, Giulia; Olmi, Stefano; Cesana, Giovanni; Zatti, Giovanni

    2015-01-01

    AIM: To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. METHODS: PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism. RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries. CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy. PMID:26380829

  6. Descriptive Epidemiology of Symptomatic Femoroacetabular Impingement in Young Athlete: Single Center Study

    PubMed Central

    Lee, Woo-Yong; Kang, Chan; Jeon, Je-Hyung; Zheng, Long

    2016-01-01

    Purpose The purpose of this study was to determine the prevalence of symptomatic femoroacetabular impingement (FAI) in athletic patients. Materials and Methods From July 2003 to May 2013, 388 patients (422 hips) who underwent arthroscopic surgery for FAI were evaluated demographic characteristics. The patients' age, gender, diagnosis, and type of sports were analyzed using medical records and radiography. Results Among 422 hips in 388 patients, 156 hips were involved with sports. Among the 156 hips, 86, 43, and 27 hips were categorized as cam, pincer, and mixed type, respectively. Types of sports were soccer, baseball and taekwondo which showed 44, 36 and 35 hips, respectively. Also, cases related to sports according to age were 63 hips for twenties and 12 hips for teenagers in which the two showed highest association to FAI. The kinds of sports that showed high association were 28 hips of soccer and 20 cases of martial arts such as taekwondo and judo for twenties and 9 hips of martial arts for teenagers which was the highest. Conclusion FAI usually occurs in young adults and is highly related to sports activity. Most of the FAI type related to sports activity was cam type, and soccer and martial arts such as taekwondo were the most common cause of it. PMID:27536641

  7. Prevalence of Cam Morphology in Females with Femoroacetabular Impingement

    PubMed Central

    Levy, David M.; Hellman, Michael D.; Harris, Joshua D.; Haughom, Bryan; Frank, Rachel M.; Nho, Shane J.

    2015-01-01

    Cam and pincer are two common morphologies responsible for femoroacetabular impingement (FAI). Previous literature has reported that cam deformity is predominantly a male morphology, while being significantly less common in females. Cam morphology is commonly assessed with the alpha angle, measured on radiographs. The purpose of this study is to determine the prevalence of cam morphology utilizing the alpha angle in female subjects diagnosed with symptomatic FAI. All females presenting to the senior author’s clinic diagnosed with symptomatic FAI between December 2006 and January 2013 were retrospectively reviewed. Alpha (α) angles were measured on anteroposterior and lateral (Dunn 90°, cross-table lateral, and/or frog-leg lateral) plain radiographs by two blinded physicians, and the largest measured angle was used. Using Gosvig et al.’s classification, alpha angle was characterized as (pathologic > 57°), borderline (51–56°), subtle (46–50°), very subtle (43–45°), or normal (≤42°). Three hundred and ninety-one patients (438 hips) were analyzed (age 36.2 ± 12.3 years). Among the hips included, 35.6% were normal, 14.6% pathologic, 15.1% borderline, 14.6% subtle, and 20.1% very subtle. There was no correlation between alpha angle and patient age (R = 0.17) or body mass index (R = 0.05). The intraclass correlation coefficient for α-angle measurements was 0.84. Sixty-four percent of females in this cohort had an alpha angle >42°. Subtle cam deformity plays a significant role in the pathoanatomy of female patients with symptomatic FAI. As the majority of revision hip arthroscopies are performed due to incomplete cam correction, hip arthroscopists need to be cognizant of and potentially surgically address these subtle lesions. PMID:26649291

  8. Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement.

    PubMed

    Diamond, Laura E; Wrigley, Tim V; Bennell, Kim L; Hinman, Rana S; O'Donnell, John; Hodges, Paul W

    2016-01-01

    Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip/groin pain and impaired function in younger active adults, and may lead to stiffness, muscle weakness, structural damage, and hip osteoarthritis. Understanding the impairments associated with FAI is crucial to guide treatment and rehabilitation strategies. Evidence is limited and conflicting about whether hip biomechanics are impaired during walking in people with symptomatic FAI. The objective of this study was to determine whether kinematics and kinetics during gait differ between people with symptomatic FAI and control participants. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age-, and sex-matched disease-free controls underwent three-dimensional gait analysis. Tri-planar hip kinematics and kinetics were compared between the two groups. There were limited significant between-group differences with respect to spatiotemporal variables. Participants with FAI walked with less range of motion in the sagittal plane during a gait cycle, but did not exhibit any significant kinematic differences in the frontal or transverse planes. There were no systematic differences in kinetics between the groups in any plane. Findings suggest that individuals with symptomatic FAI have minimal impairments in gait biomechanics. Although these individuals demonstrate reduced hip joint motion in the sagittal plane, the size of the difference is small and its significance for symptoms and function is unclear. More pronounced deficits in hip kinetics and kinematics may be evident during functional tasks that challenge the hip towards the position of impingement.

  9. The Fate of the Contralateral Hip in Femoroacetabular Impingement

    PubMed Central

    Nepple, Jeffrey J.; Louer, Craig; Clohisy, John C.

    2016-01-01

    Objectives: The pathophysiology of femoroacetabular impingement (FAI) remains to be better understood. Only a fraction of all individuals with bony FAI morphology will ever develop hip symptoms or osteoarthritis. The purpose of the current study was to determine (1) rates of initial and subsequent symptom development in the contralateral hip of patients with symptomatic ipsilateral FAI and (2) to identify predictors of symptomatic contralateral FAI. Methods: The study cohort included 179 consecutive patients presenting for surgical treatment of FAI. Patients were excluded if they had previously underwent contralateral surgery. At baseline and postoperative follow-up time points, patients recorded standardized outcome questionnaires, including the presence of symptoms in the contralateral hip. Significant symptoms were defined as the presence of at least mild pain, while none or slight pain was not included. All patients underwent AP pelvis and bilateral 45 degree Dunn lateral radiographs at baseline. Patients developing symptoms in the contralateral hip were subclassified as having symptoms at presentation (initial symptoms) or developing symptoms during the follow-up period (symptom development). Patients were followed over a minimum of one year time period postoperatively. Multivariate logistic regression was performed to identify independent predictors of symptoms development. Results: The study cohort had a mean age of 30.2 years and included 60.3% females. FAI was classified as isolated cam in 63.1% (n=113), isolated pincer 1.1% (n=2), and combined type in 35.8% (n=64). Forty-two (23.5%) of patients had initial symptoms in the contralateral hip. Twenty-two additional hips developed symptoms during the follow-up period (16.1% of initially asymptomatic hips). For multivariate logistic regression of any symptoms development (initial or subsequent), competitive athletes (p=0.041) and contralateral HNO ratio on AP pelvis (p=0.009). However, the overall model poorly

  10. Osteonecrosis and femoro-acetabular impingement: sequelae of developmental dysplasia of the hip

    PubMed Central

    Cheung, Jason Pui Yin; Chow, Wang; To, Michael

    2012-01-01

    A 2-year-old girl with developmental dysplasia of the right hip underwent open reduction and capsulorrhaphy via the anterior approach with hip spica casting in an internally rotated position. During her 26 years of follow-up, she was found to have osteonecrosis and subsequently cam-type femoro-acetabular impingement at 28 years of age. She was treated with surgical dislocation of the hip and osteochondroplasty to recreate the normal contour of the head and neck offset. PMID:22605717

  11. Prevalence of Radiographic Parameters Predisposing to Femoroacetabular Impingement in Young Asymptomatic Chinese and White Subjects

    PubMed Central

    Van Houcke, Jan; Yau, Wan Pan; Yan, Chun Hoi; Huysse, Wouter; Dechamps, Hannes; Lau, Wing Hang; Wong, Chun Sing; Pattyn, Christophe; Audenaert, Emmanuel Albert

    2015-01-01

    Background: Osteoarthritis of the hip is five to ten times more common in white people than in Chinese people. Little is known about the true prevalence of femoroacetabular impingement or its role in the development of osteoarthritis in the Chinese population. A cross-sectional study of both white and Chinese asymptomatic individuals was conducted to compare the prevalences of radiographic features posing a risk for femoroacetabular impingement in the two groups. It was hypothesized that that there would be proportional differences in hip anatomy between the white and Asian populations. Methods: Pelvic computed tomography scans of 201 subjects (ninety-nine white Belgians and 102 Chinese; 105 men and ninety-six women) without hip pain who were eighteen to forty years of age were assessed. The original axial images were reformatted to three-dimensional pelvic models simulating standardized radiographic views. Ten radiographic parameters predisposing to femoroacetabular impingement were measured: alpha angle, anterior offset ratio, and caput-collum-diaphyseal angle on the femoral side and crossover sign, ischial spine projection, acetabular anteversion angle, center-edge angle, acetabular angle of Sharp, Tönnis angle, and anterior acetabular head index on the acetabular side. Results: The white subjects had a less spherical femoral head than the Chinese subjects (average alpha angle, 56° compared with 50°; p < 0.001). The Chinese subjects had less lateral acetabular coverage than the white subjects, with average center-edge angles of 35° and 39° (p < 0.001) and acetabular angles of Sharp of 38° and 36° (p < 0.001), respectively. A shallower acetabular configuration was predominantly present in Chinese women. Conclusions: Significant differences in hip anatomy were demonstrated between young asymptomatic Chinese and white subjects. However, the absolute size of the observed differences appears to contrast with the reported low prevalence of femoroacetabular

  12. Expert opinion and controversies in musculoskeletal and sports medicine: femoroacetabular impingement.

    PubMed

    Standaert, Christopher J; Manner, Paul A; Herring, Stanley A

    2008-05-01

    Femoroacetabular impingement (FAI) has been proposed as a distinct clinical entity that may be a potentially significant cause of hip osteoarthritis (OA). There is a growing body of literature on this condition, including descriptions of biomechanic mechanisms of impingement, anatomic and radiographic findings, and surgical interventions. Although a connection between anatomic abnormalities of the hip and the development of OA has been recognized for some time, there are limited data on the natural history of FAI and no long-term studies on the effect of surgical treatment. Thus, the diagnosis engenders a degree of controversy in multiple regards, including the diagnostic criteria and the role of operative intervention. PMID:18452737

  13. The Role of Femoroacetabular Impingement in Core Muscle Injury/Athletic Pubalgia: Diagnosis and Management

    PubMed Central

    Strosberg, David S.; Ellis, Thomas J.; Renton, David B.

    2016-01-01

    Chronic groin pain in athletes represents a major diagnostic and therapeutic challenge in sports medicine. Two recognized causes of inguinal pain in the young adult athlete are core muscle injury/athletic pubalgia (CMI/AP) and femoroacetabular impingement (FAI). CMI/AP and FAI were previously considered to be two distinct entities; however, recent studies have suggested both entities to frequently coincide in the athlete with groin pain. This article briefly discusses the role of FAI in CMI/AP and the diagnosis and management of this complex disease. PMID:26904546

  14. Femoroacetabular Impingement Surgery Is on the Rise-But What Is the Next Step?

    PubMed

    Reiman, Michael P; Thorborg, Kristian; Hölmich, Per

    2016-06-01

    Surgery for femoroacetabular impingement (FAI) has been advocated for correction of cam and pincer hip joint morphology. Surgery for FAI was first pioneered by Myers et al, who surgically treated FAI by open dislocation. Arthroscopy was then introduced in 2005 by Sampson. Arthroscopy has continued to develop since then, with the intent of providing pain relief and improving function in patients with FAI. This Viewpoint discusses the escalating popularity of FAI surgery, the widespread acceptance of this relatively new surgical procedure, and next steps for determination of who benefits from this treatment. J Orthop Sports Phys Ther 2016;46(6):406-408. doi:10.2519/jospt.2016.0605. PMID:27245488

  15. Cam Femoroacetabular Impingement as a Possible Explanation of Recalcitrant Anterior Knee Pain

    PubMed Central

    Sanchis-Alfonso, Vicente; Tey, Marc; Monllau, Joan Carles

    2016-01-01

    We present a case of a patient with chronic anterior knee pain (AKP) recalcitrant to conservative treatment who returned to our office for severe hip pain secondary to Cam femoroacetabular impingement (Cam FAI) at 10 months after the onset of knee pain. This case highlights the fact that the main problem is not in the patella but in the hip in some patients with AKP. We hypothesize that there is an external femoral rotation in order to avoid the impingement and therefore the hip pain in patients with Cam FAI. This functional femoral rotation could provoke a patellofemoral imbalance that may be, in theory, responsible for patellofemoral pain in this particular patient. In our case, Cam FAI resolution was related to the resolution of AKP. PMID:27247817

  16. An increase in cranial acetabular version with age: implications for femoroacetabular impingement.

    PubMed

    Kopydlowski, Nathan J; Tannenbaum, Eric P; Bedi, Asheesh; Smith, Matthew V; Sekiya, Jon K

    2014-09-01

    This cadaveric study aimed to determine if acetabular retroversion demonstrates predictable changes with age that could inform understanding of factors that may contribute to the pathophysiology of femoroacetabular impingement. Two-hundred forty pelves were divided into young and old groups. Version was measured at the cranial (5mm below superior rim), central (transverse of acetabulum), and caudal (5mm above inferior rim) locations. The data showed a significant difference between young (10±10°) and old (13±9°) cranial version (P=.02). Cranial retroversion increases with age and may reflect a developmental component in the etiology of the focal rim impingement lesion or ossification of the damaged labrum. Global acetabular retroversion does not appear to change with age and may reflect a congenital etiology.

  17. Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report

    PubMed Central

    MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D’Angelo, Kevin

    2015-01-01

    Objective: To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. Clinical Features: A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. Summary: FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury. PMID:26816416

  18. Predictors of Length of Career Following Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players

    PubMed Central

    Menge, Travis; Briggs, Karen K.; Philippon, Marc J.

    2016-01-01

    Objectives: Previous studies have shown that professional hockey players return to sport at a high rate following hip arthroscopy. The average length of a National Hockey League (NHL) career has been reported to be 5.5 years, and it is unknown how long players continue to play after hip arthroscopy. The purpose of this study was 1) to determine predictors of length of career in players following hip arthroscopy for treatment of symptomatic femoroacetabular impingement (FAI), and 2) investigate the rate of those who continue to play professional hockey a minimum of 5 years after hip arthroscopy. Methods: Seventy professional hockey players underwent hip arthroscopy for FAI between 2005 and 2010 by a single surgeon. Data was retrieved from NHL.com regarding the duration of each player’s professional career. In addition, position played, draft position, age at time of surgery, and surgical details were also used in data analysis. Results: Our cohort included thirteen players that were centers, 15 defensemen, 20 goalies, and 22 wings. The average overall draft number was 57 (range 1 to 228), and average age at surgery was 27 years (range 17 to 38). Forty of the 70 athletes (57%) continued to play professionally a minimum of 5 years after hip arthroscopy. As of the most recent 2015 season, the average NHL length of career was 13 years (range 8 to 23 years), with an average of 6.9 years played following hip arthroscopy. Therre was no different in length of career and years played when goalies were compared to other players(p=0.760). Length of career and years played after arthroscopy correlated with age at surgery (r=0.799 and r=-0.408). Players who played 5 or more years after arthroscopy were significantly younger than those who did not (25 vs. 30 years, p=0.001). Sixty-five players (93%) had labral repair and 5 (7%) had labral reconstruction. There were no differences in length of career or years played after arthroscopy based on type of labral treatment (p=0

  19. Arthroscopic Treatment of Posterior Impingement of the Hindfoot

    PubMed Central

    Carreira, Dominic S.; Vora, Anand Mahesh; Kozy, John

    2015-01-01

    Objectives: Open and arthroscopic techniques have been utilized in the treatment of posterior impingement of the ankle and hindfoot. Because posterior impingement occurs more frequently in patients who repetitively plantarflex the ankle, this population may especially benefit from a procedure that reduces pain and results in maximal range of motion (ROM). The purpose of this study was to assess the outcome of hindfoot endoscopy in patients with posterior ankle impingement through higher level of function outcome measures and physical examination parameters, focused on analysis of ROM. Methods: 20 ankles (19 patients) were followed prospectively at a minimum 1 year follow-up (mean 38.2 months). 19 of 20 patients were competitive athletes. Patients completed a minimum of 3 months of nonoperative treatment. Diagnoses included os trigonum, tibial exostosis, talar exostosis, loose body or fracture nonunion, and ganglion cyst removal. Patients underwent arthroscopic treatment utilizing a posterior approach; all relevant pathology was addressed. Post-surgery, patients were placed in a splint for 3 to 7 days then placed in a CAM boot for 2 to 3 weeks, weight bearing as tolerated. Physical therapy was initiated within 7-10 days; strengthening exercises were initiated postoperatively at 1 month. Results: At most recent follow-up, VAS Pain and AOFAS Hindfoot scores showed significant improvement (p<0.01) pre to post-operatively; Tegner score remained unchanged (p=0.888). 3 patients were professional athletes; all returned to their previous level of professional activity. ROM variables between affected and unaffected sides reached statistical similarity at most recent follow-up. 15% of patients reported post-operative neuritis. No other complications were reported. Conclusion: Posterior ankle arthroscopy allows for maintenance or restoration of anatomic ROM of the ankle and hindfoot, ability to return to at least previous level of activity, and improvement in objective

  20. Surgical innovation and safety: femoroacetabular impingement and the IDEAL collaborative framework.

    PubMed

    Lee, Cara Beth

    2016-07-01

    Operative treatment of femoroacetabular impingement (FAI) is a relatively new, yet rapidly expanding surgical innovation. Although the practice of surgery is inherently innovative, there is no clear distinction between minor technical variation and true modification that warrants testing. This raises important questions about how new procedures should be evaluated before being broadly disseminated. The IDEAL Collaborative is a consortium that promotes safe and responsible translation of research into clinical practice. The collaborative has delineated the typical stages of evolution of new interventional technologies, and the type of study designs appropriate for each stage. This report examines the surgical treatment of FAI as a case study of the IDEAL framework and discusses both missed and future opportunities for critical assessment. PMID:27583143

  1. Surgical innovation and safety: femoroacetabular impingement and the IDEAL collaborative framework

    PubMed Central

    Lee, Cara Beth

    2016-01-01

    Operative treatment of femoroacetabular impingement (FAI) is a relatively new, yet rapidly expanding surgical innovation. Although the practice of surgery is inherently innovative, there is no clear distinction between minor technical variation and true modification that warrants testing. This raises important questions about how new procedures should be evaluated before being broadly disseminated. The IDEAL Collaborative is a consortium that promotes safe and responsible translation of research into clinical practice. The collaborative has delineated the typical stages of evolution of new interventional technologies, and the type of study designs appropriate for each stage. This report examines the surgical treatment of FAI as a case study of the IDEAL framework and discusses both missed and future opportunities for critical assessment. PMID:27583143

  2. MRI of the hip for the evaluation of femoroacetabular impingement; past, present, and future.

    PubMed

    Riley, Geoffrey M; McWalter, Emily J; Stevens, Kathryn J; Safran, Marc R; Lattanzi, Riccardo; Gold, Garry E

    2015-03-01

    The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review, we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition.

  3. MAGNETIC RESONANCE IMAGING OF THE HIP FOR THE EVALUATION OF FEMOROACETABULAR IMPINGEMENT; PAST, PRESENT, AND FUTURE

    PubMed Central

    Riley, Geoffrey M.; McWalter, Emily J.; Stevens, Kathryn J.; Safran, Marc R.; Lattanzi, Riccardo; Gold, Garry E.

    2014-01-01

    The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition. PMID:25155435

  4. Core Muscle Injury/Sports Hernia/Athletic Pubalgia, and Femoroacetabular Impingement.

    PubMed

    Ross, James R; Stone, Rebecca M; Larson, Christopher M

    2015-12-01

    Core muscle injury/sports hernia/athletic pubalgia is an increasingly recognized source of pain, disability, and time lost from athletics. Groin pain among athletes, however, may be secondary to various etiologies. A thorough history and comprehensive physical examination, coupled with appropriate diagnostic imaging, may improve the diagnostic accuracy for patients who present with core muscular injuries. Outcomes of nonoperative management have not been well delineated, and multiple operative procedures have been discussed with varying return-to-athletic activity rates. In this review, we outline the clinical entity and treatment of core muscle injury and athletic pubalgia. In addition, we describe the relationship between athletic pubalgia and femoroacetabular impingement along with recent studies that have investigated the treatment of these related disorders. PMID:26524557

  5. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes' disease.

    PubMed

    Eijer, H; Podeszwa, D A; Ganz, R; Leunig, M

    2006-01-01

    Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively. At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively. Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.; PMID:19219805

  6. In-vivo hip arthrokinematics during supine clinical exams: Application to the study of femoroacetabular impingement.

    PubMed

    Kapron, Ashley L; Aoki, Stephen K; Peters, Christopher L; Anderson, Andrew E

    2015-08-20

    Visualization of hip articulation relative to the underlying anatomy (i.e., arthrokinematics) is required to understand hip dysfunction in femoroacetabular (FAI) patients. In this exploratory study, we quantified in-vivo arthrokinematics of a small cohort of asymptomatic volunteers and three symptomatic patients with varying FAI deformities during the passive impingement, FABER, and rotational profile exams using dual fluoroscopy and model-based tracking. Joint angles, joint translations, and relative pelvic angles were calculated. Compared to the 95% confidence interval of the asymptomatic cohort, FAI patients appeared to have decreased adduction and internal rotation during the impingement exam and greater flexion and less abduction/external rotation in the FABER exam. During the rotational profile, only the FAI patient with the most severe deformities demonstrated considerable rotation deficits. In all participants, contact between the labrum and femoral head/neck limited motion during the impingement exam, but not the rotational profile. Substantial pelvic motion was measured during the impingement exam and FABER test in all participants. Femoral translation along any given anatomical direction ranged between 0.69 and 4.1mm. These results suggest that hip articulation during clinical exams is complex in asymptomatic hips and hips with FAI, incorporating pelvic motion and femur translation. Range of motion appears to be governed by femur-labrum contact and other soft tissue constraints, suggesting that current computer simulations that rely on direct bone contact to predict impingement may be unrealistic. Additional research is necessary to confirm these preliminary results. Still, dual fluoroscopy data may serve to validate existing software platforms or create new programs that better-represent hip arthrokinematics. PMID:25997726

  7. Does high level youth sports participation increase the risk of femoroacetabular impingement? A review of the current literature.

    PubMed

    de Silva, Viran; Swain, Michael; Broderick, Carolyn; McKay, Damien

    2016-03-11

    Sports participation can be an integral part of adolescent development with numerous positive short and long-term effects. Despite these potential benefits very high levels of physical activity, during skeletal maturation, have been proposed as a possible cause of cam-type femoroacetabular impingement (FAI). The influence of physical activity on the developing physis has been previously described both in animal studies and epidemiological studies of adolescent athletes. It is therefore important to determine whether the development of FAI is secondary to excessive physical activity or a combination of a vulnerable physis and a set level of physical activity. A review of the current literature suggests that adolescent males participating in ice-hockey, basketball and soccer, training at least three times a week, are at greater risk than their non-athletic counterparts of developing the femoral head-neck deformity associated with femoroacetabular impingement.

  8. Does high level youth sports participation increase the risk of femoroacetabular impingement? A review of the current literature.

    PubMed

    de Silva, Viran; Swain, Michael; Broderick, Carolyn; McKay, Damien

    2016-01-01

    Sports participation can be an integral part of adolescent development with numerous positive short and long-term effects. Despite these potential benefits very high levels of physical activity, during skeletal maturation, have been proposed as a possible cause of cam-type femoroacetabular impingement (FAI). The influence of physical activity on the developing physis has been previously described both in animal studies and epidemiological studies of adolescent athletes. It is therefore important to determine whether the development of FAI is secondary to excessive physical activity or a combination of a vulnerable physis and a set level of physical activity. A review of the current literature suggests that adolescent males participating in ice-hockey, basketball and soccer, training at least three times a week, are at greater risk than their non-athletic counterparts of developing the femoral head-neck deformity associated with femoroacetabular impingement. PMID:26968690

  9. Finite element analyses of femoroacetabular impingement before and after hip arthroscopy.

    PubMed

    Lourenço, J; Simões, F M F; Rego, P A

    2015-01-01

    In this study, three-dimensional finite element models based on the specific anatomy of a patient presenting a femoroacetabular impingement of the "cam" type were developed. The finite element meshes were obtained from arthrographic magnetic resonance images captured before and after hip arthroscopy. All soft tissues were considered linear elastic and isotropic and the bones were assumed as rigid. Physiological loads and rotational motions were applied. Stresses and contact pressures were evaluated in these patient specific models in order to better interpret the mechanism of aggression of the cartilages and of the labrum and to evaluate the effectiveness of the surgery. The results of the analyses are presented and discussed. The values obtained for the stresses and contact pressures in the pathological hip were similar to those reported by other models based on idealised geometries or similar reconstruction methodologies and were larger than the ones obtained in the same hip after the surgical treatment. The surgical treatment effectively reduces the intra-articular pressures and stresses approaching the values of a normal hip. Thus, early surgical treatment may help to prevent, or delay, the joint degeneration. PMID:26684891

  10. The Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

    PubMed Central

    Royer, Nathaniel K.

    2012-01-01

    Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement (FAI) have been recently implicated as risk factors for hip osteoarthritis (OA). The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search using PubMed, Embase and Central was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and FAI and hip OA and preliminary evidence suggests that AD is a risk factor for OA, however these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA. PMID:22108232

  11. Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients☆

    PubMed Central

    Canella, Richard Prazeres; Adam, Guilherme Pradi; de Castillo, Roberto André Ulhôa; Codonho, Daniel; Ganev, Gerson Gandhi; de Vicenzi, Luiz Fernando

    2016-01-01

    Objective To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI), using computed tomography (CT). Methods We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third), femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient. Results There were inverse correlations between the following angles: (1) acetabular coverage versus alpha angle (p = 0.019); (2) acetabular version (supraequatorial) versus alpha angle (p = 0.049). For patients with femoral anteversion lower than 15 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.026); (2) acetabular version (middle third) versus alpha angle (p = 0.02). For patients with acetabular version (supraequatorial) lower than 10 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.004); (2) acetabular version (middle third) versus alpha angle (p = 0.009). Conclusion There was a statistically significant inverse correlation between the acetabular version and alpha angles (the smaller the acetabular anteversion angle was, the larger the alpha angle was) in symptomatic patients, thus supporting the hypothesis that FAI occurs when cam and pincer findings due to acetabular retroversion are seen simultaneously, and that the latter alone does not cause FAI, which leads to overdiagnosis in these cases. PMID:27069890

  12. Incidence of symptomatic femoroacetabular impingement in the general population: a prospective registration study

    PubMed Central

    Röling, Maarten A.; Mathijssen, Nina M.C.; Bloem, Rolf M.

    2016-01-01

    Groin pain is a frequent cause of discomfort in patients and highly prevalent in active patients. One of the diagnoses causing groin pain is femoroacetabular impingement (FAI). However, the incidence of FAI in the general population is unknown. This study aimed to identify the incidence of groin pain suggestive of FAI in a cohort of 31 451 patients in the Netherlands during 1 year. A cooperation of 16 general practitioners (GPs) participated in this prospective registry. All GPs were educated in the clinical manifestation of FAI and the physical examination for FAI. Patients of all ages were registered when presenting with ‘groin pain’. Between July 2013 and July 2014, 84 patients aged between 15 and 60 years of age presented with groin pain, reflecting an incidence of 0.44%. Of these patients, 17% (14 patients) were radiologically diagnosed with FAI. Another 30% of these patients had a high clinical suspicion for FAI. This is the first report on the incidence of groin pain suggestive of FAI in a general population diagnosed by GPs. Of all 84 patients presenting with groin pain, 17% were diagnosed with FAI. Creating awareness of FAI in GPs helps identifying patients that might benefit from FAI treatment. PMID:27583159

  13. Femoroacetabular Impingement: A Retrospective Case Study With 8-Year Follow-Up

    PubMed Central

    Stobert, Julia R.; Emary, Peter C.; Taylor, John A.

    2015-01-01

    Objective The purpose of this case report is to describe a patient with femoroacetabular impingement (FAI) who was initially misdiagnosed and treated for a hip flexor strain. Clinical Features A 36-year-old male patient presented with insidious onset of progressive anterior right hip and groin pain of 7 years' duration. He was diagnosed with a right-sided hip flexor muscle strain and was discharged from care 1 month later. The patient then returned to the office 8 years later for treatment of unrelated lower back pain. This time, the doctor of chiropractic learned that the patient was misdiagnosed years before. The patient's past radiographs in fact revealed FAI, including severe hip joint osteoarthritis on the right and mild osteoarthritis on the left. As a result, the patient had undergone right hip joint replacement surgery. Recent radiographs also revealed FAI in the contralateral hip. Intervention and Outcome After investigating for FAI, the doctor of chiropractic was able to identify through symptomatology, history, physical examination, and radiographs the presence of FAI in the patient's left hip. An “active surveillance” approach is being taken. Conclusion This case illustrates the importance of an increasing awareness of FAI, as doctors of chiropractic are frequently the primary contact for patients with this condition. PMID:26793042

  14. Incidence of symptomatic femoroacetabular impingement in the general population: a prospective registration study.

    PubMed

    Röling, Maarten A; Mathijssen, Nina M C; Bloem, Rolf M

    2016-08-01

    Groin pain is a frequent cause of discomfort in patients and highly prevalent in active patients. One of the diagnoses causing groin pain is femoroacetabular impingement (FAI). However, the incidence of FAI in the general population is unknown. This study aimed to identify the incidence of groin pain suggestive of FAI in a cohort of 31 451 patients in the Netherlands during 1 year. A cooperation of 16 general practitioners (GPs) participated in this prospective registry. All GPs were educated in the clinical manifestation of FAI and the physical examination for FAI. Patients of all ages were registered when presenting with 'groin pain'. Between July 2013 and July 2014, 84 patients aged between 15 and 60 years of age presented with groin pain, reflecting an incidence of 0.44%. Of these patients, 17% (14 patients) were radiologically diagnosed with FAI. Another 30% of these patients had a high clinical suspicion for FAI. This is the first report on the incidence of groin pain suggestive of FAI in a general population diagnosed by GPs. Of all 84 patients presenting with groin pain, 17% were diagnosed with FAI. Creating awareness of FAI in GPs helps identifying patients that might benefit from FAI treatment. PMID:27583159

  15. Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial

    PubMed Central

    Wall, Peter DH; Dickenson, Edward J; Robinson, David; Hughes, Ivor; Realpe, Alba; Hobson, Rachel; Griffin, Damian R; Foster, Nadine E

    2016-01-01

    Introduction Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. Methods In phase one, we developed a protocol for non-operative care for FAI in the UK National Health Service (NHS), through a process of systematic review and consensus gathering. In phase two, the protocol was tested in an internal pilot RCT for protocol adherence and adverse events. Results The final protocol, called Personalised Hip Therapy (PHT), consists of four core components led by physiotherapists: detailed patient assessment, education and advice, help with pain relief and an exercise-based programme that is individualised, supervised and progressed over time. PHT is delivered over 12–26 weeks in 6–10 physiotherapist-patient contacts, supplemented by a home exercise programme. In the pilot RCT, 42 patients were recruited and 21 randomised to PHT. Review of treatment case report forms, completed by physiotherapists, showed that 13 patients (62%) received treatment that had closely followed the PHT protocol. 13 patients reported some muscle soreness at 6 weeks, but there were no serious adverse events. Conclusion PHT provides a structure for the non-operative care of FAI and offers guidance to clinicians and researchers in an evolving area with limited evidence. PHT was deliverable within the National Health Service, is safe, and now forms the comparator to arthroscopic surgery in the UK FASHIoN trial (ISRCTN64081839). Trial registration number ISRCTN 09754699. PMID:27629405

  16. Preferred patient-rated outcome measure in patients with femoroacetabular impingement: a comparison between selected instruments

    PubMed Central

    Impellizzeri, Franco M.; Naal, Florian D.; Mannion, Anne F.; Leunig, Michael

    2015-01-01

    The first aim of this study was to establish which questionnaire patients with femoroacetabular impingement (FAI) most often preferred out of a set of self-reported generic and region/joint-specific outcome measures. A second aim was to evaluate their preferred type of response scale. One hundred and sixty-two consecutive FAI patients undergoing surgery (51% females, age 32 [SD 12] years, body mass index 24 [SD 4] kg/m2) completed five specific questionnaires [Hip Outcome Score (HOS), Oxford Hip Score (OHS), Hip disability and Osteoarthritis Outcome Score, self-administered Harris Hip Score and Western Ontario and McMaster Universities Arthritis Index] and three generic questionnaires (WHO Quality of Life-BREF, EuroQoL and 12-Item Short Form Survey). In addition, the patients completed the International Physical Activity Questionnaire, a questionnaire on expectation, and two sports activity scales (TEGNER and UCLA). Patients were asked to indicate the questionnaires that best reflected their situation, the most difficult to complete, and had the preferred response scale. 64% indicated a joint specific questionnaire as the one that best addressed their situation, with 27 and 20% choosing the HOS and the OHS, respectively. Most patients (62%) expressed no difficulties completing the questionnaires: just 12% considered the IPAQ difficult to complete, and 6% the HOS. The preferred response scale was the adjectival scale (57%), compared with the Numeric Rating Scale (39%) and the VAS (4%). This study showed that patients with FAI consider joint-specific instruments to be most relevant to them, in particular the HOS and OHS, and generally prefer responding on an adjectival scale. PMID:27011860

  17. Feasibility of a Randomized Clinical Trial for Treatment of Femoroacetabular Impingement of the Hip

    PubMed Central

    Boye, Gloria N.; Murray, Kerri; Clohisy, John C.; Kim, Young-Jo

    2015-01-01

    Background: Symptomatic femoroacetabular impingement (FAI) is currently corrected by surgery. However, it is possible that nonsurgical treatment could resolve symptomatic FAI in some patients; thus, uncertainty about the necessity of surgical treatment exists. The current equipoise concerning FAI treatment presents an opportunity to conduct a randomized controlled trial (RCT) of surgical and nonsurgical treatment options. Given the unique challenge of adequate patient enrollment in RCTs, it is important that a preliminary study is done to appraise the feasibility of conducting an RCT. Purpose: To estimate enrollment rates of a planned future RCT to compare surgical and nonsurgical treatments for symptomatic FAI and to identify factors associated with patients’ willingness to participate in the randomized trial. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Patients diagnosed with FAI at 2 orthopaedic centers were presented with a hypothetical randomized trial comparing 2 treatment options for FAI. All patients completed forms providing information regarding their willingness to participate and treatment preferences. Results: A total of 75 patients participated in the study: 53 and 22 from 2 centers, respectively. Twenty-eight percent indicated absolute willingness to participate in the trial, 40% were probably willing or unsure, and 32% were definitely not willing; 18.7% had a strong preference for surgery while 2.7% strongly preferred nonsurgical treatment. The majority (78.6%) had no strong preference for either treatment arm. There were correlations between treatment preferences and willingness to participate. Patients with a strong treatment preference and/or a preference for surgery were less likely to be willing to participate. Conclusion: The study findings suggest that sufficient patient accrual for a randomized trial of FAI treatment is currently feasible while equipoise still exists among patients and surgeons. PMID:26673688

  18. Quantitative MRI Evaluation of Articular Cartilage Using T2 Mapping Following Hip Arthroscopy for Femoroacetabular Impingement

    PubMed Central

    Mayer, Stephanie W.; Wagner, Naomi; Fields, Kara G.; Wentzel, Catherine; Burge, Alissa; Potter, Hollis G.; Lyman, Stephen; Kelly, Bryan T.

    2016-01-01

    Objectives: Cam-type femoroacetabular impingement (FAI) causes a shearing and delamination injury to the acetabular articular cartilage due to a mismatch between the size of the femoral head and the acetabulum. This mechanism is thought to lead to early osteoarthritis in this population. Cam decompression has been advocated to eliminate impingement, with the ultimate goal of halting the progression of articular cartilage delamination. Although outcomes following this procedure in the young adult population have been favorable at short and medium term follow up, it is not known whether the articular cartilage itself is protected from further injury by changing the biomechanics of the joint with decompression of the cam morphology. The purpose of this study is to compare the pre- and post-operative integrity of the acetabular articular cartilage using T2 mapping to determine if hip arthroscopy is protective of the articular cartilage at short- to medium term follow up. Methods: Males between 18 and 35 years of age who had pre-operative T2 mapping MRIs, underwent hip arthroscopy for cam or mixed-type FAI with an alpha angle greater than 50°, and had at least 2 year follow-up were identified. Post-operative MRIs were performed and T2 relaxation times in the transition zone and weight bearing articular cartilage in the anterosuperior acetabulum at deep and superficial chondral layers were recorded at nine points on three sagittal sequences on pre and post-operative MRIs. A paired t-test was used to compare T2 relaxation values between pre-operative and post-operative scans. Results: Eleven hips were evaluated. Mean age was 26.3 years (range 21 - 35). Mean follow up time to post-operative T2 mapping MRI was 2.6 years (range 2.4 - 2.7). The change in T2 relaxation time was not significantly different between pre- and post-operative MRI scans for any of the nine regions in the deep zone of the acetabular cartilage (p=0.065 - 0.969) or the superficial zone of the

  19. Arthroscopic fenestration of the distal humerus: a viable option for painful elbow impingement in sportsmen.

    PubMed

    Degreef, Ilse

    2009-10-01

    Open ulnohumeral arthroplasty, also known as the Outerbridge-Kashiwaghi procedure, is performed in elbow arthritis to relieve pain and improve the range of motion. A similar technique of distal humeral fenestration is applied in elbow arthroscopy to achieve pain relief in degenerative elbow arthritis. We report a possible new indication in young sportsmen with recurrent posterior elbow impingement. A professional javelin thrower and a basketball player with recurrent loose bodies, posterior impingement and a minimal extension lack were free of complaints and resumed all sports activities within 6 weeks after an arthroscopic fenestration of the distal humerus. Their elbow function remained perfect within a 2 year follow-up period. We suggest that arthroscopic ulnohumeral arthroplasty is a viable option in sportsmen with recurrent loose bodies and elbow locking due to ongoing elbow arthritis.

  20. [Arthroscopic correction of extra-articular subspinal impingement in the hip joint].

    PubMed

    Hufeland, M; Hartwig, T; Krüger, D; Perka, C; Haas, N P; Schröder, J H

    2013-10-01

    We report the case of symptomatic extra-articular subspinal impingement in the hip joint caused by a pathological contact between the anterior inferior iliac spine (AIIS) and the femoral neck. A 28-year-old patient presented with activity-related inguinal pain on the right side and a positive anterior impingement test in the clinical examination. Radiological examinations revealed a hypertrophic AIIS with caudal extension below the acetabulum. After a positive injection test confirmed the AIIS as the origin of the pain, arthroscopic correction with partial resection of the AIIS was performed resulting in significant pain relief and improved range of motion. PMID:23918293

  1. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter.

    PubMed

    Wilson, Mark D; Keene, James S

    2016-07-01

    Ischiofemoral impingement (IFI) is an often unrecognized cause of hip pain caused by abnormal contact between the lesser trochanter and the ischium. To date, surgical treatment for those whose pain is not relieved by activity modification and steroid injections has not been defined. This study describes our imaging protocol and reports the results of arthroscopic, lesser trochanteric resections that were performed to treat this condition. Seven patients with symptomatic, MRI-documented IFI had ultrasound injections of ropivicaine and steroid into their ischiofemoral space. The injections provided complete but only transient relief of their groin and buttock pain and thus, all seven ultimately had an arthroscopic resection of their lesser trochanter. All hips were evaluated preoperatively and at 3, 6 and 12 months postoperatively with Byrd's modified Harris hip scoring system. Average age of the seven patients was 46 years and there were five females and one male. Preoperative scores averaged 43 points. After surgery, all patients used crutches for 4-6 weeks, and had 6-week scores that averaged 58 points. The patients and their scores continued to improve and at 6 and 12 months, their scores averaged 86 and 91 points, and none had chronic hip flexor weakness or recurrence of their hip pain or snapping. Arthroscopic iliopsoas tenotomies in combination with a resection of the lesser trochanter will provide complete relief of the painful snapping, groin and buttock pain caused by ischiofemoral impingement. PMID:27583151

  2. Treatment of ischiofemoral impingement: results of diagnostic injections and arthroscopic resection of the lesser trochanter

    PubMed Central

    Wilson, Mark D.; Keene, James S.

    2016-01-01

    Ischiofemoral impingement (IFI) is an often unrecognized cause of hip pain caused by abnormal contact between the lesser trochanter and the ischium. To date, surgical treatment for those whose pain is not relieved by activity modification and steroid injections has not been defined. This study describes our imaging protocol and reports the results of arthroscopic, lesser trochanteric resections that were performed to treat this condition. Seven patients with symptomatic, MRI-documented IFI had ultrasound injections of ropivicaine and steroid into their ischiofemoral space. The injections provided complete but only transient relief of their groin and buttock pain and thus, all seven ultimately had an arthroscopic resection of their lesser trochanter. All hips were evaluated preoperatively and at 3, 6 and 12 months postoperatively with Byrd’s modified Harris hip scoring system. Average age of the seven patients was 46 years and there were five females and one male. Preoperative scores averaged 43 points. After surgery, all patients used crutches for 4–6 weeks, and had 6-week scores that averaged 58 points. The patients and their scores continued to improve and at 6 and 12 months, their scores averaged 86 and 91 points, and none had chronic hip flexor weakness or recurrence of their hip pain or snapping. Arthroscopic iliopsoas tenotomies in combination with a resection of the lesser trochanter will provide complete relief of the painful snapping, groin and buttock pain caused by ischiofemoral impingement. PMID:27583151

  3. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases.

    PubMed

    de Sa, Darren; Stephens, Kellee; Kuang, Michelle; Simunovic, Nicole; Karlsson, Jon; Ayeni, Olufemi R

    2016-07-01

    Health care facilities produce significant waste (2200 kg/bed/year) creating 2% of greenhouse gas emissions and 1% total solid waste nationwide, with 20-70% of waste coming from operating rooms. We performed a waste audit of hip arthroscopy for femoroacetabular impingement (FAI) to understand its environmental impact and identify areas for greening practices. A waste audit of five hip arthroscopy procedures for FAI was performed. All waste was collected and separated into six waste streams in real time: (i) normal/landfill waste; (ii) recyclable cardboards and plastics; (iii) biohazard waste; (iv) sharp items; (v) linens and (vi) sterile wrapping. The surgical waste (except laundered linens) from five FAI surgeries totaled 47.4 kg, including 21.7 kg (45.7%) of biohazard waste, 11.7 kg (24.6%) of sterile wrap, 6.4 kg (13.5%) of normal/landfill waste, 6.4 kg (13.5%) of recyclable plastics and 1.2 kg (2.6%) of sharp items. An average of 9.4 kg (excluding laundered linens) of waste was produced per procedure. Given the considerable biohazard waste produced by FAI procedures, additional recycling programs, continued adherence to proper waste segregation and an emphasis on 'green outcomes' is encouraged to demonstrate environmental responsibility and effectively manage and allocate finite resources. PMID:27583149

  4. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases.

    PubMed

    de Sa, Darren; Stephens, Kellee; Kuang, Michelle; Simunovic, Nicole; Karlsson, Jon; Ayeni, Olufemi R

    2016-07-01

    Health care facilities produce significant waste (2200 kg/bed/year) creating 2% of greenhouse gas emissions and 1% total solid waste nationwide, with 20-70% of waste coming from operating rooms. We performed a waste audit of hip arthroscopy for femoroacetabular impingement (FAI) to understand its environmental impact and identify areas for greening practices. A waste audit of five hip arthroscopy procedures for FAI was performed. All waste was collected and separated into six waste streams in real time: (i) normal/landfill waste; (ii) recyclable cardboards and plastics; (iii) biohazard waste; (iv) sharp items; (v) linens and (vi) sterile wrapping. The surgical waste (except laundered linens) from five FAI surgeries totaled 47.4 kg, including 21.7 kg (45.7%) of biohazard waste, 11.7 kg (24.6%) of sterile wrap, 6.4 kg (13.5%) of normal/landfill waste, 6.4 kg (13.5%) of recyclable plastics and 1.2 kg (2.6%) of sharp items. An average of 9.4 kg (excluding laundered linens) of waste was produced per procedure. Given the considerable biohazard waste produced by FAI procedures, additional recycling programs, continued adherence to proper waste segregation and an emphasis on 'green outcomes' is encouraged to demonstrate environmental responsibility and effectively manage and allocate finite resources.

  5. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases

    PubMed Central

    de SA, Darren; Stephens, Kellee; Kuang, Michelle; Simunovic, Nicole; Karlsson, Jon; Ayeni, Olufemi R.

    2016-01-01

    Health care facilities produce significant waste (2200 kg/bed/year) creating 2% of greenhouse gas emissions and 1% total solid waste nationwide, with 20–70% of waste coming from operating rooms. We performed a waste audit of hip arthroscopy for femoroacetabular impingement (FAI) to understand its environmental impact and identify areas for greening practices. A waste audit of five hip arthroscopy procedures for FAI was performed. All waste was collected and separated into six waste streams in real time: (i) normal/landfill waste; (ii) recyclable cardboards and plastics; (iii) biohazard waste; (iv) sharp items; (v) linens and (vi) sterile wrapping. The surgical waste (except laundered linens) from five FAI surgeries totaled 47.4 kg, including 21.7 kg (45.7%) of biohazard waste, 11.7 kg (24.6%) of sterile wrap, 6.4 kg (13.5%) of normal/landfill waste, 6.4 kg (13.5%) of recyclable plastics and 1.2 kg (2.6%) of sharp items. An average of 9.4 kg (excluding laundered linens) of waste was produced per procedure. Given the considerable biohazard waste produced by FAI procedures, additional recycling programs, continued adherence to proper waste segregation and an emphasis on ‘green outcomes’ is encouraged to demonstrate environmental responsibility and effectively manage and allocate finite resources. PMID:27583149

  6. Hip Joint Stresses Due to Cam-Type Femoroacetabular Impingement: A Systematic Review of Finite Element Simulations

    PubMed Central

    Ng, K. C. Geoffrey; Lamontagne, Mario; Labrosse, Michel R.; Beaulé, Paul E.

    2016-01-01

    Background The cam deformity causes the anterosuperior femoral head to obstruct with the acetabulum, resulting in femoroacetabular impingement (FAI) and elevated risks of early osteoarthritis. Several finite element models have simulated adverse loading conditions due to cam FAI, to better understand the relationship between mechanical stresses and cartilage degeneration. Our purpose was to conduct a systematic review and examine the previous finite element models and simulations that examined hip joint stresses due to cam FAI. Methods The systematic review was conducted to identify those finite element studies of cam-type FAI. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and studies that reported hip joint contact pressures or stresses were included in the quantitative synthesis. Results Nine articles studied FAI morphologies using finite element methods and were included in the qualitative synthesis. Four articles specifically examined contact pressures and stresses due to cam FAI and were included in the quantitative synthesis. The studies demonstrated that cam FAI resulted in substantially elevated contact pressures (median = 10.4 MPa, range = 8.5–12.2 MPa) and von Mises stresses (median 15.5 MPa, range = 15.0–16.0 MPa) at the acetabular cartilage; and elevated maximum-shear stress on the bone (median = 15.2 MPa, range = 14.3–16.0 MPa), in comparison with control hips, during large amplitudes of hip motions. Many studies implemented or adapted idealized, ball-and-cup, parametric models to predict stresses, along with homogeneous bone material properties and in vivo instrumented prostheses loading data. Conclusion The formulation of a robust subject-specific FE model, to delineate the pathomechanisms of FAI, remains an ongoing challenge. The available literature provides clear insight into the estimated stresses due to the cam deformity and provides an assessment of its risks leading to early

  7. Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

    PubMed Central

    2015-01-01

    Purpose We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. Materials and Methods Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. Results Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. Conclusion Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up. PMID:27536632

  8. The validity of a non-radiologist reader in identifying cam and pincer femoroacetabular impingement (FAI) using plain radiography.

    PubMed

    Ratzlaff, C; Zhang, C; Korzan, J; Josey, L; Wong, H; Cibere, J; Prlic, H M; Kopec, J A; Esdaile, J M; Li, L C; Barber, M; Forster, B B

    2016-03-01

    The purpose of this study was to evaluate the validity and reliability of a radiographic diagnosis of femoroacetabular impingement (FAI) by a non-radiologist. Symptomatic FAI is prevalent and thought to be a cause of hip osteoarthritis. However, the diagnosis is often delayed by 1-2 years, in large part because radiographic findings are often subtle and clinicians have been unaware of their significance. The purpose of this study was to evaluate the validity of a radiographic diagnosis of FAI by a non-radiologist. A population-based sample of 701 subjects was recruited in Vancouver, Canada. For the current study, 50 subjects were selected-40 randomly from the population sample and 10 from an orthopedic practice with confirmed FAI. An anterior-posterior pelvis and bilateral Dunn radiographs were acquired and read by a fellowship-trained musculoskeletal radiologist and a third-year medical student who received basic training in radiographic signs of FAI. Three radiographic signs were evaluated: the lateral center edge angle, alpha angle and crossover sign. Validity was assessed using sensitivity and specificity, Bland-Altman limits of agreement and kappa. The sample contained 65% women (n = 31), was 62% Caucasian and 38% Chinese and had a mean age of 38.3 years. For correctly diagnosing FAI, the non-radiologist reader had a sensitivity of 0.83 and specificity of 0.87. Intra-rater κ value was 0.72, and prevalence-adjusted bias-adjusted κ was 0.76. This study provides evidence that a non-radiologist can accurately and reliably identify FAI on plain films. PMID:26433895

  9. Arthroscopy of the hip for patients with mild to moderate developmental dysplasia of the hip and femoroacetabular impingement: Outcomes following hip arthroscopy for treatment of chondrolabral damage.

    PubMed

    Fukui, K; Trindade, C A C; Briggs, K K; Philippon, M J

    2015-10-01

    The purpose of this study was to determine patient-reported outcomes of patients with mild to moderate developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) undergoing arthroscopy of the hip in the treatment of chondrolabral pathology. A total of 28 patients with a centre-edge angle between 15° and 19° were identified from an institutional database. Their mean age was 34 years (18 to 53), with 12 female and 16 male patients. All underwent labral treatment and concomitant correction of FAI. There were nine reoperations, with two patients requiring revision arthroscopy, two requiring periacetabular osteotomy and five needing total hip arthroplasty. Patients who required further major surgery were more likely to be older, male, and to have more severe DDH with a larger alpha angle and decreased joint space. At a mean follow-up of 42 months (24 to 89), the mean modified Harris hip score improved from 59 (20 to 98) to 82 (45 to 100; p < 0.001). The mean Western Ontario and McMaster Universities Osteoarthritis Index score improved from 30 (1 to 61) to 16 (0 to 43; p < 0.001). Median patient satisfaction was 9.0/10 (1 to 10). Patients reported excellent improvement in function following arthroscopy of the hip. This study shows that with proper patient selection, arthroscopy of the hip can be successful in the young patient with mild to moderate DDH and FAI. PMID:26430004

  10. Soft Tissue Impingement of the Ankle: Pathophysiology, Evaluation, and Arthroscopic Treatment.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Vazales, Ryan; Farley, Zachary

    2016-10-01

    Soft tissue impingement (STI) syndrome is one of 3 causes of a larger all-encompassing joint impingement pathologic condition, which also includes bone and neuropathic entrapment. Altered joint biomechanics and friction of joint tissues combine to cause chronic pain and often functional instability. Although the most common form of STI to the ankle is anterolateral in location, posterior and anteromedial impingement is also discussed in this article. Furthermore, a discussion of biomechanical deficiencies and how they may effect location and cause of STI of the ankle is explored along with pathophysiology, clinical and diagnostic evaluation, current treatments, and long-term outcomes. PMID:27599436

  11. Impingement.

    ERIC Educational Resources Information Center

    Uziel, Mary S.

    1978-01-01

    Presents a literature review of the impact of impingement in fishery resources at different power plants in the United States, covering publications of 1976-77. Consideration is given to engineering studies and biological effects for reducing impingement. A list of 96 references is also presented. (HM)

  12. PRE- AND POST-OPERATIVE SELF-REPORTED FUNCTION AND QUALITY OF LIFE IN WOMEN WITH AND WITHOUT GENERALIZED JOINT LAXITY UNDERGOING HIP ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT

    PubMed Central

    Pontiff, Mattie; Ithurburn, Matthew P.; Ellis, Thomas; Cenkus, Kathleen

    2016-01-01

    ABSTRACT Background Generalized joint laxity is more prevalent in women than men and may lead to poorer post-operative outcomes in select orthopedic populations. There are no studies examining peri-operative function in patients with generalized joint laxity (GJL) and femoroacetabular impingement (FAI). Purpose The purpose of this study was to determine the difference in perceived function and quality of life as measured by the Hip Outcome Score ADL subscale (HOS-ADL), International Hip Outcomes Tool (iHOT-33) and the Short Form 12-Item Health Survey (SF-12) in women with and without GJL prior to and six months after undergoing hip arthroscopy for FAI. Study Design Cohort Study Methods Peri-operative data were collected from women with FAI from November 2011-September 2014. Lax subjects were women with laxity scores ≥4/9 on the Beighton and Horan Joint Mobility Index; Nonlax subjects were women with laxity scores <4/9. Functional outcomes were evaluated using the HOS-ADL, iHOT-33, PCS-12, and the MCS-12 pre-operatively and at 6 months post-operatively. Change scores (post-score – pre-score) were calculated for each outcome measure and compared between groups, along with pre-operative and post-operative means, using Mann-Whitney U tests. Results 166 women met the inclusion criteria: Nonlax (n = 131), Lax (n = 35). There were no statistically significant differences between groups in pre-operative functional outcomes (all p > .05). Additionally, there were no statistically significant differences between groups in post-operative means or change scores, respectively, for HOS-ADL (p = .696, .358), iHOT-33 (p = .550, .705), PCS-12 (p = .713, .191), and MCS-12 (p = .751, .082). Laxity score was not associated with any post-operative functional outcome score or change score (all p > .05). Conclusion Women with and without generalized joint laxity do not appear to report differences in hip function in the 6-month peri-operative period before and after hip

  13. COMPARISON OF RANGE OF MOTION, STRENGTH, AND HOP TEST PERFORMANCE OF DANCERS WITH AND WITHOUT A CLINICAL DIAGNOSIS OF FEMOROACETABULAR IMPINGEMENT

    PubMed Central

    Carcia, Christopher R.; Christoforetti, John J.; Martin, RobRoy L.

    2016-01-01

    ABSTRACT Background Dancers commonly experience anterior hip pain caused by femoroacetabular impingement (FAI) that interrupts training and performance in dance. A paucity of literature exists to guide appropriate evaluation and management of FAI among dancers. Purpose The purpose of this study was to determine if dancers with clinical signs of FAI have differences in hip range of motion, strength, and hop test performance compared to healthy dancers. Study Design Quasi-experimental, cohort comparison. Methods Fifteen dancers aged between 18- 21 years with clinical signs of FAI that included anterior hip pain and provocative impingement tests were compared to 13 age-matched dancers for passive hip joint range of motion, isometric hip strength, and performance of the medial triple hop, lateral triple hop, and cross-over hop tests. Results No statistically significant differences in range of motion were noted for flexion (Healthy = 145° + 7°; FAI = 147° + 10°; p=0.59), internal rotation (Healthy = 63° + 7°; FAI = 61° + 11°; p=0.50), and external rotation (Healthy = 37° + 9°; FAI = 34° + 12°; p=0.68) between the two groups. Hip extension strength was significantly less in the dancers with FAI (224 + 55 Newtons) compared to the healthy group (293 ± 58 Newtons; F(1,26) = 10.2; p=0.004). No statistically significant differences were noted for flexion, internal rotation, external rotation, abduction, or adduction isometric strength. The medial triple hop test was significantly less in the FAI group (354 ± 43 cm) compared to the healthy group (410 ± 50 cm; F(1,26) = 10.3; p = 0.004). Similar results were observed for the lateral hop test, as the FAI group (294 ± 38 cm) performed worse than the healthy controls (344 ± 54cm; F(1,26) = 7.8; p = 0.01). There was no statistically significant difference between the FAI group (2.7 ± 0.92 seconds) and the healthy

  14. Arthroscopic Hip Revision Surgery for Residual FAI

    PubMed Central

    Larson, Christopher M.; Giveans, Russell; Bedi, Asheesh; Samuelson, Kathryn M.; Stone, Rebecca M.

    2014-01-01

    Objectives: There is a steep surgical learning curve when managing femoroacetabular impingement (FAI) and residual FAI can lead to continued pain and disability. There is very limited data reporting outcomes after revision arthroscopy for residual FAI. Methods: The records of patients that underwent arthroscopic hip revision surgery for residual FAI based on plain radiographs and 3D CT scans were reviewed. Pre and post-operative structural pathomorphology, intra-operative findings, and pre and post-operative outcomes measures using Modified Harris Hip Scoring (MHHS), SF-12 scoring, and pain on a visual analogue scale (VAS) were evaluated. Outcomes after revision arthroscopic FAI correction were compared to a cohort that underwent primary arthroscopic FAI correction. Results: 59 patients (85 hips) underwent arthroscopic revision FAI correction (mean 20.8 months follow-up). There were 98 previous arthroscopic surgeries and 4 previous surgical dislocations. There were 39 males and 46 females with a mean age of 29.5 years (range 16 - 59). 80 hips had residual cam-type FAI, and 64 hips had residual pincer-type FAI and underwent femoral and rim resections, respectively. The labrum was debrided in 27 hips, repaired in 48 hips and reconstructed with allograft in 8 hips. Adhesions were excised for 54 hips. The results of revision arthroscopic FAI correction were compared to 154 patients (169 hips) that underwent primary arthroscopic FAI correction (mean 25.2 months follow-up). The mean improvement for outcomes scores after revision FAI correction was 18.9 points (MHHS, p<.01), 13.4 points (SF-12, p<.01), and 2.2 points (VAS, p<.01) compared to 23.7 points (MHHS, p<.01), 22.3 points (SF-12, p<.01), and 4.6 points (VAS, p<.01) after primary arthroscopic FAI correction. Most recent outcomes scores and mean improvement in outcome scores were significantly better after primary (81.1% good/ excellent results) compared to revision (69.8% good/excellent results) FAI correction (MHS

  15. Unrecognized osteoid osteoma of the proximal femur with associated cam impingement

    PubMed Central

    Ly, Justin A.; Coleman, Erin M.; Cohen, Gary S.; Kropf, Eric J.

    2016-01-01

    Femoro-acetabular impingement is a common cause of hip pain in young athletes. Evaluation typically includes radiographs and magnetic resonance imaging. It is important to appreciate uncommon diagnoses and the role of complimentary imaging. This clinical vignette emphasizes the need complete imaging with CT in select case of atypical hip pain. We present a 19-year old soccer player who underwent seemingly successful arthroscopic FAI surgery but returned with pain. Computed tomography (CT) revealed osteoid osteoma of the lesser trochanter. The lesion was successfully treated with percutaneous CT guided radiofrequency ablation. PMID:27583164

  16. Return to Elite Level of Play and Performance in Professional Golfers After Arthroscopic Hip Surgery

    PubMed Central

    Newman, Justin T.; Saroki, Adriana J.; Briggs, Karen K.; Philippon, Marc J.

    2016-01-01

    Background: Hip conditions, such as femoroacetabular impingement and labral injury, can cause pain and limit the ability to play sports at a professional level. Purpose: To evaluate performance metrics of professional golfers prior to arthroscopic hip surgery and after surgery. Study Design: Case series; Level of evidence, 4. Methods: This study included professional golfers who underwent arthroscopic hip surgery. Primary outcome variables were greens in regulation and driving distance. Metrics were recorded for 2 years prior to arthroscopic hip surgery and 1, 2, and 5 years after arthroscopy. Results: A consecutive cohort of 20 male professional golfers (27 hips) from 2000 to 2011 underwent arthroscopic hip surgery by a single surgeon. All players were on the PGA Tour with a mean age of 38 years (range, 26-54 years). Eleven hips had labral repair and 16 had labral debridements. Four hips required microfracture of a chondral lesion. All players returned to play at a mean of 4.7 months (range, 1 month to 2 years). The mean number of years played after surgery was 5.72. There was no significant difference between preoperative and postoperative greens in regulation (P = .227). The mean distance per golf drive was significantly longer at 1 and 2 years postoperative compared with prior to surgery (P < .01), and driving distance at 5 years was also longer than preoperative (P = .008). Conclusion: Arthroscopic management of chondrolabral dysfunction due to femoroacetabular impingement in the professional golfer allowed the golfer to return to the same skill level prior to surgery. Mean driving distance was found to increase after arthroscopy, demonstrating not only a return but also an improvement in driving performance from prior level of play. PMID:27141515

  17. Arthroscopic Resection of Osteochondroma of Hip Joint Associated with Internal Snapping: A Case Report

    PubMed Central

    Jung, Heung-Tae; Hwang, Deuk-Soo; Jeon, Yoo-Sun

    2015-01-01

    A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option. PMID:27536601

  18. Arthroscopic Hip Revision Surgery for Residual FAI: Surgical Outcomes

    PubMed Central

    Larson, Christopher M.; Giveans, Russell; Bedi, Asheesh; Samuelson, Kathryn M.; Stone, Rebecca M.

    2013-01-01

    Objectives: There is a steep surgical learning curve when managing femoroacetabular impingement (FAI) and residual FAI can lead to continued pain and disability. There is very limited data reporting outcomes after revision arthroscopy for residual FAI. Methods: The records of patients that underwent arthroscopic hip revision surgery for residual FAI based on plain radiographs and 3D CT scans were reviewed. Pre and post-operative structural pathomorphology, intra-operative findings, and pre and post-operative outcomes measures using Modified Harris Hip Scoring (MHHS), SF-12 scoring, and pain on a visual analogue scale (VAS) were evaluated. Outcomes after revision arthroscopic FAI correction were compared to a cohort that underwent primary arthroscopic FAI correction. Results: 48 patients (53 hips) underwent arthroscopic revision FAI correction (mean 20.0 months follow-up). There were 62 previous arthroscopic surgeries and 4 previous surgical dislocations. There were 23 males and 25 females with a mean age of 29.9 years (range 18 - 59). 48 hips had residual cam-type FAI, and 40 hips had residual pincer-type FAI and underwent femoral and rim resections, respectively. The labrum was debrided in 27 hips, repaired in 24 hips and reconstructed with allograft in 2 hips. Adhesions were excised for 35 hips. The results of revision arthroscopic FAI correction were compared to 154 patients (169 hips) that underwent primary arthroscopic FAI correction (mean 25.2 months follow-up). The mean improvement for outcomes scores after revision FAI correction was 13.7 points (MHHS, p<.01), 8.6 points (SF-12, p<.01), and 2.6 points (VAS, p<.01) compared to 23.7 points (MHHS, p<.01), 22.3 points (SF-12, p<.01), and 4.6 points (VAS, p<.01) after primary arthroscopic FAI correction. Most recent outcomes scores and mean improvement in outcome scores were significantly better after primary (81% good/ excellent results) compared to revision (63.3% good/excellent results) FAI correction (MHS (p

  19. The Etiology and Arthroscopic Surgical Management of Cam Lesions.

    PubMed

    Werner, Brian C; Gaudiani, Michael A; Ranawat, Anil S

    2016-07-01

    Cam-type deformity of the proximal femur is a relative increase in the discrepancy of the femoral head-neck offset. The etiology is unknown; several conditions have been implicated in the development of abnormal proximal femoral anatomy. Recent evidence suggests that high-impact sports place stress on the immature physis during growth and may play an important role. Imaging is essential in the initial diagnostic workup, characterization of pathology, preoperative planning, and intraoperative decision making. Short-term and mid-term outcomes for arthroscopic osteoplasty of cam lesions for both isolated cam-type deformity and mixed cam-pincer femoroacetabular impingement have been well-described and are favorable. PMID:27343392

  20. Pincer Impingement.

    PubMed

    Hadeed, Michael M; Cancienne, Jourdan M; Gwathmey, F Winston

    2016-07-01

    This article presents a brief review of pincer impingement pathomechanics and the current methods of diagnosis, followed by a discussion of many of the current controversies in addressing pincer morphology. These controversies include controversial surgical indications such as global acetabular retroversion and the role of prophylactic surgery, controversial surgical techniques to address the acetabular labrum, as well as the best methods for intraoperative evaluation of the arthroscopic acetabuloplasty. PMID:27343393

  1. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    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.…

  2. Ankle impingement.

    PubMed

    Lavery, Kyle P; McHale, Kevin J; Rossy, William H; Theodore, George

    2016-01-01

    Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed. PMID:27608626

  3. Ankle impingement.

    PubMed

    Lavery, Kyle P; McHale, Kevin J; Rossy, William H; Theodore, George

    2016-09-09

    Ankle impingement is a syndrome that encompasses a wide range of anterior and posterior joint pathology involving both osseous and soft tissue abnormalities. In this review, the etiology, pathoanatomy, diagnostic workup, and treatment options for both anterior and posterior ankle impingement syndromes are discussed.

  4. Subspine Hip Impingement: An Unusual Cause of Hip Pain in an Elite Weightlifter.

    PubMed

    Nabhan, Dustin C; Moreau, William J; McNamara, Shannen C; Briggs, Karen K; Philippon, Marc J

    2016-01-01

    Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury. PMID:27618239

  5. [Secondary impingement syndrome in athletes].

    PubMed

    Jerosch, J; Castro, W H; Sons, H U

    1990-12-01

    Dysfunction of the shoulder joint is based not only on anatomic conditions. The consideration of the special kinesiology of the shoulder helps to understand the shoulder pathology. This mainly applies to young "overhead athletes" like swimmers, handball-, basketball-, volleyball-, and racketplayers. These disciplines cause stress on the anterior joint structures (capsule, ligaments, labrum, subscapularis tendon) and lead to anterior instability. This includes anterior subluxation or even dislocation. Finally, an impingement syndrome with the typical symptoms can frequently result from these conditions. The impingement-syndrome of the elderly must be considered as a primary disease, whereas the young overhead athlete suffers from the impingement syndrome as a secondary disease and does not take the first place in therapy. The first step in therapy should to be treat the muscular imbalance of the shoulder. To gain a regular pattern of motion the rotator cuff must be strengthened. This regimen is likely to be successful in 80-90% of the cases. If the conservative therapy fails the surgical treatment may come into consideration. Arthroscopic surgery has the advantage not to affect the proprioceptivity. To retain the previous level of performance an adequate rehabilitation programme is essential for the athlete.

  6. Normal anatomy and imaging of the hip: emphasis on impingement assessment.

    PubMed

    Jesse, Mary Kristen; Petersen, Brian; Strickland, Colin; Mei-Dan, Omer

    2013-07-01

    A comprehensive knowledge of normal hip anatomy and imaging techniques is essential in the evaluation and assessment of the patient with hip pain. This article reviews the osseous, soft tissue, and vascular components of the hip and the normal anatomical variants encountered in routine hip imaging. Basic and advanced hip imaging is discussed with particular emphasis on radiographic and computed tomography measurements and their utility in evaluating patients with developmental hip dysplasia and femoroacetabular impingement syndrome.

  7. Arthroscopic Ankle Arthrodesis.

    PubMed

    Hutchinson, Byron

    2016-10-01

    Arthroscopic ankle arthrodesis is a cost-effective option for many patients with posttraumatic arthritis of the ankle joint. Rehabilitation is generally quicker than conventional open techniques, and rates of fusion are comparable or better than traditional open techniques. Unless the arthroscopic surgeon has considerable experience, the best results are seen in patients with very little deformity in the ankle joint. PMID:27599442

  8. Microinstability and internal impingement in overhead athletes.

    PubMed

    Chambers, Lauchlan; Altchek, David W

    2013-10-01

    A complex interplay exists between the static and dynamic stabilizers in the glenohumeral joint, especially in overheard athletes who need a shoulder hypermobile enough to perform overhead activity yet stable enough to prevent joint subluxation. Concomitant shoulder pathologies commonly occur in the setting of microinstability and internal impingement. Before any surgical intervention, a 3- to 6-month course of conservative measures should first be attempted, with exercises focused on rotator cuff and scapular stabilizer strengthening combined with posterior capsule stretching. If surgery is needed, arthroscopic suture plication with treatment of concomitant lesions has been shown to provide the best clinical outcomes.

  9. Cam impingement of the hip: a risk factor for hip osteoarthritis.

    PubMed

    Agricola, Rintje; Waarsing, Jan H; Arden, Nigel K; Carr, Andrew J; Bierma-Zeinstra, Sita M A; Thomas, Geraint E; Weinans, Harrie; Glyn-Jones, Sion

    2013-10-01

    Femoroacetabular impingement (FAI) is characterized by abnormal contact between the proximal femur and the acetabulum. Two subtypes have been described: pincer impingement, caused by an overcovered acetabulum; and cam impingement, which occurs as a result of an aspherical femoral head (cam abnormality). A strong correlation exists between cam impingement and the subsequent development of hip osteoarthritis (OA). Major cam abnormalities confer a high risk of OA. However, the association between cam abnormalities and the pathology of OA has been difficult to compare between studies, as different methods have been used to define the abnormality. Cam abnormalities are acquired during skeletal growth and could be influenced by high impact sporting activities. Preventative treatments aiming to reduce the incidence of cam abnormalities and subsequent OA could, therefore, be developed. In this Perspective, we discuss the current understanding of FAI, focusing on cam abnormalities and their association with OA.

  10. Arthroscopic Posteromedial Capsular Release.

    PubMed

    Dean, Chase S; Chahla, Jorge; Mikula, Jacob D; Mitchell, Justin J; LaPrade, Robert F

    2016-06-01

    Post-traumatic or postsurgical flexion contractures of the knee can significantly limit function and lead to gait abnormalities. In this setting, interventions to regain full extension may include bracing, physical therapy, and open or arthroscopic surgery. Open surgical approaches to restore full motion often demand extensive recovery and promote further adhesions and loss of motion, which has led to the advent of arthroscopic techniques to address these pathologies. We present a safe, effective, and reproducible arthroscopic technique for posteromedial capsular release to address knee flexion contractures. PMID:27656368

  11. Treatments for Shoulder Impingement Syndrome

    PubMed Central

    Dong, Wei; Goost, Hans; Lin, Xiang-Bo; Burger, Christof; Paul, Christian; Wang, Zeng-Li; Zhang, Tian-Yi; Jiang, Zhi-Chao; Welle, Kristian; Kabir, Koroush

    2015-01-01

    Abstract Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking. Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant–Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities. Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses. Exercise and other exercise-based therapies, such as kinesio taping

  12. Arthroscopic Repair of Ankle Instability.

    PubMed

    Sorensen, Matthew D; Baca, John; Arbuckle, Keith

    2016-10-01

    Arthroscopic lateral ankle stabilization procedures have been described for many years. New technological advances and a deeper understanding of the pathobiomechanics involved in chronic lateral ankle instability have allowed an expansion of arthroscopic approaches to this common pathology. As experience is gained and outcomes within the patient profile are understood, the authors feel that the arthroscopic approach to lateral ankle stabilization may prove superior to traditional methods secondary to the risk and traditional complications that are mitigated within minimally invasive arthroscopic approaches. Additionally, the arthroscopic approach may allow a quicker return to ballistic sport and decrease time for rehabilitation. PMID:27599440

  13. Peroneal spastic flatfoot in adolescents with accessory talar facet impingement: a preliminary report.

    PubMed

    Niki, Hisateru; Aoki, Haruhito; Hirano, Takaaki; Akiyama, Yui; Fujiya, Hiroto

    2015-07-01

    This study analyzed imaging, arthroscopic findings, and treatment responses for peroneal spastic flatfoot (PSFF) caused by talocalcaneal impingement at the accessory anterolateral talar facet (AALTF) (accessory talar facet impingement) in 13 adolescents without histories of trauma and tarsal coalition. The AALTF was determined with computed tomography and MRI. Focal abutting bone marrow edema (FABME) on MRI around the AALTF was confirmed. In seven patients who underwent AALTF resection, subtalar arthroscopy was performed. All experienced alleviation PSFF after treatment; reduction in FABME was observed. AALTF resection alone is beneficial for PSFF caused by accessory talar facet impingement when peroneal spasms are restored by an injection of local anesthesia.

  14. [Impingement and kinesiology].

    PubMed

    Brasseur, J L; Zeitoun-Eiss, D

    2007-01-01

    During physical activity, especially in sport, repeated and/or exaggerated movements may lead to different impingements. Rupture, luxation, and tendon insertion injuries are seen after mobilization in the acute phase, but the goal of this paper is to analyze chronic impingements. It is possible to see the consequences of these impingements in all the musculoskeletal structures but, in relation to movement, three groups can be described. In the first, there is chronic compression and percussion between two structures; in the second there is entrapment and friction, and in the third, there is distraction. These impingements are frequent and are seen in all people, but particular movements during sport can increase their frequency.

  15. Symptomatic thrower's exostosis. Arthroscopic evaluation and treatment.

    PubMed

    Meister, K; Andrews, J R; Batts, J; Wilk, K; Baumgarten, T; Baumgartner, T

    1999-01-01

    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.

  16. US in ankle impingement syndrome.

    PubMed

    Pesquer, Lionel; Guillo, Stephane; Meyer, Philippe; Hauger, Olivier

    2014-06-01

    Ankle impingement is a common condition occurring secondary to sprain or repeated microtrauma. Clinical symptoms are chronic pain located in the affected region and limited range of ankle motion. There are three types of ankle impingement syndrome: anterior impingement, which can be subdivided into anterolateral, anteromedial and purely anterior impingement; posterior impingement, which can be subdivided into posterior and posteromedial impingement; and calcaneal peroneal impingement which is secondary to planovalgus foot deformity. This paper evaluates physiological and clinical elements of these three types of ankle impingement syndrome as well as the role of ultrasound (US) imaging and US-guided treatment.

  17. Arthroscopic Anatomy of the Ankle Joint.

    PubMed

    Ray, Ronald G

    2016-10-01

    There are a number of variations in the intra-articular anatomy of the ankle which should not be considered pathological under all circumstances. The anteromedial corner of the tibial plafond (between the anterior edge of the tibial plafond and the medial malleolus) can have a notch, void of cartilage and bone. This area can appear degenerative arthroscopically; it is actually a normal variant of the articular surface. The anterior inferior tibiofibular ligament (AITF) can possess a lower, accessory band which can impinge on the anterolateral edge of the talar dome. In some cases it can cause irritation along this area of the talus laterally. If it is creating local irritation it can be removed since it does not provide any additional stabilization to the syndesmosis. There is a beveled region at the anterior leading edge of the lateral and dorsal surfaces of the talus laterally. This triangular region is void of cartilage and subchondral bone. The lack of talar structure in this region allows the lower portion of the AITF ligament to move over the talus during end range dorsiflexion of the ankle, preventing impingement. The variation in talar anatomy for this area should not be considered pathological. PMID:27599433

  18. Arthroscopic tennis elbow release.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2015-01-01

    Lateral epicondylitis, originally referred to as tennis elbow, affects between 1% and 3% of the population and is usually found in patients aged 35 to 50 years. Although it was initially thought that lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon and in any of the associated structures. Most cases of lateral epicondylitis respond to appropriate nonsurgical treatment protocols, which include medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal or ultrasound ablation devices. However, when these protocols are unsuccessful, surgical measures may be appropriate and have a high rate of success. The results of arthroscopic surgical procedures have documented satisfactory results, with improvement rates reported between 91% and 97.7%. Recent advances in arthroscopic repair and plication of these lesions, along with recognizing the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide excellent results. PMID:25745908

  19. Arthroscopic tennis elbow release.

    PubMed

    Savoie, Felix H; VanSice, Wade; O'Brien, Michael J

    2010-03-01

    Lateral epicondylitis, originally referred to as "tennis elbow," affects between 1% and 3% of the population and is usually noted in patients aged between 35 and 50 years old. Although it was first thought lateral epicondylitis was caused by an inflammatory process, most microscopic studies of excised tissue demonstrate a failure of reparative response in the extensor carpi radialis brevis tendon in any of these associated structures. Most cases of lateral epicondylitis respond to appropriate nonoperative treatment protocols. Nonoperative management includes medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices. When these are unsuccessful, however, surgical measures may be performed with a high rate of success. Satisfactory results of the arthroscopic surgical procedures have been documented, with reported improvement rates of 91% to 97.7%. The recent advances in arthroscopic repair and plication of these lesions, along with the recognition of the presence and repair of coexisting lesions, have allowed arthroscopic techniques to provide results superior to other measures. PMID:20188266

  20. Management of Rotator Cuff and Impingement Injuries in the Athlete

    PubMed Central

    Williams, Gerald R.; Kelley, Martin

    2000-01-01

    Objective: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. Data Synthesis: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. Conclusions/Recommendations: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition. ImagesFigure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13. PMID:16558644

  1. Impingement syndrome (image)

    MedlinePlus

    ... arch of the shoulder blade, it can cause shoulder pain called impingement syndrome. The tendons become compressed, damaged, and inflamed leading to rotator cuff tendonitis. This can occur ... use of the shoulder like baseball pitching, or from an injury.

  2. ARTHROSCOPIC TREATMENT OF ELBOW STIFFNESS

    PubMed Central

    Vieira, Luis Alfredo Gómez; Dal Molin, Fabio Farina; Visco, Adalberto; Fernandes, Luis Filipe Daneu; dos Santos, Murilo Cunha Rafael; Cardozo Filho, Nivaldo Souza; Gómez Cordero, Nicolas Gerardo

    2015-01-01

    To present the arthroscopic surgical technique and the evaluation of the results from this technique for treating elbow stiffness. Methods: Between April 2007 and January 2010, ten elbows of ten patients with elbow stiffness underwent arthroscopic treatment to release the range of motion. The minimum follow-up was 11 months, with an average of 27 months. All the patients were male and their average age was 32.8 years (ranging from 22 to 48 years). After the arthroscopic treatment, they were followed up weekly in the first month and every three months thereafter. The clinical evaluation was made using the criteria of the University of California at Los Angeles (UCLA). Results: All the patients were satisfied with the results from the arthroscopic treatment. The average UCLA score was 33.8 points. Conclusion: Arthroscopic treatment for elbow stiffness is a minimally invasive surgical technique that was shown to be efficient for treating this complication. PMID:27027027

  3. EVALUATION OF PRESENTATION OF SIGNS AND SYMPTOMS OF FEMOROACETABULAR IMPINGEMENT AFTER EPIPHYSIOLYSIS OF THE PROXIMAL FEMUR

    PubMed Central

    Krüger, Fábio Peng; de Britto, Paulo Sérgio Gérzon; Neto, Lauro Machado; Schwartsmann, Carlos Roberto

    2015-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures. PMID:27027007

  4. Differences in Acetabular Rim Thickness in Patients with Unilateral Symptomatic Pincer-Type Femoroacetabular Impingement

    PubMed Central

    Weber, Alexander E.; Kuhns, Benjamin; Cvetanovich, Gregory; Inoue, Nozomu; Nho, Shane Jay

    2016-01-01

    Objectives: The objective of this study was to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and asymptomatic acetabula in a cohort of patients with symptomatic unilateral pincer-type FAI. Methods: After IRB approval, computed tomography (CT) scans of 43 patients (22 males, 21 females) diagnosed with unilateral pincer-type FAI were obtained. CT images of both hips were imported in DICOM format and segmented into 3-dimensional (3D) hemi-pelvises using 3D reconstruction software (Mimics, Materialise, Leuven, Belgium). The point-cloud data of the asymptomatic hemi-pelvis was mirrored onto the symptomatic side. Protrusion of the symptomatic side was recorded as a positive value and appeared as red on the color map (Figure 1). Data was collected in 3° intervals and analyzed by quadrant using the clock face method; reflecting the 12-3, 3-6, 6-9, and 9-12 o’clock positions. Results: The symptomatic acetabular rim was on average 0.39 ± 0.36 mm thicker than the corresponding location on the asymptomatic rim. When the acetabular clock face was broken up into quadrants, reflecting the 12-3, 3-6, 6-9, and 9-12 o’clock positions, the 12-3 o’clock position demonstrated the greatest difference between symptomatic and asymptomatic sides (Table 1). The 12-3 o’clock quadrant demonstrated significantly greater difference between symptomatic and asymptomatic sides (0.53±0.22 mm) as compared to the 3-6 o’clock position (0.39±0.27 mm; p=0.006), the 6-9 o’clock position (0.34±0.05 mm; p<0.001), and the 9-12 o’clock position (0.33±0.03; p<0.001). There was no correlation between gender and magnitude of difference at any location. Conclusion: Small changes in acetabular rim morphology, on the order of 0.5 mm or less can be the difference between symptomatic pincer-type FAI and the asymptomatic state. Knowledge of the healthy, unaffected side in unilateral FAI may provide a better template for rim recession rather than broadly applying previously described anterior or lateral center-edge angle parameters.

  5. Arthroscopic debridement for bilateral calcific tendinitis of the subscapularis tendons: a case report.

    PubMed

    Tung, Kam-Lung; Woo, Siu-Bon

    2015-04-01

    We report on a 36-year-old man who underwent arthroscopic debridement for bilateral calcific tendinitis of the subscapularis tendons. The patient had a positive coracoid impingement test for both shoulders. Radiology showed calcific deposits at the insertion of both subscapularis tendons, close to the lesser tuberosities and just posterior to the coracoid tips. The patient underwent sequential arthroscopic coracoplasty and removal of calcific deposits in the subscapularis tendons. The patient returned to work 6 weeks after each surgery. At 2 years, the patient had no shoulder pain, with full range of motion and full power of the subscapularis muscles. The coracoid impingement test was negative for both shoulders. There was no evidence of recurrence.

  6. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis.

    PubMed

    Farr, Derek; Selesnick, Harlan; Janecki, Chet; Cordas, Daniel

    2007-08-01

    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 chronic condition. We believe that the iliotibial band must be addressed and is the main cause of pain, inflammation, and trochanteric impingement leading to the development of bursitis. We report a new technique for arthroscopic trochanteric bursectomy with iliotibial band release. Our technique involves 2 incisions--one 4 cm proximal to the greater trochanter along the anterior border of the iliotibial band, and the other 4 cm distal and along the posterior border. The 30 degrees arthroscope is introduced through the inferior portal, and a cannula is introduced through the superior portal. A 5.5-mm arthroscopic shaver is inserted through the superior cannula to clear off the surface of the iliotibial band, so that it may be adequately visualized. A hooked electrocautery probe is then used to longitudinally incise the iliotibial band until it no longer rubs, causing impingement over the greater trochanter.

  7. Shoulder impingement in tennis/racquetball players treated with subscapularis myofascial treatments.

    PubMed

    Ingber, R S

    2000-05-01

    Conservative care of the athlete with shoulder impingement includes activity modification, application of ice, nonsteroidal anti-inflammatory drugs, subacromial corticosteroid injections, and physiotherapy. This case report describes the clinical treatment and outcome of three patients with shoulder impingement syndrome who did not respond to traditional treatment. Two of the three were previously referred for arthroscopic surgery. All three were treated with subscapularis trigger point dry needling and therapeutic stretching. They responded to treatment and had returned to painless function at follow-up 2 years later.

  8. Anterosuperior glenoid impingement syndrome.

    PubMed

    Bath, Shelley S; Bath, Shaun S; Tehranzadeh, Jamshid

    2012-01-01

    Anterosuperior glenoid impingement is a well documented cause of shoulder pain. It occurs when there is deep tearing of the subscapularis, with fibers becoming embedded between the anterosuperior glenoid and humeral head. To our knowledge, this has not been described in radiologic literature and we present MRI findings depicting this entity. PMID:22346366

  9. Direct Flame Impingement

    SciTech Connect

    2005-09-01

    During the DFI process, high velocity flame jets impinge upon the material being heated, creating a high heat transfer rate. As a result, refractory walls and exhaust gases are cooler, which increases thermal efficiency and lowers NOx emissions. Because the jet nozzles are located a few inches from the load, furnace size can be reduced significantly.

  10. [Arthroscopic treatment for osteoarthritis: knee and shoulder].

    PubMed

    Almazán, Arturo; Cruz, Francisco; Pérez, Francisco; Bravo, César; Ibarra, Clemente

    2007-10-01

    We discuss the role of arthroscopy in the treatment of knee and shoulder osteoarthritis. The most widely used arthroscopic techniques used in these joints for the treatment of osteoarthritis are arthroscopic lavage, arthroscopic debridement, abrasion arthrosplasty and microfractures. Even though arthroscopic techniques are only useful for a specific group of patients and that the procedure does not modify disease's natural history, it is an accessible therapeutic option.

  11. Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture

    PubMed Central

    Cha, Seung-Do; Gwak, Heui-Chul; Ha, Dong-Jun; Kim, Jong-Yup; Kim, Ui-Cheol; Jang, Yue-Chan

    2015-01-01

    Background The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. Methods A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. Results Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. Conclusions Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes. PMID:26640633

  12. Impingement syndrome in athletes.

    PubMed

    Hawkins, R J; Kennedy, J C

    1980-01-01

    Athletes, particularly those who are involved in sporting activities requiring repetitive overhead use of the arm (for example, tennis players, swimmers, baseball pitchers, and quarterbacks), may develop a painful shoulder. This is often due to impingement in the vulnerable avascular region of the supraspinatus and biceps tendons. With the passage of time, degeneration and tears of the rotator cuff may result. Pathologically the syndrome has been classified into Stage I (edema and hemorrhage), Stage II (fibrosis and tendonitis), and Stage III (tendon degeneration, bony changes, and tendon ruptures). The impingement syndrome may be a problem for the young, active, and competitive athlete as well as the casual weekend athlete. The "impingement sign" which reproduces pain and resulting facial expression when the arm is forceably forward flexed (jamming the greater tuberosity against the anteroinferior surface of the acromion) is the most reliable physical sign in establishing the diagnosis. Flexibility exercises, strengthening programs, and special training techniques are a preventive and treatment requirement. Rest and local modalities such as ice, ultrasound, and antiinflammatory agents are usually effective to lessen the inflammatory reaction. Surgical decompression by resecting the coracoacromial ligament or a more definitive anterior acromioplasty may rarely be indicated.

  13. [Arthroscopic wrist arthrolysis].

    PubMed

    Luchetti, R; Atzei, A; Papini Zorli, I

    2006-11-01

    Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3 to 6 months. From 1988 to 2003, 47 cases (45 patients: 35 males and 10 females), with a mean age of 36 years were operated on. All the radiocarpal, midcarpal and DRUJ portals were used in relationship with the site of rigidity. At a mean follow up of 58 months (range from 3 to 176 months) no complications were documented. Pain was almost absent in all the cases, mean flexion-extension ROM increased from 92 degrees preop to 106 degrees postop, mean pronation/supination increased from 145 degrees preop to 155 degrees postop, and mean grip strength increased from 25 to 31 kg postop. The average modified Mayo Wrist Score improved from 39 to 87, and the postop DASH Questionnaire obtained an average of 21 points.

  14. Arthroscopic treatment of infrapatellar tendonitis.

    PubMed

    Romeo, A A; Larson, R V

    1999-04-01

    Infrapatellar tendonitis is a chronic overload lesion in the patellar ligament at the attachment to the lower pole of the patella. This lesion is found primarily in athletes who participate in jumping sports. Magnetic resonance imaging or ultrasound can show the extent of tendon pathology. Patellar tendonitis is treated with modification of activities, medications, and therapy. When conservative measures fail, operative debridement has been recommended. Previous reports have described a technique of open debridement of the patellar tendon, followed by an extended period of rehabilitation before returning to sports. Two athletes with persistent infrapatellar tendonitis were treated with an arthroscopic debridement. Both athletes returned to full activities without restrictions within 8 weeks of surgery. Arthroscopic treatment of infrapatellar tendonitis has not been previously described. This technical note describes the technique and two case reports of the arthroscopic treatment of infrapatellar tendonitis.

  15. Extra-articular hip impingement due to heterotopic ossification formation at the anterior inferior iliac spine following previous pelvic external fixation.

    PubMed

    Sandilands, Scott M; Raudenbush, Brandon L; Carreira, Dominic S; Cross, Brian J

    2016-01-01

    Femoroacetabular impingements (FAIs), specifically cam type and pincer type, continue to be accepted as causes of intra-articular hip pathology and sources of hip pain. Reports of other causes of hip impingement including extra-articular causes have surfaced recently. One structure of importance is the anterior inferior iliac spine (AIIS) due to its inconsistent bony morphology and the pull of the rectus femoris muscle putting it at risk for an avulsion fracture. Under certain circumstances, open surgical excision of exostosis formation after an avulsion fracture of the AIIS has been used. The case below represents a clinical scenario in which a medically unstable and multiply injured trauma patient had an external pelvic fixator placed as part of the treatment plan for an unstable pelvic injury. Following this pelvic external fixation treatment, the patient went on to develop clinically significant heterotopic bone formation at the AIIS pin site with extra-articular hip impingement syndrome. PMID:27637275

  16. Etiology and severity of impingement injuries of the acetabular labrum: what is the role of femoral morphology?

    PubMed

    Dy, Christopher J; Schroder, Steven J; Thompson, Matthew T; Alexander, Jerry W; Noble, Philip C

    2012-06-01

    Injuries to the acetabular labrum have been seen in association with femoroacetabular impingement, but recent studies have reported labral pathology in patients with normal hip morphology. The hypothesis of the current study was that labral lesions could occur without femoroacetabular impingement but that labral pathology would occur more commonly and more severely in hip joints that exhibit reduced head-neck offset. The presence, location, and severity of labral injury were recorded in 22 cadaveric specimens. Computed tomography was used to define the anatomic parameters of proximal femoral morphology. Three-dimensional modeling was used to simulate hip positions that typically cause labral impingement, including high flexion and internal rotation. Femoral morphology was compared between specimens with and without labral pathology using descriptive statistics. Labral pathology was seen in 15 of 22 specimens and was located in the anterosuperior portion of the labrum. No difference existed in age, femoral neck shaft angle, anteversion, acetabular depth, head diameter, alpha angle, or beta angle between specimens with and without labral pathology. The severity of labral pathology correlated with the alpha angle of the proximal femur. This study demonstrates that damage to the labrum may occur in hips with normal proximal femur morphology. However, the findings also indicate that the presence of morphologic features that increase the risk of impingement may predispose the hip joint to a characteristic pattern or severity of labral pathology. The results confirm the importance of considering both femoral morphology and athletic-type activities of the hip when determining the mechanism responsible for injury of the acetabular labrum.

  17. Liquid film target impingement scrubber

    DOEpatents

    McDowell, William J.; Coleman, Charles F.

    1977-03-15

    An improved liquid film impingement scrubber is provided wherein particulates suspended in a gas are removed by jetting the particle-containing gas onto a relatively small thin liquid layer impingement target surface. The impingement target is in the form of a porous material which allows a suitable contacting liquid from a pressurized chamber to exude therethrough to form a thin liquid film target surface. The gas-supported particles collected by impingement of the gas on the target are continuously removed and flushed from the system by the liquid flow through each of a number of pores in the target.

  18. Arthroscopic treatment of tibial spine malunion with resorbable screws.

    PubMed

    Estes, A Reed; Oladeji, Lasun O

    2015-05-01

    Anterior tibial spine fractures are rare and were thought to occur mainly in children; however, recent literature indicates that the incidence in adults is much greater than previously thought. Because the tibial spine is an attachment point for the anterior cruciate ligament (ACL), an avulsion may produce ACL laxity, predisposing to further issues. We report the case of an 11-year-old boy with a tibial spine fracture that failed conservative management. He developed a malunion with impingement anteriorly of the tibial spine on the notch and residual instability of the ACL. In this report, we present a novel approach for arthroscopic reduction of a tibial spine fracture using 8 resorbable poly-L-lactic/polyglycolic acid nails. PMID:25950547

  19. Arthroscopic management of popliteal cysts

    PubMed Central

    Pankaj, Amite; Chahar, Deepak; Pathrot, Devendra

    2016-01-01

    Background: Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous management of intraarticular pathology. We retrospectively analysed clinical results of symptomatic popliteal cysts after arthroscopic management at 24 month followup. Materials and Methods: Retrospective analysis of hospital database for patients presenting with pathology suggestive of a popliteal cyst from June 2007 to December 2012 was done. Twelve cases of popliteal cyst not responding to NSAIDS and with Rauschning and Lindgren Grade 2 or 3 who consented for surgical intervention were included in the study. All patients underwent arthroscopic decompression using a posteromedial portal along with management of intraarticular pathologies as encountered. Furthermore, the unidirectional valvular effect was corrected to a bidirectional one by widening the cyst joint interface. The results were assessed as per the Rauschning and Lindgren criteria. Results: All patients were followed for a minimum of 24 months (range 24-36 months). It revealed that among the study group, six patients achieved Grade 0 status while five had a minimal limitation of range of motion accompanied by occasional pain (Grade 1). One patient had a failure of treatment with no change in the clinical grading. Conclusion: Arthroscopic approach gives easy access to decompression with the simultaneous management of articular pathologies. PMID:27053804

  20. Does arthroscopic subacromial decompression improve quality of life

    PubMed Central

    Whiteman, A; Wilson, J; Paul, E; Roy, B

    2015-01-01

    Introduction There has been a significant rise in the volume of subacromial decompression surgery performed in the UK. This study aimed to determine whether arthroscopic subacromial decompression improves health related quality of life in a cost effective manner. Methods Patients undergoing arthroscopic subacromial decompression surgery for impingement were enrolled between 2012 and 2014. The Oxford shoulder score and the EQ-5D™ instruments were completed prior to and following surgery. A cost–utility analysis was performed. Results Eighty-three patients were eligible for the study with a mean follow-up duration of 15 months (range: 4–27 months). The mean Oxford shoulder score improved by 13 points (95% confidence interval [CI]: 11–15 points). The mean health utility gain extrapolated from the EQ-5D™ questionnaire improved by 0.23 (95% CI: 0.16–0.30), translating to a minimum cost per QALY of £5,683. Conclusions Subacromial decompression leads to significant improvement in function and quality of life in a cost effective manner. This provides justification for its ongoing practice by appropriately trained shoulder surgeons in correctly selected patients. PMID:26263808

  1. Intratendinous supraspinatus cyst as a cause of shoulder impingement

    PubMed Central

    Garg, Akshay; Karuppaiah, Karthik; Elias, David; Tavakkolizadeh, Adel

    2014-01-01

    We report the case of a 29-year-old gentleman with shoulder impingement. An articular-sided intratendinous supraspinatus cyst was identified as the cause of his symptoms. Arthroscopic cyst debridement resulted in a good outcome at 1-year follow-up. Cysts around the shoulder are a well described pathological entity. They consist of different categories, including intraosseus cysts of the humeral head and glenoid, paralabral cysts and cysts associated with the acromioclavicular joint. Although paralabral cysts that lie intramuscularly or between the muscle bellies have frequently been reported, this is the first report of an intratendinous supraspinatus cyst with an intact rotator cuff. We describe the case, its management and the postsurgical outcome. PMID:27582975

  2. Fiber-optics couple arthroscope to TV

    NASA Technical Reports Server (NTRS)

    Franke, J. M.; Rhodes, D. B.

    1981-01-01

    Convenient, hand-held coupler images output of arthroscope onto coherent fiber bundle. Arthroscope allows surgeons to examine internal organs through any small opening in body. Coupler is also used for engine inspection, instrument repair, and around-corner visual inspection. Image from arthroscope travels along flexible bundle and appears at other cable end where it is recollimated by lens. Image is read from lens or projected on color TV camera.

  3. Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

    PubMed Central

    Ketola, Saara; Lehtinen, Janne; Rousi, Timo; Nissinen, Maunu; Huhtala, Heini; Arnala, Ilkka

    2015-01-01

    Background and purpose — Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation. Patients and methods — In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure. Results — Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation. Interpretation — The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either. PMID:25809315

  4. Arthroscopic examination of the throwing shoulder.

    PubMed

    Savoie, F H

    1993-08-01

    Throwing athletes may develop a multitude of problems in the glenohumeral joint and subacromial area. On occasions when rehabilitation is unsuccessful, diagnostic arthroscopy and arthroscopic management of these disorders may be indicated. The present study demonstrates several common injury patterns noted on arthroscopic examination of the throwing shoulder.

  5. Current UK practices in the management of subacromial impingement

    PubMed Central

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

  6. Superior labral anterior and posterior lesions and internal impingement in the overhead athlete.

    PubMed

    Jazrawi, Laith M; McCluskey, George M; Andrews, James R

    2003-01-01

    Superior labral lesions and internal impingement are believed to be the primary cause of shoulder pathology in the overhead athlete, particularly the baseball player. Increased shoulder external rotation can lead to repetitive impingement of the rotator cuff and superior labrum resulting in a superior labrum anterior and posterior lesion and partial articular-sided rotator cuff tearing. Although the etiology for this phenomenon remains controversial, the end result remains the same: pathology in the rotator cuff and superior labrum. Isolated treatment of the pathology alone, without addressing the capsular laxity, results in lower return to play rates. Addressing the capsular laxity arthroscopically at the same time as the intra-articular pathology is necessary to give these athletes the best chance to return to their prior competitive level. Although short-term results are promising, long-term follow-up is necessary to determine the ultimate usefulness of this treatment philosophy.

  7. Arthroscopic Subtalar, Double, and Triple Fusion.

    PubMed

    Walter, Richard; Parsons, Stephen; Winson, Ian

    2016-09-01

    Arthroscopic approaches to subtalar, double, and triple arthrodesis allow relative preservation of the soft tissue envelope compared with traditional open approaches. The surgical technique involving the use of a 4.5-mm 30° arthroscope via sinus tarsi portals is described. All 3 joints of the triple joint can be prepared for fusion with motorized burrs. Rigid fixation is achieved with cannulated screws. High union rates and low complication rates have been reported. PMID:27524712

  8. Particle impingement in SRM nozzles

    NASA Astrophysics Data System (ADS)

    Ikeda, Hirohide; Tanno, Haruhito; Tokudome, Shinichiro; Kohno, Masahiro

    It is experimentally shown that an improved two-phase flow program can well predict the alumina particle impingement location in small rocket motor nozzles as well as motor performance. The size distribution of particles in the nozzle flow is well characterized by a log-normal distribution. The program has achieved sufficient accuracy of prediction to be an effective nozzle contouring design tool.

  9. Arthroscopic training resources in orthopedic resident education.

    PubMed

    Koehler, Ryan; John, Tamara; Lawler, Jeffrey; Moorman, Claude; Nicandri, Gregg

    2015-02-01

    The purpose of this study was to determine the frequency of use, perceived effectiveness, and preference for arthroscopic surgical skill training resources. An electronic survey was sent to orthopedics residents, residency program directors, and orthopedic sports medicine attending physicians in the United States. The frequency and perceived effectiveness of 10 types of adjunctive arthroscopic skills training was assessed. Residents and faculty members were asked to rate their confidence in resident ability to perform common arthroscopic procedures. Surveys were completed by 40 of 152 (26.3%) orthopedic residency program directors, 70 of 426 (16.4%) sports medicine faculty, and 235 of 3,170 (7.4%) orthopedic residents. The use of adjunctive methods of training varied from only 9.8% of programs with virtual reality training to 80.5% of programs that used reading of published materials to develop arthroscopic skill. Practice on cadaveric specimens was viewed as the most effective and preferred adjunctive method of training. Residents trained on cadaveric specimens reported increased confidence in their ability to perform arthroscopic procedures. The resources for developing arthroscopic surgical skill vary considerably across orthopedic residency programs in the United States. Adjunctive training methods were perceived to be effective at supplementing traditional training in the operating room.

  10. Is there a pathological alpha angle for hip impingement? A diagnostic test study.

    PubMed

    Barrientos, Cristián; Barahona, Maximiliano; Diaz, Jorge; Brañes, Julian; Chaparro, Felipe; Hinzpeter, Jaime

    2016-08-01

    The normal value of alpha angle is controversial. The aim of this study was to compare the alpha angle in asymptomatic volunteers versus patients who had undergone surgery for symptomatic cam-type femoroacetabular impingement (FAI) and determine a diagnostic cut-off value for symptomatic cam impingement. This is a diagnostic test study. Cases were defined as those patients who had undergone surgery for symptomatic cam or mixed type FAI. Controls were defined as asymptomatic volunteers, with no history of hip pain who had undergone a computed tomography (CT) scan of the abdomen and pelvis for a non-joint or bone-related reason. In both groups, the alpha angle was measured in an oblique axial CT reconstruction of the femoral neck. A logistic regression model was first estimated and a receiver operating characteristics (ROC) curve was then calculated. The diagnostic cut-off value selected was the one that maximizes sensitivity and specificity. Data were analysed from 38 consecutive cases of cam or mixed FAI and 101 controls. The average alpha angle was 67°(±12°) among cases and 48°°(±5°) among controls. An odds ratio of 1.28 [1.18-1.39] was obtained. A ROC curve of 0.96 [0.93-0.99] was calculated, and using an alpha angle of 57° as the diagnostic cut-off value, provided a sensitivity of 92% and a specificity of 95%. If a patient complains of hip pain and an alpha angle of 57° is found in CT, strongly suggest that cam impingement is causing the pain. PMID:27583162

  11. Is there a pathological alpha angle for hip impingement? A diagnostic test study.

    PubMed

    Barrientos, Cristián; Barahona, Maximiliano; Diaz, Jorge; Brañes, Julian; Chaparro, Felipe; Hinzpeter, Jaime

    2016-08-01

    The normal value of alpha angle is controversial. The aim of this study was to compare the alpha angle in asymptomatic volunteers versus patients who had undergone surgery for symptomatic cam-type femoroacetabular impingement (FAI) and determine a diagnostic cut-off value for symptomatic cam impingement. This is a diagnostic test study. Cases were defined as those patients who had undergone surgery for symptomatic cam or mixed type FAI. Controls were defined as asymptomatic volunteers, with no history of hip pain who had undergone a computed tomography (CT) scan of the abdomen and pelvis for a non-joint or bone-related reason. In both groups, the alpha angle was measured in an oblique axial CT reconstruction of the femoral neck. A logistic regression model was first estimated and a receiver operating characteristics (ROC) curve was then calculated. The diagnostic cut-off value selected was the one that maximizes sensitivity and specificity. Data were analysed from 38 consecutive cases of cam or mixed FAI and 101 controls. The average alpha angle was 67°(±12°) among cases and 48°°(±5°) among controls. An odds ratio of 1.28 [1.18-1.39] was obtained. A ROC curve of 0.96 [0.93-0.99] was calculated, and using an alpha angle of 57° as the diagnostic cut-off value, provided a sensitivity of 92% and a specificity of 95%. If a patient complains of hip pain and an alpha angle of 57° is found in CT, strongly suggest that cam impingement is causing the pain.

  12. Is there a pathological alpha angle for hip impingement? A diagnostic test study

    PubMed Central

    Barrientos, Cristián; Barahona, Maximiliano; Diaz, Jorge; Brañes, Julian; Chaparro, Felipe; Hinzpeter, Jaime

    2016-01-01

    The normal value of alpha angle is controversial. The aim of this study was to compare the alpha angle in asymptomatic volunteers versus patients who had undergone surgery for symptomatic cam-type femoroacetabular impingement (FAI) and determine a diagnostic cut-off value for symptomatic cam impingement. This is a diagnostic test study. Cases were defined as those patients who had undergone surgery for symptomatic cam or mixed type FAI. Controls were defined as asymptomatic volunteers, with no history of hip pain who had undergone a computed tomography (CT) scan of the abdomen and pelvis for a non-joint or bone-related reason. In both groups, the alpha angle was measured in an oblique axial CT reconstruction of the femoral neck. A logistic regression model was first estimated and a receiver operating characteristics (ROC) curve was then calculated. The diagnostic cut-off value selected was the one that maximizes sensitivity and specificity. Data were analysed from 38 consecutive cases of cam or mixed FAI and 101 controls. The average alpha angle was 67°(±12°) among cases and 48°°(±5°) among controls. An odds ratio of 1.28 [1.18–1.39] was obtained. A ROC curve of 0.96 [0.93–0.99] was calculated, and using an alpha angle of 57° as the diagnostic cut-off value, provided a sensitivity of 92% and a specificity of 95%. If a patient complains of hip pain and an alpha angle of 57° is found in CT, strongly suggest that cam impingement is causing the pain. PMID:27583162

  13. Rotational effects on impingement cooling

    NASA Astrophysics Data System (ADS)

    Epstein, A. H.; Kerrebrock, J. L.; Koo, J. J.; Preiser, U. Z.

    The present consideration of rotation effects on heat transfer in a radially exhausted, impingement-cooled turbine blade model gives attention to experimental results for Reynolds and Rossby numbers and blade/coolant temperature ratio values that are representative of small gas turbine engines. On the basis of a model that encompasses the effects of Coriolis force and buoyancy on heat transfer, bouyancy is identified as the cause of an average Nusselt number that is 20-30 percent lower than expected from previous nonrotating data. A heuristic model is proposed which predicts that the impingement jets nearest the blade roots should deflect inward, due to a centripetal force generated by their tangential velocity counter to the blade motion. Potentially serious thermal stresses must be anticipated from rotation effects in the course of blade design.

  14. Electrical Aspects of Impinging Flames

    NASA Astrophysics Data System (ADS)

    Chien, Yu-Chien

    This dissertation examines the use of electric fields as one mechanism for controlling combustion as flames are partially extinguished when impinging on nearby surfaces. Electrical aspects of flames, specifically, the production of chemi-ions in hydrocarbon flames and the use of convective flows driven by these ions, have been investigated in a wide range of applications in prior work but despite this fairly comprehensive effort to study electrical aspects of combustion, relatively little research has focused on electrical phenomena near flame extinguishment, nor for flames near impingement surfaces. Electrical impinging flames have complex properties under global influences of ion-driven winds and flow field disturbances from the impingement surface. Challenges of measurements when an electric field is applied in the system have limited an understanding of changes to the flame behavior and species concentrations caused by the field. This research initially characterizes the ability of high voltage power supplies to respond on sufficiently short time scales to permit real time electrical flame actuation. The study then characterizes the influence of an electric field on the impinging flame shape, ion current and flow field of the thermal plume associated with the flame. The more significant further examinations can be separated into two parts: 1) the potential for using electric fields to control the release of carbon monoxide (CO) from surface-impinging flames, and 2) an investigation of controlling electrically the heat transfer to a plate on which the flame impinges. Carbon monoxide (CO) results from the incomplete oxidation of hydrocarbon fuels and, while CO can be desirable in some syngas processes, it is usually a dangerous emission from forest fires, gas heaters, gas stoves, or furnaces where insufficient oxygen in the core reaction does not fully oxidize the fuel to carbon dioxide and water. Determining how carbon monoxide is released and how heat transfer

  15. Os trigonum impingement in dancers.

    PubMed

    Marotta, J J; Micheli, L J

    1992-01-01

    Sixteen patients underwent surgical excision of an impinging ossicle through a posterior lateral approach. Twelve of these patients (15 ankles) were available for followup and were retrospectively surveyed at an average of 28 months after surgery. There were 9 women and 3 men. Nine were professional ballet dancers and 3 were students of advanced ballet schools. Preoperative symptoms included pain localized to the posterior ankle, limitation of motion, weakness, swelling, or neurologic changes associated with dance activities. All patients were severely hampered in their dance participation and had failed nonsurgical therapies. Postoperatively, all patients followed an aggressive rehabilitation protocol. All had improvement in their impingement symptoms; eight (67%) still had occasional discomfort. All professional dancers returned to unrestricted dance activity. The mean time to full activity was 3 months. One patient had a superficial wound infection requiring antibiotic treatment and another suffered a transient tibial nerve neurapraxia. Both of these complications resolved without sequelae. We conclude that posterior ankle impingement in ballet dancers, caused by an os trigonum and resistant to nonsurgical therapies, is effectively treated with simple excision of the offending structure.

  16. Arthroscopic quadriceps tendon repair: two case reports.

    PubMed

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

  17. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    PubMed Central

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. PMID:25815224

  18. Arthroscopically confirmed femoral button deployment.

    PubMed

    Sonnery-Cottet, Bertrand; Rezende, Fernando C; Martins Neto, Ayrton; Fayard, Jean M; Thaunat, Mathieu; Kader, Deiary F

    2014-06-01

    The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications. PMID:25126492

  19. Excimer laser in arthroscopic surgery

    NASA Astrophysics Data System (ADS)

    Koort, Hans J.

    1991-05-01

    The development of efficient high-power lasersystems for use in surgery, especially in arthroscopic fields, leads to a new push for all endoscopic techniques. Both techniques, laser and endoscope, complete each other in an ideal way and allow applications which could not be reached with conventional techniques. One of the newer laser types is the excimer laser, which will be a good choice for surface treatment because of its very considerate interaction with tissue. One example is the ablation or smoothing of articular cartilage and meniscal shaving in orthopaedics. On the other hand, the power of this laser system is high enough to cut tissue, for instance in the lateral release, and offers therefore an alternative to the mechanical and electrical instruments. All lasers can only work fine with effective delivery systems. Sometimes there is only a single fiber, which becomes very stiff at diameters of more than 800 micrometers . This fiber often allows only the tangential treatment of tissue, most of the laser power is lost in the background. New fiber systems with many, sometimes hundreds of very thin single fibers, could offer a solution. Special handpieces and fibersystems offer distinct advantages in small joint arthroscopy, especially those for use with excimer lasers will be discussed.

  20. Arthroscopically confirmed femoral button deployment.

    PubMed

    Sonnery-Cottet, Bertrand; Rezende, Fernando C; Martins Neto, Ayrton; Fayard, Jean M; Thaunat, Mathieu; Kader, Deiary F

    2014-06-01

    The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications.

  1. Arthroscopic treatment of iliotibial band syndrome.

    PubMed

    Cowden, Courtney H; Barber, F Alan

    2014-02-01

    Lateral knee pain in athletes is commonly seen in the sports medicine clinic, and the diagnosis of iliotibial band (ITB) syndrome is frequently made. Although conservative management including rest from activity, equipment modification, oral nonsteroidal anti-inflammatory drug use, and physical therapy is the mainstay of treatment initially, refractory cases do exist. Multiple surgical techniques have been described including an arthroscopic technique. Arthroscopic release of the ITB attachment to the lateral femoral epicondyle and resection of the lateral synovial recess for recalcitrant ITB syndrome comprise a valid option that can have a good outcome. This option avoids the complications associated with open surgery and allows for a complete arthroscopic knee examination. Division or lengthening of the ITB band itself is not a necessary step in this technique.

  2. Arthroscopic Treatment of Iliotibial Band Syndrome

    PubMed Central

    Cowden, Courtney H.; Barber, F. Alan

    2013-01-01

    Lateral knee pain in athletes is commonly seen in the sports medicine clinic, and the diagnosis of iliotibial band (ITB) syndrome is frequently made. Although conservative management including rest from activity, equipment modification, oral nonsteroidal anti-inflammatory drug use, and physical therapy is the mainstay of treatment initially, refractory cases do exist. Multiple surgical techniques have been described including an arthroscopic technique. Arthroscopic release of the ITB attachment to the lateral femoral epicondyle and resection of the lateral synovial recess for recalcitrant ITB syndrome comprise a valid option that can have a good outcome. This option avoids the complications associated with open surgery and allows for a complete arthroscopic knee examination. Division or lengthening of the ITB band itself is not a necessary step in this technique. PMID:24843846

  3. Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

    PubMed Central

    Saper, Michael; Kasik, Connor; Dietzel, Douglas

    2015-01-01

    Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example. PMID:26870637

  4. Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome.

    PubMed

    Saper, Michael; Kasik, Connor; Dietzel, Douglas

    2015-12-01

    Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example. PMID:26870637

  5. Impingement of Water Droplets on a Sphere

    NASA Technical Reports Server (NTRS)

    Dorsch, Robert G.; Saper, Paul G.; Kadow, Charles F.

    1955-01-01

    Droplet trajectories about a sphere in ideal fluid flow were calculated. From the calculated droplet trajectories the droplet impingement characteristics of the sphere were determined. Impingement data and equations for determining the collection efficiency, the area, and the distribution of impingement are presented in terms of dimensionless parameters. The range of flight and atmospheric conditions covered in the calculations was extended considerably beyond the range covered by previously reported calculations for the sphere.

  6. Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

    PubMed Central

    Mook, William R.; Greenspoon, Joshua A.; Millett, Peter J.

    2016-01-01

    Background: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. Methods: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. Results: The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Conclusion: Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears. PMID:27733881

  7. Nanofluid impingement jet heat transfer.

    PubMed

    Zeitoun, Obida; Ali, Mohamed

    2012-02-17

    Experimental investigation to study the heat transfer between a vertical round alumina-water nanofluid jet and a horizontal circular round surface is carried out. Different jet flow rates, jet nozzle diameters, various circular disk diameters and three nanoparticles concentrations (0, 6.6 and 10%, respectively) are used. The experimental results indicate that using nanofluid as a heat transfer carrier can enhance the heat transfer process. For the same Reynolds number, the experimental data show an increase in the Nusselt numbers as the nanoparticle concentration increases. Size of heating disk diameters shows reverse effect on heat transfer. It is also found that presenting the data in terms of Reynolds number at impingement jet diameter can take into account on both effects of jet heights and nozzle diameter. Presenting the data in terms of Peclet numbers, at fixed impingement nozzle diameter, makes the data less sensitive to the percentage change of the nanoparticle concentrations. Finally, general heat transfer correlation is obtained verses Peclet numbers using nanoparticle concentrations and the nozzle diameter ratio as parameters.

  8. Nanofluid impingement jet heat transfer

    PubMed Central

    2012-01-01

    Experimental investigation to study the heat transfer between a vertical round alumina-water nanofluid jet and a horizontal circular round surface is carried out. Different jet flow rates, jet nozzle diameters, various circular disk diameters and three nanoparticles concentrations (0, 6.6 and 10%, respectively) are used. The experimental results indicate that using nanofluid as a heat transfer carrier can enhance the heat transfer process. For the same Reynolds number, the experimental data show an increase in the Nusselt numbers as the nanoparticle concentration increases. Size of heating disk diameters shows reverse effect on heat transfer. It is also found that presenting the data in terms of Reynolds number at impingement jet diameter can take into account on both effects of jet heights and nozzle diameter. Presenting the data in terms of Peclet numbers, at fixed impingement nozzle diameter, makes the data less sensitive to the percentage change of the nanoparticle concentrations. Finally, general heat transfer correlation is obtained verses Peclet numbers using nanoparticle concentrations and the nozzle diameter ratio as parameters. PMID:22340669

  9. Open Versus Arthroscopic Tennis Elbow Release

    PubMed Central

    Leiter, Jeff; Clark, Tod; McRae, Sheila; Dubberley, James; MacDonald, Peter B.

    2016-01-01

    Objectives: The primary objective of this study was to determine if quality of life and function are different following arthroscopic versus open tennis elbow release surgery. Based on retrospective studies, both approaches have been found to be beneficial, but no prospective randomized comparison has been conducted to date. Methods: Following a minimum six-months of conservative treatment, seventy-one patients (>16 yrs old) were randomized intraoperatively to undergo either arthroscopic or open lateral release. Outcome measures were the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), a 5-question VAS Pain Scale, and grip strength. Study assessments took place pre-, and 6-week, 3-, 6-, and 12-months post-surgery. Comparisons between groups and within groups over time were conducted using repeated measures ANOVA. A minimal clinically significant difference for the DASH had been previously identified as 15 points, and was used to compare groups as well at 12-months post-operative (Beaton et al. 2001). Results: Fifteen women and 19 men underwent the open procedure with a mean age of 47.1 years (6.7) and 13 women and 21 men were in the arthroscopic group with a mean age of 45.0 (6.9). No pre-surgery differences were found between groups based on age, sex, DASH or VAS scores. Both groups demonstrated a significant improvement in subjective measures and grip strength by 12-months post-surgery, and no significant differences were found between groups at any time point. The DASH, our primary outcome, decreased from a mean (SD) of 47.5 (14.5) pre-surgery to 21.9 (21.8) at 12-months post-surgery in the Open group and from 52.7 (16.0) to 22.6 (21.1) in the Arthroscopic group. VAS-pain scores (%) decreased in the Open group from 62.5 (17.2) pre-operatively to 30.0 (26.5) at 12-months. In the arthroscopic group, scores decreased from 63.7 (15.9) to 26.2 (24.6). Grip strength (kg) increased on the affected side from 23.6 (14.9) to 29.3 (16.3) and 21.4 (15.4) to

  10. Fluorescence Imaging Study of Impinging Underexpanded Jets

    NASA Technical Reports Server (NTRS)

    Inman, Jennifer A.; Danehy, Paul M.; Nowak, Robert J.; Alderfer, David W.

    2008-01-01

    An experiment was designed to create a simplified simulation of the flow through a hole in the surface of a hypersonic aerospace vehicle and the subsequent impingement of the flow on internal structures. In addition to planar laser-induced fluorescence (PLIF) flow visualization, pressure measurements were recorded on the surface of an impingement target. The PLIF images themselves provide quantitative spatial information about structure of the impinging jets. The images also help in the interpretation of impingement surface pressure profiles by highlighting the flow structures corresponding to distinctive features of these pressure profiles. The shape of the pressure distribution along the impingement surface was found to be double-peaked in cases with a sufficiently high jet-exit-to-ambient pressure ratio so as to have a Mach disk, as well as in cases where a flow feature called a recirculation bubble formed at the impingement surface. The formation of a recirculation bubble was in turn found to depend very sensitively upon the jet-exit-to-ambient pressure ratio. The pressure measured at the surface was typically less than half the nozzle plenum pressure at low jet pressure ratios and decreased with increasing jet pressure ratios. Angled impingement cases showed that impingement at a 60deg angle resulted in up to a factor of three increase in maximum pressure at the plate compared to normal incidence.

  11. Bistability and hysteresis of annular impinging jets

    NASA Astrophysics Data System (ADS)

    Tisovsky, Tomas

    2016-06-01

    In present study, the bistability and hysteresis of annular impinging jets is investigated. Annular impinging jets are simulated using open source CFD code - OpenFOAM. Both flow field patterns of interest are obtained and hysteresis is found by means of dynamic mesh simulation. Effect of nozzle exit velocity on resulting hysteresis loop is also illustrated.

  12. Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex

    PubMed Central

    Babaqi, AbdulRahman A.; Kotb, Mohammed M.; Said, Hatem G.; AbdelHamid, Mohamed M.; ElKady, Hesham A.; ElAssal, Maher A.

    2014-01-01

    Background There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores. Methods In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria. Results After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P < 0.05). Conclusion Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex. PMID:25104891

  13. Arthroscopic management of septic arthritis of the wrist.

    PubMed

    Sammer, Douglas M; Shin, Alexander Y

    2011-08-01

    Bacterial septic arthritis of the wrist is a joint-threatening emergency that is often treated by open irrigation and debridement (I and D). There is evidence that patients with isolated septic arthritis of the wrist require fewer operations and have a shorter hospital stay when treated arthroscopically. This article describes the surgical technique for arthroscopic I and D of the wrist and discusses the indications and benefits of arthroscopic versus open I and D for septic arthritis of the wrist.

  14. [Bony avulsions of the rotator cuff : Arthroscopic concepts].

    PubMed

    Greiner, S; Scheibel, M

    2011-01-01

    Bony avulsions of the rotator cuff and isolated greater or lesser tuberosity fractures are rare injuries and a clear consensus regarding classification and therapy does not yet exist. Conservative therapy is limited, especially in injuries with displaced fragments and in these cases surgical treatment is frequently indicated. The ongoing development of arthroscopic techniques has led to quite a number of reports about arthroscopically assisted or total arthroscopic techniques in the treatment of these injuries. The advantages and disadvantages of arthroscopic concepts for the treatment of bony avulsions of the rotator cuff are presented with reference to the current literature. PMID:21153534

  15. Graft impingement in anterior cruciate ligament reconstruction.

    PubMed

    Iriuchishima, Takanori; Shirakura, Kenji; Fu, Freddie H

    2013-03-01

    Anterior cruciate ligament (ACL) graft impingement is one of the most troubling complications in ACL reconstruction. In the previous strategy of isometric "non-anatomical" ACL reconstruction, posterior tibial tunnel placement and notchplasty were recommended to avoid graft impingement. Recently, the strategy of ACL reconstruction is shifting towards "anatomical" reconstruction. In anatomical ACL reconstruction, the potential risk of graft impingement is higher than in non-anatomical reconstruction because the tibial tunnel is placed at a more anterior portion on the tibia. However, there have been few studies reporting on graft impingement in anatomical ACL reconstruction. This study will provide a review of graft impingement status in both non-anatomical and the more recent anatomical ACL reconstruction techniques. In conclusion, with the accurate creation of bone tunnels within ACL native footprint, the graft impingement might not happen in anatomical ACL reconstruction. For the clinical relevance, to prevent graft impingement, surgeons should pay attention of creating correct anatomical tunnels when they perform ACL reconstruction. Level of evidence IV.

  16. Arthroscopic Marginal Resection of a Lipoma of the Supraspinatus Muscle in the Subacromial Space

    PubMed Central

    Pagán Conesa, Alejandro; Aznar, Carlos Verdú; Herrera, Manuel Ruiz; Lopez-Prats, Fernando Anacleto

    2015-01-01

    Subacromial impingement syndrome is a common cause of shoulder pain in young adults and seniors at present. The etiology of this syndrome is associated with several shoulder disorders, most related to aging, overhead activities, and overuse. The subacromial space is well circumscribed and limited in size, and soft-tissue growing lesions, such as tumors, can endanger the normal function of the shoulder girdle. We present a case of shoulder impingement syndrome caused by an intramuscular lipoma of the supraspinatus muscle in the subacromial space in a 50-year-old male bank manager. Radiographs, magnetic resonance imaging, and a computed tomography scan showed a well-circumscribed soft-tissue tumor at the supraspinatus-musculotendinous junction. It was arthroscopically inspected and dissected and complete marginal excision was performed through a conventional augmented anterolateral portal, avoiding the need to open the trapezius fascia or perform an acromial osteotomy. Microscopic study showed a benign lipoma, and the shoulder function of the patient was fully recovered after a rehabilitation period of 4 months. This less invasive technique shows similar results to conventional open surgery. PMID:26759779

  17. Arthroscopic Marginal Resection of a Lipoma of the Supraspinatus Muscle in the Subacromial Space.

    PubMed

    Pagán Conesa, Alejandro; Aznar, Carlos Verdú; Herrera, Manuel Ruiz; Lopez-Prats, Fernando Anacleto

    2015-08-01

    Subacromial impingement syndrome is a common cause of shoulder pain in young adults and seniors at present. The etiology of this syndrome is associated with several shoulder disorders, most related to aging, overhead activities, and overuse. The subacromial space is well circumscribed and limited in size, and soft-tissue growing lesions, such as tumors, can endanger the normal function of the shoulder girdle. We present a case of shoulder impingement syndrome caused by an intramuscular lipoma of the supraspinatus muscle in the subacromial space in a 50-year-old male bank manager. Radiographs, magnetic resonance imaging, and a computed tomography scan showed a well-circumscribed soft-tissue tumor at the supraspinatus-musculotendinous junction. It was arthroscopically inspected and dissected and complete marginal excision was performed through a conventional augmented anterolateral portal, avoiding the need to open the trapezius fascia or perform an acromial osteotomy. Microscopic study showed a benign lipoma, and the shoulder function of the patient was fully recovered after a rehabilitation period of 4 months. This less invasive technique shows similar results to conventional open surgery. PMID:26759779

  18. Arthroscopic anatomy of the subdeltoid space.

    PubMed

    J Salata, Michael; J Nho, Shane; Chahal, Jaskarndip; Van Thiel, Geoffrey; Ghodadra, Neil; Dwyer, Tim; A Romeo, Anthony

    2013-01-01

    From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears. PMID:24191185

  19. Stem cell procedures in arthroscopic surgery.

    PubMed

    Dyrna, Felix; Herbst, Elmar; Hoberman, Alexander; Imhoff, Andreas B; Schmitt, Andreas

    2016-07-13

    The stem cell as the building block necessary for tissue reparation and homeostasis plays a major role in regenerative medicine. Their unique property of being pluripotent, able to control immune process and even secrete a whole army of anabolic mediators, draws interest. While new arthroscopic procedures and techniques involving stem cells have been established over the last decade with improved outcomes, failures and dissatisfaction still occur. Therefore, there is increasing interest in ways to improve the healing response. MSCs are particularly promising for this task given their regenerative potential. While methods of isolating those cells are no longer poses a challenge, the best way of application is not clear. Several experiments in the realm of basic science and animal models have recently been published, addressing this issue, yet the application in clinical practice has lagged. This review provides an overview addressing the current standing of MSCs in the field of arthroscopic surgery.

  20. Arthroscopic Anatomy of the Subdeltoid Space

    PubMed Central

    J. Salata, Michael; J. Nho, Shane; Chahal, Jaskarndip; Van Thiel, Geoffrey; Ghodadra, Neil; Dwyer, Tim; A. Romeo, Anthony

    2013-01-01

    From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears. PMID:24191185

  1. Arthroscopic Debridement for Irreparable Rotator Cuff Tears

    PubMed Central

    Hawi, N.; Schmiddem, U.; Omar, M.; Stuebig, T.; Krettek, C.; Petri, M.; Meller, R.

    2016-01-01

    Background: Arthroscopic debridement represents a salvage procedure for irreparable rotator cuff tears. It is important to accurately diagnose the patient for irreparable rotator cuff tears. The diagnosis and the therapeutic options must be explained to the patient. It is mandatory that the patient understands the primary goal of the arthroscopic debridement being reduction of pain, not improving strength or function. Methods: The procedure consists of 7 distinct steps to debride the soft tissues and alleviate pain. Results: Even though there is a lack of evidence that this procedure is superior to other therapeutic options, it has shown good results in patients with the main complaint of pain. Conclusion: The results reported in some studies should, however, be interpreted with caution, taking into consideration the substantial structural damage in irreparable defects.

  2. The Arthroscopic Surgical Skill Evaluation Tool (ASSET)

    PubMed Central

    Koehler, Ryan J.; Amsdell, Simon; Arendt, Elizabeth A; Bisson, Leslie J; Braman, Jonathan P; Butler, Aaron; Cosgarea, Andrew J; Harner, Christopher D; Garrett, William E; Olson, Tyson; Warme, Winston J.; Nicandri, Gregg T.

    2014-01-01

    Background Surgeries employing arthroscopic techniques are among the most commonly performed in orthopaedic clinical practice however, valid and reliable methods of assessing the arthroscopic skill of orthopaedic surgeons are lacking. Hypothesis The Arthroscopic Surgery Skill Evaluation Tool (ASSET) will demonstrate content validity, concurrent criterion-oriented validity, and reliability, when used to assess the technical ability of surgeons performing diagnostic knee arthroscopy on cadaveric specimens. Study Design Cross-sectional study; Level of evidence, 3 Methods Content validity was determined by a group of seven experts using a Delphi process. Intra-articular performance of a right and left diagnostic knee arthroscopy was recorded for twenty-eight residents and two sports medicine fellowship trained attending surgeons. Subject performance was assessed by two blinded raters using the ASSET. Concurrent criterion-oriented validity, inter-rater reliability, and test-retest reliability were evaluated. Results Content validity: The content development group identified 8 arthroscopic skill domains to evaluate using the ASSET. Concurrent criterion-oriented validity: Significant differences in total ASSET score (p<0.05) between novice, intermediate, and advanced experience groups were identified. Inter-rater reliability: The ASSET scores assigned by each rater were strongly correlated (r=0.91, p <0.01) and the intra-class correlation coefficient between raters for the total ASSET score was 0.90. Test-retest reliability: there was a significant correlation between ASSET scores for both procedures attempted by each individual (r = 0.79, p<0.01). Conclusion The ASSET appears to be a useful, valid, and reliable method for assessing surgeon performance of diagnostic knee arthroscopy in cadaveric specimens. Studies are ongoing to determine its generalizability to other procedures as well as to the live OR and other simulated environments. PMID:23548808

  3. All-Arthroscopic Latissimus Dorsi Transfer.

    PubMed

    Cutbush, Kenneth; Peter, Noel A; Hirpara, Kieran

    2016-06-01

    Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function. PMID:27656385

  4. Arthroscopic treatment of glenoid bone loss.

    PubMed

    Taverna, Ettore; Garavaglia, Guido; Ufenast, Henri; D'Ambrosi, Riccardo

    2016-02-01

    Recurrent anterior instability of the glenohumeral joint has long been an arduous problem to solve surgically, owing to its difficulty to the need to restore both osseous and dynamic constraints in the unstable shoulder. Biomechanical studies have indicated that glenoid bone loss shortens the safe arc through which the glenoid can resist axial forces; in these cases, a soft tissue repair alone may be insufficient to maintain stability. Clinical studies have confirmed that major bone loss is associated with an unfavourable outcome. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions and less soft tissue dissection, better access for repair and, potentially, the maximum respect for the undamaged anatomical structures. The biggest disadvantage of arthroscopic procedures until recently was the inability to successfully treat a significant bone defect. Over the last 10 years, several new arthroscopic techniques have been developed, providing new surgical options for successfully treating soft tissues and bony lesions in anterior-inferior glenohumeral instability. Level of evidence V. PMID:26658567

  5. Arthroscopic Treatment for External Snapping Hip

    PubMed Central

    Yoon, Jae Youn; Kwak, Hong Suk; Yoon, Kang Sup; Chang, Jae Suk

    2014-01-01

    Purpose The purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip. Materials and Methods Between September 2011 and June 2013, we evaluated 7 patients (10 cases) with snapping hip who were refractory to conservative treatments for at least 3 months. Two patients (4 cases) were impossible to adduct both knees in 90°of hip flexion. Surgery was done in lateral decubitus position, under spinal anesthesia. We made 2 arthroscopic portals to operate the patients, and used cross-cutting with flap resection technique to treat the lesion. We performed additional gluteal sling release in those 2 patients (4 cases) with adduction difficulty. Average follow-up length was 19 months (range, 12-33 months). Clinical improvement was evaluated with visual analog scale (VAS), modified Harris hip score (mHHS), and also investigated for presence of limping or other complications as well. Results The VAS decreased from 6.8 (range, 6-9) preoperatively to 0.2 (range, 0-2) postoperatively, and the mHHS improved from 68.2 to 94.8 after surgery. None of the patients complained of post-operative wound problem or surgical complications. Conclusion The clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results. PMID:27536576

  6. Arthroscopic Decompression for a Giant Meniscal Cyst.

    PubMed

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    The authors report the case of a giant medial meniscal cyst in an osteoarthritic knee of an 82-year-old woman that was successfully treated with only arthroscopic cyst decompression. The patient noticed a painful mass on the medial side of the right knee that had been gradually growing for 5 years. Magnetic resonance imaging showed an encapsulated large medial cystic mass measuring 80×65×40 mm that was adjacent to the medial meniscus. An accompanying horizontal tear was also detected in the middle and posterior segments of the meniscus. The medial meniscus was resected up to the capsular attachment to create bidirectional flow between the joint and the cyst with arthroscopic surgery. Magnetic resonance imaging performed 14 months postoperatively showed that the cyst had completely disappeared, and no recurrence was observed during a 2-year follow-up period. An excellent result could be obtained by performing limited meniscectomy to create a channel leading to the meniscal cyst, even though the cyst was large. Among previously reported cases of meniscal cysts, this case is the largest to be treated arthroscopically without open excision.

  7. Arthroscopic latarjet procedure: safety evaluation in cadavers

    PubMed Central

    Gracitelli, Mauro Emilio Conforto; Ferreira, Arnaldo Amado; Benegas, Eduardo; Malavolta, Eduardo Angeli; Sunada, Edwin Eiji; Assunção, Jorge Henrique

    2013-01-01

    OBJECTIVE: To evaluate the safety of arthroscopic Latarjet procedure in cadavers. METHODS : Twelve cadaveric shoulders underwent arthroscopic Latarjet procedure in our laboratory for arthroscopy, by four different surgeons. Following surgery, the specimens were subjected to radiographic examination and evaluated by an independent examiner. Nineteen parameters were evaluated, including the coracoid graft fixation, positioning and angulation of the screws, neurological damage and integrity of tendons. RESULTS : Four procedures were considered to be satisfactory, with no difference among the surgeons. The mean angulation of the screws was 27.2°. The subscapularis splitting was, on average, 17.8mm from the upper edge. The coracoid graft was properly positioned relative to equator of the glenoid in 11 cases. There was no injury to the axillary or musculocutaneous nerves. The main complications were: interposition of soft tissue, suprascapular nerve injury, articular deviation of the graft, diastasis and conjoined tendon injury. CONCLUSION : The arthroscopic Latarjet procedure is a complex technique in which each step must be precise to reduce the risk of complications. Our study showed a high risk of failure of the procedure. Level of Evidence IV, Case Series. PMID:24453657

  8. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft.

    PubMed

    Lee, Byung-Ill; Min, Kyung-Dae; Choi, Hyung-Suk; Kim, Jun-Bum; Kim, Seong-Tae

    2006-03-01

    We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to be able to acquire anatomic placement of the graft without roof impingement. Therefore, it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. Our surgical technique was developed to maximize the preservation of the tibial remnant. The distally attached semitendinosus and gracilis tendons are harvested using the tendon stripper. After satisfactory placement of 2 guide pins convergently, a closed-end socket in the lateral femoral condyle is created using an adequately sized curved curette. For anatomic placement of the graft, the tibial tunnel should be positioned within the boundaries of the normal ACL tibial remnant. The reamer must be advanced very carefully to minimize injury to the residual remnant at the intra-articular margin of the tibial tunnel. Penetration should stop at the base of the stump. The folded grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant, and the femoral socket by pulling sutures under arthroscopic visualization. The ACL tibial remnant is compacted by the tendon passage. The graft is secured proximally by tying sutures in the lateral femoral condyle and distally at the tibia with double staples by a belt-buckle method. The advantages of our technique include maximal preservation of the tibial remnant, no roof impingement caused by intrasynovial anatomic placement of the graft, the simplicity of the procedure, the minimal need for hardware or special instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement by preventing synovial fluid leakage. PMID:16517320

  9. Cleaning verification by air/water impingement

    NASA Technical Reports Server (NTRS)

    Jones, Lisa L.; Littlefield, Maria D.; Melton, Gregory S.; Caimi, Raoul E. B.; Thaxton, Eric A.

    1995-01-01

    This paper will discuss how the Kennedy Space Center intends to perform precision cleaning verification by Air/Water Impingement in lieu of chlorofluorocarbon-113 gravimetric nonvolatile residue analysis (NVR). Test results will be given that demonstrate the effectiveness of the Air/Water system. A brief discussion of the Total Carbon method via the use of a high temperature combustion analyzer will also be given. The necessary equipment for impingement will be shown along with other possible applications of this technology.

  10. Arthroscopic Assessment and Treatment of Dancers' Knee Injuries.

    ERIC Educational Resources Information Center

    Silver, Daniel M.; Campbell, Pat

    1985-01-01

    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)

  11. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

    PubMed Central

    Sano, Hirotaka; Kamimura, Masayuki; Oizumi, Akira; Isefuku, Shuji

    2015-01-01

    A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement. PMID:26000187

  12. Rationale of arthroscopic surgery of the temporomandibular joint.

    PubMed

    Murakami, KenIchiro

    2013-01-01

    Arthroscopic surgery has been widely used for treatment of temporomandibular joint (TMJ) internal derangements and diseases for the last 40 years. Although 626 articles have been hit by Pubmed search in terms of "TMJ arthroscopic surgery", this review article is described based on distinguished publishing works and on my experiences with TMJ arthroscopic surgery and related research with an aim to analyse the rationale of arthroscopic surgeries of the temporomandibular joint. With arthrocentesis emerging as an alternative, less invasive, treatment for internal derangement with closed lock, the primary indication of arthroscopic surgery seems to be somewhat limited. However, the value of endoscopic inspection and surgery has its position for both patient and physician with its long-term reliable results.

  13. Rationale of arthroscopic surgery of the temporomandibular joint

    PubMed Central

    Murakami, KenIchiro

    2013-01-01

    Arthroscopic surgery has been widely used for treatment of temporomandibular joint (TMJ) internal derangements and diseases for the last 40 years. Although 626 articles have been hit by Pubmed search in terms of “TMJ arthroscopic surgery”, this review article is described based on distinguished publishing works and on my experiences with TMJ arthroscopic surgery and related research with an aim to analyse the rationale of arthroscopic surgeries of the temporomandibular joint. With arthrocentesis emerging as an alternative, less invasive, treatment for internal derangement with closed lock, the primary indication of arthroscopic surgery seems to be somewhat limited. However, the value of endoscopic inspection and surgery has its position for both patient and physician with its long-term reliable results. PMID:25737901

  14. Arthroscopic treatment for chronic lateral epicondylitis☆

    PubMed Central

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Filho, Anis Nahssen; de Almeida, Gustavo Dalla Bernardina; Cavatte, José Maria; De Nadai, Anderson

    2015-01-01

    Objective To report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment. Methods Over the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain. Results A total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p < 0.01). No correlations were observed using the Spearman test between the results and age, gender, length of time with symptoms before the operation or injury mechanism (p > 0.05). Conclusion Arthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure. PMID:26401498

  15. Arthroscopic meniscal allograft transplantation without bone plugs.

    PubMed

    Alentorn-Geli, Eduard; Seijas Vázquez, Roberto; García Balletbó, Montserrat; Álvarez Díaz, Pedro; Steinbacher, Gilbert; Cuscó Segarra, Xavier; Rius Vilarrubia, Marta; Cugat Bertomeu, Ramón

    2011-02-01

    Partial or total meniscectomy are common procedures performed at Orthopedic Surgery departments. Despite providing a great relief of pain, it has been related to early onset knee osteoarthritis. Meniscal allograft transplantation has been proposed as an alternative to meniscectomy. The purposes of this study were to describe an arthroscopic meniscal allograft transplantation without bone plugs technique and to report the preliminary results. All meniscal allograft transplantations performed between 2001 and 2006 were approached for eligibility, and a total of 35 patients (involving 37 menisci) were finally engaged in the study. Patients were excluded if they had ipsilateral knee ligament reconstruction or cartilage repair surgery before meniscal transplantation or other knee surgeries after the meniscal transplantation. Scores on Lysholm, Subjective IKDC Form, and Visual Analogue Scale (VAS) scale for pain were obtained at a mean follow-up of 38.6 months and compared to pre-operative data. Data on chondral lesions were obtained during the arthroscopic procedure and through imaging (radiographs and MRI) studies pre-operatively. Two graft failures out of 59 transplants (3.4%) were found. Daily life accidents were responsible for all graft failures. Significant improvements for Lysholm, Subjective IKDC Form, and VAS for pain scores following the meniscal allograft transplantation were found (P < 0.0001). Controlling for chondral lesion, there was no significant interactions for Lysholm (n.s.), Subjective IKDC Form (n.s.), and VAS for pain scores (n.s.). This study demonstrated that an arthroscopic meniscal allograft transplantation without bone plugs improved knee function and symptoms after a total meniscectomy. Improvements were observed independently of the degree of chondral lesion.

  16. Arthroscopic Posterior Subtalar Arthrodesis: Surgical Technique

    PubMed Central

    Vilá y Rico, Jesús; Ojeda Thies, Cristina; Parra Sanchez, Guillermo

    2016-01-01

    Surgical fusion of the subtalar joint is a procedure indicated to alleviate pain of subtalar origin, such as in post-traumatic osteoarthritis, adult-acquired flatfoot deformity, and other disorders. Open subtalar arthrodesis has been performed with predictable results, but concerns exist regarding injury to proprioception and local vascularity due to wide surgical dissection. Minimally invasive techniques try to improve results by avoiding these issues but have a reputation for being technically demanding. We describe the surgical technique for arthroscopic subtalar arthrodesis, which has proved to be a safe and reliable technique in our experience, with consistent improvements in American Orthopaedic Foot & Ankle Society scores. PMID:27073783

  17. Spray formation processes of impinging jet injectors

    NASA Technical Reports Server (NTRS)

    Anderson, W. E.; Ryan, H. M.; Pal, S.; Santoro, R. J.

    1993-01-01

    A study examining impinging liquid jets has been underway to determine physical mechanisms responsible for combustion instabilities in liquid bi-propellant rocket engines. Primary atomization has been identified as an important process. Measurements of atomization length, wave structure, and drop size and velocity distribution were made under various ambient conditions. Test parameters included geometric effects and flow effects. It was observed that pre-impingement jet conditions, specifically whether they were laminar or turbulent, had the major effect on primary atomization. Comparison of the measurements with results from a two dimensional linear aerodynamic stability model of a thinning, viscous sheet were made. Measured turbulent impinging jet characteristics were contrary to model predictions; the structure of waves generated near the point of jet impingement were dependent primarily on jet diameter and independent of jet velocity. It has been postulated that these impact waves are related to pressure and momentum fluctuations near the impingement region and control the eventual disintegration of the liquid sheet into ligaments. Examination of the temporal characteristics of primary atomization (ligament shedding frequency) strongly suggests that the periodic nature of primary atomization is a key process in combustion instability.

  18. Spray formation processes of impinging jet injectors

    NASA Astrophysics Data System (ADS)

    Anderson, W. E.; Ryan, H. M.; Pal, S.; Santoro, R. J.

    1993-11-01

    A study examining impinging liquid jets has been underway to determine physical mechanisms responsible for combustion instabilities in liquid bi-propellant rocket engines. Primary atomization has been identified as an important process. Measurements of atomization length, wave structure, and drop size and velocity distribution were made under various ambient conditions. Test parameters included geometric effects and flow effects. It was observed that pre-impingement jet conditions, specifically whether they were laminar or turbulent, had the major effect on primary atomization. Comparison of the measurements with results from a two dimensional linear aerodynamic stability model of a thinning, viscous sheet were made. Measured turbulent impinging jet characteristics were contrary to model predictions; the structure of waves generated near the point of jet impingement were dependent primarily on jet diameter and independent of jet velocity. It has been postulated that these impact waves are related to pressure and momentum fluctuations near the impingement region and control the eventual disintegration of the liquid sheet into ligaments. Examination of the temporal characteristics of primary atomization (ligament shedding frequency) strongly suggests that the periodic nature of primary atomization is a key process in combustion instability.

  19. Sustained five-year benefit of autologous matrix-induced chondrogenesis for femoral acetabular impingement-induced chondral lesions compared with microfracture treatment.

    PubMed

    Fontana, A; de Girolamo, L

    2015-05-01

    The repair of chondral lesions associated with femoroacetabular impingement requires specific treatment in addition to that of the impingement. In this single-centre retrospective analysis of a consecutive series of patients we compared treatment with microfracture (MFx) with a technique of enhanced microfracture autologous matrix-induced chondrogenesis (AMIC). Acetabular grade III and IV chondral lesions measuring between 2 cm(2) and 8 cm(2) in 147 patients were treated by MFx in 77 and AMIC in 70. The outcome was assessed using the modified Harris hip score at six months and one, two, three, four and five years post-operatively. The outcome in both groups was significantly improved at six months and one year post-operatively. During the subsequent four years the outcome in the MFx group slowly deteriorated, whereas that in the AMIC group remained stable. Six patients in the MFx group subsequently required total hip arthroplasty, compared with none in the AMIC group We conclude that the short-term clinical outcome improves in patients with acetabular chondral damage following both MFx and AMIC. However, the AMIC group had better and more durable improvement, particularly in patients with large (≥ 4 cm(2)) lesions.

  20. Arthroscopic Excision of Bone Fragments in a Neglected Fracture of the Lateral Process of the Talus in a Junior Soccer Player

    PubMed Central

    Funasaki, Hiroki; Kato, Soki; Hayashi, Hiroteru; Marumo, Keishi

    2014-01-01

    Fractures of the lateral process of the talus are uncommon and often overlooked. Typically, they are found in adult snowboarders. We report the case of an 11-year-old male soccer player who complained of lateral ankle pain after an inversion injury 6 months earlier. He did not respond to conservative treatment and thus underwent arthroscopic excision of fragments of the talar lateral process. The ankle was approached through standard medial and anterolateral portals. A 2.7-mm-diameter 30° arthroscope was used. Soft tissues around the talus were cleared with a motorized shaver, and the lateral aspect of the talar process was then visualized. The lateral process presented as an osseous overgrowth, and a loose body was impinged between the talus and the calcaneus. The osseous overgrowth was resected piece by piece with a punch, and the loose body was removed en block. The patient returned to soccer 5 weeks after the operation. This case exemplifies 2 important points: (1) This type of fracture can develop even in children and not only in snowboarders. (2) Arthroscopic excision of talar lateral process fragments can be accomplished easily, and return to sports can be achieved in a relatively short time. PMID:25126497

  1. Improved Stirling engine performance using jet impingement

    NASA Technical Reports Server (NTRS)

    Johnson, D. C.; Britt, E. J.; Thieme, L. G.

    1982-01-01

    Of the many factors influencing the performance of a Stirling engine, that of transferring the combustion gas heat into the working fluid is crucial. By utilizing the high heat transfer rates obtainable with a jet impingement heat transfer system, it is possible to reduce the flame temperature required for engine operation. Also, the required amount of heater tube surface area may be reduced, resulting in a decrease in the engine nonswept volume and a related increase in engine efficiency. A jet impingement heat transfer system was designed by Rasor Associates, Inc., and tested in the GPU-3 Stirling engine at the NASA Lewis Research Center. For a small penalty in pumping power (less than 0.5% of engine output) the jet impingement heat transfer system provided a higher combustion-gas-side heat transfer coefficient and a smoothing of heater temperature profiles resulting in lower combustion system temperatures and a 5 to 8% increase in engine power output and efficiency.

  2. Microtextured Surfaces for Turbine Blade Impingement Cooling

    NASA Technical Reports Server (NTRS)

    Fryer, Jack

    2014-01-01

    Gas turbine engine technology is constantly challenged to operate at higher combustor outlet temperatures. In a modern gas turbine engine, these temperatures can exceed the blade and disk material limits by 600 F or more, necessitating both internal and film cooling schemes in addition to the use of thermal barrier coatings. Internal convective cooling is inadequate in many blade locations, and both internal and film cooling approaches can lead to significant performance penalties in the engine. Micro Cooling Concepts, Inc., has developed a turbine blade cooling concept that provides enhanced internal impingement cooling effectiveness via the use of microstructured impingement surfaces. These surfaces significantly increase the cooling capability of the impinging flow, as compared to a conventional untextured surface. This approach can be combined with microchannel cooling and external film cooling to tailor the cooling capability per the external heating profile. The cooling system then can be optimized to minimize impact on engine performance.

  3. Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors

    PubMed Central

    McConkey, Mark O.; Moreira, Brett; Mei-Dan, Omer

    2015-01-01

    Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft. PMID:26870649

  4. Arthroscopic Fixation of Tibial Spine Avulsion Fracture in Open Physis

    PubMed Central

    Chouhan, Varun

    2016-01-01

    Introduction: Arthroscopic fixation of tibial spine fracture in patients with open physis without damaging the growth plate is very important. We have described a very simple and effective technique for the first time in this article. Case report: A 16-year-old boy sustained avulsion fractures of tibial spine while playing. He was treated arthroscopically with excellent results. Conclusion: Arthroscopic fixation of tibial spine fracture in patients with open physis with two cannulated screws perpendicular to each other is a very simple technique providing strong construct, and allowing early mobilization without risk of damage to the growth plate. PMID:27703945

  5. Industrial stator vane with sequential impingement cooling inserts

    SciTech Connect

    Jones, Russell B; Fedock, John A; Goebel, Gloria E; Krueger, Judson J; Rawlings, Christopher K; Memmen, Robert L

    2013-08-06

    A turbine stator vane for an industrial engine, the vane having two impingement cooling inserts that produce a series of impingement cooling from the pressure side to the suction side of the vane walls. Each insert includes a spar with a row of alternating impingement cooling channels and return air channels extending in a radial direction. Impingement cooling plates cover the two sides of the insert and having rows of impingement cooling holes aligned with the impingement cooling channels and return air openings aligned with the return air channel.

  6. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

    PubMed Central

    Arce, Guillermo

    2015-01-01

    Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery. PMID:26870652

  7. Arthroscopic Meniscus Repair: Clinical and Isokinetic Results

    PubMed Central

    Grosse, Carmen; Henche, Hans-Rudolph; De Koning, Bart

    1998-01-01

    The importance of the menisci for transmitting workloads in the knee joint to protect the articular cartilage is widely acknowledged. Therefore various techniques have been introduced to repair the damaged meniscus. We performed an arthroscopic meniscus repair with a modified outside-in technique on 29 patients (average 25 years) between 2/91 and 10/94. The average time between trauma and operation was 29 weeks (1–186) – the follow-up 16.3 months (4–49). All the patients were interviewed by phone – 23 were available for clinical respectively isokinetic examination, and categorized following the Lysholm and Lais scores. Twenty-eight patients were happy with the result of the procedure. Following the Lysholm score we found 78% good/excellent results (Lais score 74%). Isokinetic testing showed a muscular deficit of less than 20% in 91% of the cases for flexion (extension 69%). No significant influence neither of the age of the patient nor the time period between trauma and operation on the outcome of the procedure could be found. No complications were reported. Based on our results and well aware of the deleterious long term effects of total meniscectomy the arthroscopic menical repair performed by an experienced surgeon should be generous choice of therapy for the treatment of the ruptured meniscus. PMID:18493462

  8. Pseudoaneurysm after arthroscopic procedure in the knee.

    PubMed

    Filho, Edmar Stieven; Isolani, Guilherme Rufini; Baracho, Filipe Ribas; de Oliveira Franco, Ana Paula Gebert; Ridder Bauer, Luiz Antônio; Namba, Mario

    2015-01-01

    The aim of this study was to review all cases of pseudoaneurysm in the literature, in predominantly arthroscopic procedures on the knee, and to report on a case of pseudoaneurysm that we treated. A bibliographic search was conducted for scientific articles published in Brazilian and foreign periodicals over the last 23 years. Forty-seven cases were found, in 40 articles. In addition to these 47 cases, there was the case that we treated, which was also included in the data. Among the operations that progressed with formation of a pseudoaneurysm, 60% were cases of meniscal injuries and 23%, anterior cruciate ligament injuries. In 46% of the cases, the artery affected with the popliteal, and in 21%, the inferomedial genicular artery. The commonest clinical symptom was pain (37%), followed by pulsating tumor (31%), edema of the calf (12%) and hemarthrosis (11%). The median time taken to make the diagnosis was 11 days, but it ranged from one day to 10 weeks after the procedure. Although rare, pseudoaneurysms are a risk that is inherent to arthroscopic surgery. All patients should be made aware of the vascular risks, even in small-scale procedures.

  9. Arthroscopic Anatomic Glenoid Reconstruction Without Subscapularis Split

    PubMed Central

    Wong, Ivan H.; Urquhart, Nathan

    2015-01-01

    The role of bone loss from the anterior glenoid in recurrent shoulder instability has been well established. We present a completely arthroscopic technique for reconstructing the anterior glenoid with distal tibial allograft and without a subscapularis split. We perform the arthroscopy in the lateral position. We measure and size an allograft distal tibial graft and place it arthroscopically. We use an inside-out medial portal to introduce the graft into the shoulder, passing it through the rotator interval and above the subscapularis. A double-cannula system is used to pass the graft, which is temporarily fixed with K-wires and held in place with cannulated screws. We then perform a Bankart-like repair of the soft tissues to balance the shoulder and augment our repair. Our technique is not only anatomic in the re-creation of the glenoid surface but also anatomic in the preservation of the coracoid and subscapularis tendon and repair of the capsulolabral complex. PMID:26697303

  10. Optimal management of shoulder impingement syndrome

    PubMed Central

    Escamilla, Rafael F; Hooks, Todd R; Wilk, Kevin E

    2014-01-01

    Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities. An effective nonoperative treatment for impingement syndrome is aimed at addressing the underlying causative factor or factors that are identified after a complete and thorough evaluation. The clinician devises an effective rehabilitation program to regain full glenohumeral range of motion, reestablish dynamic rotator cuff stability, and implement a progression of resistive exercises to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers. The clinician can introduce stresses and forces via sport-specific drills and functional activities to allow a return to activity. PMID:24648778

  11. Particle-Molecule Collection by Sonic Flow Impingers

    ERIC Educational Resources Information Center

    Jackson, Melbourne L.

    1974-01-01

    The theoretical basis of the sonic-flow impinger is discussed. Details are given for the design, prediction of performance, preliminary evaluation for particle collection, and field use of a sonic-flow impinger train. (DT)

  12. Subacromial impingement syndrome secondary to scapulothoracic dyskinesia.

    PubMed

    Han, Kyeong-Jin; Cho, Jae-Ho; Han, Seung-Hwan; Hyun, Hwan-Sub; Lee, Doo-Hyung

    2012-10-01

    The authors describe two cases of subacromial impingement syndrome of the shoulder secondary to scapular dyskinesia caused by a tumor in young adults. The two tumors, an osteochondroma and a ganglion, were located in the scapulothoracic joint and inhibited normal kinesis of the scapula during arm motion. PMID:22127513

  13. Shoulder Impingement Syndrome (Beyond the Basics)

    MedlinePlus

    ... activities: ● Swim ● Throw ● Play tennis ● Lift weights ● Play golf ● Play volleyball ● Do gymnastics ● Paint ● Stock shelves SHOULDER ... impingement, your healthcare provider will examine you to learn what movements elicit symptoms. As part of the ...

  14. Shoulder Impingement/Rotator Cuff Tendinitis

    MedlinePlus

    .org Shoulder Impingement/Rotator Cuff Tendinitis Page ( 1 ) One of the most common physical complaints is shoulder pain. Your shoulder is made up of several ... is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the ...

  15. Open Versus Arthroscopic Biceps Tenodesis: A Comparison of Functional Outcomes

    PubMed Central

    Duchman, Kyle R; DeMik, David E.; Uribe, Bastian; Wolf, Brian R; Bollier, Matthew

    2016-01-01

    Background The proximal aspect of the long head of the biceps brachii (LHB) is a frequent source of anterior shoulder pain. Multiple techniques for LHB tenodesis have been described. However, comparative outcomes are lacking. The present study aims to compare functional results, patient reported outcomes, complications, and clinical failures for patients undergoing open versus arthroscopic LHB tenodesis. Methods All patients who underwent open or arthroscopic LHB tenodesis from 2009-2012 at a single institution were identified. Patient demographics, comorbidities, and operative variables of interest, including concomitant procedures, were recorded. Minimum 1-year follow-up was required for inclusion. Outcomes, including patient reported outcomes, physical exam findings, and complications were compared between open and arthroscopic LHB tenodesis patients. Results Overall, 45 patients (25 open, 20 arthroscopic) were available for analysis. In total, there was a single clinical failure in a patient who underwent arthroscopic LHB tenodesis. No other complications or failures were noted. Active shoulder forward elevation was increased in the open tenodesis group as compared to the arthroscopic tenodesis group (177.8 ± 9.3° vs. 171.3 ± 11.7°; p = 0.049). Otherwise, there was no difference in range of motion or strength. For both groups, both the SF-36 and ASES scores improved significantly from preoperative values. Conclusion Both open and arthroscopic LHB tenodesis provide good to excellent outcomes with few complications. Given the recent increased utilization of LHB tenodesis, future studies should use randomization and prospective data collection in order to determine if discrete patient populations are better served by either open or arthroscopic LHB tenodesis techniques PMID:27528841

  16. Arthroscopic Treatment of FAI in Adolescent Athletes

    PubMed Central

    Byrd, J. W. Thomas; Jones, Kay S.

    2015-01-01

    Objectives: Athletic activities are implicated in the development of symptomatic FAI in adolescents as reflected by a high prevalence of sports participation among young individuals who present with this problem. The purpose of this study is to report the outcomes of arthroscopic treatment. Methods: All patients undergoing arthroscopy are prospectively assessed with a modified Harris hip score. 104 athletes (117 hips) were identified among 108 consecutive adolescents (122 hips) less than 18 years of age who had undergone arthroscopic surgery for FAI and had achieved minimum one-year follow-up. This cohort of athletes represents the substance of this report. Results: Follow-up averaged 28 months (range 12-60 months). Average age was 16 years (range 12-17 years). There were 47 males and 57 females. The average improvement was 22 points (preop 73; postop 95) with 113 hips (97 %) improved with 112 (96%) good & excellent results. Eighty-eight athletes (84%) returned to their sport. Among the 16 that did not return to sports, 5 were unable, 6 chose not, and 5 had completed their high school athletic careers. Most common sports were football 15, soccer 13, basketball 13, dance 11, volleyball 7, cross-country 7, swim 7, gymnastics 5, baseball 4, softball 4, and lacrosse 4. FAI correction was performed for 33 cam, 17 pincer, and 67 combined lesions. 107 labral tears underwent 82 refixations and 24 debridements. There were 99 acetabular chondral lesions (42 Grade I, 18 Grade II, 34 Grade III, 5 Grade IV) with four microfractures. There were 3 femoral chondral lesions (1 Grade II, 2 Grade III). Seven loose bodies were removed and 19 lesions of the ligamentum teres were debrided. Concomitant extra-articular procedures included 13 iliopsoas tendon releases, two iliotibial band tendoplasties, and one trochanteric bursectomy. There were two complications, transient pudendal neurapraxias, that resolved within two weeks. Four patients underwent repeat arthroscopy and one a PAO

  17. Experimental Droplet Impingement on Four Bodies of Revolution

    NASA Technical Reports Server (NTRS)

    Lewis, James P.; Ruggeri, Robert S.

    1957-01-01

    The rate and. area of cloud droplet impingement on four bodies of revolution were obtained experimentally in the NACA Lewis icing tunnel with a dye-tracer technique. The study included spheres, ellipsoidal forebodies of fineness ratios of 2.5 and 3.0, and a conical forebody of 300 included angle and covered a range of angles of attack from 0? to 60 and rotational speeds up to 1200 rpm. The data were obtained at an airspeed of 157 knots and are correlated by dimensionless impingement parameters. In general, the experimental data show that the local and total impingement rates and impingement limits of bodies of revolution are primarily functions of the modified inertia parameters, the body shape, and fineness ratio. Both the local impingement rate and impingement limits depend upon the angle of attack. Rotation of the bodies had a negligible effect on the impingement characteristics except for an averaging effect at angle of attack. For comparable diameters the bluffer bodies had the largest total impingement efficiency, but the finer and sharper bodies had the largest values of maximum local impingement efficiency and, in most cases, the largest limits of impingement. In most cases, the impingement characteristics were less than those calculated from theoretical trajectories; in general, however, fairly good agreement was obtained between the experimental and theoretical impingement characteristics.

  18. Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis.

    PubMed

    Dong, Wei; Goost, Hans; Lin, Xiang-Bo; Burger, Christof; Paul, Christian; Wang, Zeng-Li; Zhang, Tian-Yi; Jiang, Zhi-Chao; Welle, Kristian; Kabir, Koroush

    2015-03-01

    Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking. Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant-Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities. Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses. Exercise and other exercise-based therapies, such as kinesio taping, specific

  19. Arthroscopic subacromial decompression: two- to seven-year follow-up.

    PubMed

    Roye, R P; Grana, W A; Yates, C K

    1995-06-01

    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 rotator cuff tears, (2) in athletes and nonathletes, and (3) in throwers and nonthrowers. Patients were evaluated by (1) Neer's Criteria for Satisfactory Result, (2) the UCLA Shoulder RAting Scale, (3) the Shoulder and Elbow Surgeons Rating Scale, (4) a detailed questionnaire, and (5) patient satisfaction. In the follow-up group (n = 90), 80% met Neer's criteria for satisfactory result; 94% had satisfactory results by the UCLA Shoulder Scale; 95% had a satisfactory result by the Shoulder and Elbow Society Scale; and 93% of shoulder patients expressed satisfaction at follow-up. There were no statistically significant differences in function between the group without rotator cuff tear (n = 47) and the group with rotator cuff tear (n = 43). Satisfactory results were obtained in 68% of throwing athletes and in 90% of nonthrowing athletes (P < .05) by the Neer Rating, whereas only 50% of competitive baseball and softball pitchers had satisfactory results. Out impression is that ASD is an acceptable alternative to open anterior acromioplasty with comparable results for the treatment of the impingement lesion. There were no differences in result in patients who had a partial rotator cuff tear and those who had no tear.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. A navigation system for shoulder arthroscopic surgery.

    PubMed

    Tyryshkin, K; Mousavi, P; Beek, M; Ellis, R E; Pichora, D R; Abolmaesumi, P

    2007-10-01

    The general framework and experimental validation of a novel navigation system designed for shoulder arthroscopy are presented. The system was designed to improve the surgeon's perception of the three-dimensional space within the human shoulder. Prior to surgery, a surface model of the shoulder was created from computed tomography images. Intraoperatively, optically tracked arthroscopic instruments were calibrated. The surface model was then registered to the patient using tracked freehand ultrasound images taken from predefined landmark regions on the scapula. Three-dimensional models of the surgical instruments were displayed, in real time, relative to the surface model in a user interface. Laboratory experiments revealed only small registration and calibration errors, with minimal time needed to complete the intraoperative tasks. PMID:18019466

  1. Arthroscopic Reverse Remplissage for Posterior Instability.

    PubMed

    Lavender, Chad D; Hanzlik, Shane R; Pearson, Sara E; Caldwell, Paul E

    2016-02-01

    Posterior shoulder dislocation is an unusual injury often associated with electrical shock or seizure. As with anterior instability, patients frequently present with an impaction injury to the anterior aspect of the humeral head known as a "reverse Hill-Sachs lesion." The treatment of this bony defect is controversial, and multiple surgical procedures to fill the defect in an effort to decrease recurrence have been described. Most of the reports have focused on an open approach using variations of lesser tuberosity and subscapularis transfers, bone allograft, and even arthroplasty to assist with persistent instability. We advocate an arthroscopic technique that involves a suture anchor-based distal tenodesis of the subscapularis tendon or a reverse remplissage procedure. PMID:27073776

  2. A navigation system for shoulder arthroscopic surgery.

    PubMed

    Tyryshkin, K; Mousavi, P; Beek, M; Ellis, R E; Pichora, D R; Abolmaesumi, P

    2007-10-01

    The general framework and experimental validation of a novel navigation system designed for shoulder arthroscopy are presented. The system was designed to improve the surgeon's perception of the three-dimensional space within the human shoulder. Prior to surgery, a surface model of the shoulder was created from computed tomography images. Intraoperatively, optically tracked arthroscopic instruments were calibrated. The surface model was then registered to the patient using tracked freehand ultrasound images taken from predefined landmark regions on the scapula. Three-dimensional models of the surgical instruments were displayed, in real time, relative to the surface model in a user interface. Laboratory experiments revealed only small registration and calibration errors, with minimal time needed to complete the intraoperative tasks.

  3. Arthroscopic Reverse Remplissage for Posterior Instability

    PubMed Central

    Lavender, Chad D.; Hanzlik, Shane R.; Pearson, Sara E.; Caldwell, Paul E.

    2016-01-01

    Posterior shoulder dislocation is an unusual injury often associated with electrical shock or seizure. As with anterior instability, patients frequently present with an impaction injury to the anterior aspect of the humeral head known as a “reverse Hill-Sachs lesion.” The treatment of this bony defect is controversial, and multiple surgical procedures to fill the defect in an effort to decrease recurrence have been described. Most of the reports have focused on an open approach using variations of lesser tuberosity and subscapularis transfers, bone allograft, and even arthroplasty to assist with persistent instability. We advocate an arthroscopic technique that involves a suture anchor–based distal tenodesis of the subscapularis tendon or a reverse remplissage procedure. PMID:27073776

  4. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes.

    PubMed

    Page, Phil

    2011-03-01

    Subacromial impingement is a frequent and painful condition among athletes, particularly those involved in overhead sports such as baseball and swimming. There are generally two types of subacromial impingement: structural and functional. While structural impingement is caused by a physical loss of area in the subacromial space due to bony growth or inflammation, functional impingement is a relative loss of subacromial space secondary to altered scapulohumeral mechanics resulting from glenohumeral instability and muscle imbalance. The purpose of this review is to describe the role of muscle imbalance in subacromial impingement in order to guide sports physical therapy evaluation and interventions.

  5. Gas turbine bucket with impingement cooled platform

    DOEpatents

    Jones, Raphael Durand

    2002-01-01

    In a turbine bucket having an airfoil portion and a root portion, with a substantially planar platform at an interface between the airfoil portion and root portion, a platform cooling arrangement including at least one bore in the root portion and at least one impingement cooling tube seated in the bore, the tube extending beyond the bore with an outlet in close proximity to a targeted area on an underside of the platform.

  6. An approximation technique for jet impingement flow

    SciTech Connect

    Najafi, Mahmoud; Fincher, Donald; Rahni, Taeibi; Javadi, KH.; Massah, H.

    2015-03-10

    The analytical approximate solution of a non-linear jet impingement flow model will be demonstrated. We will show that this is an improvement over the series approximation obtained via the Adomian decomposition method, which is itself, a powerful method for analysing non-linear differential equations. The results of these approximations will be compared to the Runge-Kutta approximation in order to demonstrate their validity.

  7. Nozzle cavity impingement/area reduction insert

    DOEpatents

    Yu, Yufeng Phillip; Itzel, Gary Michael; Osgood, Sarah Jane

    2002-01-01

    A turbine vane segment is provided that has inner and outer walls spaced from one another, a vane extending between the inner and outer walls and having leading and trailing edges and pressure and suction sides, the vane including discrete leading edge, intermediate, aft and trailing edge cavities between the leading and trailing edges and extending lengthwise of the vane for flowing a cooling medium; and an insert sleeve within at least one of the cavities and spaced from interior wall surfaces thereof. The insert sleeve has an inlet for flowing the cooling medium into the insert sleeve and has impingement holes defined in first and second walls thereof that respectively face the pressure and suction sides of the vane. The impingement holes of at least one of those first and second walls are defined along substantially only a first, upstream portion thereof, whereby the cooling flow is predominantly impingement cooling along a first region of the insert wall corresponding to the first, upstream portion and the cooling flow is predominantly convective cooling along a second region corresponding to a second, downstream portion of the at least one wall of the insert sleeve.

  8. Crater Formation Due to Lunar Plume Impingement

    NASA Technical Reports Server (NTRS)

    Marsell, Brandon

    2011-01-01

    Thruster plume impingement on a surface comprised of small, loose particles may cause blast ejecta to be spread over a large area and possibly cause damage to the vehicle. For this reason it is important to study the effects of plume impingement and crater formation on surfaces like those found on the moon. Lunar soil, also known as regolith, is made up of fine granular particles on the order of 100 microns.i Whenever a vehicle lifts-off from such a surface, the exhaust plume from the main engine will cause the formation of a crater. This crater formation may cause laterally ejected mass to be deflected and possibly damage the vehicle. This study is a first attempt at analyzing the dynamics of crater formation due to thruster exhaust plume impingement during liftoff from the moon. Though soil erosion on the lunar surface is not considered, this study aims at examining the evolution of the shear stress along the lunar surface as the engine fires. The location of the regions of high shear stress will determine where the crater begins to form and will lend insight into how big the crater will be. This information will help determine the probability that something will strike the vehicle. The final sections of this report discuss a novel method for studying this problem that uses a volume of fluid (VOF)ii method to track the movement of both the exhaust plume and the eroding surface.

  9. Circular and Elliptic Submerged Impinging Water Jets

    NASA Astrophysics Data System (ADS)

    Claudey, Eric; Benedicto, Olivier; Ravier, Emmanuel; Gutmark, Ephraim

    1999-11-01

    Experiments and CFD have been performed to study circular and elliptic jets in a submerged water jet facility. The tests included discharge coefficient measurement to evaluate pressure losses encountered in noncircular nozzles compared to circular ones. Three-dimensional pressure mappings on the impingement surface and PIV measurement of the jet mean and turbulent velocity have been performed at different compound impingement angles relative to the impingement surface and at different stand-off distances. The objective was to investigate the effect of the non-circular geometry on the flow field and on the impact region. The tests were performed in a close loop system in which the water was pumped through the nozzles into a clear Plexiglas tank. The Reynolds numbers were typically in the range of 250000. Discharge coefficients of the elliptic nozzle was somewhat lower than that of the circular jet but spreading rate and turbulence level were higher. Pressure mapping showed that the nozzle exit geometry had an effect on the pressure distribution in the impact region and that high-pressure zones were generated at specific impact points. PIV measurements showed that for a same total exit area, the elliptic jets affected a surface area that is 8the equivalent circular. The turbulence level in the elliptic jet tripled due to the nozzle design. Results of the CFD model were in good agreement with the experimental data.

  10. Unsteady pressures under impinging jets in crossflows

    NASA Astrophysics Data System (ADS)

    Knowles, K.; Bray, D.; Wilson, M. J.

    The flowfield surrounding single and twin jets impinging in a cross-flow has been investigated experimentally. Two regions of the flowfield are seen to be particularly unsteady: the ground vortex formed by separation of the wall jet in the cross-flow; and the fountain formed between two adjacent impinging jets. The ground vortex formed by twin (side-by-side) impingen jets is found to be even more unsteady than that due to a single jet. The unsteadiness has been quantified by ground plane pressure measurements. These have shown the fluctuations to be broadband in nature but with a low frequency hump. This confirms results from elsewhere using low speed jets. The present work also suggests that the peak amplitudes in ground plane pressure fluctuations occur either side of the vortex. There is, as yet, no evidence that the vortex fluctuations are fed by impinging jet instabilities. Nor does nozzle pressure ratio seem to have a direct effect on the spectrum of fluctuations.

  11. Arthroscopic Repair of Posterior Meniscal Root Tears

    PubMed Central

    Matheny, Lauren; Moulton, Samuel G.; Dean, Chase S.; LaPrade, Robert F.

    2016-01-01

    Objectives: The purpose of this study was to compare subjective clinical outcomes in patients requiring arthroscopic transtibial pullout repair for posterior meniscus root tears of the medial and lateral menisci. We hypothesized that improvement in function and activity level would be similar among patients undergoing lateral and medial meniscal root repairs. Methods: This study was IRB approved. All patients who underwent posterior meniscal root repair by a single orthopaedic surgeon were included in this study. Detailed operative data were documented at surgery. Patients completed a subjective questionnaire, including Lysholm score, Tegner activity scale, WOMAC, SF-12 and patient satisfaction with outcome, which were collected preoperatively and at a minimum of two years postoperatively. Failure was defined as any patient who underwent revision meniscal root repair or partial meniscectomy following the index surgery. Results: There were 50 patients (16 females, 34 males) with a mean age of 37.8 years (range, 16.6-65.7) and a mean BMI of 27.3 (range, 20.5-49.2) included in this study. Fifteen patients underwent lateral meniscus root repair and 35 patients underwent medial meniscus root repair. Three patients who underwent lateral meniscus root repair required revision meniscus root repair surgery, while no patients who underwent medial meniscus root repair required revision surgery (p=0.26). There was a significant difference in preoperative and postoperative Lysholm score (53 vs. 78) (p<0.001), Tegner activity scale (2.0 vs. 4.0) (p=0.03), SF-12 physical component subscale (38 vs. 50) (p=0.001) and WOMAC (36 vs. 8) (p<0.001) for the total population. Median patient satisfaction with outcome was 9 (range, 1-10). There was no significant difference in mean age between lateral and medial root repair groups (32 vs. 40) (p=0.12) or gender (p=0.19). There was no significant difference in gender between lateral and medial root repair groups (p=0.95). There was a

  12. Mucoid Degeneration of Posterior Cruciate Ligament with Secondary Impingement of Anterior Cruciate Ligament: A Rare Case Report

    PubMed Central

    Wang, Joon Ho; Jangir, Rajat R

    2015-01-01

    Introduction: Mucoid degeneration of cruciate ligament is well known entity, but symptomatic lesions are rare. It is even rarer to find a symptomatic posterior cruciate ligament mucoid degeneration than anterior cruciate ligament. Case Report: A 65-years-old female presented to our hospital complaining of pain in right knee joint on terminal extension since 6 months. On clinical examination, there was a flexion deformity of 5 degree and a further flexion of 150 degree with mild pain exacerbated by extension. MRI of the right knee joint showed a diffusely thickened posterior cruciate ligament (PCL) with increased intra ligamentous signal intensity on T2-weighted images. The arthroscopic findings of grossly thickened PCL with a yellowish hue are characteristic and the PCL was filled with a yellowish substance. We excised the yellowish substance from the PCL as precisely as possible not to damage the remaining PCL fiber (Limited Debulking). We did notchplasty of lateral wall and roof to accommodate the Anterior Cruciate Ligament and avoid impingement. Conclusion: Posterior cruciate ligament may enlarge significantly and may push the Anterior Cruciate Ligament in the notch and may lead to the anterior cruciate ligament (ACL) impingement symptoms. Partial Debulking of Posterior Cruciate Ligament and notchplasty is effective treatment with immediate postoperative pain relief and good functional results. PMID:27299097

  13. Ankle impingement syndromes: a review of etiology and related implications.

    PubMed

    Hess, Gregory William

    2011-10-01

    Ankle injuries are common occurrences in athletics involving and requiring extreme ranges of motion. Ankle sprains specifically occur with a 1 in 10,000 person rate in active individuals each day. If trauma is repetitive, the ankle structures have potential to experience secondary injury and dysfunction. Included in this category of dysfunction are both anterior and posterior ankle impingement syndromes where disruption of the bony structures, joint capsule, ligaments, and tendons typically occurs. Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion with the joint under a load. Ankle impingements can be classified according to what structures become involved both anteriorly and posteriorly. Osseous impingement, soft tissue impingement, impingement of the distal fascicle of anterior inferior tibiofibular ligament, and meniscoid lesions are all documented causes of ankle impingement. These changes tend to be brought about and exacerbated by extreme ranges of motion. Understanding various impingement types will better enable the clinician to prevent, identify, treat, and rehabilitate affected ankles. Acknowledging activities that predispose to ankle impingement syndrome will enhance prevention and recovery processes. Description of ankle impingement etiology and pathology is the objective of the current review.

  14. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair

    PubMed Central

    Yamakado, Kotaro

    2014-01-01

    Background Rotator-cuff surgery is well recognized to be a painful procedure. Objectives The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB]) following arthroscopic rotator-cuff repair (ARCR). Materials and methods This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB). The visual analog scale (at 6 hours and on the first, second, and third postoperative days) and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated. Results The respective visual analog scale scores (mm) obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73) before surgery, 9.1 and 19.4 (P=0.12) at 6 hours after surgery, 24.4 and 44.6 (P=0.019) on the first postoperative day, 19.4 and 40.4 (P=0.0060) on the second postoperative day, and 18.5 and 27.8 (P=0.21) on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020), respectively. Conclusion ca-SSNB was highly effective in controlling postoperative pain after ARCR. PMID:24982592

  15. [Rehabilitation after arthroscopic anterior cruciate ligament reconstruction].

    PubMed

    Smékal, D; Kalina, R; Urban, J

    2006-12-01

    Rehabilitation is an important part of therapy in patients who have had arthroscopic anterior cruciate ligament reconstruction. A well-designed rehabilitation program avoids potential graft damage and speeds up patients' return to their full function level. The course of rehabilitation depends on the type of surgery, mode of fixation and possible co-existing injury to the knee's soft tissues. The rehabilitation program presented here is based on the present-day knowledge of neurophysiological and biomechanical principles and is divided into five phases. In the pre-operative phase (I), the main objective is to prepare patients for surgery in terms of maximum muscle strength and range of motion. It also includes providing full information on the procedure. In the early post-operative phase (II) we are concerned with pain alleviation and reduction of knee edema. After suture removal we begin with soft techniques for the patella and post-operative physical therapy to reduce scarring. In the next post-operative phase (III) patients are able to walk with their full weight on the extremity operated on, and we continue doing exercises that improve flexor/extensor co-contraction. In this phase we also begin with exercises improving the patient's proprioceptive and sensorimotor functions. In the late post-operative phase (IV) we go on with exercises promoting proprioception of both lower extremities with the aim of increasing muscle control of the knee joints. In the convalescent phase (V) patients gradually return to their sports activities.

  16. Simulation of arthroscopic surgery using MRI data

    NASA Technical Reports Server (NTRS)

    Heller, Geoffrey; Genetti, Jon

    1994-01-01

    With the availability of Magnetic Resonance Imaging (MRI) technology in the medical field and the development of powerful graphics engines in the computer world the possibility now exists for the simulation of surgery using data obtained from an actual patient. This paper describes a surgical simulation system which will allow a physician or a medical student to practice surgery on a patient without ever entering an operating room. This could substantially lower the cost of medial training by providing an alternative to the use of cadavers. This project involves the use of volume data acquired by MRI which are converted to polygonal form using a corrected marching cubes algorithm. The data are then colored and a simulation of surface response based on springy structures is performed in real time. Control for the system is obtained through the use of an attached analog-to-digital unit. A remote electronic device is described which simulates an imaginary tool having features in common with both arthroscope and laparoscope.

  17. Meniscus repair: results of an arthroscopic technique.

    PubMed

    Barber, F A

    1987-01-01

    A prospective study of arthroscopically repaired peripheral meniscal tears in 24 patients (19 men and five women) was initiated in 1983. Two patients were lost to follow-up. Seventeen medial and five lateral tears were followed an average of 29 months (15-42 months) with 17 having clinically apparent healing (77%). Sixteen had ACL tears, 10 of which were stabilized. Thirteen of 16 stable knees healed their menisci (81%), whereas only 4 of 6 unstable knees had healed menisci (67%). Fifteen were acute tears repaired within 2 weeks of injury, and 7 were chronic tears. Four acutely repaired menisci failed. One lateral meniscus tore in the previously sutured site 12 months later, whereas 1 medial meniscus tore 24 months after repair in a new area associated with significant trauma. Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. No serious complications such as peroneal nerve or popliteal vascular damage occurred. Transient saphenous neuropraxia (22%) and posterior portal adhesions (9%) were temporary problems. The procedure is recommended only for the advanced arthroscopist, who is advised first to establish the anatomical relationships clearly by cadaver dissections.

  18. Arthroscopic bursectomy for recalcitrant trochanteric bursitis after hip arthroplasty.

    PubMed

    Van Hofwegen, Christopher; Baker, Champ L; Savory, Carlton G; Baker, Champ L

    2013-01-01

    This study evaluated the use of arthroscopic bursectomy for pain relief in patients with trochanteric bursitis after hip arthroplasty. In this retrospective case series of 12 patients undergoing arthroscopic treatment of recalcitrant trochanteric bursitis after hip arthroplasty, outcomes were assessed via phone interview with a numeric pain rating scale from 1 to 10 and were compared with preoperative pain ratings. Patients were asked the percentage of time they had painless hip function and whether they would have the surgery again. At an average 36-month follow-up (range, 4-85 months), the average numeric pain scale rating improved from 9.3 to 3.3. At an average of 62% of the time, patients had painless use of the hip. Ten of 12 patients in the study felt the pain relief gained was substantial enough to warrant having procedure again. In these patients, arthroscopic bursectomy was a viable option for patients with recalcitrant bursitis after hip arthroplasty. PMID:23628567

  19. Arthroscopic Labralization of the Hip: An Alternative to Labral Reconstruction

    PubMed Central

    Matsuda, Dean K.

    2014-01-01

    Labralization, which may be performed by open or arthroscopic means, may be an attractive alternative to hip labral reconstruction. By preserving the articular cartilage in the region of labral deficit with meticulous rim trimming, the resultant undermined free chondral margin (“pseudolabrum”) may immediately restore a fluid seal function and may theoretically enhance hip preservation. Arthroscopic hip labralization is a relatively simple and fast procedure without graft harvest morbidity. It may be performed in patients tolerating rim reduction with encouraging preliminary outcomes. PMID:24749033

  20. CO2 laser arthroscopy-through the arthroscope

    NASA Astrophysics Data System (ADS)

    Garrick, James G.

    1990-06-01

    Orthopedists have been among the last of the specialists to utilize lasers in surgery. Even today, laser usage in orthopedics is almost exclusively limited to arthroscopy procedures. Although other types of lasers have been approved for use in orthopedics, nearly all laser-assisted arthroscopic procedures have involved the carbon dioxide laser in the knee. These techniques involve skills and problems not previously encountered. In an attempt to simplify the usage and circumvent some of the problems, we describe a means of laser energy delivery through the arthroscope.

  1. Arthroscopic Recognition and Repair of the Torn Subscapularis Tendon

    PubMed Central

    Denard, Patrick J.; Burkhart, Stephen S.

    2013-01-01

    Although the subscapularis has historically received less attention than posterosuperior rotator cuff tears, repair of a torn subscapularis tendon is critically important to restoring anatomy and achieving the best functional outcome possible. Arthroscopic repair begins with proper recognition of the tear. A systematic approach can then be used to arthroscopically repair all types of subscapularis tendon tears, from partial tears to full-thickness tears, as well as those which are retracted and have adhesions medially. Subscapularis footprint restoration can be accomplished with a variety of repair techniques that must be matched to the extent of the tear and mobility of the tendon. PMID:24400185

  2. Meralgia Paresthetica and Femoral Acetabular Impingement: A Possible Association

    PubMed Central

    Ahmed, Aiesha

    2010-01-01

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Keywords Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies PMID:22043261

  3. Crystallization kinetics: A solution for geometrical impingement

    NASA Astrophysics Data System (ADS)

    Clemente, R. A.; Saleh, A. M.

    2002-04-01

    Starting from the wrong derivation by Erukhimovitch and Baram of an equation alternative to the classical Kolmogoroff-Johnson-Mehl-Avrami one for the transformed fraction in an infinite specimen, undergoing an isothermal first-order phase transformation, it is shown that a different exact solution of the geometrical problem of impingement can be obtained. Such solution is equivalent to the empirical one already presented by Austin and Rickett more than sixty years ago and allows to better fit experimental results for isothermal transformations. This also suggests that perhaps different statistical derivations could allow to reach the same result.

  4. Impinging jets in cross-flow

    NASA Astrophysics Data System (ADS)

    Knowles, K.; Bray, D.; Bailey, P. J.; Curtis, P.

    1992-02-01

    The present investigation of flowfields generated by the impingement of single and twin jets in cross-flows gives attention to the ground vortex position-defining parameters of cross-flow/nozzle velocities ratio, cross-flow boundary layer thickness, nozzle height, nozzle pressure ratio, vector angle, and nozzle splay (with both fixed and moving ground-planes). The results obtained indicate that the ground vortex moves away from the nozzle centerline as the ratio of cross-flow velocity to nozzle exit velocity is decreased. The positional rate of change, however, depends on other parameters. Self-similarity laws are proposed for the ground vortex and wall jet.

  5. Evaluation of Impingement Syndromes in the Overhead-Throwing Athlete

    PubMed Central

    Jobe, Christopher M.; Coen, Michael J.; Screnar, Pat

    2000-01-01

    Objective: We outline impingement entities, describe the history and physical examination, and provide an overview of treatment beyond that routinely used in glenohumeral and scapulothoracic dysfunction. Background: In the athlete, pain and dysfunction due to excessive overhead use or abnormal positioning of the shoulder is common and can result from multiple etiologies, including impingement syndromes. Primary, secondary, internal, and coracoid impingement have all been described. Description: These entities will be discussed, including pathology, evaluation, and treatment. Clinical Advantages: Incorporating a systematic evaluation and treatment of impingement syndromes optimizes care for the patient with shoulder pain. PMID:16558643

  6. Arthroscopic skills assessment and use of box model for training in arthroscopic surgery using Sawbones – “FAST” workstation

    PubMed Central

    Goyal, Saumitra; Radi, Mohamed Abdel; Ramadan, Islam Karam-allah; Said, Hatem Galal

    2016-01-01

    Purpose: Arthroscopic skills training outside the operative room may decrease risks and errors by trainee surgeons. There is a need of simple objective method for evaluating proficiency and skill of arthroscopy trainees using simple bench model of arthroscopic simulator. The aim of this study is to correlate motor task performance to level of prior arthroscopic experience and establish benchmarks for training modules. Methods: Twenty orthopaedic surgeons performed a set of tasks to assess a) arthroscopic triangulation, b) navigation, c) object handling and d) meniscus trimming using SAWBONES “FAST” arthroscopy skills workstation. Time to completion and the errors were computed. The subjects were divided into four levels; “Novice”, “Beginner”, “Intermediate” and “Advanced” based on previous arthroscopy experience, for analyses of performance. Results: The task performance under transparent dome was not related to experience of the surgeon unlike opaque dome, highlighting the importance of hand-eye co-ordination required in arthroscopy. Median time to completion for each task improved as the level of experience increased and this was found to be statistically significant (p < .05) e.g. time for maze navigation (Novice – 166 s, Beginner – 135.5 s, Intermediate – 100 s, Advance – 97.5 s) and the similar results for all tasks. Majority (>85%) of subjects across all the levels reported improvement in performance with sequential tasks. Conclusion: Use of the arthroscope requires visuo-spatial coordination which is a skill that develops with practice. This simple box model can reliably differentiate the arthroscopic skills based on experience and can be used to monitor progression of skills of trainees in institutions. PMID:27801643

  7. Sessile drop deformations under an impinging jet

    NASA Astrophysics Data System (ADS)

    Feng, James Q.

    2015-08-01

    The problem of steady axisymmetric deformations of a liquid sessile drop on a flat solid surface under an impinging gas jet is of interest for understanding the fundamental behavior of free surface flows as well as for establishing the theoretical basis in process design for the Aerosol direct-write technology. It is studied here numerically using a Galerkin finite-element method, by computing solutions of Navier-Stokes equations. For effective material deposition in Aerosol printing, the desired value of Reynolds number for the laminar gas jet is found to be greater than ~500. The sessile drop can be severely deformed by an impinging gas jet when the capillary number is approaching a critical value beyond which no steady axisymmetric free surface deformation can exist. Solution branches in a parameter space show turning points at the critical values of capillary number, which typically indicate the onset of free surface shape instability. By tracking solution branches around turning points with an arc-length continuation algorithm, critical values of capillary number can be accurately determined. Near turning points, all the free surface profiles in various parameter settings take a common shape with a dimple at the center and bulge near the contact line. An empirical formula for the critical capillary number for sessile drops with contact angle is derived for typical ranges of jet Reynolds number and relative drop sizes especially pertinent to Aerosol printing.

  8. Arthroscopic intervention in early hip disease.

    PubMed

    McCarthy, Joseph C; Lee, Jo-Ann

    2004-12-01

    Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship

  9. Arthroscopic intervention in early hip disease.

    PubMed

    McCarthy, Joseph C; Lee, Jo-Ann

    2004-12-01

    Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship

  10. An arthroscopic technique to treat the iliotibial band syndrome.

    PubMed

    Michels, F; Jambou, S; Allard, M; Bousquet, V; Colombet, P; de Lavigne, C

    2009-03-01

    Iliotibial band syndrome (ITBS) is an overuse injury mainly affecting runners. The initial treatment is conservative. Only, in recalcitrant cases surgery is indicated. Several open techniques have been described. The purpose of this study is to evaluate the results of a standardized arthroscopic technique for treatment of a resistant ITBS. Thirty-six athletes with a resistant ITBS were treated with a standardized arthroscopic technique, limited to the resection of lateral synovial recess. Thirty-three patients were available for follow-up (mean 2 years 4 months). Thirty-two patients (34 knees) had good or excellent results. All patients went back to sports after 3 months. In two patients a meniscal lesion was found, which required treatment. One patient with only a fair result had associated cartilage lesions of the femoral condyle. Our results show that arthroscopic treatment of resistant ITBS is a valid option with a consistently good outcome. In addition, this arthroscopic approach allows excluding or treating other intra-articular pathology.

  11. Arthroscopic Bone Graft Procedure for Anterior Inferior Glenohumeral Instability

    PubMed Central

    Taverna, Ettore; D'Ambrosi, Riccardo; Perfetti, Carlo; Garavaglia, Guido

    2014-01-01

    There are many described surgical techniques for the treatment of recurrent anterior shoulder instability. Numerous authors have performed anterior bone block procedures with good results for the treatment of anterior shoulder instability with glenoid bone loss. The benefits of using arthroscopic procedures for surgical stabilization of the shoulder include smaller incisions with less soft-tissue dissection, better visualization of the joint, better repair accessibility, and the best possible outcome for external rotation. We describe an arthroscopic anteroinferior shoulder stabilization technique with an iliac crest tricortical bone graft and capsulolabral reconstruction. It is an all-arthroscopic technique with the advantage of not using fixation devices, such as screws, but instead using special buttons to fix the bone graft. The steps of the operation are as follows: precise placement of a specific posterior glenoid guide that allows the accurate positioning of the bone graft on the anterior glenoid neck; fixation of the graft flush with the anterior glenoid rim using specific buttons under arthroscopic control; and finally, subsequent capsular, labral, and ligament reconstruction on the glenoid rim using suture anchors and leaving the graft as an extra-articular structure. PMID:25685669

  12. ANATOMIC STUDY OF THE PROXIMAL THIRD OF THE FEMUR: FEMOROACETABULAR IMPACT AND THE CAM EFFECT

    PubMed Central

    Labronici, Pedro José; Alves, Sergio Delmonte; da Silva, Anselmo Fernandes; Giuberti, Gilberto Ribeiro; de Azevedo Neto, Justino Nóbrega; Mezzalira Penedo, Jorge Luiz

    2015-01-01

    To analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. Methods: 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5mm of the head and neck junction and anteroposterior distance of the neck base. Results: we found that the impact subgroup presented a significantly larger junction diameter of 5mm (p = 0.0001) and cam-head (%) (p= 0.0001), while base-cam (%) (p = 0.0001) showed a significantly smaller diameter than the subgroup without impact. It was identified that cam-head (%) ≤ 80 e base-cam (%) ≤ 73 were identified as the optimal impact points. Conclusion: our study showed that the effect cam, caused by anatomical variations of the proximal femoral end focused the head-neck junction and base of the neck-junction head-neck. These rates can be predictive factors of the impact. PMID:26998462

  13. Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial.

    PubMed

    Nisar, Aamer; Morris, Matthew W J; Freeman, Jennifer V; Cort, Jonathan M; Rayner, Philip R; Shahane, Shantanu A

    2008-01-01

    Subacromial decompression surgery is associated with significant postoperative pain. We compared interscalene block (ISB) with subacromial bursa block (SBB). Sixty consecutive patients with subacromial impingement syndrome, scheduled for arthroscopic subacromial decompression surgery, were randomized into 3 groups receiving ISB (n = 19), SBB (n = 19), or no block (n = 15 [controls]). Patients with rotator cuff tears were excluded (n = 7). The postoperative consumption of morphine, time to the first bolus of morphine, oral analgesia, pain, sickness, and sedation scores were recorded. The pain scores in the ISB and SBB groups were lower than those in the control group in the first 12 hours postoperatively. The control group consumed more morphine (mean, 32.3 mg) compared with the SBB group (mean, 21.21 mg) and ISB group (mean, 14.00 mg) (P < .001). The time to first bolus was earlier in the control group (mean, 42.1 minutes) compared with both the SBB (mean, 92.6 minutes) and ISB (mean, 119.0 minutes) groups (P < .001). The oral analgesic intake was less in the SBB and ISB groups than in the controls (P = .004). Although ISB remains the gold standard, SBB provides effective, safe, and easily administered postoperative analgesia in patients with an intact rotator cuff undergoing arthroscopic subacromial decompression.

  14. Occult hemoglobin as an indicator of impingement stress in fishes

    SciTech Connect

    Not Available

    1980-01-01

    During the process of impingement on cooling system intake screens, fish may be subject to different types of stress, the total of which often results in the death of individual fish. This report assesses the use of occult hemoglobin in fish demand mucus as an indicator of impingement stress. (ACR)

  15. Round impinging jets with relatively large stand-off distance

    NASA Astrophysics Data System (ADS)

    Shademan, Mehrdad; Balachandar, Ram; Roussinova, Vesselina; Barron, Ron

    2016-07-01

    Large eddy simulation and particle image velocimetry measurements have been performed to evaluate the characteristics of a turbulent impinging jet with large nozzle height-to-diameter ratio (H/D = 20). The Reynolds number considered is approximately 28 000 based on the jet exit velocity and nozzle diameter. Mean normalized centerline velocity in both the free jet and impingement regions and pressure distribution over the plate obtained from simulations and experiments show good agreement. The ring-like vortices generated due to the Kelvin-Helmholtz instabilities at the exit of the nozzle merge, break down and transform into large scale structures while traveling towards the impingement plate. A Strouhal number of 0.63 was found for the vortices generated at the exit of the nozzle. However, this parameter is reduced along the centerline towards the impingement zone. A characteristic frequency was also determined for the large scale structures impinging on the plate. The expansion, growth, tilt, and three-dimensionality of the impinging structures cause dislocation of the impinging flow from the centerline, which is significantly larger when compared with flows having small H/D ratios. Contrary to the behavior of impinging jets with small stand-off distance, due to the loss of coherence, the large scale structures do not result in significant secondary vortices in the wall jet region and consequently less fluctuations were observed for wall shear stress.

  16. Arthroscopically Assisted Open Reduction-Internal Fixation of Ankle Fractures: Significance of the Arthroscopic Ankle Drive-through Sign.

    PubMed

    Schairer, William W; Nwachukwu, Benedict U; Dare, David M; Drakos, Mark C

    2016-04-01

    Standalone open reduction-internal fixation (ORIF) of unstable ankle fractures is the current standard of care. Intraoperative stress radiographs are useful for assessing the extent of ligamentous disruption, but arthroscopic visualization has been shown to be more accurate. Concomitant arthroscopy at the time of ankle fracture ORIF is useful for accurately diagnosing and managing syndesmotic and deltoid ligament injuries. The arthroscopic ankle drive-through sign is characterized by the ability to pass a 2.9-mm shaver (Smith & Nephew, Andover, MA) easily through the medial ankle gutter during arthroscopy, which is not usually possible with both an intact deltoid ligament and syndesmosis. This arthroscopic maneuver indicates instability after ankle reduction and fixation and is predictive of the need for further stabilization. Furthermore, when this sign remains positive after fracture fixation, it may guide the surgeon to further evaluate the adequacy of fixation for the possible need for further fixation of the syndesmosis or deltoid. We present the case of an ankle fracture managed with arthroscopy-assisted ORIF and describe the clinical utility of the arthroscopic ankle drive-through sign. PMID:27462542

  17. Multispecies impingement in a tropical power plant, Straits of Malacca.

    PubMed

    Azila, A; Chong, V C

    2010-07-01

    Marine organisms comprised about 70% of the total impinged materials by weight at water intake screens in the Kapar Power Station (KPS), Malaysia. The general groupings of 'fish', 'shrimp', 'crab', 'cephalopod' and 'others' contributed 26% (87 species), 65% (29), 2% (17), 2% (3) and 5% (42) of the total number of impinged organisms, respectively. In general, higher impingement occurred during spring tide, at nighttime and in shallow water. The glass perchlet, anchovies, ponyfishes, mojarra, catfishes, hairtail, scat and young croakers were the most vulnerable fishes. Vulnerable invertebrates included cephalopods, sea urchin, rockshells and jellyfishes, but penaeid shrimps were the most susceptible in terms of both mortality and body injury. Annually, KPS is estimated to kill 8.5 x 10(6) marine organisms (42 tons) by impingement. This amount, however, is minimal compared to commercial fishery harvests. Multispecies impingement at Malaysian power plants poses the problem of finding the best mitigation options for tropical situations.

  18. Regeneratively cooled transition duct with transversely buffered impingement nozzles

    SciTech Connect

    Morrison, Jay A; Lee, Ching-Pang; Crawford, Michael E

    2015-04-21

    A cooling arrangement (56) having: a duct (30) configured to receive hot gases (16) from a combustor; and a flow sleeve (50) surrounding the duct and defining a cooling plenum (52) there between, wherein the flow sleeve is configured to form impingement cooling jets (70) emanating from dimples (82) in the flow sleeve effective to predominately cool the duct in an impingement cooling zone (60), and wherein the flow sleeve defines a convection cooling zone (64) effective to cool the duct solely via a cross-flow (76), the cross-flow comprising cooling fluid (72) exhausting from the impingement cooling zone. In the impingement cooling zone an undimpled portion (84) of the flow sleeve tapers away from the duct as the undimpled portion nears the convection cooling zone. The flow sleeve is configured to effect a greater velocity of the cross-flow in the convection cooling zone than in the impingement cooling zone.

  19. Multispecies impingement in a tropical power plant, Straits of Malacca.

    PubMed

    Azila, A; Chong, V C

    2010-07-01

    Marine organisms comprised about 70% of the total impinged materials by weight at water intake screens in the Kapar Power Station (KPS), Malaysia. The general groupings of 'fish', 'shrimp', 'crab', 'cephalopod' and 'others' contributed 26% (87 species), 65% (29), 2% (17), 2% (3) and 5% (42) of the total number of impinged organisms, respectively. In general, higher impingement occurred during spring tide, at nighttime and in shallow water. The glass perchlet, anchovies, ponyfishes, mojarra, catfishes, hairtail, scat and young croakers were the most vulnerable fishes. Vulnerable invertebrates included cephalopods, sea urchin, rockshells and jellyfishes, but penaeid shrimps were the most susceptible in terms of both mortality and body injury. Annually, KPS is estimated to kill 8.5 x 10(6) marine organisms (42 tons) by impingement. This amount, however, is minimal compared to commercial fishery harvests. Multispecies impingement at Malaysian power plants poses the problem of finding the best mitigation options for tropical situations. PMID:20338631

  20. SHOULDER POSTERIOR INTERNAL IMPINGEMENT IN THE OVERHEAD ATHLETE

    PubMed Central

    Grant‐Nierman, Meggan; Lucas, Brennen

    2013-01-01

    Posterior internal impingement (PII) of the glenohumeral joint is a common cause of shoulder complex pain in the overhead athlete. This impingement is very different from standard outlet impingement seen in shoulder patients. Internal impingement is characterized by posterior shoulder pain when the athlete places the humerus in extreme external rotation and abduction as in the cocking phase of pitching or throwing. Impingement in this position occurs between the supraspinatus and or infraspinatus and the glenoid rim. Understanding regarding this pathology continues to evolve. Definitive understanding of precipitating factors, causes, presentation and methods of treatment have yet to be determined. A high index of suspicion should be used when attempting to make this diagnosis. This current concepts review presents the current thinking regarding pathophysiology, evaluation, and treatment of this condition. Level of Evidence: 5 PMID:23593557

  1. Instability and impingement in the athlete's shoulder.

    PubMed

    Ticker, J B; Fealy, S; Fu, F H

    1995-06-01

    The competitive athlete who participates in a sport requiring overhead motion depends on a shoulder with optimal function. An acute episode of injury or a gradual onset of symptoms in the shoulder can affect the athlete's ability to perform. An understanding of shoulder anatomy and function is essential, and an accurate diagnosis of the underlying pathology is critical for planning treatment options. The correct diagnosis may be less clear when the athlete presents with an insidious onset of shoulder pain. A detailed history and physical examination, as well as an evaluation of the overhead motion and onset of pain, is important when the diagnosis of instability or impingement is considered. Rehabilitation of the rotator cuff often succeeds in alleviating symptoms and restoring function. Surgery is considered when symptoms and diminished function persist despite appropriate nonoperative treatment. Operative repair or reconstruction must be anatomical in nature. Postoperative rehabilitation is equally important in this setting, and a motivated athlete helps to ensure success.

  2. Endoscopic Pubic Symphysectomy for Athletic Osteitis Pubis.

    PubMed

    Matsuda, Dean K; Sehgal, Bantoo; Matsuda, Nicole A

    2015-06-01

    Osteitis pubis is a common form of athletic pubalgia associated with femoroacetabular impingement. Endoscopic pubic symphysectomy was developed as a less invasive option than open surgical curettage for recalcitrant osteitis pubis. This technical note demonstrates the use of the anterior and suprapubic portals in the supine lithotomy position for endoscopic burr resection of pubic symphyseal fibrocartilage and hyaline endplates. Key steps include use of the suprapubic portal for burr resection of the posteroinferior symphysis and preservation of the posterior and arcuate ligaments. Endoscopic pubic symphysectomy is a minimally invasive bone-conserving surgery that retains stability and may be useful in the treatment of recalcitrant osteitis pubis or osteoarthritis. It nicely complements arthroscopic surgery for femoroacetabular impingement and may find broader application in this group of co-affected athletes.

  3. Turbine vane segment and impingement insert configuration for fail-safe impingement insert retention

    DOEpatents

    Burdgick, Steven Sebastian; Kellock, Iain Robertson

    2003-05-13

    An impingement insert sleeve is provided that is adapted to be disposed in a coolant cavity defined through a stator vane. The insert has a generally open inlet end and first and second pairs of diametrically opposed side walls, and at least one fail-safe tab defined at a longitudinal end of the insert for limiting radial displacement of the insert with respect to the stator vane.

  4. Acetabular Labral Tears in Patients with Sports Injury

    PubMed Central

    Kang, Chan; Cha, Soo-Min

    2009-01-01

    Background We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. Methods Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. Results The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. Conclusions In

  5. Arthroscopic Resection Arthroplasty of the Radial Column for SLAC Wrist

    PubMed Central

    Cobb, Tyson K.; Walden, Anna L.; Wilt, Jessica M.

    2014-01-01

    Background Symptomatic advanced scapholunate advanced collapse (SLAC) wrists are typically treated with extensive open procedures, including but not limited to scaphoidectomy plus four-corner fusion (4CF) and proximal row carpectomy (PRC). Although a minimally invasive arthroscopic option would be desirable, no convincing reports exist in the literature. The purpose of this paper is to describe a new surgical technique and outcomes on 14 patients who underwent arthroscopic resection arthroplasty of the radial column (ARARC) for arthroscopic stage II through stage IIIB SLAC wrists and to describe an arthroscopic staging classification of the radiocarpal joint for patients with SLAC wrist. Patients and Methods Data were collected prospectively on 17 patients presenting with radiographic stage I through III SLAC wrist who underwent ARARC in lieu of scaphoidectomy and 4CF or PRC. Fourteen patients (12 men and 2 women) subject to 1-year follow-up were included. The average age was 57 years (range 41 to 78). The mean follow-up was 24 months (range 12 to 61). Arthroscopic resection arthroplasty of the radial column is described for varying stages of arthritic changes of the radioscaphoid joint. Midcarpal resection was not performed. Results The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 66 preoperatively and 28 at final follow-up. The mean satisfaction (0 = not satisfied, 5 = completely satisfied) at final follow-up was 4.5 (range 3 to 5). The pain level (on 0–10 scale) improved from 6.6 to 1.3. The total arc of motion changed from 124° preoperatively to 142° postoperatively following an ARARC. Grip was 16 kg preoperatively and 18 kg postoperatively. Radiographic stages typically underestimated arthroscopic staging. Although four of our patients appeared to be radiographic stage I, all were found to have arthritis involving some or all of the radioscaphoid articulation at the time of arthroscopy. Clinical Relevance

  6. Experimental and Computational Study of Underexpanded Jet Impingement Heat Transfer

    NASA Technical Reports Server (NTRS)

    Rufer, Shann J.; Nowak, Robert J.; Daryabeigi, Kamran; Picetti, Donald

    2009-01-01

    An experiment was performed to assess CFD modeling of a hypersonic-vehicle breach, boundary-layer flow ingestion and internal surface impingement. Tests were conducted in the NASA Langley Research Center 31-Inch Mach 10 Tunnel. Four simulated breaches were tested and impingement heat flux data was obtained for each case using both phosphor thermography and thin film gages on targets placed inside the model. A separate target was used to measure the surface pressure distribution. The measured jet impingement width and peak location are in good agreement with CFD analysis.

  7. Editorial Commentary: Arthroscopic Debridement for Hip Dysplasia--The More Things Change, the More Things Stay the Same.

    PubMed

    Miller, G Klaud

    2016-02-01

    A systematic review of arthroscopic debridement versus open osteotomy for acetabular dysplasia documented essentially equivalent results; however, with much shorter follow-up and many fewer cases in the arthroscopic series. PMID:26814400

  8. Arthroscopic debridement and irrigation of periprosthetic total elbow infection.

    PubMed

    Mastrokalos, Dimitrios S; Zahos, Konstantinos A; Korres, Dimitrios; Soucacos, Panayotis N

    2006-10-01

    We report on a case of arthroscopic treatment of septic arthritis of the elbow joint in a 65-year-old man with an elbow endoprosthesis. Two months after arthroplasty of the elbow joint, the patient developed acute septic arthritis of the right elbow. Methicillin-sensitive Staphylococcus aureus was identified as the causative organism. Six days after the onset of symptoms, the patient was treated with a single arthroscopic procedure of the infected periprosthetic joint, including irrigation with 5 L of Ringer's lactate solution, debridement, and partial synovectomy with a 4.5-mm curved shaver. Intravenous antibiotic therapy was also used for 3 months including rifampicine and fucidic acid according to the intraoperative cultures. The acutely infected total elbow arthroplasty could be cured without removal of the endoprosthesis of the elbow. Ten months postoperatively, the patient remains free of symptoms and his blood rates are within normal limits.

  9. Three cases of septic arthritis following a recent arthroscopic procedure.

    PubMed

    Rowton, Joseph

    2013-01-01

    We report three cases of septic arthritis in patients who presented with a painful, swollen and supurative knee joint following a recent arthroscopic procedure, 8-15 days prior to attendance. In all three cases, patients presented with pain and swelling of the affected knee joint with discharge from the port sites. All were sent for washout of the affected joint and received intravenous antibiotic cover. Any patient presenting within 1 month of a recent arthroscopic procedure with pain and swelling of that joint should be presumed to have septic arthritis until proven otherwise. They must have urgent treatment in the form of joint washout and intravenous antibiotics, and receive 6 weeks oral antibiotics on discharge.

  10. Evaluation of arthroscopic treatment of posterior shoulder instability

    PubMed Central

    Garcia, José Carlos; Maia, Lucas Russo; Fonseca, Juliano Rocha; Zabeu, José Luís Amim; Garcia, Jesely Pereira Myrrha

    2015-01-01

    OBJECTIVE: To provide data for the analysis of arthroscopy as a method of surgical treatment for shoulder and discuss its actual indications and preliminary results. METHODS: We evaluated 15 patients submitted to reverse Bankart arthroscopic surgery. We used the UCLA (University of California at Los Angeles) score to measure the results before surgery and 12 months thereafter. RESULTS: The average UCLA score changed from 26.67±0.25 (SD 0.97) before surgery to 34.20±0.53 (SD 2.04) after surgery. The effectiveness of surgery was 93%. In five cases loose bodies were found. A patient undergoing remplissage was evaluated separately. The data did not change after 24 months post-surgery. CONCLUSION: The arthroscopic treatment of posterior shoulder instability and posterior dislocation of the shoulder has been proved feasible and results in our series followed the same trends as in the literature. Level of Evidence III, Transversal Retrospective Study. PMID:26207089

  11. Arthroscopic management of the contact athlete with instability.

    PubMed

    Harris, Joshua D; Romeo, Anthony A

    2013-10-01

    The shoulder is the most commonly dislocated joint in the body, with a greater incidence of instability in contact and collision athletes. In contact and collision athletes that have failed nonoperative treatment, the most important factors to consider when planning surgery are amount of bone loss (glenoid, humeral head); patient age; and shoulder hyperlaxity. Clinical outcomes, instability recurrence rate, and return to sport rate are not significantly different between arthroscopic suture anchor and open techniques. Lateral decubitus positioning with distraction and four portal (including seven-degree and 5-o’clock positions) techniques allow for 360-degree access to the glenoid rim, with placement of at least three sutures anchors below 3 o’clock for optimal results. In patients with significant glenoid bone loss (>20%-25%, inverted pear glenoid), open bone augmentation techniques are indicated and arthroscopic techniques are contraindicated. PMID:24079430

  12. Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder

    PubMed Central

    Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

    2014-01-01

    Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. Results: The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. Conclusions: According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid

  13. The Comprehensive Arthroscopic Management Procedure for Treatment of Glenohumeral Osteoarthritis

    PubMed Central

    Mook, William R.; Petri, Maximilian; Greenspoon, Joshua A.; Millett, Peter J.

    2015-01-01

    Younger, high-demand patients who are less suitable for joint replacement procedures are often affected by advanced glenohumeral osteoarthritis. There are several alternatives to total joint arthroplasty for the treatment of these patients. However, the outcomes of these procedures are less predictable and have limited durability. The comprehensive arthroscopic management procedure, which includes a combination of arthroscopic glenohumeral debridement, chondroplasty, synovectomy, loose body removal, humeral osteoplasty with excision of the goat's beard osteophyte, capsular releases, subacromial and subcoracoid decompressions, axillary nerve decompression, and biceps tenodesis, has been shown to reduce pain, improve function, and provide a predictable short-term joint-preserving option for patients with advanced glenohumeral osteoarthritis. A unique feature of the comprehensive arthroscopic management procedure is the indirect and direct decompression of the axillary nerve, which may explain the difference in outcomes with this technique compared with other approaches. Furthermore, the technique is technically demanding and associated with several notable pitfalls that are preventable when using the meticulous surgical technique detailed in this article and accompanying video. PMID:26697301

  14. Use of an Irrigation Pump System in Arthroscopic Procedures.

    PubMed

    Hsiao, Mark S; Kusnezov, Nicholas; Sieg, Ryan N; Owens, Brett D; Herzog, Joshua P

    2016-05-01

    Since its inception, arthroscopic surgery has become widely adopted among orthopedic surgeons. It is therefore important to have an understanding of the basic principles of arthroscopy. Compared with open techniques, arthroscopic procedures are associated with smaller incisions, less structural damage, improved intra-articular visualization, less pain in the immediate postoperative period, and faster recovery for patients. Pump systems used for arthroscopic surgery have evolved over the years to provide improved intraoperative visualization. Gravity flow systems were described first and are still commonly used today. More recently, automated pump systems with pressure or dual pressure and volume control have been developed. The advantages of automated irrigation systems over gravity irrigation include a more consistent flow, a greater degree of joint distention, improved visualization especially with motorized instrumentation, decreased need for tourniquet use, a tamponade effect on bleeding, and decreased operative time. Disadvantages include the need for additional equipment with increased cost and maintenance, the initial learning curve for the surgical team, and increased risk of extra-articular fluid dissection and associated complications such as compartment syndrome. As image quality and pump systems improve, so does the list of indications including diagnostic and treatment modalities to address intra-articular pathology of the knee, shoulder, hip, wrist, elbow, and ankle joints. This article reviews the current literature and presents the history of arthroscopy, basic science of pressure and flow, types of irrigation pumps and their functions, settings, applications, and complications. [Orthopedics. 2016; 39(3):e474-e478.].

  15. Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

    PubMed Central

    Cerlier, Alexandre; Gay, André-Mathieu; Levadoux, Michel

    2015-01-01

    Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. Arthrosynovial cyst resection, ganglion curettage, and bone grafting were performed arthroscopically. Pain had totally disappeared within 2 months after the operation in 100% of patients. The average hand grip strength was estimated at 100% compared with the opposite side, and articular ranges of motion were the same on both sides in 100% of cases. No complications were reported after surgery. On the basis of these results, arthroscopic treatment of intraosseous synovial ganglion cysts seems to be more efficient and helpful in overcoming the limitations of classic open surgery in terms of complications. PMID:26697314

  16. ARTHROSCOPIC TREATMENT OF POST-TRAUMATIC ELBOW STIFFNESS

    PubMed Central

    Júnior, Jose Carlos Garcia; Zabeu, Jose Luis Amim; Junior, Ivaldo Angelo Cintra; Mattos, Carlos Augusto; Myrrha, Jesely Pereira

    2015-01-01

    To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. Methods: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months afterwards and were rated using the Mayo elbow performance score (MEPS). Results: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3° and of MEPS, 85.4. Conclusion: Arthroscopic release might enable better intra-articular viewing and enhance the options for changing strategy during surgery, reducing surgical trauma and enabling early rehabilitation. This technique can reach similar or better results than open surgery. The disadvantages of arthroscopy are the long learning curve and higher cost of the procedure. Neurovascular complications are reported with both techniques. To avoid such problems, the protocol for portal construction must be rigorously followed. Arthroscopic release was shown to be a safe and effective option for achieving range-of-motion gains in cases of post-traumatic stiff elbow. PMID:27042641

  17. Use of an Irrigation Pump System in Arthroscopic Procedures.

    PubMed

    Hsiao, Mark S; Kusnezov, Nicholas; Sieg, Ryan N; Owens, Brett D; Herzog, Joshua P

    2016-05-01

    Since its inception, arthroscopic surgery has become widely adopted among orthopedic surgeons. It is therefore important to have an understanding of the basic principles of arthroscopy. Compared with open techniques, arthroscopic procedures are associated with smaller incisions, less structural damage, improved intra-articular visualization, less pain in the immediate postoperative period, and faster recovery for patients. Pump systems used for arthroscopic surgery have evolved over the years to provide improved intraoperative visualization. Gravity flow systems were described first and are still commonly used today. More recently, automated pump systems with pressure or dual pressure and volume control have been developed. The advantages of automated irrigation systems over gravity irrigation include a more consistent flow, a greater degree of joint distention, improved visualization especially with motorized instrumentation, decreased need for tourniquet use, a tamponade effect on bleeding, and decreased operative time. Disadvantages include the need for additional equipment with increased cost and maintenance, the initial learning curve for the surgical team, and increased risk of extra-articular fluid dissection and associated complications such as compartment syndrome. As image quality and pump systems improve, so does the list of indications including diagnostic and treatment modalities to address intra-articular pathology of the knee, shoulder, hip, wrist, elbow, and ankle joints. This article reviews the current literature and presents the history of arthroscopy, basic science of pressure and flow, types of irrigation pumps and their functions, settings, applications, and complications. [Orthopedics. 2016; 39(3):e474-e478.]. PMID:27135450

  18. Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

    PubMed

    Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

    2016-01-01

    Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears. PMID:26761928

  19. Analysis of Direct Costs of Outpatient Arthroscopic Rotator Cuff Repair.

    PubMed

    Narvy, Steven J; Ahluwalia, Avtar; Vangsness, C Thomas

    2016-01-01

    Arthroscopic rotator cuff surgery is one of the most commonly performed orthopedic surgical procedures. We conducted a study to calculate the direct cost of arthroscopic repair of rotator cuff tears confirmed by magnetic resonance imaging. Twenty-eight shoulders in 26 patients (mean age, 54.5 years) underwent primary rotator cuff repair by a single fellowship-trained arthroscopic surgeon in the outpatient surgery center of a major academic medical center. All patients had interscalene blocks placed while in the preoperative holding area. Direct costs of this cycle of care were calculated using the time-driven activity-based costing algorithm. Mean time in operating room was 148 minutes; mean time in recovery was 105 minutes. Calculated surgical cost for this process cycle was $5904.21. Among material costs, suture anchor costs were the main cost driver. Preoperative bloodwork was obtained in 23 cases, adding a mean cost of $111.04. Our findings provide important preliminary information regarding the direct economic costs of rotator cuff surgery and may be useful to hospitals and surgery centers negotiating procedural reimbursement for the increased cost of repairing complex tears.

  20. ARTHROSCOPIC TREATMENT OF CALCIFYING TENDINITIS OF THE ROTATOR CUFF

    PubMed Central

    Neto, Arnaldo Amado Ferreira; Trevizani, Cassio Silva; Benegas, Eduardo; Malavolta, Eduardo Angeli; Gracitelli, Mauro Emílio Conforto; Bitar, Alexandre Carneiro; Neto, Francisco José dos Santos

    2015-01-01

    To evaluate the clinical and radiographic results from arthroscopic surgical treatment of the rotator cuff in patients with calcifying tendinitis. Method: A retrospective study was conducted on twenty patients who underwent arthroscopic treatment for calcifying tendinitis of the shoulder between March 1999 and November 2005. Six patients were excluded due to loss of follow-up. The average follow-up period was 41.4 months. Eight patients (57%) were female and six (43%) were male. The right side was affected in 10 cases (71%) and the left in four cases (29%). Nine cases (64%) had calcification in the supraspinatus tendon, two (14%) in the infraspinatus tendon, and three (21%) in both tendons. Results: In all cases, resection of the calcium deposits was performed by means of a needle (Jelco® No. 14) in combination with curettage (mini-curette). Two shoulders (14%) underwent subacromial decompression, and one (7%) underwent excision of the distal clavicle. A tendon-tendon suture was performed in three shoulders (21%). None of the patients underwent tendon-bone reinsertion. The mean score obtained on the UCLA scale was 33 points (26-35), thus indicating that a majority of patients had good results. In the final radiographic evaluation, none of the patients showed signs of calcification. Conclusion: Arthroscopic treatment of calcifying tendinitis of the shoulder safely allows excision of the calcification, leading to good results in relation to shoulder pain and function. PMID:27022591

  1. Arthroscopic coracoclavicular ligament reconstruction using biologic and suture fixation.

    PubMed

    Pennington, William T; Hergan, David J; Bartz, Brian A

    2007-07-01

    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.

  2. Arthroscopic treatment of symptomatic type D medial plica.

    PubMed

    Uysal, Mustafa; Asik, Mehmet; Akpinar, Sercan; Ciftci, Feyyaz; Cesur, Necip; Tandogan, Reha N

    2008-12-01

    We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our series were classified as fenestrated (14 knees), torn (5 knees), or reduplicated (4 knees). Fibrotic changes in the plicae and degenerative changes on the medial femoral condyle were found in 16 knees Patellofemoral chondromalacia was present in three knees Arthroscopic partial resection was performed in all patients. Comparative Lysholm Knee Scale scores before and after surgery revealed a significant clinical improvement (pre-operative status, 67.19 +/- 8.05 vs. post-operative status, 90.57 +/- 9.80; P < 0.001). Type D medial plica should be considered as a possible cause of chronic knee pain. Arthroscopic partial resection of the plicae in symptomatic patients gives satisfactory results.

  3. Modified arthroscopic suture fixation of a displaced tibial eminence fracture.

    PubMed

    Lehman, Ronald A; Murphy, Kevin P; Machen, M Shaun; Kuklo, Timothy R

    2003-02-01

    This study describes a new arthroscopic method using a whip-stitch technique for treating a displaced type III tibial eminence fracture. A 12-year-old girl who sustained a displaced type III tibial eminence fracture was treated with arthroscopic fixation using the Arthrosew disposable suture device (Surgical Dynamics, Norwalk, CT) to place a whip stitch into the anterior cruciate ligament (ACL). The Arthrex ACL guide (Arthrex, Naples, FL) was used to reduce the avulsed tibial spine fragment. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee in 20 degrees of flexion. At 9 months, the patient has a full range of motion with normal Lachman and anterior drawer testing, and she has returned to competitive basketball. Radiographs show complete fracture healing. KT-1000 and isokinetic testing at 9-month follow-up show only minimal side-to-side differences. The Arthrosew device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the ACL, thus obviating arthrotomy and hardware placement. This technique also restores the proper length and tension to the ACL, and provides a simplified, reproducible method of treatment for this injury.

  4. Impact of impingement on the Hudson River white perch population

    SciTech Connect

    Barnthouse, L W; Van Winkle, W

    1980-01-01

    The impact of power plant impingement on the 1974 and 1975 year classes of the Hudson River white perch population is assessed using a simple model derived from Ricker's theory of fisheries dynamics. The impact of impingement is expressed in the model as the conditional mortality rate, rather than as the more commonly used exploitation rate. Since the calculated impact is sensitive to errors in the estimation of population size and total mortality, ranges of probable values of these quantities are used to compute upper and lower bounds on the fractional reduction in abundance of each year class. Best estimates of abundance and mortality are used to compute the conditional impingement mortality rate separately for each plant and month. The results are used to assess the relative impacts of white perch impingement at six Hudson River power plants and to identify the seasons during which the impact is highest.

  5. Impinging jet separators for liquid metal magnetohydrodynamic power cycles

    NASA Technical Reports Server (NTRS)

    Bogdanoff, D. W.

    1973-01-01

    In many liquid metal MHD power, cycles, it is necessary to separate the phases of a high-speed liquid-gas flow. The usual method is to impinge the jet at a glancing angle against a solid surface. These surface separators achieve good separation of the two phases at a cost of a large velocity loss due to friction at the separator surface. This report deals with attempts to greatly reduce the friction loss by impinging two jets against each other. In the crude impinging jet separators tested to date, friction losses were greatly reduced, but the separation of the two phases was found to be much poorer than that achievable with surface separators. Analyses are presented which show many lines of attack (mainly changes in separator geometry) which should yield much better separation for impinging jet separators).

  6. Two stage serial impingement cooling for isogrid structures

    SciTech Connect

    Lee, Ching-Pang; Morrison, Jay A.

    2014-09-09

    A system for cooling a wall (24) of a component having an outer surface with raised ribs (12) defining a structural pocket (10), including: an inner wall (26) within the structural pocket and separating the wall outer surface within the pocket into a first region (28) outside of the inner wall and a second region (40) enclosed by the inner wall; a plate (14) disposed atop the raised ribs and enclosing the structural pocket, the plate having a plate impingement hole (16) to direct cooling air onto an impingement cooled area (38) of the first region; a cap having a skirt (50) in contact with the inner wall, the cap having a cap impingement hole (20) configured to direct the cooling air onto an impingement cooled area (44) of the second region, and; a film cooling hole (22) formed through the wall in the second region.

  7. Shoulder Impingement Syndromes: Implications on Physical Therapy Examination and Intervention

    PubMed Central

    2005-01-01

    A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed. PMID:25792938

  8. A flash photographic method for droplet impingement studies

    SciTech Connect

    Hart, V.

    1999-07-01

    This paper describes an experimental method to visualize the impingement process of a liquid droplet onto a solid surface with sufficient clarity to reveal fine details of the droplet surface structure and rim jet produced during the impingement process. The method incorporates a 35 mm SLR camera with bellows, motor drive, macro lens, backlighting by a short duration flash lamp, diffusers and a commercially available timing control unit to trigger the flash. Results using the experimental arrangement are demonstrated for a water droplet striking a horizontal surface at a velocity of about 1 m/s, though the photographic method may be applied to any other condition and liquid. A series of photographs are presented that show the repeatability of the impingement process, image clarity, surface structure of the droplet during impingement.

  9. Plume Impingement Analysis for the European Service Module Propulsion System

    NASA Technical Reports Server (NTRS)

    Yim, John Tamin; Sibe, Fabien; Ierardo, Nicola

    2014-01-01

    Plume impingement analyses were performed for the European Service Module (ESM) propulsion system Orbital Maneuvering System engine (OMS-E), auxiliary engines, and reaction control system (RCS) engines. The heat flux from plume impingement on the solar arrays and other surfaces are evaluated. This information is used to provide inputs for the ESM thermal analyses and help determine the optimal configuration for the RCS engines.

  10. Impingement of buoyancy-driven flows at a stratified interface

    NASA Astrophysics Data System (ADS)

    Cotel, Aline J.; Kudo, Yuriko

    2008-07-01

    Laser-induced fluorescence (LIF) and particle-image velocimetry (PIV) are used to study both thermals and plumes impinging on a stratified interface. Data are obtained for a central slice of the flow near the stratified interface. Both the thermal and plume are generated by releasing fresh water at the bottom of a tank filled with two layers of salt water of different densities. Thermals and plumes are studied at Reynolds numbers ranging from 3,000 to 8,000, above the value for the mixing transition, a Schmidt number of about 600, and Richardson numbers from 1 to 22. The Richardson and Reynolds numbers are based on the thermal or plume characteristics (size and vertical velocity) before impingement and the initial density difference across the interface. Laser-induced fluorescence (LIF) is used to determine the maximum penetration height, rebound distance and lateral spreading velocity. The vorticity results obtained from the PIV data reveal the vortical structure near impingement. When the thermal impinges upon the stratified interface, a baroclinic eddy generated at the interface appears to merge with eddies comprising the thermal itself to form a vortex ring. This ring remains near the interface, moving mainly along the lateral or horizontal direction away from the region of impingement. These results suggest that lateral transport is significant for thermals impinging on stratified interfaces, and that ignoring such transport may greatly underestimate overall transport and mixing in such flows.

  11. Supersonic impinging jet noise reduction using a hybrid control technique

    NASA Astrophysics Data System (ADS)

    Wiley, Alex; Kumar, Rajan

    2015-07-01

    Control of the highly resonant flowfield associated with supersonic impinging jet has been experimentally investigated. Measurements were made in the supersonic impinging jet facility at the Florida State University for a Mach 1.5 ideally expanded jet. Measurements included unsteady pressures on a surface plate near the nozzle exit, acoustics in the nearfield and beneath the impingement plane, and velocity field using particle image velocimetry. Both passive control using porous surface and active control with high momentum microjet injection are effective in reducing nearfield noise and flow unsteadiness over a range of geometrical parameters; however, the type of noise reduction achieved by the two techniques is different. The passive control reduces broadband noise whereas microjet injection attenuates high amplitude impinging tones. The hybrid control, a combination of two control methods, reduces both broadband and high amplitude impinging tones and surprisingly its effectiveness is more that the additive effect of the two control techniques. The flow field measurements show that with hybrid control the impinging jet is stabilized and the turbulence quantities such as streamwise turbulence intensity, transverse turbulence intensity and turbulent shear stress are significantly reduced.

  12. Arthroscopic Rotator Cuff Repair Using the Undersurface Technique

    PubMed Central

    Rubenis, Imants; Lam, Patrick H.; Murrell, George A.C.

    2015-01-01

    Background: Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty. Purpose: To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress–style sutures from either the bursal side (n = 100) or undersurface (n = 165) of the supraspinatus tendon. Data were collected preoperatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L’Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using standardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair. Results: At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P < .001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21% for bursal side, 23% for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursal side and 20 minutes when performed from the undersurface (P < .001). Conclusion: Arthroscopic rotator cuff repair, whether performed from the subacromial space or glenohumeral joint, resulted in decreased levels of

  13. Osteoarthritis Classification Scales: Interobserver Reliability and Arthroscopic Correlation

    PubMed Central

    Wright, Rick W.; Ross, James R.; Haas, Amanda K.; Huston, Laura J.; Garofoli, Elizabeth A.; Harris, David; Patel, Kushal; Pearson, David; Schutzman, Jake; Tarabichi, Majd; Ying, David; Albright, John P.; Allen, Christina R.; Amendola, Annunziato; Anderson, Allen F.; Andrish, Jack T.; Annunziata, Christopher C.; Arciero, Robert A.; Bach, Bernard R.; Baker, Champ L.; Bartolozzi, Arthur R.; Baumgarten, Keith M.; Bechler, Jeffery R.; Berg, Jeffrey H.; Bernas, Geoffrey A.; Brockmeier, Stephen F.; Brophy, Robert H.; Bush-Joseph, Charles A.; Butler V, J. Brad; Campbell, John D.; Carpenter, James E.; Cole, Brian J.; Cooper, Daniel E.; Cooper, Jonathan M.; Cox, Charles L.; Creighton, R. Alexander; Dahm, Diane L.; David, Tal S.; DeBerardino, Thomas M.; Dunn, Warren R.; Flanigan, David C.; Frederick, Robert W.; Ganley, Theodore J.; Gatt, Charles J.; Gecha, Steven R.; Giffin, James Robert; Hame, Sharon L.; Hannafin, Jo A.; Harner, Christopher D.; Harris, Norman Lindsay; Hechtman, Keith S.; Hershman, Elliott B.; Hoellrich, Rudolf G.; Hosea, Timothy M.; Johnson, David C.; Johnson, Timothy S.; Jones, Morgan H.; Kaeding, Christopher C.; Kamath, Ganesh V.; Klootwyk, Thomas E.; Lantz, Brett A.; Levy, Bruce A.; Ma, C. Benjamin; Maiers, G. Peter; Mann, Barton; Marx, Robert G.; Matava, Matthew J.; Mathien, Gregory M.; McAllister, David R.; McCarty, Eric C.; McCormack, Robert G.; Miller, Bruce S.; Nissen, Carl W.; O’Neill, Daniel F.; Owens, LTC Brett D.; Parker, Richard D.; Purnell, Mark L.; Ramappa, Arun J.; Rauh, Michael A.; Rettig, Arthur; Sekiya, Jon K.; Shea, Kevin G.; Sherman, Orrin H.; Slauterbeck, James R.; Smith, Matthew V.; Spang, Jeffrey T.; Spindler, Kurt P.; Stuart, Michael J.; Svoboda, LTC Steven J.; Taft, Timothy N.; Tenuta, COL Joachim J.; Tingstad, Edwin M.; Vidal, Armando F.; Viskontas, Darius G.; White, Richard A.; Williams, James S.; Wolcott, Michelle L.; Wolf, Brian R.; York, James J.; Carey, James L.

    2014-01-01

    Background: Osteoarthritis of the knee is commonly diagnosed and monitored with radiography. However, the reliability of radiographic classification systems for osteoarthritis and the correlation of these classifications with the actual degree of confirmed degeneration of the articular cartilage of the tibiofemoral joint have not been adequately studied. Methods: As the Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) Group, we conducted a multicenter, prospective longitudinal cohort study of patients undergoing revision surgery after anterior cruciate ligament reconstruction. We followed 632 patients who underwent radiographic evaluation of the knee (an anteroposterior weight-bearing radiograph, a posteroanterior weight-bearing radiograph made with the knee in 45° of flexion [Rosenberg radiograph], or both) and arthroscopic evaluation of the articular surfaces. Three blinded examiners independently graded radiographic findings according to six commonly used systems—the Kellgren-Lawrence, International Knee Documentation Committee, Fairbank, Brandt et al., Ahlbäck, and Jäger-Wirth classifications. Interobserver reliability was assessed with use of the intraclass correlation coefficient. The association between radiographic classification and arthroscopic findings of tibiofemoral chondral disease was assessed with use of the Spearman correlation coefficient. Results: Overall, 45° posteroanterior flexion weight-bearing radiographs had higher interobserver reliability (intraclass correlation coefficient = 0.63; 95% confidence interval, 0.61 to 0.65) compared with anteroposterior radiographs (intraclass correlation coefficient = 0.55; 95% confidence interval, 0.53 to 0.56). Similarly, the 45° posteroanterior flexion weight-bearing radiographs had higher correlation with arthroscopic findings of chondral disease (Spearman rho = 0.36; 95% confidence interval, 0.32 to 0.39) compared with anteroposterior radiographs (Spearman rho = 0.29; 95

  14. Ultrasonography-assisted arthroscopic proximal iliotibial band release and trochanteric bursectomy.

    PubMed

    Weinrauch, Patrick; Kermeci, Sharon

    2013-01-01

    We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression. PMID:24400195

  15. Ultrasonography-assisted arthroscopic proximal iliotibial band release and trochanteric bursectomy.

    PubMed

    Weinrauch, Patrick; Kermeci, Sharon

    2013-01-01

    We describe arthroscopic iliotibial band release and trochanteric bursectomy assisted by intraoperative ultrasonography for accurate placement of arthroscopic portals and to ensure adequate decompression of the peritrochanteric space. We have found ultrasonography for endoscopic iliotibial band release a useful tool to assist with localizing the site and length of decompression.

  16. Simulating regolith ejecta due to gas impingement

    NASA Astrophysics Data System (ADS)

    Chambers, Wesley Allen; Metzger, Philip; Dove, Adrienne; Britt, Daniel

    2016-10-01

    Space missions operating at or near the surface of a planet or small body must consider possible gas-regolith interactions, as they can cause hazardous effects or, conversely, be employed to accomplish mission goals. They are also directly related to a body's surface properties; thus understanding these interactions could provide an additional tool to analyze mission data. The Python Regolith Interaction Calculator (PyRIC), built upon a computational technique developed in the Apollo era, was used to assess interactions between rocket exhaust and an asteroid's surface. It focused specifically on threshold conditions for causing regolith ejecta. To improve this model, and learn more about the underlying physics, we have begun ground-based experiments studying the interaction between gas impingement and regolith simulant. Compressed air, initially standing in for rocket exhaust, is directed through a rocket nozzle at a bed of simulant. We assess the qualitative behavior of various simulants when subjected to a known maximum surface pressure, both in atmosphere and in a chamber initially at vacuum. These behaviors are compared to prior computational results, and possible flow patterns are inferred. Our future work will continue these experiments in microgravity through the use of a drop tower. These will use several simulant types and various pressure levels to observe the effects gas flow can have on target surfaces. Combining this with a characterization of the surface pressure distribution, tighter bounds can be set on the cohesive threshold necessary to maintain regolith integrity. This will aid the characterization of actual regolith distributions, as well as informing the surface operation phase of mission design.

  17. Space Station flexible dynamics under plume impingement

    NASA Technical Reports Server (NTRS)

    Williams, Trevor

    1993-01-01

    Assembly of the Space Station requires numerous construction flights by the Space Shuttle. A particularly challenging problem is that of control of each intermediate station configuration when the shuttle orbiter is approaching it to deliver the next component. The necessary braking maneuvers cause orbiter thruster plumes to impinge on the station, especially its solar arrays. This in turn causes both overall attitude errors and excitation of flexible-body vibration modes. These plume loads are predicted to lead to CMG saturation during the approach of the orbiter to the SC-5 station configuration, necessitating the use of the station RCS jets for desaturation. They are also expected to lead to significant excitation of solar array vibrations. It is therefore of great practical importance to investigate the effects of plume loads on the flexible dynamics of station configuration SC-5 as accurately as possible. However, this system possesses a great many flexible modes (89 below 5 rad/s), making analysis time-consuming and complicated. Model reduction techniques can be used to overcome this problem, reducing the system model to one which retains only the significant dynamics, i.e. those which are strongly excited by the control inputs or plume disturbance forces and which strongly couple with the measured outputs. The particular technique to be used in this study is the subsystem balancing approach which was previously developed by the present investigator. This method is very efficient computationally. Furthermore, it gives accurate results even for the difficult case where the structure has many closed-spaced natural frequencies, when standard modal truncation can give misleading results. Station configuration SC-5 is a good example of such a structure.

  18. Impingement is not impingement: the case for calling it "Rotator Cuff Disease".

    PubMed

    McFarland, Edward G; Maffulli, Nicola; Del Buono, Angelo; Murrell, George A C; Garzon-Muvdi, Juan; Petersen, Steve A

    2013-07-01

    Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than "impingement" as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease. PMID:24367779

  19. Study of an under-expanded sonic impinging jet array

    NASA Astrophysics Data System (ADS)

    Lee, Joon Ho

    The under-expanded impinging jet is used in various situations, such as the launch of a rocket, the takeoff and landing of a vertical/short take off and landing aircraft, jet engine exhaust impingement, or the thrust vector control system of a solid rocket motor. It is also of considerable interest to study the fluid dynamics of jet impingement on a surface with respect to heat transfer. Past investigations of sonic or supersonic impinging jets were limited to only a single jet and were primarily concentrated on fluid mechanics phenomena. No results exist in the literature for an under-expanded sonic impinging jet array. The present study is focused on the fluid dynamics for an array of under-expanded sonic impinging jets with the ultimate objective being to study the understanding of the interaction between impinging jets and the effect of jet-to-jet spacing (s/d), jet-to-plate spacing (z/d), and the degree of under-expansion (P0/Pa). Schlieren videography was applied to study the variation of structures that dominate the supersonic impinging flow, such as the intercepting shock, reflected shock, normal disk, stand-off-plate shock, and stagnation bubble. A high frequency transducer was used to measure the pressure field of the fluid flow near the impingement surface. Test configurations included non-dimensional jet-to-plate heights from 1 to 10, non-dimensional jet-to-jet spacing of 2 and 4, and pressure ratios from 3.3 to 12.9. Jets with orifice diameter of 12.7 and 25.4 mm were used. The fluid dynamics of an under-expanded sonic jet array differ largely from a single jet at s/d = 2. Midway between jets and near each stagnation bubble region, the jet array shows higher values in surface pressure due to the jet interaction. Both a single jet and a jet array have the linear dependence between z/d for the location of the shock cell and transition from supersonic wall jet to subsonic wall jet. However, the jet array show the location of the shock cell is changing

  20. Supersonic moist air jet impingements on flat surface

    NASA Astrophysics Data System (ADS)

    Alam, Miah Md. Ashraful; Matsuo, Shigeru; Setoguchi, Toshiaki

    2010-02-01

    Pronounced aeroacoustic resonances are exhibited in the flowfield where a jet emerges from an orifice or a nozzle and impinges on a solid surface. One instance where such resonances are produced is in a high speed jet impingement, such as in the space launch vehicle systems, jet-engine exhaust impingement, and in the short take-off and vertical landing (STOVL) aircraft, etc. A highly unsteady flowfield leading to a drastic increase of noise level with very high dynamic pressure and thermal loads are noticed on nearby surfaces results dramatic lift loss, severe ground erosion and hot gas ingestion to the inlet in the jet engines. This highly unsteady behavior of the impinging jets is due to a feedback loop between the fluid and acoustic fields. In actual jet flow, the working gas may contain condensable gas such as steam or moist air. In these cases, the non-equilibrium condensation may occur at the region between nozzle exit and an object. The jet flow with non-equilibrium condensation may be quite different from that without condensation. Therefore, in this study, the effect of the non-equilibrium condensation of moist air on the axisymmetric under-expanded supersonic impinging jet on a vertical flat plate was investigated numerically.

  1. The Effect of Impingement on Transitional Behavior in Underexpanded Jets

    NASA Technical Reports Server (NTRS)

    Inman, Jennifer A.; Danehy, Paul M.; Nowak, Robert J.; Alderfer, David W.

    2009-01-01

    An investigation into the development of flow unsteadiness in impinging axisymmetric underexpanded jets has been conducted at NASA Langley Research Center. The study has examined the effect of an impingement target placed at various distances and angles on transitional behavior of such jets. Two nozzles, with exit Mach numbers of 1.0 and 2.6, were used in this investigation. Planar laser-induced fluorescence of nitric oxide (NO PLIF) has been used to identify flow unsteadiness and to image transitional and turbulent flow features. Measurements of the location of the onset of various degrees of unsteady flow behavior have been made using these PLIF images. Both qualitative and quantitative comparisons are presented to demonstrate the observed effects of impingement and flow parameters on the process of the transition to turbulence. The presence of the impingement target was found to significantly shorten the distance to transition to turbulence by up to a factor of approximately three, with closer targets resulting in slightly shorter distance to transition and turbulence. The location at which the flow first exhibits unsteadiness was found to have a strong dependence on the presence and location of key flow structures. This paper presents quantitative results on transition criteria for free and impinging jets.

  2. Arthroscopic Transosseous Rotator Cuff Repair: Technical Note, Outcomes, and Complications

    PubMed Central

    Black, Eric M.; Lin, Albert; Srikumaran, Uma; Jain, Nitin; Freehill, Michael T.

    2016-01-01

    The goal of this study was to review the authors’ initial experience with arthroscopic transosseous rotator cuff repair. Thirty-one patients with full-thickness rotator cuff tears underwent arthroscopic transosseous rotator cuff repair over a 15-month period. Preoperatively, demographics and subjective scores were recorded. Postoperatively, pain levels, subjective shoulder values, satisfaction scores, American Shoulder and Elbow Surgeons (ASES) scores, complications, and reoperations were noted with a minimum 2-year follow-up. The relationships between pre- and intraoperative variables and outcome scores were determined with univariate analysis. Average patient age was 56 years, and 23 patients (74%) were men. Twenty patients (65%) underwent primary rotator cuff repair, and 11 patients (35%) underwent revision repair. Average time to follow-up was 26 months. Average preoperative pain level and subjective shoulder value were 5.1 of 10 and 35%, respectively. Average postoperative scores included pain level of 0.9 of 10, subjective shoulder value of 84%, satisfaction score of 90.6 of 100, and ASES score of 86.3 of 100. There were 3 (9.7%) major and 2 (6%) minor complications. Patients undergoing revision rotator cuff repair had significantly worse outcomes (pain level, subjective shoulder value, ASES score; P<.05) compared with those undergoing primary repair, and cortical augmentation did not significantly affect outcome. Overall, outcomes after arthroscopic transosseous rotator cuff repair are good, although patients undergoing revision repair do not have the same outcomes as those undergoing primary cuff repair. The procedure is not without complications (9.7% major, 6% minor complications). Cortical augmentation may be used to supplement fixation, although it does not necessarily affect outcomes. Patients without such augmentation may be at increased risk for suture cutout through the bone. PMID:25970360

  3. Arthroscopic laser in intra-articular knee cartilage disorders

    NASA Astrophysics Data System (ADS)

    Nosir, Hany R.; Siebert, Werner E.

    1996-12-01

    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 achieve the desired treatment effect. Clinical studies to evaluating the role of the laser in different arthroscopic knee procedures, comparing to conventional techniques, showed that the overall outcome attains a momentous confidence level which is shifted to the side of the laser versus the conventional for all maneuvers, barring meniscectomy where there is not perceiving disparity between laser versus the conventional. Meniscectomy continues to be one of the most commonly performed orthopaedic procedures. Laser provides a single tool which can ablate and debride meniscal rims with efficiency and safety. Chondroplasty can also be accomplished with ease using defocused laser energy. Both lateral release and soft tissue cermilization benefit from the cutting effect of laser along with its hemostatic effect. Synovial reduction with a defocused laser is also easily accomplished. By one gadget, one can cut, ablate, smooth, coagulate, congeal and with authentic tissue depth control The future of laser arthroscopic surgery lies in its ability to weld or repair tissues. Our research study has shown that laser activated photoactive dyes can produce a molecular bonding of collagen fibers, and therefore a repair 'weld' can be achieved with both meniscal tissues and with articular cartilage lesions.

  4. FUNCTIONAL ASSESSMENT OF ARTHROSCOPIC REPAIR FOR RECURRENT ANTERIOR SHOULDER INSTABILITY

    PubMed Central

    de Almeida Filho, Ildeu Afonso; de Castro Veado, Marco Antônio; Fim, Márcio; da Silva Corrêa, Lincoln Vargas; de Carvalho Junior, Antônio Enéas Rangel

    2015-01-01

    Objective: To clinically and radiologically evaluate patients who underwent arthroscopic surgical treatment for anterior shoulder instability by means of the Bankart technique, using metal anchors. Methods: This was a retrospective study on 49 patients who underwent arthroscopic repair of anterior shoulder instability between 2002 and 2007. The patients were evaluated using the Carter-Rowe score and the Samilson and Prieto classification. The mean age at the time of surgery was 30 years. The mean length of follow-up was 42.7 months (ranging from 18 to 74). 85% of the patients were male. Results: The mean Carter-Rowe score was 83 points (ranging from 30 to 100) including 31 excellent results, 7 good, 3 fair and 8 poor. Recurrent dislocation was observed in 16% (8 patients), and 37.5% of them were of traumatic origin. Joint degeneration was present in 32.5% of the cases, including 5 cases of grade 1, 6 cases of grade 2 and 2 cases of grade 3. The average loss of external rotation was 12° and the loss of anterior elevation was 8°. There was a statistically significant relationship (p < 0.05) between arthritis and age at first dislocation, age at surgery and crackling. 92% of the patients reported high degrees of satisfaction after the procedure. Among the complications, there were two cases of stiff shoulder, one patient with prominence of the synthesis material and one case of anchor loosening. Conclusion: Arthroscopic repair of anterior shoulder instability using metal anchors was shown to be effective, with a low complication rate. PMID:27042624

  5. [The use of the Ho: YAG laser in arthroscopic surgery].

    PubMed

    Du, L; Gu, G; Chen, X

    1995-10-01

    From May 1993 to April 1994 we had performed 72 cases (total 84 joints) of arthroscopic operations with holmium laser. It included 12 bilateral knees, and single joints in the shoulder, elbow, wrist and ankle. We performed partial menisectomy, chondroplasy, partial synovectomy and lateral retinacular release. The energy used was from 1 to 12kJ depending the complexity of the operations. All these cases had been followed up 6 to 16 months. The function of the joints was good, only two cases had joint effusion. The rate of good and excellent results was 97%.

  6. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

  7. Arthroscopic Knotless Peripheral Ulnar-Sided TFCC Repair

    PubMed Central

    Geissler, William B.

    2015-01-01

    This article describes the indications and technique for all-arthroscopic knotless repair of a peripheral tear to the triangular fibrocartilage complex (TFCC). The advantage of this technique is that it allows repair of the articular disk back to the fovea of the ulna without any suture knots to irritate the patient. The learning curve is steep, but once learned, this technique can be performed very quickly and is faster. There are no knots to irritate the patient, and in the author's opinion, there is quicker pain relief than with other techniques. PMID:25945301

  8. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft. PMID:27656395

  9. Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder Instabilities.

    PubMed

    Field, Larry D; Ryu, Richard K N; Abrams, Jeffrey S; Provencher, Matthew

    2016-01-01

    Arthroscopic shoulder stabilization offers several potential advantages compared with open surgery, including the opportunity to more accurately evaluate the glenohumeral joint at the time of diagnostic assessment; comprehensively address multiple pathologic lesions that may be identified; and avoid potential complications unique to open stabilization, such as postoperative subscapularis failure. A thorough understanding of normal shoulder anatomy and biomechanics, along with the pathoanatomy responsible for anterior, posterior, and multidirectional shoulder instability patterns, is very important in the management of patients who have shoulder instability. The treating physician also must be familiar with diagnostic imaging and physical examination maneuvers that are required to accurately diagnose shoulder instability.

  10. Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears.

    PubMed

    Petri, Maximilian; Greenspoon, Joshua A; Millett, Peter J

    2015-12-01

    Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability. Promising clinical results have been reported in 1 case series of 23 patients, indicating that superior capsular reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. This article describes our preferred technique for arthroscopic superior capsule reconstruction. PMID:27284506

  11. Arthroscopic management of talar dome lesions using a transmalleolar approach.

    PubMed

    Grady, John; Hughes, David

    2006-01-01

    Surgical treatment of posteromedial talar dome lesions is frequently necessary for Berndt and Harty grade IV osteochondral defects and nondisplaced osteochondral fragments resistant to conservative modalities. When operative intervention is indicated, the approach and management can be complicated by the location and extent of the injury. The operative technique we advocate allows direct exposure of the lesion and minimizes damage to healthy articular cartilage and surrounding soft tissue. Use of a drill guide assists the surgeon in precisely placing a transmalleolar portal through the tibia for subchondral drilling of osteochondral defects when the lesions are inaccessible through traditional arthroscopic portals. PMID:16707640

  12. Arthroscopic Management of Osteochondral Lesions of the Talus.

    PubMed

    Grambart, Sean T

    2016-10-01

    Osteochondral fractures of the ankle are typically caused by traumatic injuries of the ankle. Repetitive trauma can lead to further cartilage damage with subsequent increasing size of the lesion, ultimately leading to severe cartilage disorder and degenerative arthritis of the ankle. Arthroscopic bone marrow stimulation has been shown to be a highly successful option for patients with small osteochondral lesions. Studies show a higher failure rate for larger lesions and cystic changes that disrupt the subchondral plate. The threshold size seems to be 150 mm(2). PMID:27599437

  13. Arthroscopic Management of Complications Following Total Ankle Replacement.

    PubMed

    Lui, Tun Hing; Roukis, Thomas S

    2015-10-01

    There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.

  14. Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair

    PubMed Central

    Flanagin, Brody A.; Garofalo, Raffaele; Lo, Eddie Y.; Feher, LeeAnne; Castagna, Alessandro; Qin, Huanying; Krishnan, Sumant G.

    2016-01-01

    Purpose: Arthroscopic transosseous (TO) rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless) rotator cuff repair technique. Materials and Methods: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless) rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM) was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student's t-test to compare the effect of other clinical characteristics on final outcome. Results: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001). Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES) score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%), good in 8 (7.3%), fair in 3 (2.8%), and poor in 3 (2.8%). There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy) compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of injury preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. Conclusions: Arthroscopic TO rotator cuff repair technique leads to

  15. Arthroscopic excision of a painful bipartite patella fragment.

    PubMed

    Carney, Joseph; Thompson, Darcy; O'Daniel, Joseph; Cassidy, Jeffrey

    2010-01-01

    Bipartite patella is an uncommon finding, with the majority of cases discovered incidentally on radiographs. Occasionally, bipartite patella can become painful through sports activities, overuse, or following an injury, and the large majority of these cases resolve with nonoperative treatment. However, for patients who do not respond to a prolonged course of nonoperative treatment, surgical options may be considered. We report a successful case of arthroscopic excision of a painful bipartite patella fragment in a 19-year-old male collegiate basketball player. A review of the literature is included.

  16. Rupture of the biceps tendon after arthroscopic thermal capsulorrhaphy.

    PubMed

    Hanypsiak, Bryan T; Faulks, Craig; Fine, Kenneth; Malin, Edward; Shaffer, Benjamin; Connell, Marc

    2004-07-01

    The use of thermal energy in the shoulder to tighten capsular tissues through collagen denaturation is well established. Although reported complication rates are low, the natural history of thermal manipulation to both target and collateral tissue is poorly defined. We report two cases of biceps tendon rupture after arthroscopic capsular shrinkage. Both patients were young, athletic men with normal long head biceps tendons at the time of surgery. Each patient experienced a complete tear of the long head with distal muscle retraction, resulting in a "Popeye" deformity, at 3 months postoperatively. One patient elected further surgery with biceps tenodesis. Both patients have returned to their athletic activities with minimal functional deficits.

  17. Imaging of Common Arthroscopic Pathology of the Ankle.

    PubMed

    Grambart, Sean T

    2016-10-01

    Arthroscopy of the ankle is used in the treatment and diagnosis of a spectrum of intra-articular pathology including soft tissue and osseous impingement, osteochondral lesions, arthrofibrosis, and synovitis. To help identify the correct pathology, imaging techniques are often used to aid the surgeon in diagnosing pathology and determining best treatment options. This article discusses the use of imaging in various ankle pathologies.

  18. Lateral patellofemoral impingement: a cause of treatable pain after TKA.

    PubMed

    Cercek, Robert; Jacofsky, David; Kieffer, Karen; Larsen, Bethany; Jacofsky, Marc

    2011-09-01

    Multiple etiologies may cause anterior knee pain after total knee arthroplasty. While prior studies have addressed component positioning and surgical technique, no series in the literature describes lateral patellofemoral impingement as a source of the pain. Over a 2-year period at our institution, 18 patients with 19 painful total knee arthroplasties were diagnosed with lateral patellofemoral impingement. All underwent revision surgery with either lateral facetectomy or revision of the patellar dome. These patients were followed with Knee Society scores for 1 year. Knee Society scores were significantly improved at 8 weeks, 16 weeks, and 1 year. Lateral patellofemoral impingement should always be considered in the differential diagnosis of the painful total knee arthroplasty. This should be evaluated clinically through direct palpation of the lateral facet, and radiographically with the sunrise view. Lateral facetectomy or patellar revision can be performed with predictably good clinical results.

  19. Apollo video photogrammetry estimation of plume impingement effects

    NASA Astrophysics Data System (ADS)

    Immer, Christopher; Lane, John; Metzger, Philip; Clements, Sandra

    2011-07-01

    Future missions to the Moon may require numerous landings at the same site. Since the top few centimeters are loosely packed regolith, plume impingement from the Lander ejects the granular material at high velocities. Much work is needed to understand the physics of plume impingement during landing to protect hardware surrounding the landing sites. While mostly qualitative in nature, the Apollo Lunar Module landing videos can provide a wealth of quantitative information using modern photogrammetry techniques. The authors have used the digitized videos to quantify plume impingement effects of the landing exhaust on the lunar surface. The dust ejection angle from the plume is estimated at 1°-3°. The lofted particle density is estimated at 10 8-10 13 particles/m 3. Additionally, evidence for ejection of large 10-15 cm sized objects and a dependence of ejection angle on thrust are presented. Further work is ongoing to continue quantitative analysis of the landing videos.

  20. Apollo Video Photogrammetry Estimation of Plume Impingement Effects

    NASA Technical Reports Server (NTRS)

    Immer, Christopher; Lane, John; Metzger, Philip; Clements, Sandra

    2008-01-01

    Each of the six Apollo mission landers touched down at unique sites on the lunar surface. Aside from the Apollo 12 landing site located 180 meters from the Surveyor III lander, plume impingement effects on ground hardware during the landings were largely not an issue. The Constellation Project's planned return to the moon requires numerous landings at the same site. Since the top few centimeters are loosely packed regolith, plume impingement from the lander ejects the granular material at high velocities. With high vacuum conditions on the moon (10 (exp -14) to 10 (epx -12) torr), motion of all particles is completely ballistic. Estimates from damage to the Surveyor III show that the ejected regolith particles to be anywhere 400 m/s to 2500 m/s. It is imperative to understand the physics of plume impingement to safely design landing sites for the Constellation Program.

  1. Impingement and Dislocation in Total HIP Arthroplasty: Mechanisms and Consequences

    PubMed Central

    Brown, Thomas D; Elkins, Jacob M; Pedersen, Douglas R; Callaghan, John J

    2014-01-01

    In contemporary total hip arthroplasty, instability has been a complication in approximately 2% to 5% of primary surgeries and 5% to 10% of revisions. Due to the reduction in the incidence of wear-induced osteolysis that has been achieved over the last decade, instability now stands as the single most common reason for revision surgery. Moreover, even without frank dislocation, impingement and subluxation are implicated in a set of new concerns arising with advanced bearings, associated with the relatively unforgiving nature of many of those designs. Against that backdrop, the biomechanical factors responsible for impingement, subluxation, and dislocation remain under-investigated relative to their burden of morbidity. This manuscript outlines a 15-year program of laboratory and clinical research undertaken to improve the scientific basis for understanding total hip impingement and dislocation. The broad theme has been to systematically evaluate the role of surgical factors, implant design factors, and patient factors in predisposing total hip constructs to impinge, sublux, and/or dislocate. Because this class of adverse biomechanical events had not lent itself well to study with existing approaches, it was necessary to develop (and validate) a series of new research methodologies, relying heavily on advanced finite element formulations. Specific areas of focus have included identifying the biomechanical challenges posed by dislocation-prone patient activities, quantifying design parameter effects and component surgical positioning effects for conventional metal-on-polyethylene implant constructs, and the impingement/dislocation behavior of non-conventional constructs, quantifying the stabilizing role of the hip capsule (and of surgical repairs of capsule defects), and systematically studying impingement and edge loading of hard-on-hard bearings, fracture of ceramic liners, confounding effects of patient obesity, and subluxation-mediated worsening of third body

  2. A stochastic model for particle impingements on orbiting spacecraft

    NASA Technical Reports Server (NTRS)

    Howell, L. W., Jr.

    1986-01-01

    A general methodology for simulating particle impingements on orbiting spacecraft is developed. Major steps in the modeling process are presented as (1) modeling objective, (2) construction of the spacecraft geometrical model, (3) simulation of the particles in the space environment, (4) particle impact and subsequent events of interest, and (5) results of the simulation. A simulation of the expected meteoroid impingements on the Hubble Space Telescope and the resulting angular momentum transfers which can cause telescope pointing disturbances is given to illustrate these methods.

  3. Cold plate with combined inclined impingement and ribbed channels

    SciTech Connect

    Parida, Pritish R.

    2015-12-22

    Heat transfer devices and methods for making the same that include a first enclosure having at least one inlet port; a second enclosure having a bottom plate and one or more dividing walls to establish channels, at least one internal surface of each channel having rib structures to create turbulence in a fluid flow; and a jet plate connecting the first enclosure and the second enclosure having impinging jets that convey fluid from the first enclosure to the channels, said impinging jets being set at an angular deviation from normal to cause local acceleration of fluid and to increase a local heat transfer rate.

  4. Arthroscopic Trans-osseous Suture of Peripheral Triangular Fibrocartilage Complex Tear.

    PubMed

    Jegal, Midum; Heo, Kang; Kim, Jong Pil

    2016-10-01

    The importance of foveal repair of the triangular fibrocartilage complex (TFCC) on stability of the distal radioulnar joint (DRUJ) has been emphasized with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Although both open and arthroscopic techniques have been described for improving DRUJ stability, there has been a marked evolution of arthroscopic TFCC repair technique with successful clinical outcome. Recently, an arthroscopic trans-osseous technique has been described to repair foveal tears of the TFCC. The advantage of the technique is that it allows for anatomical repair of both the superficial and deep layers. This article describes the details of this novel technique. PMID:27595945

  5. Arthroscopic Fixation of Glenoid Rim Fractures After Reduction by Labral Repair.

    PubMed

    Voleti, Pramod B; Camp, Christopher L; Sinatro, Alec L; Dines, Joshua S

    2016-04-01

    Surgical fixation of displaced, intra-articular glenoid fractures represents a clinical challenge. These fractures have traditionally been treated through open approaches to the glenohumeral joint; however, the morbidity associated with open surgery may be reduced with arthroscopic techniques. Previously described arthroscopic methods commonly use clamps and/or Kirschner wires to obtain and maintain provisional fixation. We describe our technique for minimally invasive, arthroscopic fixation of glenoid rim fractures using labral repair as an indirect reduction maneuver, followed by final fixation with an extra-articular screw. This method is safe, efficient, and reliable, and it can be used to approach a variety of intra-articular glenoid fractures. PMID:27462537

  6. Pseudomonas osteomyelitis of the proximal humerus after arthroscopic rotator cuff repair.

    PubMed

    Aydın, Nuri; Şirin, Evrim; Aydemir, Ahmet Nadir; Zengin, Gökhan

    2014-01-01

    A 59-year-old male patient was operated arthroscopically due to a rotator cuff tear. An early postoperative Pseudomonas aeruginosa infection was treated with early arthroscopic debridement and antibiotic therapy. The patient was lost to follow-up and presented to our clinic with Pseudomonas aeruginosa osteomyelitis after two years. Debridement was again performed and antibiotic-impregnated cement beads were filled into the cavity and taken out 6 weeks postoperatively. No findings of infection were observed at the patient's 2nd year follow-up. To our knowledge, this is the first case of Pseudomonas aeruginosa osteomyelitis of the shoulder after arthroscopic rotator cuff repair. PMID:25637735

  7. Arthroscopic management of the painful total elbow arthroplasty

    PubMed Central

    Bain, Gregory I

    2015-01-01

    Background Failure of total elbow arthroplasty is more common than after other major joint arthroplasties and is often a result of aseptic loosening, peri-prosthetic infection, fracture and instability. Infection can be a devastating complication, yet there are no established guidelines for the pre-operative diagnosis of total elbow peri-prosthetic infection. This is because pre-operative clinical, radiographic and biochemical tests are often unreliable. Methods Using three case examples, a standardized protocol for the clinical and arthroscopic assessment of the painful total elbow arthroplasty is described. This is used to provide a mechanical and microbiological diagnosis of the patient’s pain. Results There have been no complications resulting from the use of this technique in the three patients described, nor in any other patient to date. Conclusions The staged protocol described in the present study, utilizing arthroscopic assessment, has refined the approach to the painful total elbow arthroplasty because it directly influences the definitive surgical management of the patient. It is recommended that other surgeons follow the principles outlined in the present study when faced with this challenging problem. PMID:27583000

  8. Arthroscopic Bullet Removal from the Acetabulum (Hip Joint)

    PubMed Central

    Al-Asiri, Jamal; Wong, Ivan

    2012-01-01

    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. PMID:23741592

  9. Arthroscopic Thermal Capsular Shrinkage for Palmar Midcarpal Instability

    PubMed Central

    Hargreaves, David G.

    2014-01-01

    Background Arthroscopic capsular shrinkage has been previously used to stabilize major joints. This is the first series of its use in the wrist for palmar midcarpal instability (PMCI). Materials and Methods This is a medium-term retrospective review of 13 patients (15 wrists) at an average follow-up of 48 months postoperative. All patients were assessed with a functional questionnaire for instability and a Disabilities of the Arm, Shoulder, and Hand (DASH) score, as well as clinical examination. Description of Technique Arthroscopic capsular shrinkage was performed to the palmar and dorsal capsules of the radiocarpal and midcarpal joints using a bipolar thermal probe. All wrists were immobilized for 6 weeks post operation. Results 100% follow-up was achieved . All cases had an improvement in the frequency and severity of instability symptoms. The average DASH score was significantly reduced. There were no complications. The average loss of movement following the procedure was 15%. Conclusions The medium-term results show that wrist instability due to PMCI can be improved significantly by thermal capsular shrinkage with only a minimal amount of secondary stiffness. PMID:25097808

  10. Results of arthroscopic debridement of glenoid labral tears.

    PubMed

    Martin, D R; Garth, W P

    1995-01-01

    We studied the long-term results of a prospectively selected group of 24 patients with 12 anteroinferior and 12 posterior glenoid labral lesions; all patients had functional instability but none had ligamentous detachment. After arthroscopic debridement, patients involved in throwing sports were not allowed to return to full athletic activity until full strength of the external rotators was achieved and documented on isokinetic evaluation. Followup was 36 to 72 months with an average of 48 months. Follow-up isokinetic evaluation revealed an average +4.4% and +8.6% concentric strength and -4.3% and -0.4% eccentric strength of the operated shoulder compared with the uninvolved shoulder at 90 and 180 deg/sec, respectively. Long-term good or excellent results were achieved in 21 patients, and 16 were functioning at their preinjury level of sports activities. Sixty-two percent of baseball pitchers were unimpaired in pitching. The average University of California Los Angeles shoulder rating score was 31 of 35 (11 excellent, 10 good, and 3 poor) and the average Rowe-Zarins ratings scale was 85 of 100 (8 excellent, 13 good, and 3 poor). These results justify an initial arthroscopic debridement of anteroinferior or posterior labral flap tears rather than capsulorrhaphy when there is no gross instability or Bankart lesion.

  11. Change in Driving Performance following Arthroscopic Shoulder Surgery.

    PubMed

    Hasan, S; McGee, A; Weinberg, M; Bansal, A; Hamula, M; Wolfson, T; Zuckerman, J; Jazrawi, L

    2016-08-01

    The current study aimed to measure perioperative changes in driving performance following arthroscopic shoulder surgery using a validated driving simulator.21 patients who underwent arthroscopic surgery for rotator cuff or labral pathology were tested on a driving simulator preoperatively, and 6 and 12 weeks postoperatively. An additional 21 subjects were tested to establish driving data in a control cohort. The number of collisions, centerline crossings, and off-road excursions were recorded for each trial. VAS and SPADI scores were obtained at each visit.The mean number of collisions in the study group significantly increased from 2.05 preoperatively to 3.75 at 6 weeks (p<0.001), and significantly decreased to 1.95 at 12 weeks (p<0.001). Centerline crossings and off-road excursions did not significantly change from preoperative through 12 weeks, although centerline crossings were statistically different from the controls at each time point (p<0.001). Surgery on the dominant driving arm resulted in greater collisions at 6 weeks than surgery on the non-dominant driving arm (p<0.001).Preliminary data shows that driving performance is impaired for at least 6 weeks postoperatively, with a return to normal driving by 12 weeks. Driving is more profoundly affected in conditions that require avoiding a collision and when the dominant driving arm is involved. PMID:27487432

  12. Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

    PubMed Central

    Mihata, Teruhisa; Lee, Thay Q.; Itami, Yasuo; HASEGAWA, Akihiko; Ohue, Mutsumi; Neo, Masashi

    2016-01-01

    Objectives: An arthroscopic superior capsule reconstruction, in which the fascia lata autograft attached medially to the superior glenoid and laterally to the greater tuberosity, restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function specifically deltoid muscle function and relieves pain. We assessed the clinical outcome of arthroscopic superior capsule reconstruction (Figure 1) in 100 consecutive patients with irreparable rotator cuff tears. Specifically, we focused on the rates of return to sport and work. Methods: From 2007 to 2014, we performed arthroscopic superior capsule reconstruction on 107 consecutive patients (mean 66.7 years; range, 43 to 82) with irreparable rotator cuff tears that had failed conservative treatment. Seven patients were lost to follow-up because of other medical problems or reasons. In the remaining 100 patients there were 56 supraspinatus and infraspinatus tears; 39 supraspinatus, infraspinatus, and subscapularis tears; 3 supraspinatus, infraspinatus, teres minor, and subscapularis tears; and 2 supraspinatus, infraspinatus, and teres minor tears. Physical examination, radiography, and MRI were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Rates of return to sport and work were also investigated in those patients who had been employed (34 patients: 21 manual workers, 10 farmers, 1 butcher, 1 cook, and 1 athletic trainer) or played sport (26 patients: 6 golf, 4 table tennis, 4 swimming, 3 martial arts, 2 baseball, 2 yoga, 1 tennis, 1 badminton, 1 skiing, 1 mountain-climbing, and 1 ground golf) before injury. Results: The average preoperative American Shoulder and Elbow Surgeons (ASES) score was 31.6 points (range, 3.3 to 63.3 points) and the average Japanese Orthopaedic Association (JOA) score was 51.6 points (26.5 to 68.5 points). Average postoperative clinical outcome scores all improved significantly at final

  13. Hip arthroscopy and osteoarthritis: Where are the limits and indications?

    PubMed Central

    Mella, Claudio; Villalón, Ignacio E.; Núñez, Álvaro; Paccot, Daniel; Díaz-Ledezma, Claudio

    2015-01-01

    The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage. PMID:27163082

  14. Corticosteroid Injections Versus Manual Physical Therapy for Treatment of the Shoulder Impingement Syndrome

    MedlinePlus

    ... Medicine Summaries for Patients Corticosteroid Injections Versus Manual Physical Therapy for Treatment of the Shoulder Impingement Syndrome The ... Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement ...

  15. Wetting and spreading behaviors of impinging microdroplets on textured surfaces

    NASA Astrophysics Data System (ADS)

    Kwon, Dae Hee; Lee, Sang Joon; CenterBiofluid and Biomimic Reseach Team

    2012-11-01

    Textured surfaces having an array of microscale pillars have been receiving large attention because of their potential uses for robust superhydrophobic and superoleophobic surfaces. In many practical applications, the textured surfaces usually accompany impinging small-scale droplets. To better understand the impinging phenomena on the textured surfaces, the wetting and spreading behaviors of water microdroplets are investigated experimentally. Microdroplets with diameter less than 50 μm are ejected from a piezoelectric printhead with varying Weber number. The final wetting state of an impinging droplet can be estimated by comparing the wetting pressures of the droplet and the capillary pressure of the textured surface. The wetting behaviors obtained experimentally are well agreed with the estimated results. In addition, the transition from bouncing to non-bouncing behaviors in the partially penetrated wetting state is observed. This transition implies the possibility of withdrawal of the penetrated liquid from the inter-pillar space. The maximum spreading factors (ratio of the maximum spreading diameter to the initial diameter) of the impinging droplets have close correlation with the texture area fraction of the surfaces. This work was supported by Creative Research Initiatives (Diagnosis of Biofluid Flow Phenomena and Biomimic Research) of MEST/KOSEF.

  16. A comprehensive analysis of cavitation and liquid impingement erosion data

    NASA Technical Reports Server (NTRS)

    Rao, P. V.; Young, S. G.

    1983-01-01

    Cavitation-erosion experimental data previously covering several materials tested in a rotating disk device and a magnetostriction apparatus were analyzed using new normalization and curve-fitting techniques. From this process a universal approach is derived which can include data from cavitation and liquid impingement studies for specific materials from different test devices.

  17. All-arthroscopic iliotibial band autograft harvesting and labral reconstruction technique.

    PubMed

    Deshmane, Prashant P; Kahlenberg, Cynthia A; Patel, Ronak M; Han, Brian; Terry, Michael A

    2013-02-01

    The labrum is essential for stability, movement, and prevention of arthritis in the hip. In cases of labral damage where repair of a labral tear is not possible, reconstruction can be a useful alternative. Several different autografts have been used, including the iliotibial band (ITB), the ligamentum teres capitis, and the gracilis tendon. Authors have reported both open and arthroscopic techniques for reconstruction with good preliminary results. However, an all-arthroscopic labral reconstruction technique including the graft harvest and reconstruction portions of a labral reconstruction procedure using an ITB autograft has not been previously described. We describe a technique for an all-arthroscopic labral reconstruction performed using a novel method for arthroscopic harvest of the ITB. The decreased invasiveness of our described technique for labral reconstruction may potentially minimize scarring, bodily disfigurement, infection, and postoperative pain associated with the graft harvesting incision.

  18. Arthroscopic Repair of Ankle Instability With All-Soft Knotless Anchors

    PubMed Central

    Pereira, Hélder; Vuurberg, Gwen; Gomes, Nuno; Oliveira, Joaquim Miguel; Ripoll, Pedro L.; Reis, Rui Luís; Espregueira-Mendes, João; Niek van Dijk, C.

    2016-01-01

    In recent years, arthroscopic and arthroscopically assisted techniques have been increasingly used to reconstruct the lateral ligaments of the ankle. Besides permitting the treatment of several comorbidities, arthroscopic techniques are envisioned to lower the amount of surgical aggression and to improve the assessment of anatomic structures. We describe our surgical technique for arthroscopic, two-portal ankle ligament repair using an all-soft knotless anchor, which is made exclusively of suture material. This technique avoids the need for classic knot-tying methods. Thus it diminishes the chance of knot migration caused by pendulum movements. Moreover, it avoids some complications that have been related to the use of metallic anchors and some currently available biomaterials. It also prevents prominent knots, which have been described as a possible cause of secondary complaints. PMID:27073785

  19. ARTHROSCOPIC TREATMENT OF ACROMIOCLAVICULAR JOINT DISLOCATION BY TIGHT ROPE TECHNIQUE (ARTHREX®)

    PubMed Central

    GÓmez Vieira, Luis Alfredo; Visco, Adalberto; Daneu Fernandes, Luis Filipe; GÓmez Cordero, Nicolas Gerardo

    2015-01-01

    Presenting the arthroscopic treatment by Tight Rope - Arthrex® system for acute acromioclavicular dislocation and to evaluate results obtained with this procedure. Methods: Between August 2006 and May 2007, 10 shoulders of 10 patients with acute acromioclavicular dislocation were submitted to arthroscopic repair using the Tight Rope - Arthrex® system. Minimum follow-up was 12 months, with a mean of 15 months. Age ranged from 26 to 42, mean 34 years. All patients were male. Radiology evaluation was made by trauma series x-ray. The patients were assisted in the first month weekly and after three months after the procedure. Clinical evaluation was based on the University of California at Los Angeles (UCLA) criteria. Results: All patients were satisfied after the arthroscopic procedure and the mean UCLA score was 32,5. Conclusion: The arthroscopic treatment by Tight Rope – Arthrex® system for acute acromioclavicular dislocation showed to be an efficient technique. PMID:26998453

  20. Result from arthroscopic surgical treatment of renewed tearing of the rotator cuff of the shoulder☆

    PubMed Central

    Godinho, Glaydson Gomes; França, Flávio de Oliveira; Freitas, José Márcio Alves; Santos, Flávio Márcio Lago; Prandini, Alexandre; Godinho, André Couto; Costa, Rafael Patrocínio de Paula

    2015-01-01

    Objectives To evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series) and compare this with function in patients without recurrence (control group); and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3 cm. Methods This was a retrospective evaluation of patients who underwent arthroscopic revision of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analog pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair. Results The size of the rotator cuff injury recurrence had a statistically significant influence on the result from the arthroscopic surgical treatment. The functional scores showed worse results than those from the first procedure. Conclusion Arthroscopic surgical treatment of renewed tearing of rotator cuff injuries showed worse functional scores than those from primary repair of the injury. PMID:26229900

  1. A comparison of radiographic, arthroscopic and histological measures of articular pathology in the canine elbow joint.

    PubMed

    Goldhammer, Marc A; Smith, Sionagh H; Fitzpatrick, Noel; Clements, Dylan N

    2010-10-01

    Validation of radiographic and arthroscopic scoring of joint pathology requires their comparison with histological measures of disease from the same joint. Fragmentation of the medial coronoid process (FMCP) is a naturally occurring disease of the canine elbow joint that results in osteoarthritis, and the objectives of this study were to compare the severity of histopathological changes in the medial coronoid process (MCP) and medial articular synovial membrane with gross radiographic scoring of elbow joint osteophytosis and the arthroscopic assessment of the MCP articular cartilage surface. Radiographic scoring of osteophytosis and the arthroscopic scoring of visual cartilage pathology of the MCP correlated moderately well with the histopathological evaluation of cartilage damage on the MCP and synovial inflammation in the medial part of the joint, but not with bone pathology in the MCP. Marked cartilage pathology on the MCP was identified in joints with either no radiographic evidence of osteophytosis or with mild cartilage damage that was evident arthroscopically.

  2. Arthroscopic rotator cuff repair with platelet-rich plasma (PRP) gel: a technical note.

    PubMed

    Jo, Chris Hyunchul

    2011-10-01

    Evidence suggesting that platelet-rich plasma (PRP) may have a potential for augmenting tissue healing has been growing recently. However, its local application technique has not been well established. Because of saline irrigation for keeping clear vision during arthroscopic procedures, it appears unreasonable to apply PRP in liquid form. We describe a technique of PRP gel application in arthroscopic rotator cuff repair. It does not require any special instruments nor a long additional time. It can be easily performed with routine arthroscopic instruments such as a regular knot pusher, a 5.5 mm metal cannula, and a regular 8.0 mm cannula. With this technique, the PRP gels could be accurately and reproducibly placed in the repair site without concerns of loss or tearing off during delivery under a direct vision without closing the inflow. We suggest that this technique could be useful for arthroscopic application of PRP gels.

  3. Can arthroscopic revision surgery for shoulder instability be a fair option?

    PubMed Central

    De Giorgi, Silvana; Garofalo, Raffaele; Tafuri, Silvio; Cesari, Eugenio; Rose, Giacomo Delle; Castagna, Alessandro

    2014-01-01

    Summary Background: the aim of this study was to evaluate the role of arthroscopic capsuloplasty in the treatment of failed primary arthroscopic treatment of glenohumeral instability. Methods: we retrospectively examined at a minimum of 3-years follow-up 22 patients who underwent arthroscopic treatment between 1999 and 2007 who had recurrent anterior shoulder instability with a post-surgical failure. A statistical analysis was performed to evaluate which variable could influence the definitive result and clinical outcomes at final follow-up. A p value of less than 0.05 was considered significant. Results: we observed after revision surgery an overall failure rate of 8/22 (36.4%) including frank dislocations, subluxations and also apprehension that seriously inhibit the patient's quality of life. No significant differences were observed in the examined parameters. Conclusions: according to our outcomes we generally do not recommend an arthroscopic revision procedure for failed instability surgery. PMID:25332940

  4. Arthroscopic Repair of Ankle Instability With All-Soft Knotless Anchors.

    PubMed

    Pereira, Hélder; Vuurberg, Gwen; Gomes, Nuno; Oliveira, Joaquim Miguel; Ripoll, Pedro L; Reis, Rui Luís; Espregueira-Mendes, João; Niek van Dijk, C

    2016-02-01

    In recent years, arthroscopic and arthroscopically assisted techniques have been increasingly used to reconstruct the lateral ligaments of the ankle. Besides permitting the treatment of several comorbidities, arthroscopic techniques are envisioned to lower the amount of surgical aggression and to improve the assessment of anatomic structures. We describe our surgical technique for arthroscopic, two-portal ankle ligament repair using an all-soft knotless anchor, which is made exclusively of suture material. This technique avoids the need for classic knot-tying methods. Thus it diminishes the chance of knot migration caused by pendulum movements. Moreover, it avoids some complications that have been related to the use of metallic anchors and some currently available biomaterials. It also prevents prominent knots, which have been described as a possible cause of secondary complaints. PMID:27073785

  5. Imaging of Common Arthroscopic Pathology of the Ankle.

    PubMed

    Grambart, Sean T

    2016-10-01

    Arthroscopy of the ankle is used in the treatment and diagnosis of a spectrum of intra-articular pathology including soft tissue and osseous impingement, osteochondral lesions, arthrofibrosis, and synovitis. To help identify the correct pathology, imaging techniques are often used to aid the surgeon in diagnosing pathology and determining best treatment options. This article discusses the use of imaging in various ankle pathologies. PMID:27599435

  6. Does Success Of Arthroscopic Laser Surgery In The Knee Joint Warrant Its Extension To "Non-Knee" Joints?

    NASA Astrophysics Data System (ADS)

    Smith, Chadwick F.; Johansen, W. Edward; Vangness, C. Thomas; Yamaguchi, Ken; McEleney, Emmett T.; Bales, Peter

    1987-03-01

    One of the authors has performed 162 arthroscopic laser surgeries in the knee joint without any major complication. Other investigators have recently proposed diagnostic arthroscopy and arthroscopic surgery for "non-knee" joints. The authors have proposed that arthroscopic laser surgery he extended to "non-knee" joints. The authors have performed arthroscopic laser surgery on "non-knee" joints of twelve cadavers. One of the authors have performed one successful arthroscopic surgery on a shoulder joint with only a minor, transient complication of subcutaneous emphysema. Is laser arthroscopic surgery safe and effective in "non-knee" joints? The evolving answer appears to be a qualified "Yes," which needs to be verified by a multicenter trial.

  7. All-Arthroscopic Technique for Reconstruction of Acute Acromioclavicular Joint Dislocations

    PubMed Central

    Cutbush, Kenneth; Hirpara, Kieran M.

    2015-01-01

    Acromioclavicular joint dislocations are a common injury particularly among contact sports players. There has been an increasing trend toward arthroscopic management of these injuries. To date, these reconstructions have primarily addressed superoinferior instability by reconstructing the coracoclavicular ligaments. We describe an all-arthroscopic technique for reconstruction of the coracoclavicular ligaments using Arthrex ABS TightRopes (Arthrex, Naples, FL), with additional stabilization of the superior acromioclavicular joint capsule using an anchor-based suture bridge to address anteroposterior instability. PMID:26697307

  8. Arthroscopic Autologous Chondrocyte Transplantation for Osteochondritis Dissecans of the Elbow.

    PubMed

    Patzer, Thilo; Krauspe, Ruediger; Hufeland, Martin

    2016-06-01

    Osteochondritis dissecans of the humeral capitellum is characterized by separation of a circumscript area of the articular surface and the subchondral bone in juvenile patients. In advanced lesions, arthroscopic fragment refixation or fragment removal with microfracturing or drilling can be successful. The purpose of this technical note is to describe an all-arthroscopic surgical technique for 3-dimensional purely autologous chondrocyte transplantation for osteochondral lesions of the humeral capitellum. PMID:27656389

  9. Arthroscopic autograft reconstruction of the inferior glenohumeral ligament: Exploration of technical feasibility in cadaveric shoulder specimens.

    PubMed

    Bouaicha, Samy; Moor, Beat K

    2013-01-01

    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.

  10. Rapid chondrolysis after arthroscopic partial lateral meniscectomy in athletes: a case report.

    PubMed

    Ishida, Kazunari; Kuroda, Ryosuke; Sakai, Hiroshige; Doita, Minoru; Kurosaka, Masahiro; Yoshiya, Shinichi

    2006-12-01

    We present a patient with a severe chondrolysis after arthroscopic partial lateral meniscectomy in a 17-year-old high school basketball player. This is a rare but severe complication after arthroscopic partial lateral meniscectomy. At 7 months after the first operation, a second-look arthroscopy showed numerous cartilaginous debris floating in the knee and a high-grade cartilage damage on the lateral compartment of the tibia. This unexpected complication and a consideration of its etiology are shown.

  11. EFFECT OF IMPACTION, BOUNCE AND REAEROSOLIZATION ON THE COLLECTION EFFICIENCY OF IMPINGERS

    EPA Science Inventory

    The collection efficiency of liquid impingers was studied experimentally as a function of the sampling flow rate with test particles in the bacterial size range. Three impingers were tested: two All-Glass Impingers(AGI-4 and AGI-30),widely used for bioaerosol sampling, and a newl...

  12. The 1991 version of the plume impingement computer program. Volume 1: Description

    NASA Technical Reports Server (NTRS)

    Bender, Robert L.; Somers, Richard E.; Prendergast, Maurice J.; Clayton, Joseph P.; Smith, Sheldon D.

    1991-01-01

    The objective of this contract was to continue development of a vacuum plume impingement evaluator to provide an analyst with a capability for rapid assessment of thruster plume impingement scenarios. The research was divided into three areas: Plume Impingement Computer Program (PLIMP) modification/validation; graphics development; and documentation in the form of a Plume Handbook and PLIMP Input Guide.

  13. Arthroscopic Microfracture for Osteochondritis Dissecans Lesions of the Capitellum.

    PubMed

    Camp, Christopher L; Dines, Joshua S; Degen, Ryan M; Sinatro, Alec L; Altchek, David W

    2016-06-01

    Capitellar osteochondritis dissecans (OCD) is one of the most common causes of elbow pain and dysfunction in adolescent athletes. It typically occurs in gymnasts and overhead throwers and presents along a wide spectrum of severity. Stable lesions can typically be treated with conservative therapy; however, those presenting with instability, fragmentation, or loose bodies generally require surgical intervention. Although there are a number of described surgical options used to treat capitellar OCD lesions, microfracture is one of the most commonly performed and well studied. Patients who are candidates for microfracture generally have favorable outcomes with high rates of return to athletic activity after postoperative rehabilitation. In this work, we present our preferred arthroscopic technique for microfracture of OCD lesions of the capitellum. This technique is most suitable for patients with unstable or fragmented OCD lesions that are less than 1 cm in diameter and do not violate the lateral-most articular margin of the capitellum. PMID:27656365

  14. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft.

    PubMed

    Trindade, Christiano A C; Sawyer, Gregory A; Fukui, Kiyokazu; Briggs, Karen K; Philippon, Marc J

    2015-02-01

    The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft.

  15. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft.

    PubMed

    Trindade, Christiano A C; Sawyer, Gregory A; Fukui, Kiyokazu; Briggs, Karen K; Philippon, Marc J

    2015-02-01

    The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft. PMID:25973378

  16. Open and arthroscopic surgical anatomy of the ankle.

    PubMed

    Frank, Rachel M; Hsu, Andrew R; Gross, Christopher E; Walton, David M; Lee, Simon

    2013-01-01

    Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

  17. All-inside arthroscopic suturing technique for meniscal ruptures.

    PubMed

    Darabos, Nikica; Dovzak-Bajs, Ivana; Bilić, Vide; Darabos, Anela; Popović, Iva; Cengić, Tomislav

    2012-03-01

    The most frequent indication for surgical treatment of the knee is lesion of the meniscus. The "all inside" arthroscopic technique with bioresorptive material for meniscus lesion is becoming the most popular treatment. This prospective study included 10 patients with posterior meniscal horn lesion operatively treated at Sports Traumatology Department. The "all inside" technique was performed by intra-articular application of bioresorptive pins-Darts sticks or Meniscus Viper and bioresorptive string. Patients were followed up for 2-6 months postoperatively and graded according to the IKDC 2000 scale. All surgical treatments showed satisfactory results. Young patients with acute longitudinal peripheral lesion-posterior horn lesions, in the red-red or red-white meniscal zone, 1-2 centimeters long are most appropriate for this type of treatment. In these patients, this technique proved to be superior and free from the risk of neurovascular damage. For better authentication of this conclusion, additional prospective randomized studies should be performed.

  18. Open and Arthroscopic Surgical Anatomy of the Ankle

    PubMed Central

    Frank, Rachel M.; Hsu, Andrew R.; Gross, Christopher E.; Walton, David M.

    2013-01-01

    Ankle-related complaints are among the most commonly encountered problems for musculoskeletal clinicians. Ankle pathology is widely variable, including, but not limited to, fractures, deformity, infection, oncologic diseases, neuromuscular conditions, and arthritis. While nonoperative management with activity modification, bracing and/or shoe modifications, and medications is usually indicated as first line of treatment, surgical intervention may become necessary. A thorough understanding of the complex anatomy and biomechanics of the ankle, and in particular, the potential neurovascular structures that may be encountered, is important to reduce complications and obtain good surgical outcomes. The purpose of this review is to discuss the most common open and arthroscopic exposures to the ankle with a focus on surgically relevant anatomy for each approach. PMID:24288614

  19. Bone-on-Bone versus Hardware Impingement in Total Hips: A Biomechanical Study

    PubMed Central

    Elkins, Jacob M.; Pedersen, Douglas R.; Callaghan, John J.; Brown, Thomas D.

    2012-01-01

    Dislocation remains a serious concern for total hip arthroplasty (THA). Impingement, typically between the implant femoral neck and the acetabular cup, remains the most common dislocation impetus. Wear reductions from recent bearing technology advancements have encouraged introduction of substantially increased femoral head diameters. However, there is some evidence that range of motion with larger head sizes is limited by bone-on-bone, rather than hardware, impingement. While all impingement events are of course undesirable, currently little is known biomechanically if these two impingement modes differ in terms of generation of potentially deleterious stress concentrations or with regard to dislocation resistance. Finite element (FE) analysis was therefore used to parametrically investigate the role of head diameter on the local biomechanics of bone-on-bone versus component-on-component impingement events. Of several dislocation-prone patient motion challenges considered, only squatting consistently resulted in bone-on-bone (as opposed to hardware) impingement. Implant stress concentrations arising from hardware impingement during squatting were greater than those from bony impingement, for all head sizes considered. Additionally, dislocation resistance was substantially greater for instances of bony impingement versus hardware-only impingement. These findings suggest that hardware impingement may still be a/the the predominant mode of impingement even with the use of larger femoral heads, for sub-optimally positioned cups. Additionally, the data indicate that, should impingement occur, impingements between the implant neck and cup are (1) more likely to dislocate, and (2) have a greater propensity for causing damage to the implant compared to impingement events involving bony members. PMID:23576916

  20. The impingement of sonic and sub-sonic jets onto a flat plate at inclined angles

    NASA Astrophysics Data System (ADS)

    Crafton, Jimmy Wayne

    The flow field associated with a jet impinging onto a surface at an inclined angle is investigated using the image-based technologies of Temperature- and Pressure-Sensitive Paints and Particle Image Velocimetry. These diagnostics are used to produce two-dimensional measurements of temperature, Nusselt number, and pressure on the impingement surface and two-components of velocity above the surface. In the process of measuring Nusselt number a novel technique for determining the adiabatic wall temperature has been developed. This image-based technique was used to measure the adiabatic wall temperature on the impingement surface beneath both compressible and incompressible jets. The results of this investigation indicate that as a free jet impinges on a flat surface at an inclined angle the jet is turned by and spread laterally onto the impingement surface. The impingement angle of the jet is the dominant parameter in determining the rate of turning/spreading for the jet. Qualitatively, the structure of the half maximum pressure contour on the impingement surface is similar to an ellipse created by projecting the nozzle through the impingement surface. The center of the ellipse is located near the location of maximum pressure and the eccentricity is a function of the impingement angle. The width of the minor axis is just over one jet diameter. The point of maximum pressure, Nusselt number, and the stagnation point are each located upstream of the geometric impingement point, and this location is a strong function of impingement angle. The relative locations of the stagnation point, the point of maximum Nusselt number, the point of maximum pressure, and the geometric impingement point are identified and a simple correlation for the location of each of these points relative to the geometric impingement point is presented. Finally, the maximum value of both pressure and Nusselt number are found to be a function of impingement distance and impingement angle.

  1. Extra-articular hip impingement: a narrative review of the literature

    PubMed Central

    Cheatham, Scott W.

    2016-01-01

    There is growing subgroup of patients with poor outcomes after hip arthroscopy for intra-articular pathology suggesting unrecognized cause(s) of impingement may exist. Extra-articular hip impingement (EHI) is an emerging group of conditions that have been associated with intra-articular causes of impingement and may be an unrecognized source of pain. EHI is caused by abnormal contact between the extra-articular regions of the proximal femur and pelvis. This review discusses the most common forms for EHI including: central iliopsoas impingement, subspine impingement, ischiofemoral impingement, and greater trochanteric-pelvic impingement. The clinical presentation of each pathology will be discussed since EHI conditions share similar clinical features as the intra-articular pathology but also contain some unique characteristics. PMID:27069266

  2. Heat transfer and flow visualization of swirling impinging jets

    SciTech Connect

    Huang, L.; El-Genk, M.S.

    1996-12-31

    The heat transfer performance of swirling impinging jets was experimentally investigated, and the flow fields were visualized for a jet diameter, d{sub j} = 12.7 mm and swirl angles, {theta} = 15{degree}, 30{degree}, and 45{degree}. Other experimental parameters included Reynolds number, Re = 3,620--17,600, vertical jet spacing, h = 12.7--76.2 mm, and radial distance from the stagnation point, r = 0--65 mm. The results showed significant enhancement in the heat transfer coefficient, both with respect to radial uniformity and local values, compared to a circular straight impinging jet of the same dimensions at the same test conditions. The flow field visualizations confirmed the measured enhancement in the heat transfer coefficient for the swirling jets as well as the radial distribution of local Nusselt number.

  3. Single and multiple jet impingement heat transfer on rotating disks

    NASA Astrophysics Data System (ADS)

    Metzger, D. E.; Partipilo, V. A.

    1989-01-01

    In some gas turbine engine designs cooling air jets are directed at the rotating disk in an atempt to enhance the convection coefficients and reduce the amount of gas flow required for cooling. The jet-impingement scheme is particularly attractive for achieving intense cooling at a specific radial location, such as the blade attachment region. In earlier single-jet studies, the interaction between an impinging jet and rotating disk has been found to involve a flow regime transition. The present study extends the previously acquired data base with new results from both heat-transfer and flow-visualization testing, including effects of hub size, jet travel distance, and the number of jets. Results include a superposition scheme for predicting heat transfer for multiple jets and a criterion for the minimum amount of flow required through each jet nozzle to assure enhancement of the disk convection.

  4. Subdeltoid lipoma causing shoulder impingement syndrome – a case report

    PubMed Central

    Lenza, Mario; Lenza, Miguel Vicente; Carrerra, Eduardo da Frota; Ferretti, Mario

    2014-01-01

    The impingement syndrome is defined by the compression of the rotator cuff tendons against the coracoacromial arch. Several factors contribute to this condition and they are classified as structural or functional factors. The former are changes in the coracoacromial arch, proximal humerus, bursa and rotator cuff, and the latter are related to the mechanism of the upper limb by means of synchronized activity and balanced between the rotator cuff and scapular girdle muscles. The authors report here a case of parosteal lipoma of the proximal humerus, located between the muscles deltoid, teres minor and infraspinatus causing clinical signs of impingement. It is a rare occurrence, characterized as a structural cause for the onset of this symptom. PMID:25167335

  5. ISCHIOFEMORAL IMPINGEMENT – AN ETIOLOGY OF HIP PAIN: CASE REPORT

    PubMed Central

    Yanagishita, Carlos Massao Aramaki; Falótico, Guilherme Guadagnini; Rosário, Davi Araújo Veiga; Pugina, Gustavo Gambuggi; Wever, André Azambuja Neves; Takata, Edmilson Takehiro

    2015-01-01

    An association between hip pain and quadratus femoris muscle abnormality on magnetic resonance imaging (MRI) with concurrent narrowing of the ischiofemoral space has been reported in the recent literature. This raises the possibility that the muscle damage observed is due to ischiofemoral impingement. This diagnosis has been noted in middle-aged females either with or without a history of trauma or surgery, is a rarely described feature. We report here on a 31-year-old woman who presented with non-traumatic hip pain and evidence of narrowing of the ischiofemoral space and edema in the quadratus femoris. Nonsurgical treatment was administered, which relieved her hip pain. The diagnosis of ischiofemoral impingement should be considered in female patients complaining of hip pain without any other evident cause. PMID:27047901

  6. FRACTURE PROPAGATION PROPENSITY OF CERAMIC LINERS DURING IMPINGEMENT-SUBLUXATION

    PubMed Central

    Elkins, Jacob M.; Pedersen, Douglas R.; Callaghan, John J.; Brown, Thomas D.

    2011-01-01

    Although improvements in materials engineering have greatly reduced fracture rates in ceramic femoral heads, concerns still exist for liners. Ceramics are vulnerable fracture due to impact, and from stress concentrations (point and line loading) such as those associated with impingement-subluxation. Thus, ceramic cup fracture propensity is presumably very sensitive to surgical cup positioning. A novel fracture mechanics finite element formulation was developed to identify cup orientations most susceptible to liner fracture propagation, for several impingement-prone patient maneuvers. Other factors being equal, increased cup inclination and increased anteversion were found to elevate fracture risk. Squatting, stooping and leaning shoe-tie maneuvers were associated with highest fracture risk. These results suggest that fracture risk can be reduced by surgeons’ decreasing cup abduction and by patients’ avoiding of specific activities. PMID:21855277

  7. Atomization Performance of an Atomizer with Internal Impingement

    NASA Astrophysics Data System (ADS)

    Wang, Muh-Rong; Lin, Tien-Chu; Lai, Teng-San; Tseng, Ing-Ren

    This paper describes the atomization performance of a newly designed atomizer with internal impinging mechanisms inside the atomizer. The spray drop size distribution was measured by a Malvern RT-Sizer. Results show that the Sauter mean diameter below 10µm has been achieved with GLR of 0.14. The minimum mean drop size can be lowered to 4.0µm under a test condition of the liquid pressure and gas pressure of 2.5bar and 3.5bar, respectively. This test suggests that extra fine atomization on the liquid phase can be achieved under low pressure conditions using this particular atomizer. Such performance cannot be easily achieved with the conventional nozzle design. Results also show that better atomization performance can be achieved by increasing the internal impinging angle and the orifice diameter. An empirical formula of SMD, in terms of operating conditions and nozzle length scale is also presented in this paper.

  8. Particle streak velocimetry and its application to impinging laminar jets

    NASA Astrophysics Data System (ADS)

    Bergthorson, Jeff; Dimotakis, Paul

    2002-11-01

    The technique of Particle Streak Velocimetry (PSV) was improved to include digital imaging and image processing, allowing it to compete with PIV or LDV in terms of accuracy and ease of implementation. PSV provides advantages over other techniques, such as low particle mass loading, short run time experiments, and high accuracy velocity data through the direct measurement of Lagrangian trajectories. PSV, coupled with measurements of the static (Bernoulli) pressure drop across a well designed nozzle contraction, provided redundancy in the measurement of the axisymmetric impinging laminar jet. The impinging laminar jet was studied in the intermediate regime where the existence of a stagnation plate will affect the flow out of the nozzle. This nozzle separation to diameter ratio, L/d_j, regime has not been well characterized. The results indicate that a one-dimensional streamfunction formulation is not sufficient to characterize this flow.

  9. Heat transfer measurements and CFD simulations of an impinging jet

    NASA Astrophysics Data System (ADS)

    Petera, Karel; Dostál, Martin

    2016-03-01

    Heat transport in impinging jets makes a part of many experimental and numerical studies because some similarities can be identified between a pure impingement jet and industrial processes like, for example, the heat transfer at the bottom of an agitated vessel. In this paper, experimental results based on measuring the response to heat flux oscillations applied to the heat transfer surface are compared with CFD simulations. The computational cost of a LES-based approach is usually too high therefore a comparison with less computationally expensive RANS-based turbulence models is made in this paper and a possible improvement of implementing an anisotropic explicit algebraic model for the turbulent heat flux model is evaluated.

  10. Shoulder impingement syndrome in athletes treated by an anterior acromioplasty.

    PubMed

    Tibone, J E; Jobe, F W; Kerlan, R K; Carter, V S; Shields, C L; Lombardo, S J; Yocum, L A

    1985-09-01

    Shoulder pain caused by a impingement syndrome commonly affects an athlete's performance. Thirty-five shoulders in 33 athletes had an impingement syndrome treated by an anterior acromioplasty after failure of conservative treatment. Thirty-one of 35 shoulders (89%) were subjectively judged improved by the patients from their preoperative status. The moderate and severe pain was reduced from 97% of the shoulders preoperation to 20% postoperation. The pain at rest and with activities of daily living was reduced from 71% of the shoulders preoperation to 9% postoperation. However, only 15 of 35 operated shoulders (43%) allowed return to the same preinjury level of competitive athletics, and only four of 18 athletes involved in pitching and throwing returned to their former preinjury status. This operation is satisfactory for pain relief but does not allow an athlete to return to his former competitive status. A prolonged rehabilitation program may improve the results.

  11. Reduction of glycine particle size by impinging jet crystallization.

    PubMed

    Tari, Tímea; Fekete, Zoltán; Szabó-Révész, Piroska; Aigner, Zoltán

    2015-01-15

    The parameters of crystallization processes determine the habit and particle size distribution of the products. A narrow particle size distribution and a small average particle size are crucial for the bioavailability of poorly water-soluble pharmacons. Thus, particle size reduction is often required during crystallization processes. Impinging jet crystallization is a method that results in a product with a reduced particle size due to the homogeneous and high degree of supersaturation at the impingement point. In this work, the applicability of the impinging jet technique as a new approach in crystallization was investigated for the antisolvent crystallization of glycine. A factorial design was applied to choose the relevant crystallization factors. The results were analysed by means of a statistical program. The particle size distribution of the crystallized products was investigated with a laser diffraction particle size analyser. The roundness and morphology were determined with the use of a light microscopic image analysis system and a scanning electron microscope. Polymorphism was characterized by differential scanning calorimetry and powder X-ray diffraction. Headspace gas chromatography was utilized to determine the residual solvent content. Impinging jet crystallization proved to reduce the particle size of glycine. The particle size distribution was appropriate, and the average particle size was an order of magnitude smaller (d(0.5)=8-35 μm) than that achieved with conventional crystallization (d(0.5)=82-680 μm). The polymorphic forms of the products were influenced by the solvent ratio. The quantity of residual solvent in the crystallized products was in compliance with the requirements of the International Conference on Harmonization.

  12. Jet-impingement heat transfer in gas turbine systems.

    PubMed

    Han, B; Goldstein, R J

    2001-05-01

    A review of jet-impingement heat transfer in gas turbine systems is presented. Characteristics of the different flow regions for submerged jets--free jet, stagnation flow, and wall jet--are reviewed. Heat transfer characteristics of both single and multiple jets are discussed with consideration of the effects of important parameters relevant to gas turbine systems including curvature of surfaces, crossflow, angle of impact, and rotation.

  13. Quantifying Cell Adhesion through Impingement of a Controlled Microjet

    PubMed Central

    Visser, Claas Willem; Gielen, Marise V.; Hao, Zhenxia; Le Gac, Séverine; Lohse, Detlef; Sun, Chao

    2015-01-01

    The impingement of a submerged, liquid jet onto a cell-covered surface allows assessing cell attachment on surfaces in a straightforward and quantitative manner and in real time, yielding valuable information on cell adhesion. However, this approach is insufficiently characterized for reliable and routine use. In this work, we both model and measure the shear stress exerted by the jet on the impingement surface in the micrometer-domain, and subsequently correlate this to jet-induced cell detachment. The measured and numerically calculated shear stress data are in good agreement with each other, and with previously published values. Real-time monitoring of the cell detachment reveals the creation of a circular cell-free area upon jet impingement, with two successive detachment regimes: 1), a dynamic regime, during which the cell-free area grows as a function of both the maximum shear stress exerted by the jet and the jet diameter; followed by 2), a stationary regime, with no further evolution of the cell-free area. For the latter regime, which is relevant for cell adhesion strength assessment, a relationship between the jet Reynolds number, the cell-free area, and the cell adhesion strength is proposed. To illustrate the capability of the technique, the adhesion strength of HeLa cervical cancer cells is determined ((34 ± 14) N/m2). Real-time visualization of cell detachment in the dynamic regime shows that cells detach either cell-by-cell or by collectively (for which intact parts of the monolayer detach as cell sheets). This process is dictated by the cell monolayer density, with a typical threshold of (1.8 ± 0.2) × 109 cells/m2, above which the collective behavior is mostly observed. The jet impingement method presents great promises for the field of tissue engineering, as the influence of both the shear stress and the surface characteristics on cell adhesion can be systematically studied. PMID:25564849

  14. Empirical relations for cavitation and liquid impingement erosion processes

    NASA Technical Reports Server (NTRS)

    Rao, P. V.; Buckley, D. H.

    1984-01-01

    A unified power-law relationship between average erosion rate and cumulative erosion is presented. Extensive data analyses from venturi, magnetostriction (stationary and oscillating specimens), liquid drop, and jet impact devices appear to conform to this relation. A normalization technique using cavitation and liquid impingement erosion data is also presented to facilitate prediction. Attempts are made to understand the relationship between the coefficients in the power-law relationships and the material properties.

  15. Chronic rotator cuff impingement in the throwing athlete.

    PubMed

    Jackson, D W

    1976-01-01

    Compromise of the space between the humeral head and the coracoacromial arch may be a source of chronic shoulder pain associated with rotator cuff impingement in the athlete participating in throwing sports. In certain carefully selected individuals, surgical decompression may alleviate these symptoms. The surgical procedure can be done under local anesthesia and may enable the athlete to return to his previous level of performance without disability.

  16. Apollo Video Photogrammetry Estimation Of Plume Impingement Effects

    NASA Technical Reports Server (NTRS)

    Immer, Christopher; Lane, John; Metzger, Philip T.; Clements, Sandra

    2008-01-01

    The Constellation Project's planned return to the moon requires numerous landings at the same site. Since the top few centimeters are loosely packed regolith, plume impingement from the Lander ejects the granular material at high velocities. Much work is needed to understand the physics of plume impingement during landing in order to protect hardware surrounding the landing sites. While mostly qualitative in nature, the Apollo Lunar Module landing videos can provide a wealth of quantitative information using modem photogrammetry techniques. The authors have used the digitized videos to quantify plume impingement effects of the landing exhaust on the lunar surface. The dust ejection angle from the plume is estimated at 1-3 degrees. The lofted particle density is estimated at 10(exp 8)- 10(exp 13) particles per cubic meter. Additionally, evidence for ejection of large 10-15 cm sized objects and a dependence of ejection angle on thrust are presented. Further work is ongoing to continue quantitative analysis of the landing videos.

  17. Role of coherent structures in supersonic impinging jetsa)

    NASA Astrophysics Data System (ADS)

    Kumar, Rajan; Wiley, Alex; Venkatakrishnan, L.; Alvi, Farrukh

    2013-07-01

    This paper describes the results of a study examining the flow field and acoustic characteristics of a Mach 1.5 ideally expanded supersonic jet impinging on a flat surface and its control using steady microjets. Emphasis is placed on two conditions of nozzle to plate distances (h/d), of which one corresponds to where the microjet based active flow control is very effective in reducing flow unsteadiness and near-field acoustics and the other has minimal effectiveness. Measurements include unsteady pressures, nearfield acoustics using microphone and particle image velocimetry. The nearfield noise and unsteady pressure spectra at both h/d show discrete high amplitude impinging tones, which in one case (h/d = 4) are significantly reduced with control but in the other case (h/d = 4.5) remain unaffected. The particle image velocimetry measurements, both time-averaged and phase-averaged, were used to better understand the basic characteristics of the impinging jet flow field especially the role of coherent vortical structures in the noise generation and control. The results show that the flow field corresponding to the case of least control effectiveness comprise well defined, coherent, and symmetrical vortical structures and may require higher levels of microjet pressure supply for noise suppression when compared to the flow field more responsive to control (h/d = 4) which shows less organized, competing (symmetrical and helical) instabilities.

  18. Simultaneous convective heat and mass transfer in impingement ink drying

    SciTech Connect

    Can, M.

    1998-08-01

    Effective and economical drying of thin ink films is essential in the printing, packaging and coating industries. In evaporative drying, high heat and mass transfer rates are commonly achieved by means of high velocity impinging air jets. To provide data for dryer design a program of research has been implemented to study the heat and mass transfer processes which underlie the drying of thin ink films. The heat transfer situation under impinging air jets is outlined and some experimental results are presented. Optimization of nozzle arrays for impinging air jets is analyzed for practical applications. A non-contact infra-red technique for continuously monitoring the ink drying process is described and drying curves for an ink based on a single solvent (4-Methyl-2-pentanol-MIBC) are presented. Heat and mass transfer theory has been used to predict drying times in the constant rate drying period. These predictions have been compared with experimentally determined drying times. This research has served to confirm the fundamental importance of the drying curve as a basis for dryer design.

  19. Conservative management of posterior ankle impingement: a case report

    PubMed Central

    Senécal, Isabelle; Richer, Nadia

    2016-01-01

    Objective: To describe the pain and functional improvements of a patient with posterior ankle impingement following a treatment plan incorporating soft tissue therapy, chiropractic adjustment and a progressive rehabilitation program. Clinical Features: A 37-year- old male presented with posterolateral ankle pain exacerbated by plantar flexion two weeks after sustaining an inversion ankle sprain. Oedema was present and the patient was describing a sensation of instability while walking. The initial diagnosis of lateral ankle sprain was found to be complicated by a posterior ankle impingement caused by a tenosynovitis of the flexor hallucis longus sheath suspected during the physical examination and confirmed by MRI. Intervention and Outcome: The patient was treated over a 14-week period. Soft tissue therapy, a rehabilitation program and cortisone injection were used to treat this condition. A precise description of the rehabilitation program that contains open kinetic chain, closed kinetic chain, proprioception, and conditioning exercises prescribed to the patient is given. After the treatment plan, the patient returned to play pain free and had no daily living restrictions. Summary: A protocol including rest, soft tissue therapy, open and closed kinetic chain exercises, sport-specific exercises and cortisone injection appeared to facilitate complete recovery of this patient’s posterior ankle impingement. PMID:27385836

  20. Impingement Resistance of HVAF WC-Based Coatings

    NASA Astrophysics Data System (ADS)

    Deng, C.; Liu, M.; Wu, C.; Zhou, K.; Song, J.

    2007-12-01

    High-velocity oxygen/air fuel (HVO/AF) WC-17Co and WC-10Co4Cr coatings exhibit great potential in the replacement of electrolytic hard chrome (EHC) plating, and comprehensive properties of such coatings should be superior to those of electrolytic hard chrome plating. The impingement resistance of HVAF WC-based coatings sprayed on 300M ultrahigh-strength steel was studied in this paper. As an important property index, the fracture toughness of HVAF WC-based coatings was measured using the microindentation method at loads of 9.8, 19.6, 24.5, 29.4, and 49.0 N, respectively. The cracks resulting from stress concentration in the microindentation were analyzed. The impingement resistance for two HVAF WC coatings and EHC was evaluated according to the ASTM D 3170 standard, and steel ball free-fall experiment was performed at the height of 0.61, 1.52, 1.83, 2.36, and 2.59 m, respectively. The cracks caused by both impingements were analyzed using scanning electron microscopy (SEM) and optical microscopy (OM) in comparison with the cracks in microindentation test.

  1. Directional transport of impinging capillary jet on wettability engineered surfaces

    NASA Astrophysics Data System (ADS)

    Ghosh, Aritra; Chatterjee, Souvick; Sinha Mahapatra, Pallab; Ganguly, Ranjan; Megaridis, Constantine

    2015-11-01

    Impingement of capillary jet on a surface is important for applications like heat transfer, or for liquid manipulation in bio-microfluidic devices. Using wettability engineered surfaces, we demonstrate pump-less and directional transport of capillary jet on a flat surface. Spatial contrast of surface energy and a wedge-shape geometry of the wettability confined track on the substrate facilitate formation of instantaneous spherical bulges upon jet impingement; these bulges are further transported along the superhydrophilic tracks due to Laplace pressure gradient. Critical condition warranted for formation of liquid bulge along the varying width of the superhydrophilic track is calculated analytically and verified experimentally. The work throws light on novel fluid phenomena of unidirectional jet impingement on wettability confined surfaces and provides a platform for innovative liquid manipulation technique for further application. By varying the geometry and wettability contrast on the surface, one can achieve volume flow rates of ~ O(100 μL/sec) and directionally guided transport of the jet liquid, pumplessly at speeds of ~ O(10cm/sec).

  2. Subacromial Impingement Syndrome Caused by a Voluminous Subdeltoid Lipoma

    PubMed Central

    2014-01-01

    Subacromial impingement syndrome is a clinical diagnosis encompassing a spectrum of possible etiologies, including subacromial bursitis, rotator cuff tendinopathy, and partial- to full-thickness rotator cuff tears. This report presents an unusual case of subdeltoid lipoma causing extrinsic compression and subacromial impingement syndrome. The patient, a 60-year-old man, presented to our institution with a few years' history of nontraumatic, posteriorly localized throbbing pain in his right shoulder. Despite a well-followed 6-months physiotherapy program, the patient was still suffering from his right shoulder. The MRI scan revealed a well-circumscribed 6 cm × 2 cm × 5 cm homogenous lesion compatible with a subdeltoid intermuscular lipoma. The mass was excised en bloc, and subsequent histopathologic examination confirmed a benign lipoma. At 6-months follow-up, the patient was asymptomatic with a complete return to his activities. Based on this case and a review of the literature, a subacromial lipoma has to be included in the differential diagnosis of a subacromial impingement syndrome refractory to nonoperative treatment. Complementary imaging modalities are required only after a failed conservative management to assess the exact etiology and successfully direct the surgical treatment. PMID:24778890

  3. Mach number effect on jet impingement heat transfer.

    PubMed

    Brevet, P; Dorignac, E; Vullierme, J J

    2001-05-01

    An experimental investigation of heat transfer from a single round free jet, impinging normally on a flat plate is described. Flow at the exit plane of the jet is fully developed and the total temperature of the jet is equal to the ambient temperature. Infrared measurements lead to the characterization of the local and averaged heat transfer coefficients and Nusselt numbers over the impingement plate. The adiabatic wall temperature is introduced as the reference temperature for heat transfer coefficient calculation. Various nozzle diameters from 3 mm to 15 mm are used to make the injection Mach number M vary whereas the Reynolds number Re is kept constant. Thus the Mach number influence on jet impingement heat transfer can be directly evaluated. Experiments have been carried out for 4 nozzle diameters, for 3 different nozzle-to-target distances, with Reynolds number ranging from 7200 to 71,500 and Mach number from 0.02 to 0.69. A correlation is obtained from the data for the average Nusselt number. PMID:11460655

  4. Droplet-surface Impingement Dynamics for Intelligent Spray Design

    NASA Technical Reports Server (NTRS)

    VanderWal, Randy L.; Kizito, John P.; Tryggvason, Gretar; Berger, Gordon M.; Mozes, Steven D.

    2004-01-01

    Spray cooling has high potential in thermal management and life support systems by overcoming the deleterious effect of microgravity upon two-phase heat transfer. In particular spray cooling offers several advantages in heat flux removal that include the following: 1. By maintaining a wetted surface, spray droplets impinge upon a thin fluid film rather than a dry solid surface 2. Most heat transfer surfaces will not be smooth but rough. Roughness can enhance conductive cooling, aid liquid removal by flow channeling. 3. Spray momentum can be used to a) substitute for gravity delivering fluid to the surface, b) prevent local dryout and potential thermal runaway and c) facilitate liquid and vapor removal. Yet high momentum results in high We and Re numbers characterizing the individual spray droplets. Beyond an impingement threshold, droplets splash rather than spread. Heat flux declines and spray cooling efficiency can markedly decrease. Accordingly we are investigating droplet impingement upon a) dry solid surfaces, b) fluid films, c) rough surfaces and determining splashing thresholds and relationships for both dry surfaces and those covered by fluid films. We are presently developing engineering correlations delineating the boundary between splashing and non-splashing regions.

  5. Splattering during turbulent liquid jet impingement on solid targets

    SciTech Connect

    Bhunia, S.K.; Lienhard, J.H. V . Dept. of Mechanical Engineering)

    1994-06-01

    In turbulent liquid jet impingement, a spray of droplets often breaks off of the liquid layer formed on the target. This splattering of liquid alters the efficiencies of jet impingement heat transfer processes and chemical containment safety devices, and leads to problems of aerosol formation in jet impingement cleaning processes. In this paper, the authors present a more complete study of splattering and improved correlations that extend and supersede the previous reports on this topic. The authors report experimental results on the amount of splattering for jets of water, isopropanol-water solutions, and soap-water mixtures. Jets were produced by straight tube nozzles of diameter 0.8--5.8 mm, with fully developed turbulent pipe-flow upstream of the nozzle exist. These experiments cover Weber numbers between 130--31,000, Reynolds numbers between 2,700--98,000, and nozzle-to-target separations of 0.2 [<=]l/d[<=]125. Splattering of up to 75 percent of the incoming jet liquid is observed. The results show that only the Weber number and l/d affect the fraction of jet liquid splattered. The presence of surfactants does not alter the splattering. A new correlation for the onset condition for splattering is given. In addition, the authors establish the range of applicability of the model of Lienhard et al. and the authors provide a more accurate set of coefficients for their correlation.

  6. The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes.

    PubMed

    Meister, Keith; Buckley, Bernadette; Batts, Joel

    2004-08-01

    We conducted this study to determine whether a test, the posterior impingement maneuver, could be used to prospectively identify articular side tears of the rotator cuff and/or posterior labrum. Sixty-nine athletes presented with posterior shoulder pain that developed during overhand athletics. Injured shoulders were placed into 90 degrees to 110 degrees of abduction, slight extension, and maximum external rotation, and an effort was made to elicit pain deep within the posterior aspect. Overall sensitivity of the test was 75.5%, and specificity was 85%. When only athletes with noncontact injuries (gradual onset of pain) were considered, sensitivity was 95% and specificity was 100%. A positive posterior impingement sign correlated highly with undersurface tearing of the rotator cuff and/or tearing of the posterior labrum in athletes with gradual onset of posterior shoulder pain during overhand athletics. PMID:15379239

  7. Heat transfer characteristics of a pair of impinging synthetic jets: Effect of orifice spacing and impingement distance

    NASA Astrophysics Data System (ADS)

    Fanning, Eoin; Persoons, Tim; Murray, Darina B.

    2012-11-01

    Recent research has shown that an impinging synthetic jet attains local heat transfer rates that rival those of a steady impinging jet. A single synthetic jet still requires a buoyancy-driven or forced cross flow to avoid recirculation of heated fluid. However, multiple adjacent synthetic jets exhibit a fluidic interaction that results in flow vectoring towards the direction of the jet leading in phase. Previous results have shown a significant heat transfer enhancement and the establishment of a jet-induced cross-flow, which could eliminate the need for an external forced cross-flow. This paper presents the findings of an experimental study to optimize the orifice-to-impingement distance H and orifice centre-to-centre separation distance S. The convective heat transfer rate is determined on an electrically heated metal foil using thermal imaging. The jets are driven by a pair of adjacent jet actuators forcing air through two rectangular slot orifices of width D = 1.65mm and aspect ratio α = 27:1. The jets are maintained at a constant Reynolds number and stroke length (Re = 600, L0/D = 29). For the parameter range considered, an optimum setting of H/D = 24 and S/D = 3 operated within a phase difference region of 60° < phi < 120° gives the best cooling performance.

  8. Arthroscopic technique for patch augmentation of rotator cuff repairs.

    PubMed

    Labbé, Marc R

    2006-10-01

    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

  9. Correlation among Radiographic, Arthroscopic and Pain Criteria for the Diagnosis of Knee Osteoarthritis

    PubMed Central

    Bedarakota, Dhanraj; Vidyasagar, JVS; Rapur, Sivaprasad; Karra, Madhulatha

    2015-01-01

    Introduction Osteoarthritis (OA) is the most common degenerative joint disorder leading to functional impairment and dependency in older adults. Early detection and intervention is of paramount importance in decreasing the morbidity. Radiography is the first investigation of choice for OA patients presenting with knee pain. But, there is a high degree of discordance between clinical and radiographic findings. Arthroscopy aids in accurate diagnosis of OA knee. Aim In view of the conflicting reports in the literature the present study was undertaken to report the correlation among radiographic, arthroscopic and pain findings in knee OA patients to facilitate early and precise diagnosis. Materials and Methods Twenty eight cases (14 males and 14 females) of primary OA knee (7 each from radiographic grade 1 to 4) were screened and selected for the study. Spearman’s rank correlation coefficients (Rho/r estimate) were calculated to determine the relationship between pain, radiographic and arthroscopic grades in patients with knee OA. Results Among 28 patients, 10.71% had grade 1, 14.28% had grade 2, 25% had grade 3 and 50% had grade 4 arthroscopic findings. Overall Spearman’s correlation coefficient (r) for radiographic and arthroscopic grades was 0.8077, 0.8212 for radiographic and pain grades and 0.7634 for arthroscopic and pain grades. Correlation coefficient could not be calculated for individual grades in isolation which would otherwise represent the factual correlation. The Mean arthroscopic grade for radiographic grades 1 to 4 were 1.57, 3.42, 3.57,4.0 respectively and the Mean pain grades for radiographic grades 1 to 4 were1.57, 2.57,3.28, 3.57 respectively. Radiological findings were found to lag behind the arthroscopic findings significantly. Conclusion Arthroscopic findings represent the exact extent and degree of the pathology of OA knee. Kellgren-Lawrence grading read with conventional Antero-posterior standing radiographs of knee underscores the

  10. Arthroscopic Assessment of Stifle Synovitis in Dogs with Cranial Cruciate Ligament Rupture

    PubMed Central

    Little, Jeffrey P.; Bleedorn, Jason A.; Sutherland, Brian J.; Sullivan, Ruth; Kalscheur, Vicki L.; Ramaker, Megan A.; Schaefer, Susan L.; Hao, Zhengling; Muir, Peter

    2014-01-01

    Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3+ T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p<0.05). Numbers of CD3+ T lymphocytes (SR = 0.50, p<0.05) and TRAP+ cells in joint pouches (SR = 0.59, p<0.01) were correlated between joint pairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p<0.05). Arthroscopic grading of villus hypertrophy correlated with numbers of CD3+ T lymphocytes (SR = 0.34, p<0.05). Synovial intima thickness was correlated with arthroscopic hypertrophy, vascularity, and synovitis (SR>0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs

  11. Lateral Decubitus All-Arthroscopic Latarjet Procedure for Treatment of Shoulder Instability.

    PubMed

    Lewington, Matthew R; Urquhart, Nathan; Wong, Ivan H

    2015-06-01

    Shoulder instability can be a challenging condition to treat when it becomes refractory to soft-tissue procedures or when bone loss exceeds 25% to 27% of the glenoid. The Bristow-Latarjet procedure has been developed and popularized to deal with these concerns. Traditionally, the procedure has been performed as an open approach; however, this has been recently supplanted by novel arthroscopic techniques. We present a technique for the procedure performed with the patient in a semi-lateral decubitus position that assists with optimal graft placement on the native glenoid. We use the cannulated Bristow-Latarjet Instability Shoulder System (DePuy Mitek, Raynham, MA). After a diagnostic arthroscopic evaluation, we use multiple arthroscopic anterior portals to debride the rim of the glenoid. The coracoid is prepared and taken down arthroscopically, and the cannulated guide is attached and advanced through an arthroscopically created subscapularis split. With the shoulder held in a reduced position, we are then able to drill and anchor the graft to the native glenoid. The patient is able to begin gentle range-of-motion exercises immediately postoperatively.

  12. Lateral Decubitus All-Arthroscopic Latarjet Procedure for Treatment of Shoulder Instability

    PubMed Central

    Lewington, Matthew R.; Urquhart, Nathan; Wong, Ivan H.

    2015-01-01

    Shoulder instability can be a challenging condition to treat when it becomes refractory to soft-tissue procedures or when bone loss exceeds 25% to 27% of the glenoid. The Bristow-Latarjet procedure has been developed and popularized to deal with these concerns. Traditionally, the procedure has been performed as an open approach; however, this has been recently supplanted by novel arthroscopic techniques. We present a technique for the procedure performed with the patient in a semi-lateral decubitus position that assists with optimal graft placement on the native glenoid. We use the cannulated Bristow-Latarjet Instability Shoulder System (DePuy Mitek, Raynham, MA). After a diagnostic arthroscopic evaluation, we use multiple arthroscopic anterior portals to debride the rim of the glenoid. The coracoid is prepared and taken down arthroscopically, and the cannulated guide is attached and advanced through an arthroscopically created subscapularis split. With the shoulder held in a reduced position, we are then able to drill and anchor the graft to the native glenoid. The patient is able to begin gentle range-of-motion exercises immediately postoperatively. PMID:26258032

  13. Arthroscopic posterior cruciate ligament reconstruction with allograft versus autograft

    PubMed Central

    Sun, Xiujiang; Zhang, Jianfeng; Qu, Xiaoyi

    2015-01-01

    Introduction The aim of the study was to compare and analyze retrospectively the outcomes of arthroscopic posterior cruciate ligament reconstruction with autograft versus allograft. Material and methods Seventy-one patients who underwent arthroscopic posterior cruciate ligament reconstruction with an autograft or allograft met our inclusion criteria. There were 36 patients in the autograft group and 35 patients in the allograft group. All the patients were evaluated by physical examination and a functional ligament test. Comparative analysis was done in terms of operation time, incision length, fever time, postoperative infection rate, incidence of numbness and dysesthesia around the incision, as well as a routine blood test. Results The average follow-up of the autograft group was 3.2 ±0.2 years and that of the allograft group was 3.3 ±0.6 years; there was no significant difference (p > 0.05). No differences existed in knee range of motion, Lysholm scores, International Knee Documentation Committee standard evaluation form and Tegner activity score at final follow-up (p > 0.05), except that patients in the allograft group had a shorter operation time and incision length and a longer fever time (p < 0.05). We found a difference in posterior drawer test and KT-2000 arthrometer assessment (p < 0.05). The posterior tibia displacement averaged 3.8 ±1.5 mm in the autograft group and 4.8 ±1.7 mm in the allograft group (p < 0.05). The incidence of numbness and dysesthesia around the incision in the autograft group was higher than that in the allograft group (p < 0.05). There was no infection postoperatively. The white blood cells and neutrophils in the allograft group increased more than those in the autograft group postoperatively (p < 0.05). Conclusions Both groups of patients had satisfactory outcomes after the operation. However, in the instrumented posterior laxity test, the autograft gave better results than the allograft. No differences in functional scores

  14. The role of arthroscopic thermal capsulorrhaphy in the hip.

    PubMed

    Philippon, M J

    2001-10-01

    Arthroscopic thermal modification of collagen in the hip capsular tissue appears to be a treatment option for patients with hip instability. Traumatic hip instability is associated with frank dislocation or a subluxation, and labral tears. Atraumatic hip instability is associated with evidence of generalized ligament laxity. It can be associated with bone-collagen type disorders, including Ehlers-Danlos syndrome, Down syndrome, arthrochalasis multiplex congenita, developmental dysplastic hip, and idiopathic type. As previously discussed by Bellabarba et al, capsular laxity may be the underlying cause of dynamic hip instability. The capsule is a fibrous, thick, and strong structure that encircles the proximal femur and the acetabulum. The capsule is thicker anteriorly than posteriorly, and consists of two sets of fibers, circular and longitudinal. The capsule ligaments play a very important role in hip stability. The hip joint capsule is reinforced by the iliofemoral, pubofemoral, and ischiofemoral ligaments. It remains sensitive to stretch and serves as a mechanism for muscular feedback and pain. The iliofemoral ligament limits hyperextension and lateral rotation of the hip joint and is taut in full extension. Full extension of the hip exposes the capsule and ligaments to a twisting and shortening effect that forces the head onto the acetabulum. We are currently studying the effect of iliofemoral ligament deficiency and its relationship to instability. Many of the properties of synovial lubrication depend on contact with articular surfaces, and incongruency due to instability may have some functional role in distribution of synovial fluid, leading to stresses from weightbearing and eventually to rapid deterioration of the articular surfaces. The high-level athletes in this series include two professional baseball players, three professional golfers (PGA), one professional football player (NFL), one figure skater (Olympic gold medalist), one gymnast (Olympic level

  15. Arthroscopic Shoulder Surgery in Female Professional Tennis Players

    PubMed Central

    Young, Simon W.; Safran, Marc R.; Dakic, Jodie; Nguyen, Michael L.; Stroia, Kathleen

    2013-01-01

    Objectives: Recent publications have highlighted the relatively poor outcome of other overhead athletes, particularly baseball players, with regard to return to sports at the same or higher level after shoulder surgery. However, true assessment of their ability when returning to sport is not as clear. Further, ability to return to other overhead sports has not been reported. Our objective was to assess outcome and time to return to previous level of function following shoulder surgery in professional tennis players. Methods: The records of all female tennis players on the Women’s Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Details of the surgery including date, procedures performed, and complications were recorded. The primary outcomes were ability and time to return to professional play, and if they were able to return to their previous level of function, as determined by singles ranking. Pre and post-operative singles rankings were used to determine rate and completeness of return to preoperative function. Their highest ranking pre-injury, post operatively, and the time to return to pre-injury ranking were evaluated. Results: During the study period eight professional women tennis players from the WTA underwent shoulder surgery on their dominant arm. All surgery was performed arthroscopically, 7 out of 8 players had more than one procedure performed during the surgery. In total, 3 players underwent debridement of a partial rotator cuff tear and 2 players underwent repair of a complete supraspinatus tear. Three players had an anterior labral repair or reconstruction for anterior instability, and one player underwent repair of a SLAP lesion. Two players underwent neurolysis of a suprascapular nerve, and three players in total underwent a subacromial decompression. All players (100%) returned to professional play. The mean

  16. Controversial role of arthroscopic meniscectomy of the knee: A review

    PubMed Central

    Ha, Austin Y; Shalvoy, Robert M; Voisinet, Anne; Racine, Jennifer; Aaron, Roy K

    2016-01-01

    The role of arthroscopic partial meniscectomy (APM) in reducing pain and improving function in patients with meniscal tears remains controversial. Five recent high-quality randomized controlled trials (RCTs) compared non-operative management of meniscal tears to APM, with four showing no difference and one demonstrating superiority of APM. In this review, we examined the strengths and weaknesses of each of these RCTs, with particular attention to the occurrence of inadvertent biases. We also completed a quantitative analysis that compares treatment successes in each treatment arm, considering crossovers as treatment failures. Our analysis revealed that each study was an excellent attempt to compare APM with non-surgical treatment but suffered from selection, performance, detection, and/or transfer biases that reduce confidence in its conclusions. While the RCT remains the methodological gold standard for establishing treatment efficacy, the use of an RCT design does not in itself ensure internal or external validity. Furthermore, under our alternative analysis of treatment successes, two studies had significantly more treatment successes in the APM arm than the non-operative arm although original intention-to-treat analyses showed no difference between these two groups. Crossovers remain an important problem in surgical trials with no perfect analytical solution. With the studies available at present, no conclusion can be drawn concerning the optimal treatment modality for meniscal tears. Further work that minimizes significant biases and crossovers and incorporates sub-group and cost-benefit analyses may clarify therapeutic indications. PMID:27190756

  17. Review of Arthroscopic and Histological Findings Following Knee Inlay Arthroplasty.

    PubMed

    Markarian, Gregory G; Kambour, Michael T; Uribe, John W

    2016-01-01

    The phenomenon of cartilage rim loading in defects exceeding the threshold diameter of 10 mm is well documented. Contoured defect fill off-loads the perimeter and counteracts further delamination and progression of defects. When biological procedures have failed, inlay arthroplasty follows these concepts. The human biological response to contoured metallic surface implants has not been described. Four patients underwent non-implant-related, second-look arthroscopy following inlay arthroplasty for bi- (n=3) and tricompartmental (n=1) knee arthrosis without subchondral bone collapse. Arthroscopic probing of the implant-cartilage interface of nine prosthetic components did not show signs of implant-cartilage gap formation, loosening, or subsidence. The implant periphery was consistently covered by cartilage confluence leading to a reduction of the original defect size diameter. Femoral condyle cartilage flow appeared to have more hyaline characteristics. Trochlear cartilage flow showed greater histological variability and less organization with fibrocartilage and synovialized scar tissue. This review reconfirmed previous basic science results and demonstrated effective defect fill and rim off-loading with inlay arthroplasty.

  18. Review of Arthroscopic and Histological Findings Following Knee Inlay Arthroplasty.

    PubMed

    Markarian, Gregory G; Kambour, Michael T; Uribe, John W

    2016-01-01

    The phenomenon of cartilage rim loading in defects exceeding the threshold diameter of 10 mm is well documented. Contoured defect fill off-loads the perimeter and counteracts further delamination and progression of defects. When biological procedures have failed, inlay arthroplasty follows these concepts. The human biological response to contoured metallic surface implants has not been described. Four patients underwent non-implant-related, second-look arthroscopy following inlay arthroplasty for bi- (n=3) and tricompartmental (n=1) knee arthrosis without subchondral bone collapse. Arthroscopic probing of the implant-cartilage interface of nine prosthetic components did not show signs of implant-cartilage gap formation, loosening, or subsidence. The implant periphery was consistently covered by cartilage confluence leading to a reduction of the original defect size diameter. Femoral condyle cartilage flow appeared to have more hyaline characteristics. Trochlear cartilage flow showed greater histological variability and less organization with fibrocartilage and synovialized scar tissue. This review reconfirmed previous basic science results and demonstrated effective defect fill and rim off-loading with inlay arthroplasty. PMID:27082884

  19. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction.

    PubMed

    Fanelli, G C; Giannotti, B F; Edson, C J

    1996-02-01

    This article presents the minimum 2-year results (range, 24 to 48 months) of 20 arthroscopically assisted combined anterior cruciate ligament/posterior cruciate ligament (ACL/PCL) reconstructions, evaluated preoperatively and postoperatively using the Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales, and the KT 1000 knee ligament arthrometer (Medmetric Corp, San Diego, CA). There were 16 men or boys, 4 women or girls; 9 right, 11 left; 10 acute, and 10 chronic knee injuries. Ligament injuries included 1 ACL/PCL tear, 2 ACL/PCL/medial collateral ligament (MCL)/posterior lateral corner tears. 7 ACL/PCL/MCL tears, and 10 ACL/PCL/posterior lateral corner tears. ACLs were reconstructed using autograft or allograft patellar tendons. PCLs were reconstructed using allograft Achilles tendon, or autograft patellar tendon. MCL tears were successfully treated with bracing. Posterior lateral instability was successfully treated with long head of the biceps femoris tendon tenodesis. Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales significantly improved preoperatively to postoperatively (P = .0001). Corrected anterior KT 1000 measurements improved from preoperative to postoperative status (P = .0078).

  20. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft.

    PubMed

    Yoo, Yon-Sik; Seo, Young-Jin; Noh, Kyu-Cheol; Patro, Bishu Prasad; Kim, Do-Young

    2011-07-01

    We describe a method of arthroscopically assisted, mini-open, anatomical reconstruction of the coracoclavicular ligament. This method restores both components of the native ligament with the aim of achieving maximum stability with minimal disruption of the normal anatomy. Using the same principles of ligament reconstruction that are employed in other joints, transosseous tunnels are created following the native footprints of the conoid and trapezoid ligaments and an autologous graft is fixed using a PEEK screw. Adequate healing of the ligament occurs within the bone, to prevent stress risers with an appropriate working length. This procedure is unique, as it replaces the torn ligament with a natural substitute, in the appropriate location, through a minimally invasive procedure. This technique would be suitable for treatment of patients with either grade III or V acute acromioclavicular dislocations. Clinical outcomes for the first 13 consecutive patients treated with this procedure are reported, revealing excellent satisfaction rates with a Constant score of 96.6 at final follow-up.

  1. EXTENSIVE ROTATOR CUFF INJURIES: AN EVALUATION OF ARTHROSCOPIC REPAIR OUTCOMES

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; Silva, Luciana Andrade; Eduardo, Cesar Moreira Mariz Pinto Rodrigo Tormin Ortiz; Checchia, Sergio Luiz

    2015-01-01

    To assess the outcomes of the surgical treatment of extensive rotator cuff injuries through arthroscopy. Methods: Between June 1998 and October 2006, 61 patients with extensive rotator cuff injuries and submitted to surgical arthroscopy technique by the Shoulder and Elbow Group of the Department of Orthopaedics and Traumatology, Santa Casa de Misericórdia Medical School were reassessed. The study included all patients with at least two tendons affected or with retraction at least on two tendons up to the glenoidal cavity edge and with at least 12 months of follow-up. Results: According to UCLA's evaluation criteria, 54 (89%) patients showed excellent or good outcomes; no fair outcome in none of the patients; and seven (11%) poor outcomes. A satisfaction rate of 92% was reported. Postoperative joint motion went from a mean lifting value of 93° to 141°, the mean lateral rotation went from 32° to 48° and the mean medial rotation went from L1 to T10. These differences were regarded as statistically significant. Conclusion: The arthroscopic repair of extensive rotator cuff injuries leads to satisfactory outcomes for most of the patients, with a high satisfaction degree. PMID:26998466

  2. Cartilage change after arthroscopic repair for an isolated meniscal tear.

    PubMed

    Soejima, Takashi; Murakami, Hidetaka; Inoue, Takashi; Kanazawa, Tomonoshin; Katouda, Michihiro; Nagata, Kensei

    2005-01-01

    To investigate the direct effect to the cartilage caused by the meniscal repair, we examined patients who underwent an isolated meniscal repair without any other abnormalities by arthroscopic examination. A total of 17 patients were examined by second-look arthroscopy after an average interval of 9 months from the meniscal repair, and have been evaluated the status of the repaired meniscus and of the relative femoral condylar cartilage. Changes in the severity of the cartilage lesion between at the time of meniscal repair and the time of the second-look arthroscopy were considered based on the status of the repaired meniscus. Regardless of the healing status of the repair site, it was possible to prevent degeneration in the cartilage in 9 of the 10 patients who demonstrated no degeneration in the meniscal body. Of the 7 patients who demonstrated degeneration in the meniscal body, progression in cartilage degeneration was noted as 1 grade in 2 patients and 2 grades in another 3 patients. Even in those in which stable fusion of the repair site was achieved, the condition of the inner meniscal body was not necessarily maintained favorably in all cases, indicating that degeneration in the meniscal body was a risk factor for cartilage degeneration. It was concluded that recovery could not be expected even at 9 months after the repair if the lesion had already demonstrated degeneration in the meniscal body at the time of repair.

  3. Posterior Ankle Impingement in Two Athletic Twin Brothers, Could Genetics Play a Role?

    PubMed

    Bech, Niels H; de Leeuw, Peter A J; Haverkamp, Daniel

    2016-01-01

    Pain posteriorly in the ankle can be caused by bony impingement of the posterolateral process of the talus. This process impinges between the tibia and calcaneus during deep forced plantar flexion. If this occurs it is called posterior ankle impingement syndrome. We report the case of 2 athletic monozygotic twin brothers with bony impingement posteriorly in the left ankle. Treatment consisted of ankle arthroscopy in both patients during which the symptomatic process was easily removed. At 3 months after surgery, both patients were completely free of pain, and 1 of the brothers had already returned to sports. The posterior ankle impingement syndrome is not a rare syndrome, but it has not been described in siblings thus far. That these 2 patients are monozygotic twin brothers suggests that genetics could play a role in the development of skeletal deformities that can result in posterior ankle impingement syndrome.

  4. Droplet-Surface Impingement Dynamics for Intelligent Spray Design

    NASA Technical Reports Server (NTRS)

    Wal, Randy L. Vander; Kizito, John P.; Tryggvason, Gretar

    2004-01-01

    Spray cooling has high potential in thermal management and life support systems by overcoming the deleterious effect of microgravity upon two-phase heat transfer. In particular spray cooling offers several advantages in heat flux removal that include the following: 1) By maintaining a wetted surface, spray droplets impinge upon a thin fluid film rather than a dry solid surface; 2. Most heat transfer surfaces will not be smooth but rough. Roughness can enhance conductive cooling, aid liquid removal by flow channeling; and 3. Spray momentum can be used to a) substitute for gravity delivering fluid to the surface, b) prevent local dryout and potential thermal runaway and c) facilitate liquid and vapor removal. Yet high momentum results in high We and Re numbers characterizing the individual spray droplets. Beyond an impingement threshold, droplets splash rather than spread. Heat flux declines and spray cooling efficiency can markedly decrease. Accordingly we are investigating droplet impingement upon a) dry solid surfaces, b) fluid films, c) rough surfaces and determining splashing thresholds and relationships for both dry surfaces and those covered by fluid films. We are presently developing engineering correlations delineating the boundary between splashing and non-splashing regions. Determining the splash/non-splash boundary is important for many practical applications. Coating and cooling processes would each benefit from near-term empirical relations and subsequent models. Such demonstrations can guide theoretical development by providing definitive testing of its predictive capabilities. Thus, empirical relations describing the boundary between splash and non-splash are given for drops impinging upon a dry solid surface and upon a thin fluid film covering a similar surface. Analytical simplification of the power laws describing the boundary between the splash and non-splash regions yields insight into the engineering parameters governing the splash and non

  5. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-01-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  6. Arthroscopic-assisted reduction and percutaneous fixation of tibial plateau fractures.

    PubMed

    Hartigan, David E; McCarthy, Mark A; Krych, Aaron J; Levy, Bruce A

    2015-02-01

    Tibial plateau fractures present a difficult range of fractures to treat. Arthroscopy allows for a less invasive option when compared with arthrotomy. Furthermore, visualization of the articular surface arthroscopically can allow for a precise reduction and assessment of any concomitant injuries to the articular cartilage and meniscus. By use of arthroscopy, unicondylar lateral plateaus were traditionally approached through a laterally based metaphyseal window. However, in carefully selected patients and fracture patterns, a medially based, arthroscopic-assisted approach can create long bony tunnels for subchondral support and allow for greater ease in fracture reduction. We present our technique using a medial approach for arthroscopic-assisted fixation of lateral tibial plateau fractures. PMID:25973374

  7. Traumatic arteriovenous fistula as consequence of TMJ arthroscopic surgery. A case report

    PubMed Central

    Marin-Fernandez, Ana-Belen; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

    2016-01-01

    The ocurrence of a traumatic arteriovenous fistula after arthroscopic surgery of TMJ represents an extremely rare event. Specifically, this uncommon complication has been described only in a few case reports. In this light, the most frequent symptoms showed by this disease are thrills, bruits, pulsatile tinnitus, and an expansible vascular mass. Importantly, the severity of these symptoms is also dependent on the vessels involved. With regard to the management, is important to note that the vessel ligation with surgery as well as vessel emolization with endovascular procedures have been shown to be effective in the treatment of these cases. In view of that, the present study describes a case of superficial temporal arteriovenous fistula that arose as a postoperative complication of a bilateral arthroscopic eminoplasty of TMJ. The aim of the present report is to characterize this rare syndrome with the goal of proposing suitable treatments. Key words:Arteriovenous fistula, arthroscopic surgery, eminoplasty of TMJ, temporal vessels. PMID:27398189

  8. Arthroscopic Conjoint Tendon Transfer: A Technique for Revision Anterior Shoulder Stabilization.

    PubMed

    Tennent, Duncan; Colaço, Henry B; Arnander, Magnus; Pearse, Eyiyemi

    2016-02-01

    Revision anterior stabilization of the shoulder presents a challenge to the surgeon and carries a higher risk of recurrent dislocation than primary repair. The Latarjet procedure may be more reliable than revision soft-tissue repair but may not be indicated in patients without significant glenoid bone loss. We describe an arthroscopic technique of conjoint tendon transfer using a combination of suspensory and interference screw fixation for patients without significant glenoid bone loss (<15%). The arthroscopic approach to this procedure allows intra-articular visualization to assist in mobilization of the conjoint tendon, accurate bone tunnel placement, and subsequent labral repair. It avoids the additional steps of bone block preparation and the larger portals required for arthroscopic Latarjet techniques, in addition to eliminating potential complications due to coracoid bone block resorption. PMID:27274454

  9. Enhancement of KTP/532 laser disc decompression and arthroscopic microdiscectomy with a vital dye

    NASA Astrophysics Data System (ADS)

    Yeung, Anthony T.

    1993-07-01

    Currently, the clinical indications and results of arthroscopic microdiscectomy and laser disc decompression come close to, but do not exceed, the results of classic discectomy or microdiscectomy for the whole spectrum of surgical disc herniations. However, as minimally invasive techniques continue to evolve, results can be expected to equal or be potentially superior to conventional surgery. This exhibit demonstrates how the use of a vital dye can enhance standard arthroscopic microdiscectomy techniques and, when used in conjunction with KTP/532 laser disc decompression, allows for better arthroscopic visualization, documentation, and extraction of nucleus pulposus, ultimately expanding the current limiting criteria for minimally invasive techniques. When proper patient selection is combined with good clinical indications, the surgical results are rather dramatic, often achieving immediate relief of sciatica in the operating room.

  10. [The arthroscopic "wafer procedure" in degenerative disc ulnocarpal tears with ulnocarpal compression syndrome. Techniques, indications, results].

    PubMed

    Feldkamp, G

    2004-06-01

    The wafer procedure is a technique involving the partial resection of the distal ulna for the treatment of patients with symptomatic tears of the TFCC, for ulnar abutment syndrome or both. The TFCC-tears are classified as Palmer type 2. The wafer procedure can be performed as an open procedure or arthroscopically. It is an alternative to a shortening osteotomy of the ulna and decompresses the ulnocarpal joint. In ten cases with long-term follow-up, the preferability of the arthroscopic method is demonstrated: a minimally invasive technique, optimal assessment of all lesions, maximum protection of all uninjured structures in comparison to the open method, single stage procedure, and low complication rate. The long-term results are predominantly positive, so that the arthroscopic wafer procedure should be performed more often than it is today. PMID:15112036

  11. Numerical study of a confined slot impinging jet with nanofluids

    PubMed Central

    2011-01-01

    Background Heat transfer enhancement technology concerns with the aim of developing more efficient systems to satisfy the increasing demands of many applications in the fields of automotive, aerospace, electronic and process industry. A solution for obtaining efficient cooling systems is represented by the use of confined or unconfined impinging jets. Moreover, the possibility of increasing the thermal performances of the working fluids can be taken into account, and the introduction of nanoparticles in a base fluid can be considered. Results In this article, a numerical investigation on confined impinging slot jet working with a mixture of water and Al2O3 nanoparticles is described. The flow is turbulent and a constant temperature is applied on the impinging. A single-phase model approach has been adopted. Different geometric ratios, particle volume concentrations and Reynolds number have been considered to study the behavior of the system in terms of average and local Nusselt number, convective heat transfer coefficient and required pumping power profiles, temperature fields and stream function contours. Conclusions The dimensionless stream function contours show that the intensity and size of the vortex structures depend on the confining effects, given by H/W ratio, Reynolds number and particle concentrations. Furthermore, for increasing concentrations, nanofluids realize increasing fluid bulk temperature, as a result of the elevated thermal conductivity of mixtures. The local Nusselt number profiles show the highest values at the stagnation point, and the lowest at the end of the heated plate. The average Nusselt number increases for increasing particle concentrations and Reynolds numbers; moreover, the highest values are observed for H/W = 10, and a maximum increase of 18% is detected at a concentration equal to 6%. The required pumping power as well as Reynolds number increases and particle concentrations grow, which is almost 4.8 times greater than the

  12. Study of Plume Impingement Effects in the Lunar Lander Environment

    NASA Technical Reports Server (NTRS)

    Marichalar, Jeremiah; Prisbell, A.; Lumpkin, F.; LeBeau, G.

    2010-01-01

    Plume impingement effects from the descent and ascent engine firings of the Lunar Lander were analyzed in support of the Lunar Architecture Team under the Constellation Program. The descent stage analysis was performed to obtain shear and pressure forces on the lunar surface as well as velocity and density profiles in the flow field in an effort to understand lunar soil erosion and ejected soil impact damage which was analyzed as part of a separate study. A CFD/DSMC decoupled methodology was used with the Bird continuum breakdown parameter to distinguish the continuum flow from the rarefied flow. The ascent stage analysis was performed to ascertain the forces and moments acting on the Lunar Lander Ascent Module due to the firing of the main engine on take-off. The Reacting and Multiphase Program (RAMP) method of characteristics (MOC) code was used to model the continuum region of the nozzle plume, and the Direct Simulation Monte Carlo (DSMC) Analysis Code (DAC) was used to model the impingement results in the rarefied region. The ascent module (AM) was analyzed for various pitch and yaw rotations and for various heights in relation to the descent module (DM). For the ascent stage analysis, the plume inflow boundary was located near the nozzle exit plane in a region where the flow number density was large enough to make the DSMC solution computationally expensive. Therefore, a scaling coefficient was used to make the DSMC solution more computationally manageable. An analysis of the effectiveness of this scaling technique was performed by investigating various scaling parameters for a single height and rotation of the AM. Because the inflow boundary was near the nozzle exit plane, another analysis was performed investigating three different inflow contours to determine the effects of the flow expansion around the nozzle lip on the final plume impingement results.

  13. Study of Plume Impingement Effects in the Lunar Lander Environment

    NASA Astrophysics Data System (ADS)

    Marichalar, J.; Prisbell, A.; Lumpkin, F.; Lebeau, G.

    2011-05-01

    Plume impingement effects from the descent and ascent engine firings of the Lunar Lander were analyzed in support of the Lunar Architecture Team under the Constellation Program. The descent stage analysis was performed to obtain shear and pressure forces on the lunar surface as well as velocity and density profiles in the flow field in an effort to understand lunar soil erosion and ejected soil impact damage which was analyzed as part of a separate study. A Computational Fluid Dynamics (CFD)/Direct Simulation Monte Carlo (DSMC) decoupled methodology was used with the Bird continuum breakdown parameter to distinguish the continuum flow from the rarefied flow. The ascent stage analysis was performed to ascertain the forces and moments acting on the Lunar Lander Ascent Module due to the firing of the main engine on take-off. The Reacting and Multiphase Program (RAMP) method of characteristics (MOC) code was used to model the continuum region of the nozzle plume, and the DSMC Analysis Code (DAC) was used to model the impingement results in the rarefied region. The ascent module (AM) was analyzed for various pitch and yaw rotations and for various heights in relation to the descent module (DM). For the ascent stage analysis, the plume inflow boundary was located near the nozzle exit plane in a region where the flow number density was large enough to make the DSMC solution computationally expensive. Therefore, a scaling coefficient was used to make the DSMC solution more computationally manageable. An analysis of the effects of this scaling technique was performed. Because the inflow boundary was near the nozzle exit plane, another analysis was performed investigating three different inflow contours to determine the effects of the flow expansion around the nozzle lip on the final plume impingement results.

  14. Impingement of Droplets in 60 Deg Elbows with Potential Flow

    NASA Technical Reports Server (NTRS)

    Hacker, Paul T.; Saper, Paul G.; Kadow, Charles F.

    1956-01-01

    Trajectories were determined for water droplets or other aerosol particles in air flowing through 600 elbows especially designed for two-dimensional potential motion. The elbows were established by selecting as walls of each elbow two streamlines of a flow field produced by a complex potential function that establishes a two-dimensional flow around. a 600 bend. An unlimited number of elbows with slightly different shapes can be established by selecting different pairs of streamlines as walls. Some of these have a pocket on the outside wall. The elbows produced by the complex potential function are suitable for use in aircraft air-inlet ducts and have the following characteristics: (1) The resultant velocity at any point inside the elbow is always greater than zero but never exceeds the velocity at the entrance. (2) The air flow field at the entrance and exit is almost uniform and rectilinear. (3) The elbows are symmetrical with respect to the bisector of the angle of bend. These elbows should have lower pressure losses than bends of constant cross-sectional area. The droplet impingement data derived from the trajectories are presented along with equations so that collection efficiency, area, rate, and distribution of droplet impingement can be determined for any elbow defined by any pair of streamlines within a portion of the flow field established by the complex potential function. Coordinates for some typical streamlines of the flow field and velocity components for several points along these streamlines are presented in tabular form. A comparison of the 600 elbow with previous calculations for a comparable 90 elbow indicated that the impingement characteristics of the two elbows were very similar.

  15. Visualization of heat transfer for impinging swirl flow

    SciTech Connect

    Bakirci, K.; Bilen, K.

    2007-10-15

    The objective of the experimental study was to visualize the temperature distribution and evaluate heat transfer rate on the impingement surface kept at a constant wall temperature boundary condition for the swirling (SIJ), multi-channel (MCIJ) and conventional impinging jet (CIJ) using liquid crystal technique. The swirling jet assembly consisted of a housing tube and a solid swirl generator insert which had four narrow slots machined on its surface. The swirl angle, {theta}, was set as 0 , 22.5 , 41 , 50 to change the direction and strength of the swirl in the air flow exiting the housing tube. The local Nusselt numbers of the MCIJ ({theta} = 0 ) were generally much higher than those of CIJ and SIJs. As the swirl angle increased, the radial uniformity of the heat transfer was seen compared to MCIJ and SIJ; the best results were for {theta} = 50 and the jet-to-surface distance of H/D = 14. The location of the distance of the maximum heat transfer for the swirl angles of {theta} = 41 and 50 was shifted away from the stagnation point in a radial distance of nearly r/D = 2.5. Increasing Reynolds number for same swirler angle increased the heat transfer rate on the entire surface, and increased saddle shape heat transfer distribution on the surface, but had no significant effect on the position of the individual impingement regions, but increased saddle shape heat transfer distribution on the surface. The lower Reynolds number (Re = 10 000) and the highest H/D = 14 gave much more uniform local and average heat transfer distribution on the surface, but decreased their values on the entire surface. (author)

  16. Comparison of Three Virtual Reality Arthroscopic Simulators as Part of an Orthopedic Residency Educational Curriculum

    PubMed Central

    Martin, Kevin D; Amendola, Annunziato; Phisitkul, Phinit

    2016-01-01

    Abstract Purpose Orthopedic education continues to move towards evidence-based curriculum in order to comply with new residency accreditation mandates. There are currently three high fidelity arthroscopic virtual reality (VR) simulators available, each with multiple instructional modules and simulated arthroscopic procedures. The aim of the current study is to assess face validity, defined as the degree to which a procedure appears effective in terms of its stated aims, of three available VR simulators. Methods Thirty subjects were recruited from a single orthopedic residency training program. Each subject completed one training session on each of the three leading VR arthroscopic simulators (ARTHRO mentor-Symbionix, ArthroS-Virtamed, and ArthroSim-Toltech). Each arthroscopic session involved simulator-specific modules. After training sessions, subjects completed a previously validated simulator questionnaire for face validity. Results The median external appearances for the ARTHRO Mentor (9.3, range 6.7-10.0; p=0.0036) and ArthroS (9.3, range 7.3-10.0; p=0.0003) were statistically higher than for Arthro- Sim (6.7, range 3.3-9.7). There was no statistical difference in intraarticular appearance, instrument appearance, or user friendliness between the three groups. Most simulators reached an appropriate level of proportion of sufficient scores for each categor y (≥70%), except for ARTHRO Mentor (intraarticular appearance-50%; instrument appearance- 61.1%) and ArthroSim (external appearance- 50%; user friendliness-68.8%). Conclusion These results demonstrate that ArthroS has the highest overall face validity of the three current arthroscopic VR simulators. However, only external appearance for ArthroS reached statistical significance when compared to the other simulators. Additionally, each simulator had satisfactory intraarticular quality. This study helps further the understanding of VR simulation and necessary features for accurate arthroscopic representation

  17. Discharge coefficients of impingement and film cooling holes

    NASA Astrophysics Data System (ADS)

    Chu, T.; Brown, A.; Garret, S.

    1985-03-01

    In this article measurements of fluid flow through impingement and film cooling holes for typical turbine blade cooling systems are presented. The purpose of the measurements was to determine hole discharge coefficients over a range of Reynolds numbers from 5,000 to 30,000 and to observe in this range the dependence of discharge coefficient on Reynolds number. The effect of hole geometry, that is, sharp edged inlet or corner radius inlet, on discharge coefficients is also measured. Correlations relating discharge coefficients to Reynolds number, corner radius to hole diameter ratio, and blowing parameter are suggested.

  18. Jet impingement and primary atomization of non-Newtonian liquids

    NASA Astrophysics Data System (ADS)

    Mallory, Jennifer A.

    The effect of liquid rheology on the flowfield resulting from non-Newtonian impinging jets was investigated experimentally and analytically. Experimental data were acquired using a unique experimental apparatus developed to examine the jet impingement of non-Newtonian liquids. The analytical modeling was aimed at determining which physical mechanisms transform non-Newtonian impinging jets into a sheet with waves on its surface, how those waves influence sheet fragmentation and subsequent ligament formation, and how those ligaments break up to form drops (primary atomization). Prior to impinging jet measurements, the rheological properties of 0.5 wt.-% CMC-7HF, 1.4 wt.-% CMC-7MF, 0.8 wt.-% CMC-7MF, 0.06 wt.-% CMC-7MF 75 wt.-% glycerin, 1 wt.-% Kappa carrageenan, and 1 wt.-% Agar were determined through the use of rotational and capillary rheometers. Two approaches were used to experimentally measure solid-like gel propellant simulant static surface tension. All liquids exhibited pseudoplastic rheological behavior. At various atomizer geometric and flow parameters sheet instability wavelength, sheet breakup length, ligament diameter, and drop sizes were measured from high-speed video images. Results showed that viscosity dependence on shear rate is not the sole factor that determines atomization likelihood. Instead, a key role is played by the interaction of the gelling agent with the solvent at the molecular level. For instance, despite high jet exit velocities and varying atomizer geometric parameters HPC gel propellant simulants did not atomize. The molecular nature of HPC results in physical entanglement of polymer chains when gelled, which resists liquid breakup and subsequent spray formation. However, atomization was achieved with Agar, which absorbs the water and forms a network around it rather than bonding to it. The measured liquid sheet instability wavelength, sheet breakup length, ligament diameter, and drop sizes were compared to predictions from a

  19. Acetabular Paralabral Cyst: An Unusual Cause of Femoral Vein Compression

    PubMed Central

    Kullar, Raj S.; Kapron, Ashley L.; Ihnat, Daniel; Aoki, Stephen K.; Maak, Travis G.

    2015-01-01

    Acetabular labral tears are a known cause of hip pain in the young, active patient. Labral tears can be due to trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degenerative pathology. Paralabral cysts are relatively common in association with labral tears of the hip, with cysts seen on magnetic resonance imaging studies in as many as 50% to 70% of patients with labral tears. In some cases the cysts can become sizeable and cause neurovascular compression. Nonoperative interventions for the management of paralabral cysts in the shoulder and knee have shown high recurrence rates. In the shoulder and knee, arthroscopic debridement of paralabral cysts has shown good results with lower recurrence rates and resolution of neurovascular function. In the hip there is limited literature regarding surgical management of paralabral cysts. We present a surgical technique for arthroscopic decompression of acetabular paralabral cysts combined with labral repair. PMID:25973371

  20. Arthroscopic Release of Adhesive Capsulitis of the Shoulder Complicated With Shoulder Dislocation and Brachial Plexus Injury.

    PubMed

    Nunez, Fiesky A; Papadonikolakis, Anastasios; Li, Zhongyu

    2016-01-01

    The incidence of brachial plexus injury after shoulder dislocation or arthroscopic shoulder surgery is low. Complex regional pain syndrome (CRPS) is an uncommon but painful condition that can develop after nerve injury. Historically, CRPS has been difficult to treat and therapeutic efforts are sometimes limited to ameliorating symptoms. However, if a dystrophic focus can be identified, the condition can be addressed with surgical exploration for potential neurolysis or nerve repair. The present article reports on a case of type II CRPS that developed in the postoperative setting of arthroscopic shoulder surgery complicated with simple shoulder dislocation. PMID:27518297

  1. Arthroscopic treatment of painful Sinding-Larsen-Johansson syndrome in a professional handball player.

    PubMed

    Kajetanek, C; Thaunat, M; Guimaraes, T; Carnesecchi, O; Daggett, M; Sonnery-Cottet, B

    2016-09-01

    Sinding-Larsen-Johansson (SLJ) syndrome is a type of osteochondrosis of the distal pole of the patella most often caused by repeated microtrauma. Here, we describe the case of a professional athlete with painful SLJ syndrome treated arthroscopically. A 29-year-old male professional handball player presented with anterior knee pain that persisted after 4 months of an eccentric rehabilitation protocol and platelet-rich plasma injections. Despite this conservative treatment, the patient could not participate in his sport. The SLJ lesion was excised arthroscopically, which led to complete disappearance of symptoms and return to competitive sports after 5 months.

  2. Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance.

    PubMed

    Howse, Elizabeth A; Botros, Daniel B; Mannava, Sandeep; Stone, Austin V; Stubbs, Allston J

    2016-04-01

    Hip arthroscopy has gained popularity in recent years for diagnostic and therapeutic hip preservation management. This article details the establishment of arthroscopic portals of the hip, specifically the anterolateral and modified anterior portals without fluoroscopic guidance. The anterolateral portal is established anatomically, and the modified anterior portal is then established under arthroscopic guidance. A through understanding of the hip anatomy allows for these portals to be made both safely and reliably for hip arthroscopies in the modified supine positioned patient. The reduced use of fluoroscopy with this technique lowers the risk of ionizing radiation exposure to the patient and surgeon.

  3. Arthroscopic treatment of painful Sinding-Larsen-Johansson syndrome in a professional handball player.

    PubMed

    Kajetanek, C; Thaunat, M; Guimaraes, T; Carnesecchi, O; Daggett, M; Sonnery-Cottet, B

    2016-09-01

    Sinding-Larsen-Johansson (SLJ) syndrome is a type of osteochondrosis of the distal pole of the patella most often caused by repeated microtrauma. Here, we describe the case of a professional athlete with painful SLJ syndrome treated arthroscopically. A 29-year-old male professional handball player presented with anterior knee pain that persisted after 4 months of an eccentric rehabilitation protocol and platelet-rich plasma injections. Despite this conservative treatment, the patient could not participate in his sport. The SLJ lesion was excised arthroscopically, which led to complete disappearance of symptoms and return to competitive sports after 5 months. PMID:27450859

  4. Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion.

    PubMed

    Kon, Yoshiaki; Shiozaki, Hiroyuki; Sugaya, Hiroyuki

    2005-05-01

    We describe 3 cases of an all-arthroscopic technique for repair of a humeral avulsion of the glenohumeral ligament (HAGL) lesion and the postoperative clinical outcomes. From a technical perspective, the most critical part of the surgeries was the anchor insertion at an optimal position on the humerus in order to achieve proper tension of the glenohumeral ligament. The arm-free beach-chair position, which facilitates maximum internal rotation, use of a 70 degrees angled arthroscope, and an anterior-inferior trans-subscapularis tendon portal were considered key factors to accomplish this procedure.

  5. Use of a Bone Graft Drill Harvester to Create the Fenestration During Arthroscopic Ulnohumeral Arthroplasty.

    PubMed

    Wijeratna, Malin D; Ek, Eugene T; Hoy, Gregory A; Chehata, Ash

    2015-10-01

    The Outerbridge-Kashiwagi procedure, or ulnohumeral arthroplasty, was described in 1978 as a method of treating elbow arthritis by creating a fenestration in the olecranon fossa. This fenestration diminishes the likelihood of recurrent spurs in the olecranon fossa and coronoid fossa, without loss of structural bony strength. Arthroscopic techniques have now been developed to perform this procedure. We describe an efficient method of creating the fenestration between the olecranon fossa and coronoid fossa during an arthroscopic ulnohumeral arthroplasty, or Outerbridge-Kashiwagi procedure, that also reduces the amount of residual bone debris produced during the resection.

  6. Experimental simulation of impingement cooling in midchord region of turbine blade

    NASA Astrophysics Data System (ADS)

    Li, Liguo; Jiang, Jun; Chang, Haiping; Zhang, Donglia

    1989-10-01

    Simulation experiments have been completed to research the characteristics of impingement cooling in the midchord region of a turbine blade for a given geometric parameter of jet array, initial crossflow, and pressure ratios of the film-cooling exhaust. Comparative experiments have been made on curvilinear and flat plate impinged surfaces, and impinged surfaces with and without a chordwise fin. Moreover, the thermal patterns from a liquid crystal show that the jet hole arrangement and distance between cooled surface and jet plate affect the heat transfer distributions for jet array impingement. Finally, the effects of the cooling air axially injected into guide tube on radial jet flow have also been determined.

  7. Modeling Single-Phase and Boiling Liquid Jet Impingement Cooling in Power Electronics

    SciTech Connect

    Narumanchi, S. V. J.; Hassani, V.; Bharathan, D.

    2005-12-01

    Jet impingement has been an attractive cooling option in a number of industries over the past few decades. Over the past 15 years, jet impingement has been explored as a cooling option in microelectronics. Recently, interest has been expressed by the automotive industry in exploring jet impingement for cooling power electronics components. This technical report explores, from a modeling perspective, both single-phase and boiling jet impingement cooling in power electronics, primarily from a heat transfer viewpoint. The discussion is from the viewpoint of the cooling of IGBTs (insulated-gate bipolar transistors), which are found in hybrid automobile inverters.

  8. Wall jets created by single and twin high pressure jet impingement

    NASA Astrophysics Data System (ADS)

    Miller, P.; Wilson, M.

    1993-03-01

    An extensive experimental investigation into the nature of the wall jets produced by single and twin normal jet impingement has been undertaken. Wall jet velocity profiles have been recorded up to 70 jet diameters from the impingement point, at pressures representative of current VStol technology. The tests used fixed convergent nozzles, with nozzle height and spacing and jet pressure being varied. Single jet impingement displays a consistent effect of nozzle height on wall jet development. For twin jet cases a powerful reinforcement exists along the wall jet interaction plane. Remote from the interaction plane the wall jets are weaker than those produced by a single jet impingement.

  9. Jet array impingement with crossflow-correlation of streamwise resolved flow and heat transfer distributions

    NASA Technical Reports Server (NTRS)

    Florschuetz, L. W.; Metzger, D. E.; Truman, C. R.

    1981-01-01

    Correlations for heat transfer coefficients for jets of circular offices and impinging on a surface parallel to the jet orifice plate are presented. The air, following impingement, is constrained to exit in a single direction along the channel formed by the jet orifice plate and the heat transfer (impingement) surface. The downstream jets are subjected to a crossflow originating from the upstream jets. Impingement surface heat transfer coefficients resolved to one streamwise jet orifice spacing, averaged across the channel span, are correlated with the associated individual spanwise orifice row jet and crossflow velocities, and with the geometric parameters.

  10. Impingement of Water Droplets on NACA 65A004 Airfoil at 8 deg Angle of Attack

    NASA Technical Reports Server (NTRS)

    Brun, R. J.; Gallagher, H. M.; Vogt, D. E.

    1954-01-01

    The trajectories of droplets in the air flowing past an NACA 65AO04 airfoil at an angle of attack of 8 deg were determined.. The amount of water in droplet form impinging on the airfoil, the area of droplet impingement, and the rate of droplet impingement per unit area on the airfoil surface were calculated from the trajectories and presented to cover a large range of flight and atmospheric conditions. These impingement characteristics are compared briefly with those previously reported for the same airfoil at an angle of attack of 4 deg.

  11. Laser impingement on bare and encased high explosives: safety limits

    SciTech Connect

    Roeske, F

    1999-03-15

    During the course of experiments involving high explosives, (HE), alignment lasers are often employed where the laser beam impinges upon a metal encased HE sample or on the bare HE itself during manned operations. While most alignment lasers are of low enough power so as not to be of concern, safety questions arise when considering the maximum credible power output of the laser in a failure mode, or when multiple laser spots are focused onto the experiment simultaneously. Safety questions also arise when the focused laser spot size becomes very small, on the order of 100 {micro}m or less. This paper addresses these concerns by describing a methodology for determining safety margins for laser impingement on metal encased HE as well as one for bare HE. A variety of explosives encased in Al, Cu, Ta and stainless steel were tested using the first of these techniques. Additional experiments were performed using the second method where the laser beam was focused directly on eight different samples of pressed-powder HE.

  12. Visualization and modeling of the hydrodynamics of an impinging microjet.

    PubMed

    Bitziou, Eleni; Rudd, Nicola C; Edwards, Martin A; Unwin, Patrick R

    2006-03-01

    The use of fluorescence confocal laser scanning microscopy (CLSM) for flow visualization is described, with a focus on elucidating the pattern of flow in the microjet electrode (MJE). The MJE employs a nozzle, formed from a fine glass capillary, with an inner diameter of approximately 100 microm, to direct solution at an electrode surface, using high velocity but at moderate volume flow rates. For CLSM visualization, the jetted solution contains a fluorescent probe, fluorescein at high pH, which flows into a solution buffered at low pH, where the fluorescence is extinguished, thereby highlighting the flow field of the impinging microjet. The morphology of the microjet and the hydrodynamic boundary layer are shown to be highly sensitive to the volume flow rate, with a collimated jet and thin boundary layer formed at the faster flow rates (approximately 1 cm(3) min(-1)). In contrast, at lower flow rates and for relatively large substrates, an unusual recirculation zone is observed experimentally for the first time. This effect can be eliminated by employing small substrates. The experimental observations have been quantified through numerical solution of the Navier-Stokes equations of continuity and momentum balance. The new insights provided by CLSM imaging demonstrate that flow in the MJE, and impinging jets in general, are more complex than predicted by classical models but are well-defined and quantifiable.

  13. Impingement of Droplets in 90 deg Elbows with Potential Flow

    NASA Technical Reports Server (NTRS)

    Hacker, Paul T.; Brun, Rinaldo J.; Boyd, Bemrose

    1953-01-01

    Trajectories were determined for droplets in air flowing through 90 deg elbows especially designed for two-dimensional potential motion with low pressure losses. The elbows were established by selecting as walls of each elbow two streamlines of the flow field produced by a complex potential function that establishes a two-dimensional flow around a 90 deg bend. An unlimited number of elbows with slightly different shapes can be established by selecting different pairs of streamlines as walls. The elbows produced by the complex potential function selected are suitable for use in aircraft air-intake ducts. The droplet impingement data derived from the trajectories are presented along with equations in such a manner that the collection efficiency, the area, the rate, and the distribution of droplet impingement can be determined for any elbow defined by any pair of streamlines within a portion of the flow field established by the complex potential function. Coordinates for some typical streamlines of the flow field and velocity components for several points along these streamlines are presented in tabular form.

  14. Sound generated by vortex ring impingement on a heated wall

    NASA Astrophysics Data System (ADS)

    Kotsari, E. Giannos; Howe, M. S.

    2009-11-01

    An analysis is made of the sound generated when a vortex ring impinges normally on a heated section of a plane wall. The unsteady convective diffusion occurring when the vortex is close to the wall causes a rapid increase in heat transfer and the emission of sound of monopole type. The approximate dependence on vortex Reynolds number of the enhancement of heat transfer is deduced from recent experiments reported by Arévalo et al. [Vortex ring head-on collision with a heated vertical plate, Physics of Fluids 19 (2007) 083603-1-083603-9], and is used to derive a scaling law for the acoustic pressure. The sound pressure signature is dominated by a large amplitude pulse associated with an explosive, but brief increase in the rate of heat transfer at the start of the vortex-wall interaction. The quadrupole sound pressure also produced during impingement on the wall is found to be smaller than the thermally induced sound by a factor proportional to M2T0/(Tw-T0) where M, Tw, T0 respectively denote the Mach number of the vortex motion, the mean wall temperature and the fluid temperature at large distances from the wall.

  15. Numerical modeling of LOX/methane impingement, evaporation, and combustion

    NASA Astrophysics Data System (ADS)

    Harpal, Naimishkumar

    A computational fluid dynamics approach is used to model the impingement and subsequent combustion of LOX/LCH4 "green" propellants. The objective of this investigation is to assess the capabilities of current state-of-the-art CFD codes, here STAR-CCM+ v5.2, to model the associated multi-phase, multi-component, reacting flow field. The two multiphase methods, Volume of Fluid and Lagrangian Discrete Droplet, are evaluated to model the like-on-like and unlike doublet impingement configurations. Subsequently, droplet combustion simulation is performed in Lagrangian-Eulerian coupled framework using integrated models including Standard Eddy Break-Up combustion, quasi-steady evaporation, and RANS k-epsilon turbulence models. For an oxidizer-to-fuel ratio of3.4, flame temperatures of2880 K and 2670 K are predicted for two different kinds of Lagrangian injectors, point and cone, respectively, which, as expected, is less than the Chemical Equilibrium Analysis prediction of 3000 K. Besides recommendations in current methodology, an outline of modeling multi-species reaction in immiscible multiphase domain is presented.

  16. Repair Integrity and Clinical Outcomes Following Arthroscopic Rotator Cuff Repair

    PubMed Central

    Williams, Ariel A.; Mark, P.; DiVenere, Jessica Megan; Klinge, Stephen Austin; Arciero, Robert A.; Mazzocca, Augustus D.

    2016-01-01

    Objectives: To prospectively evaluate the effect of early versus delayed motion on repair integrity on 6-month postoperative magnetic resonance imaging (MRI) scans following rotator cuff repair, and to correlate repair integrity with clinical and functional outcomes. We hypothesized that repair integrity would differ between the early and delayed groups and that patients with repair failures would have worse clinical and functional outcomes. Methods: This was a prospective, randomized, single blinded clinical trial comparing an early motion (post-op day 2-3) to a delayed motion (post-op day 28) rehabilitation protocol following arthroscopic repair of isolated supraspinatus tears. All patients underwent MRI at 6 months post-operatively as part of the study protocol. A blinded board-certified and fellowship-trained orthopaedic surgeon (not part of the surgical team) reviewed operative photos and video to confirm the presence of a full thickness supraspinatus tear and to ensure an adequate and consistent repair. The same surgeon along with a blinded sports medicine fellowship-trained musculoskeletal radiologist independently reviewed all MRIs to determine whether the repair was intact at 6 months. Outcome measures were collected by independent evaluators who were also blinded to group assignment. These included the Western Ontario Rotator Cuff (WORC) index, Single Assessment Numeric Evaluation (SANE) ratings, pain scores, sling use, and physical exam data. Enrolled patients were followed at 6 weeks, 6 months, and 1 year. Results: From October 2008 to April 2012, 73 patients met all inclusion criteria and were willing to participate. 36 patients were randomized to delayed motion and 37 were randomized to early motion. The final study group at 6 months consisted of 58 study participants. Postoperative MRIs were obtained on all of these patients at 6 months regardless of whether or not they were progressing as expected. These MRIs demonstrated an overall failure rate of

  17. Study of Impingement Types and Printing Quality during Laser Printing of Viscoelastic Alginate Solutions.

    PubMed

    Zhang, Zhengyi; Xiong, Ruitong; Corr, David T; Huang, Yong

    2016-03-29

    Laser-induced forward transfer-based laser printing has been being implemented as a promising orifice-free direct-write strategy for different printing applications. The printing quality during laser printing is largely affected by the jet and droplet formation process and subsequential impingement. The objective of this study is to investigate the impingement-based printing type and resulting printing quality during the laser printing of viscoelastic alginate solutions, which are representative inks for soft structure printing such as bioprinting. Three printing types are identified: droplet-impingement printing, jet-impingement printing with multiple breakups, and jet-impingement printing with a single breakup. Printing quality, in terms of printed droplet morphology and size, has been investigated as a function of alginate concentration, laser fluence, and direct-writing height based on a time-resolved imaging approach and microarrays of printed droplets. Of these, the best printing quality is achieved with single-breakup jet-impingement printing, followed by multiple-breakup jet-impingement printing, with droplet-impingement printing producing the lowest quality printing. The printing quality can be improved by using high-concentration alginate solutions. The increase of laser fluence may lead to a well-defined primary droplet for low-concentration alginate solutions; however, this can cause the droplet diameter to increase, which may not be desirable. The direct-writing height (i.e., ribbon coating-receiving substrate distance) also influences the print quality. For example, an increase in direct-writing height can cause the printing type to change from the ideal jet-impingement with a single breakup, to the jet-impingement with multiple breakups, and even the least desired droplet-impingement printing, with only slight variations in droplet diameter. PMID:26934283

  18. Arthroscopic intralesional curettage for large benign talar dome cysts

    PubMed Central

    El Shazly, Ossama; Abou El Soud, Maged M.; Nasef Abdelatif, Nasef Mohamed

    2015-01-01

    Introduction: Surgical management of large talar dome cysts is challenging due to increased morbidity by associated cartilage damage and malleolar osteotomy. The purpose of this study is to evaluate the clinical and radiological outcome of endoscopic curettage and bone graft for large talar dome cysts. Methods: This is a retrospective analysis of data for eight patients (eight feet) who were treated by arthroscopic curettage and grafting for large talar dome cysts. Seven cases were treated by posterior ankle arthroscopy as the lesion was located posteriorly while one case was treated by anterior ankle arthroscopy as the lesion was breached anteriorly. Results: The final diagnosis, was; large osteochondral lesion of talus (two cases), aneurysmal bone cyst (ABC) (two case), intra-osseous ganglion (two cases), Chronic infection in talus (one case) and angiomatous lesion of the talus (one case). The mean follow up period was 18.3 (±3.06 SD) months (range 16–25 months). The median preoperative AOFAS score was 74.5 (±5.34 SD) points. The mean postoperative AOFAS score at one year follow up was 94.6 (±2.97 SD) points. None of the patient had recurrence of the lesion during follow up. Return to normal daily activity was achieved at 11.25 (±2.37 SD) weeks. Discussion: In this short case series study, large talar dome bony cysts of different pathologies including aneurysmal bone cysts could be treated effectively by endoscopic curettage and bone grafting with no recurrence no complications during the follow-up period. PMID:27163087

  19. Arthroscopical and histological study of cartilaginous lesions treated by mosaicplasty

    PubMed Central

    Cirstoiu, CF; Bădilă, AE

    2010-01-01

    Aim. The aim of our study was to assess macro– and microscopically the knee cartilaginous lesions outcome treated by mosaicplasty. Material and method Our study included 32 patients which underwent mosaicplasty for nondegenerative cartilaginous lesions of the knee and a second look arthroscopy. In 21 patients, minibiopsies from the repaired lesion were performed under arthroscopic control (from the cartilaginous region of the transplanted osteocartilaginous grafts and from the spaces between grafts). All repaired lesions were carefully examined during arthroscopy and all harvested minifragments were studied by optical microscopy (staining method – hematoxylin eosin). Results Macroscopically, the articular surface of the repaired cartilaginous lesions was smooth and congruent to the adjacent surfaces. The aspect and resistance to compression of grafted area was similar to those of the normal surrounding cartilage. The transferred cartilage maintained its height, being at the level of the neighboring cartilage. One year postoperatively, the limits of the cartilaginous autografts were still visible. Two years postoperatively, these limits were no longer visible. Microscopically, the region of the former lesion was constituted mainly by viable hyaline cartilage. Fibrous cartilaginous tissue was visualized in the spaces between the grafts. Conclusions The second look arthroscopy showed that after mosaicplasty the repaired articular surface was smooth, leveled, homogenous and congruent to adjacent cartilage. The spaces between grafts are progressively covered by fibrous cartilaginous tissue with a more textured and uneven surface. Mosaicplasty is a biological surgical technique which restores the normal osteocartilaginous architecture of the most part of the grafted area. The transplanted osteocartilaginous cylindrical grafts maintain its viability and mechanical properties. PMID:21254739

  20. Editorial Commentary: Arthroscopic Rotator Cuff Repair--Infection Rate After Rotator Cuff Repair With Arthroscopic, Open, and Mini-open Techniques.

    PubMed

    Brand, Jefferson C

    2016-03-01

    In "Risk Factors for Infection After Rotator Cuff Repair," B. G. Vopat et al. report a lower rate of postoperative infection with an arthroscopic rotator cuff repair than with an open or mini-open approach. Although there were only 14 infections (infection rate of 0.77%), the reason for the preponderance of male patients, 13 of the 14 infections, needs further research to determine effective preventive strategies.

  1. Same day discharge following inter-scalene block administration for arthroscopic shoulder surgery: implementing a change in practice.

    PubMed

    Lane, Suzanne; Blundell, Clare; Mills, Simon; Charalambous, C P

    2014-10-01

    Patients who had arthroscopic shoulder surgery with the provision of an inter-scalene nerve block (ISB) at Blackpool Teaching Hospitals, were previously required to remain in hospital overnight. We introduced a new protocol that allowed same day discharge following arthroscopic shoulder surgery under general anaesthesia and ISB. The aim of this study was to review the outcome of this change in practice. Our results indicated that providing a discharge protocol for patients having arthroscopic shoulder surgery with the inclusion of ISB can avoid unnecessary overnight stay and enable significant cost savings, without detriment to patient safety or satisfaction.

  2. Determination of the normal arthroscopic anatomy of the femoropatellar and cranial femorotibial joints of cattle

    PubMed Central

    Nichols, Sylvain; Anderson, David E.

    2014-01-01

    The arthroscopic approach and anatomy of the bovine femoropatellar and femorotibial joints are described. A 4-mm diameter, 15-cm long arthroscope with a 30° forward angle view was used. The structures viewed were recorded according to the position of the arthroscope within the joint. The femoropatellar joint was best accessed via a lateral approach, between the middle and lateral patellar ligaments. The axial portion of the medial femorotibial joint was viewed from a medial approach between the middle and medial patellar ligaments and the abaxial portion was viewed from a lateral approach between the middle and the lateral patellar ligaments. The axial portion of the lateral femorotibial joint was viewed from a lateral approach between the middle and the lateral patellar ligaments and the abaxial portion was viewed from a medial approach between the middle and medial patellar ligaments. The results of this study provide guidelines regarding the location of arthroscopic portals to evaluate precisely different areas of the stifle in cattle. PMID:24587506

  3. The Impact of Arthroscopic Capsular Release in Patients with Primary Frozen Shoulder on Shoulder Muscular Strength

    PubMed Central

    Waszczykowski, Michał; Fabiś, Jarosław

    2014-01-01

    The aim of this study was to evaluate the impact of arthroscopic capsular release in patients with primary frozen shoulder on muscular strength of nonaffected and treated shoulder after at least two-year follow-up after the surgery. The assessment included twenty-seven patients, who underwent arthroscopic capsular release due to persistent limitation of range of passive and active motion, shoulder pain, and limited function of upper limb despite 6-month conservative treatment. All the patients underwent arthroscopic superior, anteroinferior, and posterior capsular release. After at least two-year follow-up, measurement of muscular strength of abductors, flexors, and external and internal rotators of the operated and nonaffected shoulder, as well as determination of range of motion (ROM) and function (ASES) in the operated and nonaffected shoulder, was performed. Measurement of muscular strength in the patient group did not reveal statistically significant differences between operated and nonaffected shoulder. The arthroscopic capsular release does not have significant impact on the decrease in the muscular strength of the operated shoulder. PMID:25050374

  4. Application of optical coherence tomography enhances reproducibility of arthroscopic evaluation of equine joints

    PubMed Central

    2014-01-01

    Background Arthroscopy is widely used in various equine joints for diagnostic and surgical purposes. However, accuracy of defining the extent of cartilage lesions and reproducibility in grading of lesions are not optimal. Therefore, there is a need for new, more quantitative arthroscopic methods. Arthroscopic optical coherence tomography (OCT) imaging is a promising tool introduced for quantitative detection of cartilage degeneration and scoring of the severity of chondral lesions. The aim of this study was to evaluate the inter-investigator agreement and inter-method agreement in grading cartilage lesions by means of conventional arthroscopy and with OCT technique. For this aim, 41 cartilage lesions based on findings in conventional and OCT arthroscopy in 14 equine joints were imaged, blind coded and independently ICRS (International Cartilage Repair Society) scored by three surgeons and one PhD-student. Results The intra- and inter-investigator percentages of agreement by means of OCT (68.9% and 43.9%, respectively) were higher than those based on conventional arthroscopic imaging (56.7% and 31.7%, respectively). The intra-investigator Kappa coefficients were 0.709 and 0.565 for OCT and arthroscopy, respectively. Inter-investigator Kappa coefficients were 0.538 and 0.408 for OCT and arthroscopy, respectively. Conclusions OCT can enhance reproducibility of arthroscopic evaluation of equine joints. PMID:24410869

  5. KNEE ARTHROSCOPIC VISIBILITY ALTERATIONS IN OBESE AND NON-OBESE PATIENTS

    PubMed Central

    ZINI, Cássio; STIEVEN-FILHO, Edmar; TABUSHI, Fernando Issamu; RIBAS, Carmen Australia Paredes Marcondes; RIBAS, Fernanda Marcondes; OPOLSKI, Ana Cristina; ERBANO, Bruna Olandoski

    2016-01-01

    ABSTRACT Background: Obesity is a chronic disease and has become the most prevalent public health problem worldwide. The impact of obesity on knee is strong and the BMI is correlated with the different alterations. Aim: Compare surgical visualization of arthroscopic field in partial meniscectomy in obese and non-obese. Method: Sixty patients were selected, 30 obese and 30 non-obese who underwent arthroscopic partial meniscectomy. The arthroscopic surgical procedures were recorded and analyzed. For the analysis of visualization was used the Johnson's classification (2000). Results: Were analyzed 48 men and 12 women, the average age was 42.9 years with BMI between 21.56 to 40.14 kg/m2. The distribution of visibility of the surgical field according to the classification was: grade 1 - 38/60 (63.3%); grade 2 - 13/60 (21.6%); grade 3 - 6/60 (10%); grade 4 - 3/60 (5%). Conclusion: Knee arthroscopy did not show a significant difference in the visibility of arthroscopic field in obese and non-obese patients. Thus, it should not be indicated as the preferred method of diagnostic evaluation of joint changes in these patients. PMID:27683782

  6. Beach chair position with instrumental distraction for arthroscopic and open shoulder surgeries.

    PubMed

    Correa, Mario Chaves; Gonçalves, Lucas B J; Andrade, Ronaldo P; Carvalho, Lucio H

    2008-01-01

    Arthroscopy is widely used in the diagnosis and treatment of shoulder disorders. It can be performed in the lateral or sitting position (beach chair). Both have advantages and disadvantages. We present a simple, inexpensive, versatile, portable, continuous distraction device for arthroscopic, combined, and open shoulder surgeries in the sitting position that offers the advantages of the 2 classic positions without their disadvantages. The device was used in 101 consecutive procedures: 61 rotator cuff repairs (29 arthroscopic, 18 mini-open, 14 open), 4 two-part humeral fractures, 1 septic arthritis, 3 calcifying tendinitis, 9 capsular releases, 8 Bankart repairs (6 arthroscopic, 2 open), 13 acromioplasty and biceps tenotomy, and 2 superior labrum anteroposterior repairs. Our experience with this device is extremely positive. We have had no complications and have used it for shoulder arthroscopy, open, and combined surgeries. We have also not had difficulty visualizing or approaching the glenohumeral and subacromial spaces in the treatment of shoulder disorders. It is a safe, practical, easy, and fast set up. Its versatility makes it particularly helpful for the less experienced arthroscopic surgeon.

  7. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note.

    PubMed

    Park, Jin Young; Chung, Woo Chull; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-06-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  8. Arthroscopic contact Nd:YAG laser meniscectomy: basic science, surgical technique, and clinical follow up

    NASA Astrophysics Data System (ADS)

    O'Brien, Stephen J.; Fealy, Stephen V.; Gibney, Mary A.; Miller, Drew V.; Kelly, Anne M.

    1990-06-01

    Recent basic science studies (5) have provided a scientific foundation for the use of the Contact Nd:YAG Laser as an arthroscopic tool for xneniscal resection and acroxnioplasty of the shoulder in a saline medium. This study prospectively evaluates the results of a three stage laboratory investigation as well as the clinical results of arthroscopic xneniscal resection. Fifteen patients with meniscal tears underwent subtotal meniscectomies utilizing a Contact Nd:YAG Laser (Surgical Laser Technologies; Malvern, Pennsylvania) . This was done in a saline medium with an average laser wattage of 25 W, (range 20 W to 30 W). Patients were evaluated postoperatively with reference to subjective and objective parameters at one week and four weeks postoperatively. Patients were evaluated with regard to wound healing, intraarticular swelling and pain. Assessment of technical parameters such as ease of resection, time of resection and instrument access were compared to conventional instruments. All fifteen patients were rated as having clinically excellent results based on pain relief, wound healing and swelling. In addition, although there was increased time with setting up the laser and calibrating it, there was not an increase in time for meniscal resection. Little, or no, secondary "trimmuning" was necessary with the laser. Increased accessibility was noted due to the small size of the laser. Arthroscopic Contact Nd:YAG Laser surgery is a safe and effective tool for menisca]. resection and coagulation in arthroscopic acromioplasties. It provides significant advantages over conventional cutting instruments with regard to accessibility and reduced need for secondary instruments.

  9. Arthroscopic lysis of adhesions for the stiff total knee: results after failed manipulation.

    PubMed

    Tjoumakaris, Fotios Paul; Tucker, Bradfords Chofield; Post, Zachary; Pepe, Matthew David; Orozco, Fabio; Ong, Alvin C

    2014-05-01

    Arthrofibrosis after total knee arthroplasty (TKA) is a potentially devastating complication, resulting in loss of motion and function and residual pain. For patients in whom aggressive physical therapy and manipulation under anesthesia fail, lysis of adhesions may be the only option to rescue the stiff TKA. The purpose of this study is to report the results of arthroscopic lysis of adhesions after failed manipulation for a stiff, cruciate-substituting TKA. This retrospective study evaluated patients who had undergone arthroscopic lysis of adhesions for arthrofibrosis after TKA between 2007 and 2011. Minimum follow-up was 12 months (average, 31 months). Average total range of motion of patients in this series was 62.3°. Average preoperative flexion contracture was 16° and average flexion was 78.6°. Statistical analysis was performed using Student's t test. Pre- to postoperative increase in range of motion was significant (P<.001) (average, 62° preoperatively to 98° postoperatively). Average preoperative extension deficit was 16°, which was reduced to 4° at final follow-up. This value was also found to be statistically significant (P<.0001). With regard to ultimate flexion attained, average preoperative flexion was 79°, which was improved to 103° at final follow-up. This improvement in flexion was statistically significant (P<.0001). Patients can reliably expect an improvement after arthroscopic lysis of adhesions for a stiff TKA using a standardized arthroscopic approach; however, patients achieved approximately half of the improvement that was obtained at the time of surgery.

  10. Arthroscopic repair of peripheral triangular fibrocartilage complex tears with suture welding: a technical report.

    PubMed

    Badia, Alejandro; Jiménez, Alexis

    2006-10-01

    This report presents a method of arthroscopic repair of the peripheral triangular fibrocartilage complex tears that replaces traditional suture knots with ultrasonic welding of sutures. This will help eliminate potential causes of ulnar-sided wrist discomfort during the postoperative period.

  11. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note

    PubMed Central

    Park, Jin young; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-01-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  12. A novel technique of arthroscopic excision of a symptomatic os trigonum.

    PubMed

    Horibe, Shuji; Kita, Keisuke; Natsu-ume, Takashi; Hamada, Masayuki; Mae, Tatsuo; Shino, Konsei

    2008-01-01

    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.

  13. Do nonsteroidal anti-inflammatory drugs affect the outcome of arthroscopic Bankart repair?

    PubMed

    Blomquist, J; Solheim, E; Liavaag, S; Baste, V; Havelin, L I

    2014-12-01

    To achieve pain control after arthroscopic shoulder surgery, nonsteroidal anti-inflammatory drugs (NSAIDs) are a complement to other analgesics. However, experimental studies have raised concerns that these drugs may have a detrimental effect on soft tissue-to-bone healing and, thus, have a negative effect on the outcome. We wanted to investigate if there are any differences in the clinical outcome after the arthroscopic Bankart procedure for patients who received NSAIDs prescription compared with those who did not. 477 patients with a primary arthroscopic Bankart procedure were identified in the Norwegian shoulder instability register and included in the study. 32.5% received prescription of NSAIDs post-operatively. 370 (78%) of the patients answered a follow-up questionnaire containing the Western Ontario Shoulder Instability index (WOSI). Mean follow-up was 21 months. WOSI at follow-up were 75% in the NSAID group and 74% in the control group. 12% of the patients in the NSAID group and 14% in the control group reported recurrence of instability. The reoperation rate was 5% in both groups. There were no statistically significant differences between the groups. Prescription of short-term post-operative NSAID treatment in the post-operative period did not influence on the functional outcome after arthroscopic Bankart procedures. PMID:24750379

  14. Editorial Commentary: Arthroscopic Hip Preservation Is Critical for Preserving Health and Function in Adolescents and Adults.

    PubMed

    Martin, Hal David

    2016-09-01

    Hip health is a critical factor in preserving daily life activities and wellbeing for both adults and adolescents. There are several potential economic influences in developing arthroscopic hip techniques for the evaluation and treatment of hip pathology in patients of all ages. PMID:27594331

  15. SVDS plume impingement modeling development. Sensitivity analysis supporting level B requirements

    NASA Technical Reports Server (NTRS)

    Chiu, P. B.; Pearson, D. J.; Muhm, P. M.; Schoonmaker, P. B.; Radar, R. J.

    1977-01-01

    A series of sensitivity analyses (trade studies) performed to select features and capabilities to be implemented in the plume impingement model is described. Sensitivity analyses were performed in study areas pertaining to geometry, flowfield, impingement, and dynamical effects. Recommendations based on these analyses are summarized.

  16. Results of Latarjet Coracoid Transfer to Revise Failed Arthroscopic Instability Repairs

    PubMed Central

    Nicholson, Gregory P.; Rahman, Zain; Verma, Nikhil N.; Romeo, Anthony A.; Cole, Brian J.; Gupta, Anil Kumar; Bruce, Benjamin

    2014-01-01

    Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically reconstruct anteroinferior instability pathology. Arthroscopic technique can fail for a variety of reasons. We have utilized the Latarjet as a revision option in failed arthroscopic instability repairs when there is altered surgical anatomy, capsular deficiency and/or glenoid bone compromise and recurrent glenohumeral instability. Methods: We reviewed 51 shoulders (40 ♀, 11♂) that underwent Latarjet coracoid transfer for the revision of failed previous arthroscopic instability repair. The avg. age was 32.6 yrs (16-58). All patients had recurrent symptomatic anterior instability after previous arthroscopic surgery, and avg. time from arthroscopic repair to Latarjet was 13 months (4-40 mn). All had either CT or MRI that revealed suture anchor material in the glenoid, labral and capsular stripping, and anteroinferior glenoid bone loss or erosion. Advanced bone loss percentage analysis was not performed for this study. We excluded all patients that had a previous open repair, a seizure disorder, or if the Latarjet was a primary procedure. Outcome scores pre-operatively avg: SST: 6.7 (1-12); VAS: 3 (0-8); ASES: 63 (32-89). Coracoid transfer was performed thru a subscapularis split in 38, and with tendon takedown in 13. The coracoid was osteotomized along its long axis parallel to the undersurface of the lateral aspect. This provided at least 2.5 to 3.5 cm of graft with the conjoined tendon attached. The coracoacromial (CA) ligament was incised leaving a 1 cm. stump. The transfer was affixed flush with the articular surface but not lateral to it, with two 3.5 mm cortical screws in lag fashion overdrilling the coracoid with the CA ligament directed laterally. The capsule was then repaired to the CA ligament to make the transfer extra-articular. Results: At avg. 4 yr (2-7 yrs) follow-up stability had been maintained in 51 (100%).without further instability surgery. There were no

  17. A Method for Determining Cloud-Droplet Impingement on Swept Wings

    NASA Technical Reports Server (NTRS)

    Dorsch, Robert G.; Brun, Rinaldo J.

    1953-01-01

    The general effect of wing sweep on cloud-droplet trajectories about swept wings of high aspect ratio moving at subsonic speeds is discussed. A method of computing droplet trajectories about yawed cylinders and swept wings is presented, and illustrative droplet trajectories are computed. A method of extending two-dimensional calculations of droplet impingement on nonswept wings to swept wings is presented. It is shown that the extent of impingement of cloud droplets on an airfoil surface, the total rate of collection of water, and the local rate of impingement per unit area of airfoil surface can be found for a swept wing from two-dimensional data for a nonswept wing. The impingement on a swept wing is obtained from impingement data for a nonswept airfoil section which is the same as the section in the normal plane of the swept wing by calculating all dimensionless parameters with respect to flow conditions in the normal plane of the swept wing.

  18. Trailing edge cooling using angled impingement on surface enhanced with cast chevron arrangements

    SciTech Connect

    Lee, Ching-Pang; Heneveld, Benjamin E.; Brown, Glenn E.; Klinger, Jill

    2015-05-26

    A gas turbine engine component, including: a pressure side (12) having an interior surface (34); a suction side (14) having an interior surface (36); a trailing edge portion (30); and a plurality of suction side and pressure side impingement orifices (24) disposed in the trailing edge portion (30). Each suction side impingement orifice is configured to direct an impingement jet (48) at an acute angle (52) onto a target area (60) that encompasses a tip (140) of a chevron (122) within a chevron arrangement (120) formed in the suction side interior surface. Each pressure side impingement orifice is configured to direct an impingement jet at an acute angle onto an elongated target area that encompasses a tip of a chevron within a chevron arrangement formed in the pressure side interior surface.

  19. Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses.

    PubMed

    Hayashi, Daichi; Roemer, Frank W; D'Hooghe, Pieter; Guermazi, Ali

    2015-11-01

    Posterior ankle impingement is a clinical diagnosis which can be seen following a traumatic hyper-plantar flexion event and may lead to painful symptoms in athletes such as female dancers ('en pointe'), football players, javelin throwers and gymnasts. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion, and can be due to osseous or soft tissue lesions. There are multiple causes of posterior ankle impingement. Most commonly, the structural correlates of impingement relate to post-traumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences. The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses. PMID:26239710

  20. Modular jet impingement assemblies with passive and active flow control for electronics cooling

    DOEpatents

    Zhou, Feng; Dede, Ercan Mehmet; Joshi, Shailesh

    2016-09-13

    Power electronics modules having modular jet impingement assembly utilized to cool heat generating devices are disclosed. The modular jet impingement assemblies include a modular manifold having a distribution recess, one or more angled inlet connection tubes positioned at an inlet end of the modular manifold that fluidly couple the inlet tube to the distribution recess and one or more outlet connection tubes positioned at an outlet end of the modular manifold that fluidly coupling the outlet tube to the distribution recess. The modular jet impingement assemblies include a manifold insert removably positioned within the distribution recess and include one or more inlet branch channels each including an impinging slot and one or more outlet branch channels each including a collecting slot. Further a heat transfer plate coupled to the modular manifold, the heat transfer plate comprising an impingement surface including an array of fins that extend toward the manifold insert.

  1. Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study

    PubMed Central

    Lee, Woo Hyung; Do, Hyun Kyung; Lee, Joong Hoon; Kim, Bo Ram; Noh, Jee Hyun; Choi, Soo Hyun; Chung, Sun Gun; Lee, Shi-Uk; Choi, Ji Eun; Kim, Seihee; Kim, Min Jee

    2016-01-01

    Objective To compare the clinical outcomes following conservative treatment and arthroscopic repair in patients with a rotator cuff tear. Methods In this retrospective study, patients aged >50 years with a symptomatic rotator cuff tear were reviewed. The rotator cuff tendons were evaluated using ultrasonography, shoulder magnetic resonance imaging or MR arthrography, and the patients with either a high-grade partial-thickness or small-to-medium-sized (≤3 cm) full-thickness tear were included in this study. The primary outcome measures were a pain assessment score and range of motion (ROM) at 1-year follow-up. The secondary outcomes were the rate of tear progression or retear along with the rate of symptom aggravation after the treatments. Results A total of 357 patients were enrolled, including 183 patients that received conservative treatment and 174 patients who received an arthroscopic repair. The pain assessment score (p<0.001) and the ROM in forward flexion (p<0.001) were significantly improved in both groups. The ROM in internal rotation did not significantly change after conservative treatment and arthroscopic repair. The pain assessment score and ROM were not significantly different between the two groups. Retear was observed in 9.6% of patients who had an arthroscopic repair and tear progression was found in 6.7% of those who underwent conservative treatment. The proportion of aggravation for pain and ROM did not significantly differ between the two groups. Conclusion The effectiveness of conservative treatment is not inferior to arthroscopic repair for patients >50 years old with a less than medium-sized rotator cuff tear in a 1-year follow-up period. Further study is warranted to find the optimal combination of conservative treatment for a symptomatic rotator cuff tear. PMID:27152275

  2. Rewetting of hot vertical rod during jet impingement surface cooling

    NASA Astrophysics Data System (ADS)

    Agrawal, Chitranjan; Kumar, Ravi; Gupta, Akhilesh; Chatterjee, Barun

    2016-06-01

    A stainless steel (SS-316) vertical rod of 12 mm diameter at 800 ± 10 °C initial temperature was cooled by normal impinging round water jet. The surface rewetting phenomenon was investigated for a range of jet diameter 2.5-4.8 mm and jet Reynolds number 5000-24,000 using a straight tube type nozzle. The investigation were made from the stagnation point to maximum 40 mm downstream locations, simultaneously for both upside and downside directions. The cooling performance of the vertical rod was evaluated on the basis of rewetting parameters i.e. rewetting temperature, wetting delay, rewetting velocity and the maximum surface heat flux. Two separate Correlations have been proposed for the dimensionless rewetting velocity in terms of rewetting number and the maximum surface heat flux that predicts the experimental data within an error band of ±20 and ±15 % respectively.

  3. Thermal Characterization of porous graphitic foam ? convection in impinging flow

    SciTech Connect

    Sultan, K; DeGroot, CT; Straatman, Anthony G; Gallego, Nidia C; Hangan, H

    2009-01-01

    An experimental study has been undertaken to explore the convective heat transfer enhancement that can be achieved in an impinging airflow arrangement by bonding layers of graphitic foam to a heated metal substrate. The effects of foam protrusion, foam thickness and foam properties were explored in this study. The results show that surfaces with a layer of foam protruding upward with open edges had the highest convective enhancement over that of the bare substrate under the same conditions. For the protruding cases, convective enhancements of 30-70% were observed for airflows ranging from 7-11 m/s, for foam thicknesses in the range 2-10 mm. The highest enhancements were observed for foam specimens with the most open, interconnected void structure.

  4. Subcoracoid impingement and subscapularis tendon: is there any truth?

    PubMed Central

    Osti, Leonardo; Soldati, Francesco; Del Buono, Angelo; Massari, Leo

    2013-01-01

    Summary Subcoracoid impingement and stenosis have been described related to anterior shoulder pain and subscapularis tendon tears, but the pathogenesis and related treatment of this condition has still not been explained properly. Variability of coracoid morphology has been described and both traumatic and iatrogenic factors can modify it. Some authors referred this to a primary narrow coracohumeral distance with different threshold values defined as increased risk factor for subscapularis and antero-superior RC tear; opposite theories stated that the stenosis is secondary to an anterosuperior translation of the humeral head toward the coracoid due to degenerative changes of the rotator cuff tendons. Limited coracoplasty can be performed when related risk factors are identified; however no clear consensus arises from specific literature review and extensive clinical and instrumental examination of the patient should be performed in order to identify specific risk factors for subscapularis tendon pathology and, subsequently, tailor the proper approach. PMID:23888292

  5. Ice Accretion Modeling using an Eulerian Approach for Droplet Impingement

    NASA Technical Reports Server (NTRS)

    Kim, Joe Woong; Garza, Dennis P.; Sankar, Lakshmi N.; Kreeger, Richard E.

    2012-01-01

    A three-dimensional Eulerian analysis has been developed for modeling droplet impingement on lifting bodes. The Eulerian model solves the conservation equations of mass and momentum to obtain the droplet flow field properties on the same mesh used in CFD simulations. For complex configurations such as a full rotorcraft, the Eulerian approach is more efficient because the Lagrangian approach would require a significant amount of seeding for accurate estimates of collection efficiency. Simulations are done for various benchmark cases such as NACA0012 airfoil, MS317 airfoil and oscillating SC2110 airfoil to illustrate its use. The present results are compared with results from the Lagrangian approach used in an industry standard analysis called LEWICE.

  6. Comparison of methods for detection and enumeration of airborne microorganisms collected by liquid impingement.

    PubMed Central

    Terzieva, S; Donnelly, J; Ulevicius, V; Grinshpun, S A; Willeke, K; Stelma, G N; Brenner, K P

    1996-01-01

    Bacterial agents and cell components can be spread as bioaerosols, producing infections and asthmatic problems. This study compares four methods for the detection and enumeration of aerosolized bacteria collected in an AGI-30 impinger. Changes in the total and viable concentrations of Pseudomonas fluorescens in the collection fluid with respect to time of impingement were determined. Two direct microscopic methods (acridine orange and BacLight) and aerodynamic aerosol-size spectrometry (Aerosizer) were employed to measure the total bacterial cell concentrations in the impinger collection fluid and the air, respectively. These data were compared with plate counts on selective (MacConkey agar) and nonselective (Trypticase soy agar) media, and the percentages of culturable cells in the collection fluid and the bacterial injury response to the impingement process were determined'. The bacterial collection rate was found to be relatively unchanged during 60 min of impingement. The aerosol measurements indicated an increased amount of cell fragments upstream of the impinger due to continuous bacterial nebulization. Some of the bacterial clusters, present in the air upstream of the impinger, deagglomerated during impingement, thus increasing the total bacterial count by both direct microscopic methods. The BacLight staining technique was also used to determine the changes in viable bacterial concentration during the impingement process. The percentage of viable bacteria, determined as a ratio of BacLight live to total counts was only 20% after 60 min of sampling. High counts on Trypticase soy agar indicated that most of the injured cells could recover. On the other hand, the counts from the MacConkey agar were very low, indicating that most of the cells were structurally damaged in the impinger. The comparison of data on the percentage of injured bacteria obtained by the traditional plate count with the data on percentage of nonviable bacteria obtained by the Bac

  7. Biomass and number of fish impinged at a nuclear power plant by the Baltic Sea.

    PubMed

    Bryhn, Andreas C; Bergenius, Mikaela A J; Dimberg, Peter H; Adill, Anders

    2013-12-01

    The main aim of this study was to investigate the number and biomass of impinged fish at Forsmark Nuclear Power Plant in Sweden, located on the coast of the Baltic Sea. Of particular interest was the number of impinged individuals of the critically endangered European eel (Anguilla anguilla) which is regularly caught in the cooling system. Another aim was to determine the comparability of the results from Forsmark and results from impingement studies in other types of waters. Cross-systems studies make it possible to (1) estimate fish loss at plants where fish is not counted, and (2) to predict changes in fish loss from changes in electricity production or cooling water use. In 2010, 31,300,000 fish with a total biomass of 62,600 kg were impinged at Forsmark. In 2011, 27,300,000 fish weighing 38,500 kg were impinged. The maximum peak in total fish number and biomass occurred in spring. The most critical period for herring was in late summer and early autumn. Regarding eel, the largest impingement losses were recorded in November. The number of fish agreed with earlier established quantities of impinged fish in both freshwater and marine ecosystems. The study also estimated that 1,300 critically endangered eels could survive at Forsmark each year if a fish return system would be constructed to allow the passage of fish from the plant back to the Baltic Sea. PMID:23880915

  8. Heat transfer from a liquid bath due to an impinging gas jet: A numerical study

    SciTech Connect

    Qian, F.; Farouk, B.; Mutharasan, R.

    1995-12-31

    An impinging gasjet on a liquid surface is found in many industrial processes such as electric arc furnace steel-making and welding. Fundamental understanding of the interaction of a gas or plasmajet impinging on a liquid pool can provide important insights into process behavior resulting in improved efficiency. A numerical model is developed for solving both the impinging gas jet and the liquid pool temperature and flow fields along with the deformed interface shape for the above processing operation. Using curvilinear coordinates, the Navier-Stokes equations of each phase are solved separately and then coupled via continuity of static pressure, shear stress, temperature and heat flux at the interface.

  9. MR imaging of the thrower's shoulder. Internal impingement, latissimus dorsi/subscapularis strains, and related injuries.

    PubMed

    Schickendantz, M S; Ho, C P; Keppler, L; Shaw, B D

    1999-02-01

    In conclusion, internal impingement apparently occurs in nearly all patients and is demonstrable on MR imaging. Pathologic changes associated with internal impingement seem to develop with repetitive placement of the arm into a position of extreme external rotation and abduction. Findings may include lesions of the posterior superior labrum, undersurface irritation, or tearing of the supraspinatus-infraspinatus junction near the attachment site and cystic changes of the posterior superior glenoid and posterior lateral greater tuberosity. There is no evidence for a particular sequence of pathologic changes. Instability may be associated with but does not appear to be a prerequisite for the development of the pathologic lesions of internal impingement.

  10. Effects of the Neurac® technique in patients with acute-phase subacromial impingement syndrome

    PubMed Central

    Kim, Soo-Yong; Kang, Min-Hyeok; Lee, Dong-Kyu; Oh, Jae-Seop

    2015-01-01

    [Purpose] This study investigated the effects of the Neurac technique on shoulder pain, function, and range of motion in patients with acute-phase subacromial impingement syndrome. [Subjects] Thirteen patients (seven females and six males) with acute-phase subacromial impingement syndrome participated in this study. [Methods] Shoulder pain, function, and range of motion were assessed before and after the application of the Neurac technique. [Results] Pain and function scores were significantly lower after than before the Neurac intervention. Shoulder range of motion was significantly greater after Neurac intervention than before it. [Conclusion] The Neurac technique is a useful intervention for patients with acute-phase subacromial impingement syndrome. PMID:26157230

  11. Modeling and experimental validation of unsteady impinging flames

    SciTech Connect

    Fernandes, E.C.; Leandro, R.E.

    2006-09-15

    This study reports on a joint experimental and analytical study of premixed laminar flames impinging onto a plate at controlled temperature, with special emphasis on the study of periodically oscillating flames. Six types of flame structures were found, based on parametric variations of nozzle-to-plate distance (H), jet velocity (U), and equivalence ratio (f). They were classified as conical, envelope, disc, cool central core, ring, and side-lifted flames. Of these, the disc, cool central core, and envelope flames were found to oscillate periodically, with frequency and sound pressure levels increasing with Re and decreasing with nozzle-to-plate distance. The unsteady behavior of these flames was modeled using the formulation derived by Durox et al. [D. Durox, T. Schuller, S. Candel, Proc. Combust. Inst. 29 (2002) 69-75] for the cool central core flames where the convergent burner acts as a Helmholtz resonator, driven by an external pressure fluctuation dependent on a velocity fluctuation at the burner mouth after a convective time delay {tau}. Based on this model, the present work shows that {tau} = [Re[2jtanh{sup -1}((2{delta}{omega}+(1+N)j{omega}{sup 2}-j{omega}{sub 0}{sup 2})/ (2{delta}{omega}+(1-N)j{omega}{sup 2}-j{omega}{sub 0}{sup 2}))]+2{pi}K]/{omega}, i.e., there is a relation between oscillation frequency ({omega}), burner acoustic characteristics ({omega}{sub 0},{delta}), and time delay {tau}, not explicitly dependent on N, the flame-flow normalized interaction coefficient [D. Durox, T. Schuller, S. Candel, Proc. Combust. Inst. 29 (2002) 69-75], because {partial_derivative}t/{partial_derivative}N = 0. Based on flame motion and noise analysis, K was found to physically represent the integer number of perturbations on flame surface or number of coherent structures on impinging jet. Additionally, assuming that {tau}={beta}H/U, where H is the nozzle-to-plate distance and U is the mean jet velocity, it is shown that {beta}{sub Disc}=1.8, {beta}{sub CCC}=1

  12. Heat convection in a micro impinging jet system

    NASA Astrophysics Data System (ADS)

    Mai, John Dzung Hoang

    2000-10-01

    This thesis covers the development of an efficient micro impinging jet heat exchanger, using MEMS technology, to provide localized cooling for present and next generation microelectronic computer chips. Before designing an efficient localized heat exchanger, it is necessary to investigate fluid dynamics and heat transfer in the micro scale. MEMS technology has been used in this project because it is the only tool currently available that can provide a large array of batch-fabricated, micro-scale nozzles for localized cooling. Our investigation of potential MEMS heat exchanger designs begins with experiments that measure the pressure drops and temperature changes in a micro scale tubing system that will be necessary to carry fluid to the impingement point. Our basic MEMS model is a freestanding micro channel with integrated temperature microsensors. The temperature distribution along the channel in a vacuum is measured. The measured flow rates are compared with an analytical model developed for capillary flow that accounts for 2-D, slip and compressibility effects. The work is focused on obtaining correlations in the form of the Nussult number, the Reynolds number and a H/d geometric factor. A set of single MEMS nozzles have been designed to test heat transfer effectiveness as a function of nozzle diameter, ranging from 1.0 mm to 250 um. In addition, nozzle and slot array MEMS devices have been fabricated. In order to obtain quantitative measurements from these micron scale devices, a series of target temperature sensor chips were custom made and characterized for these experiments. The heat transfer characteristics of various MEMS nozzle configurations operating at various steady inlet pressures, at different heights above the heated substrate, have been characterized. These steady results showed that the average heat transfer coefficient, averaged over a 1 cm2 test area, was usually less than 0.035 W/cm 2K for any situation. However, the local heat transfer

  13. Space shuttle vehicle rocket plume impingement study for separation analysis. Tasks 2 and 3: Definition and preliminary plume impingement analysis for the MSC booster

    NASA Technical Reports Server (NTRS)

    Wojciechowski, C. J.; Penny, M. M.; Prozan, R. J.

    1970-01-01

    The results are presented of a space shuttle plume impingement study for the Manned Spacecraft Center configuration. This study was conducted as two tasks which were to (1) define the orbiter main stage engine exhaust plume flow field, and (2) define the plume impingement heating, force and resulting moment environments on the booster during the staging maneuver. To adequately define these environments during the staging maneuver and allow for deviation from the nominal separation trajectory, a multitude of relative orbiter/booster positions are analyzed which map the region that contains the separation trajectories. The data presented can be used to determine a separation trajectory which will result in acceptable impingement heating rates, forces, and the resulting moments. The data, presented in graphical form, include the effect of roll, pitch and yaw maneuvers for the booster. Quasi-steady state analysis methods were used with the orbiter engine operating at full thrust. To obtain partial thrust results, simple ratio equations are presented.

  14. Posterior ankle impingement syndrome: A systematic four-stage approach

    PubMed Central

    Yasui, Youichi; Hannon, Charles P; Hurley, Eoghan; Kennedy, John G

    2016-01-01

    Posterior ankle impingement syndrome (PAIS) is a common injury in athletes engaging in repetitive plantarflexion, particularly ballet dancers and soccer players. Despite the increase in popularity of the posterior two-portal hindfoot approach, concerns with the technique remain, including; the technical difficulty, relatively steep learning curve, and difficulty performing simultaneous anterior ankle arthroscopy. The purpose of the current literature review is to provide comprehensive knowledge about PAIS, and to describe a systematic four-stage approach of the posterior two-portal arthroscopy. The etiology, clinical presentation, diagnostic strategies are first introduced followed by options in conservative and surgical management. A detailed systematic approach to posterior hindfoot arthroscopy is then described. This technique allows for systematic review of the anatomic structures and treatment of the bony and/or soft tissue lesions in four regions of interest in the hindfoot (superolateral, superomedial, inferomedial, and inferolateral). The review then discusses biological adjuncts and postoperative rehabilitation and ends with a discussion on the most recent clinical outcomes after posterior hindfoot arthroscopy for PAIS. Although clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal arthroscopy may improve upon this problem. PMID:27795947

  15. Low extreme-ultraviolet luminosities impinging on protoplanetary disks

    SciTech Connect

    Pascucci, I.; Hendler, N. P.; Ricci, L.; Gorti, U.; Hollenbach, D.; Brooks, K. J.; Contreras, Y.

    2014-11-01

    The amount of high-energy stellar radiation reaching the surface of protoplanetary disks is essential to determine their chemistry and physical evolution. Here, we use millimetric and centimetric radio data to constrain the extreme-ultraviolet (EUV) luminosity impinging on 14 disks around young (∼2-10 Myr) sun-like stars. For each object we identify the long-wavelength emission in excess to the dust thermal emission, attribute that to free-free disk emission, and thereby compute an upper limit to the EUV reaching the disk. We find upper limits lower than 10{sup 42} photons s{sup –1} for all sources without jets and lower than 5 × 10{sup 40} photons s{sup –1} for the three older sources in our sample. These latter values are low for EUV-driven photoevaporation alone to clear out protoplanetary material in the timescale inferred by observations. In addition, our EUV upper limits are too low to reproduce the [Ne II] 12.81 μm luminosities from three disks with slow [Ne II]-detected winds. This indicates that the [Ne II] line in these sources primarily traces a mostly neutral wind where Ne is ionized by 1 keV X-ray photons, implying higher photoevaporative mass loss rates than those predicted by EUV-driven models alone. In summary, our results suggest that high-energy stellar photons other than EUV may dominate the dispersal of protoplanetary disks around sun-like stars.

  16. Absorption of impinging water droplet in porous stones.

    PubMed

    Lee, J B; Radu, A I; Vontobel, P; Derome, D; Carmeliet, J

    2016-06-01

    This paper presents an experimental investigation and numerical analysis of the absorption of water droplets impacting porous stones. The absorption process of an impinging droplet is here fully characterized from spreading to evaporation in terms of absorbed mass during droplet depletion and moisture content distribution in a time-resolved manner for three different natural stones. High-speed imaging and neutron radiography are used to quantify moisture absorption in porous stones of varying moisture properties from deposition until depletion. During impact and spreading, the droplet exhibits a dynamic non-wetting behavior. At maximum spreading, the droplet undergoes pinning, resulting into the contact radius remaining constant until droplet depletion. Absorption undergoes two phases: initially, absorption is hindered due a contact resistance attributed to entrapped air; afterwards, a more perfect capillary contact occurs and absorption goes on until depletion, concurrently with evaporation and further redistribution. A finite-element numerical model for isothermal unsaturated moisture transport in porous media captures the phases of mass absorption in good agreement with the experimental data. Droplet spreading and absorption are highly determined by the impact velocity of the droplet, while moisture content redistribution after depletion is much less dependent on impact conditions.

  17. An Arthroscopic Technique for Long Head of Biceps Tenodesis With Double Knotless Screw

    PubMed Central

    Su, Wei-Ren; Ling, Florence Y.; Hong, Chih-Kai; Chang, Chih-Hsun; Chung, Kai-Chen; Jou, I-Ming

    2015-01-01

    Tenodesis of the long head of the biceps (LHB) is a frequently performed procedure during shoulder arthroscopy for the treatment of degenerative, traumatic, or inflammatory lesions of the LHB tendon. Arthroscopic techniques for LHB tenodesis using knotless screw techniques offer the advantage of circumventing the need for arthroscopic knot tying. In 2012 Song and Williams described a novel tenodesis technique that does not require any knot-tying procedures by using a knotless anchor. However, a single-anchor configuration may not offer adequate stabilization of the LHB tendon. Therefore we propose a modified method that uses a double knotless anchor that offers advantages over the single knotless anchor, such as an increase in the contact area between the tendon and bone to facilitate tendon-to-bone healing and strengthening of the tenodesis construct. PMID:26759780

  18. Osteoid osteoma (OO) of the coracoid: a case report of arthroscopic excision and review of literature

    PubMed Central

    Goyal, Saumitra; Said, Hatem Galal

    2015-01-01

    Osteoid osteoma (OO) of the coracoid is a rare entity that may present with variable symptoms from shoulder leading to delay in diagnosis and treatment. We present the clinical and radiological findings and management of one such case along with a review of similar cases reported in the literature. There was a delay of 2 years in diagnosis, which was later confirmed by computed tomography in addition to magnetic resonance imaging (MRI). The lesion was accessed arthroscopically and excised by unroofing and curettage. “OO” should be included in the differential diagnosis of shoulder pain in young patients not responding to long-term conservative treatment. Arthroscopic excision and curettage provide a good choice for management, with low morbidity and rapid recovery. PMID:27163073

  19. Arthroscopic Microfracture Technique for Cartilage Damage to the Lateral Condyle of the Tibia

    PubMed Central

    Kan, Hiroyuki; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Minami, Ginjiro; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2015-01-01

    This report describes the use of arthroscopic microfracture to treat a 10-year-old female patient with extensive damage to the cartilage of the lateral condyle of the tibia before epiphyseal closure, resulting in good cartilage recovery. Magnetic resonance imaging showed a defect in part of the load-bearing surface of the articular cartilage of the condyle articular of the tibia. The patient was diagnosed with damage to the lateral condyle cartilage of the tibia following meniscectomy, and arthroscopic surgery was performed. The cartilage defect measured approximately 20 × 20 mm, and microfracture was performed. Arthroscopy performed four months postoperatively showed that the cartilage defect was completely covered with fibrous cartilage, and the patient was allowed to resume sports activities. Four years postoperatively, she has had no recurrence of pain or hydrarthrosis. PMID:26345523

  20. Current Arthroscopic Concepts in Repairing Posterior Cruciate Ligament Tibial-Sided Avulsions.

    PubMed

    Malempati, Chaitu; Felder, Jerrod; Elliott, Michael; Brunkhorst, Joseph; Miller, Mark; Johnson, Darren L

    2015-09-01

    Posterior cruciate ligament (PCL) injuries are extremely rare and most commonly occur in the trauma setting. They can lead to instability, pain, diminished function, and eventual arthrosis. Several techniques of arthroscopic PCL repair for tibial-sided bony avulsions have been described in the literature; however, no single technique has emerged as the gold standard to predictably restore posterior knee stability, PCL function, and knee biomechanics. The authors believe that the best results will come from procedures that re-create the normal human anatomy and knee kinematics. In this article, 3 arthroscopic methods of PCL avulsion repairs performed at 2 academic institutions are analyzed. The techniques described here provide good options for the treatment of these injuries.

  1. Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

    PubMed Central

    Boutsiadis, Achilleas; Karataglis, Dimitrios; Agathangelidis, Filon; Ditsios, Konstantinos; Papadopoulos, Pericles

    2014-01-01

    Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection. PMID:25685674

  2. Arthroscopic Remplissage for Engaging Hill-Sachs Lesions in Patients With Anterior Shoulder Instability

    PubMed Central

    Camp, Christopher L.; Dahm, Diane L.; Krych, Aaron J.

    2015-01-01

    Anterior shoulder instability is often accompanied by a Hill-Sachs defect on the humeral head that can contribute to recurrent instability if not addressed at the time of surgery. We describe a method of performing arthroscopic remplissage to treat engaging Hill-Sachs lesions in patients with glenohumeral instability. It has the benefits of being an efficient procedure that can be performed with minimal technical difficulty and can be used to augment other stabilization procedures such as labral repair. The indications for this technique include the presence of an engaging Hill-Sachs defect in patients will little or no glenoid bone loss. In appropriately selected patients, arthroscopic remplissage has shown reduced rates of recurrent instability. PMID:26697311

  3. Arthroscopic excision of the os trigonum: a new technique with preliminary clinical results.

    PubMed

    Marumoto, J M; Ferkel, R D

    1997-12-01

    Open excision of a painful os trigonum can be associated with prolonged recovery. An arthroscopic technique has been developed to decrease scarring, diminish surgical morbidity, and promote a faster recovery. Eleven patients were retrospectively evaluated after removal of the os trigonum after a mean follow-up of 35 months. Small joint arthroscopy equipment was utilized in a supine position with a distraction device. Average patient scores improved on the AOFAS Ankle/Hindfoot Scale from 45 to 86 points. All patients went home the same day, and no complications occurred during the procedure. All patients reached maximum recovery level within the first 3 months after surgery. Arthroscopic excision of a painful os trigonum yields good results with minimal surgical morbidity and shorter recovery time.

  4. Arthroscopic Anatomic Humeral Head Reconstruction With Osteochondral Allograft Transplantation for Large Hill-Sachs Lesions

    PubMed Central

    Snir, Nimrod; Wolfson, Theodore S.; Hamula, Mathew J.; Gyftopoulos, Soterios; Meislin, Robert J.

    2013-01-01

    Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation. PMID:24266001

  5. The contact neodymium-yttrium aluminum garnet laser. A new approach to arthroscopic laser surgery.

    PubMed

    O'Brien, S J; Miller, D V

    1990-03-01

    Arthroscopic treatment of meniscal lesions has been modified as technological advances have occurred. However, alternatives to conventional arthroscopic cutting tools, including electrocautery and CO2 lasers, have thus far met with limited success. The recent development of a sapphire tip has enabled the use of the neodymium-yttrium aluminum garnet (Nd-YAG) laser in a contact mode in a saline medium. This study compares the biology of the Nd-YAG laser to that of electrocautery and scalpel techniques with respect to its effects on articular cartilage and the meniscus. The contact Nd-YAG laser has advantages over both scalpel and electrocautery with regard to its effects on articular cartilage. It also has significant biologic advantages over electrocautery for meniscal lesions. Although in its infancy in the clinical setting, the contact Nd-YAG laser represents the possible beginning of a new era for application of laser energy in arthroscopy.

  6. Arthroscopic posterior cruciate ligament reconstruction using four-strand hamstring tendon graft and interference screws.

    PubMed

    Pinczewski, L A; Thuresson, P; Otto, D; Nyquist, F

    1997-10-01

    We describe an arthroscopic technique for reconstruction of the posterior cruciate ligament (PCL) using a four-strand hamstring tendon graft. The femoral tunnel is drilled via the anterolateral portal and the tibial tunnel through the skin incision from the graft harvest. The graft is pulled through the tunnels with pullout sutures and fastened with interference screws. The results to date are good and the procedure can often be performed as day surgery. PMID:9343661

  7. Arthroscopic resection of the distal clavicle in osteoarthritis of the acromioclavicular joint

    PubMed Central

    Park, Tae-Soo; Lee, Kwang-Won

    2016-01-01

    Background: Symptomatic acromioclavicular joint (ACJ) lesions are a common cause of shoulder complaints that can be treated successfully with both conservative and surgical methods. There are several operative techniques, including both open and arthroscopic surgery, for excising the distal end of the clavicle. Here, we present a new modified arthroscopic technique for painful osteoarthritis of the ACJ and evaluate its clinical outcomes. Our hypothesis was that 4- to 7-mm resection of the distal clavicle in an en bloc fashion would have several advantages, including no bony remnants, maintenance of stability of the ACJ, and reduced prevalence of heterotopic ossification, in addition to elimination of the pathologic portion of the distal clavicle. Materials and Methods: 20 shoulders of 20 consecutive patients with painful and isolated osteoarthritis of the ACJ who were treated by arthroscopic en bloc resection of the distal clavicle were included in the study. There were 10 males and 10 females with an average age of 56 years (range 42–70 years). The mean duration of followup was 6 years and 2 months (range 4–8 years 10 months). The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score. Results: The overall UCLA score was 13.7 preoperatively, which improved to 33.4 postoperatively. All subscores were improved significantly (P < 0.001). There were no specific complications at the latest followup. Conclusion: It is critical in this procedure to resect the distal clavicle evenly from superior to inferior in an en bloc fashion without any small bony remnants and to preserve the capsule and acromioclavicular ligament superoposteriorly. This arthroscopic procedure is a reliable and reproducible technique for painful osteoarthritis of the ACJ lesions in active patients engaged in overhead throwing sports and heavy labor. PMID:27512219

  8. Editorial Commentary: Iliotibial Band Allograft Shows Promise for Arthroscopic Hip Labral Reconstruction.

    PubMed

    Rossi, Michael J

    2016-01-01

    Arthroscopic hip labral reconstruction using iliotibial band allograft in a modified front-to-back technique results in improved outcomes after 2-year follow-up. The authors' reasoning for reconstruction are reminiscent of similar arguments for restoring hoop stresses in knee meniscal surgery. Results are comparable to reported outcomes of labral repair, and allograft is particularly indicated for severe labral damage when repair is not possible. Don't miss the related technical note with video in Arthroscopy Techniques.

  9. Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery

    PubMed Central

    Lim, Se Hun; Lee, Wonjin; Park, JaeGwan; Kim, Myoung-hun; Cho, Kwangrae; Lee, Jeong Han; Cheong, Soon Ho

    2016-01-01

    Background Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. Methods Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. Results The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. Conclusions The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery. PMID:27482313

  10. Editorial Commentary: Iliotibial Band Allograft Shows Promise for Arthroscopic Hip Labral Reconstruction.

    PubMed

    Rossi, Michael J

    2016-01-01

    Arthroscopic hip labral reconstruction using iliotibial band allograft in a modified front-to-back technique results in improved outcomes after 2-year follow-up. The authors' reasoning for reconstruction are reminiscent of similar arguments for restoring hoop stresses in knee meniscal surgery. Results are comparable to reported outcomes of labral repair, and allograft is particularly indicated for severe labral damage when repair is not possible. Don't miss the related technical note with video in Arthroscopy Techniques. PMID:26743407

  11. Eikenella corrodens septic hip arthritis in a healthy adult treated with arthroscopic irrigation and debridement.

    PubMed

    Gowda, Ashok L; Mease, Samuel J; Dhar, Yasmin

    2014-09-01

    We present the case of a seemingly spontaneous septic hip arthritis in a patient with no pertinent medical history. Our patient presented with persistent and worsening sharp lower back pain and underwent arthrocentesis of the hip joint, yielding purulent fluid positive for Eikenella corrodens. Our patient's treatment consisted of arthroscopic irrigation with debridement and limited synovectomy that used a supine 2-incision technique. To our knowledge, this is the first reported case of an E corrodens septic hip arthritis.

  12. Arthroscopic repair of the subscapularis tendon: indications, limits and technical features

    PubMed Central

    Osti, Leonardo; Soldati, Francesco; Del Buono, Angelo; Buda, Matteo

    2013-01-01

    Summary The rationale to anatomically repair this tendon is to restore the functional biomechanics of the shoulder. Clinical and imaging assessment are required before undertaking arthroscopy. In this way, associated pathologies of the biceps and labrum may be successfully addressed. The arthroscopic repair of the tendon implies to use suture anchors and reinsert the tendon itself over the footprint. Results after arthroscopy are comparable to those observed after open procedures. PMID:24367783

  13. Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature

    PubMed Central

    Woodmass, Jarret M; Esposito, John G; Ono, Yohei; Nelson, Atiba A; Boorman, Richard S; Thornton, Gail M; Lo, Ian KY

    2015-01-01

    Purpose Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. Methods Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms “Acromioclavicular Joint (MeSH)” OR “acromioclavicular* (text)” OR “coracoclavicular* (text)” AND “Arthroscopy (MeSH)” OR “Arthroscop* (text)” were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I2 statistic. Level of evidence IV Results A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients. Conclusion Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with

  14. Loose Body in Elbow of a Baseball Player: Arthroscopic/Radiologic Correlation.

    PubMed

    Folio, Les Roger; Craig, Steve H; Wright, Gregory A; Battaglia, Michael J

    2006-01-01

    We present the case of a 21 year old male college varsity baseball player who presented with sudden non-traumatic right elbow pain and limited range of motion. Plain radiographs suggested a calcified intra-articular body. Magnetic Resonance (MR) was performed to better characterize the location, consistency and mobility of this body. Multiple intra-articular bodies were found at subsequent arthroscopy. This case emphasizes the close correlation among the clinical, radiographic, MR and arthroscopic findings.

  15. Arthroscopic Knotless, Double-Row, Extended Linked Repair for Massive Rotator Cuff Tears.

    PubMed

    Greenspoon, Joshua A; Petri, Maximilian; Millett, Peter J

    2016-02-01

    The management of massive rotator cuff tears remains a challenge for physicians, with failure rates being higher when compared with smaller tears. Many surgical treatment options exist including debridement with biceps tenodesis, complete repair, partial repair, repair with augmentation devices, superior capsule reconstruction, tendon transfer, and reverse total shoulder arthroplasty. The purpose of this article is to describe our preferred surgical technique for a complete arthroscopic repair using an extended linked, knotless, double-row construct. PMID:27330944

  16. Suprascapular nerve palsy after arthroscopic Latarjet procedure: a case report and review of literature.

    PubMed

    Sastre, Sergi; Peidro, Lluis; Méndez, Anna; Calvo, Emilio

    2016-02-01

    The Bristow and Latarjet procedures have become popular among orthopaedic surgeons thanks to the development of new instruments that allow the use of arthroscopic techniques to treat cases of glenohumeral instability with bone defects or capsular deficiency. Nonetheless, several complications have been reported after Latarjet procedures, including neurological injuries. This report describes surgical damage to the suprascapular nerve, an unusual complication. Level of evidence Expert opinion, Level V.

  17. Arthroscopic excision of the os trigonum: using the posteromedial portal safely.

    PubMed

    Richards, Daniel T; Guerra, James J; Council, Dale

    2010-08-01

    The os trigonum is an accessory ossicle that, though usually asymptomatic, can become a chronic source of pain, particularly in dancers and athletes. Surgical intervention is sometimes necessary, with arthroscopy having the theoretical advantages of less pain, inflammation, and scarring. Presented here is an example of chronic posterior ankle pain in an athlete successfully treated with arthroscopic os trigonum resection using posteromedial and posterolateral portals. We review the technical features and surgical technique of safe placement of the posteromedial portal and associated advantages.

  18. How do massive immobile rotator cuff tears behave after arthroscopic interval slides? Comparison with mobile tears

    PubMed Central

    FOSSATI, CHIARA; ARRIGONI, PAOLO; RAGONE, VINCENZA; SPENNACCHIO, PIETRO; BANFI, GIUSEPPE; RANDELLI, FILIPPO; RANDELLI, PIETRO

    2014-01-01

    Purpose the aim of this study was to compare clinical outcomes of contracted immobile massive rotator cuff tears mobilised through an arthroscopic interval slide technique versus massive mobile cuff tears directly repaired without any mobilisation. Methods twenty-five patients who underwent arthroscopic repair for massive rotator cuff tears with a minimum of 18 months follow-up were included. The patients were retrospectively divided into two groups. In group 1, a single or double interval slide was performed to achieve adequate tendon mobilisation. In group 2 (control group), massive rotator cuff tears were arthroscopically repaired without any additional release. Patients were evaluated with validated outcomes scores: subjective and objective Constant score, a Visual Analogue Scale (VAS) for pain, and single Assessment Numeric Evaluation (SANE). Results the two groups were comparable in terms of age, gender and involvement of the dominant arm. The mean follow-up duration was 31 months in group 1 and 28 months in group 2 (p = 0.4). The two groups showed no significant differences in SANE and VAS results (group 1: SANE 77%, VAS 1.3; group 2: SANE 88%, VAS 1.6), or in total Constant score (group 1: 66.5 ± 11; group 2: 75 ± 14; p = 0.1) and subjective Constant score (Group 1: 31 ± 5; group 2: 30.8 ± 7; p = 0.9). A significant difference was found for the objective Constant score, which was higher in the control group (group 1: 35.5 ± 7; group 2: 44 ± 8; p = 0.009). Conclusions Subjective clinical outcomes of arthroscopic repair with or without interval slides did not differ and were satisfactory. Objectively, immobile cuff tears showed inferior results. The use of interval slides might be considered a first step or an alternative to more invasive procedures for low demanding patients. Level of evidence Level III, retrospective comparative study. PMID:25606545

  19. Apparatus and methods for impingement cooling of a side wall of a turbine nozzle segment

    DOEpatents

    Burdgick, Steven Sebastian

    2002-01-01

    A gas turbine nozzle segment has outer and inner bands and a vane therebetween. Each band includes a nozzle wall, a side wall, a cover and an impingement plate between the cover and the nozzle wall defining two cavities on opposite sides of the impingement plate. Cooling steam is supplied to one cavity for flow through apertures of the impingement plate to cool the nozzle wall. The side wall of the band and inturned flange define with the nozzle wall an undercut region. The impingement plate has a turned flange welded to the inturned flange. A backing plate overlies the turned flange and aligned apertures are formed through the backing plate and turned flange to direct and focus cooling flow onto the side wall of the nozzle segment.

  20. Intraligamentous ganglion cysts of the anterior cruciate Ligament: MR findings with clinical and arthroscopic correlations

    SciTech Connect

    Do-Dai, D.D.; Youngberg, R.A.; Lanchbury, F.D.; Pitcher, J.D. Jr.; Garver, T.H.

    1996-01-01

    Magnetic resonance findings with clinical and arthroscopic correlation of intraligamentous cysts of the anterior cruciate ligament (ACL) are presented. Three cases of intraligamentous cysts of the ACL were identified out of 681 knee MRI examinations over a 2-year period. Arthroscopy and postoperative MRI were performed in all three patients, each of whom experienced knee pain with extreme flexion and extension. In all three cases the intraligamentous cyst was homogeneously hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging relative to the ACL. Two of the three ACL cysts required a 70{degrees} scope for adequate visualization and establishment of posteromedial and posterolateral portals for arthroscopic treatment. One cyst could not be visualized arthroscopically and probing of the ACL from the anterior portal resulted in drainage of the cyst. No patient had presence of ACL cyst on follow-up MRI or recurrence of symptoms at a mean of 24 months. Intraligamentous cyst of ACL is a rare cause of knee pain. It should be suspected in patients having chronic pain with extremes of motion. Magnetic resonance findings are diagnostic and help to guide arthroscopy. 14 refs., 3 figs.