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Zhang Y, Chen Z, Wang C, Tang N, Dong B, Chen B. Understanding the structure and cutting mechanism of shaver blades: A case study on articular cartilage. Proc Inst Mech Eng H 2022; 236:1139-1156. [DOI: 10.1177/09544119221098508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mechanical shaver blades have been used in minimally invasive knee arthroscopy surgery for nearly 50 years, however, the tooth structure and cutting mechanism of shaver blades were less reported. This paper designed several shaver blades (triangular tooth/TT, circular tooth/CT and convex arc tooth/CAT), defined the cutting edges and angles of the original shaver (OS) and proposed a newly designed shaver (NDS) with a positive secondary rake angle to optimize cutting performance. The cutting process and theoretical model of the OS and NDS were analysed from 2D and 3D perspectives. A comparative experimental analysis of cutting performance, including cutting force, surface roughness, and groove geometries, was carried out to verify the influence of tooth structures and secondary rake angle. The results showed that the tooth of the OS has three different cutting edges, among which the secondary cutting edge sited at the tube section contributes to the puncturing process, and the primary cutting edge located on the outer wall of the tube participates in the oblique cutting process and finally removes the soft tissue. The cutting process of the secondary cutting edge of NDS has been changed from puncturing to oblique cutting, therefore, only the oblique cutting exists throughout the shaving process. This makes the shape and quantity of the chips of OS and NDS different, which has been verified by experiment. The cutting performance of CT was superior to that of TT and CAT, highlighting the importance of tooth roots in the cutting process. Positive secondary rake angle significantly improved the cutting performance of CAT, but not that of TT with a small profile angle (30°) and CT, which means both the puncturing and oblique cutting play important roles. Not all the positive secondary rake angle was helpful to the cutting process and 30° and 45° were suggested.
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Affiliation(s)
- Yue Zhang
- Guangdong University of Technology/Nerchd/UELOIMOD, Guangzhou, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, China
| | - Zhihua Chen
- Guangdong University of Technology/Nerchd/UELOIMOD, Guangzhou, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, China
| | - Chengyong Wang
- Guangdong University of Technology/Nerchd/UELOIMOD, Guangzhou, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, China
| | - Na Tang
- Guangdong University of Technology/Nerchd/UELOIMOD, Guangzhou, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, China
| | - Bangxi Dong
- Guangdong University of Technology/Nerchd/UELOIMOD, Guangzhou, China
- Guangdong Provincial Key Laboratory of Minimally Invasive Surgical Instruments and Manufacturing Technology, Guangdong University of Technology, Guangzhou, China
| | - Bin Chen
- Southern Medical University Affiliated Hospital Orthopedic Trauma, Guangzhou, China
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Khoury AN, Krupp MJ, Matuska AM, Friedman DJ. Bipolar Radiofrequency Ablation Does Not Result in Full-Thickness Articular Cartilage Penetration: An Ex Vivo Bovine Investigation. Arthrosc Sports Med Rehabil 2022; 4:e1067-e1073. [PMID: 35747658 PMCID: PMC9210475 DOI: 10.1016/j.asmr.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/02/2022] [Indexed: 11/02/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Liang P, Zhao G, Gu X, Chen Z, Xu S, Lai W, Liu W. Assessment of arthroscopic shavers: a comparison test of resection performance and quality. J Orthop Surg Res 2020; 15:62. [PMID: 32085784 PMCID: PMC7033941 DOI: 10.1186/s13018-020-01596-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Arthroscopic shavers play an indispensable role in arthroscopic debridement. They have exquisite structures and similar designs. The purpose of this study was to establish a reproducible testing protocol to compare the resection performance and the quality (tensile strength, torsional strength, and corrosion resistance) of different arthroscopic shavers with comparable designs. We hypothesized that there could be little difference in resection performance and quality between these shavers. Methods Incisor Plus Blade (IPB; Smith & Nephew, Andover, MA) and Double Serrated Plus Blade (DSPB; BJKMC, Shanghai, China) were selected for resection performance and quality test. For resection performance testing, the resection torque, which is the minimum torque required to cut off silicone blocks with the same cross-sectional area, was measured to evaluate the resection performance of shaver blades when the other factors remain the same. For quality testing, tensile and torsion tests of the shavers’ joint part were performed, and ultimate failure load and maximum torque were measured and compared. The corrosion resistance of these blades was assessed by the boiling water test based on the ISO13402. Results No significant difference existed in the resection torque between the shaver blades of IPB and DSPB (P = 0.54). To the failure load of shavers’ joint parts, IPB was significantly higher than DSPB, both in the outer and inner blades (P < 0.0001). The maximum torque of the joint part had no significant difference between IPB and DSPB (for inner blades P = 0.60 and outer blades P = 0.94). The failure load (for both IPB and DSPB P < 0.0001) and maximum torque (for IPB P = 0.0475 and DSPB P = 0.015) of the inner blades were higher than those of the outer blades. No blemishes were observed on the surface of the blades after corrosion resistance tests. Conclusions This study provided some new methods to evaluate the resection performance and quality of different shavers. The resection performance, the torsional strength of the joint part, and the corrosion resistance of IPB and DSPB may show comparable properties, whereas the tensile strength of the shavers’ joint part showed some level of difference.
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Affiliation(s)
- Peng Liang
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Gaiping Zhao
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.
| | - Xuelian Gu
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhi Chen
- Shanghai BJ-KMC Medical Technology Co., Ltd., Shanghai, China
| | - Shaorong Xu
- Shanghai BJ-KMC Medical Technology Co., Ltd., Shanghai, China
| | - Weiguo Lai
- Shanghai Ligetai Biotechnology Co., Ltd., Shanghai, China
| | - Wentao Liu
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Willers C, Partsalis T, Zheng MH. Articular cartilage repair: procedures versus products. Expert Rev Med Devices 2014; 4:373-92. [PMID: 17488231 DOI: 10.1586/17434440.4.3.373] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review discusses the current perspectives and practices regarding the treatment of articular cartilage injury. Specifically, the authors have delineated and examined articular cartilage repair techniques as either surgical procedures or manufactured products. Although both methodologies are used to treat articular cartilage injury, there are obvious advantages and disadvantages to the application of both, with the literature providing few recommendations on the most suitable regimen for the patient and surgeon. In recent times, cell-based tissue engineering products, predominantly autologous chondrocyte implantation, have been the subject of much research and have become clinically popular. Herein, we review the most used procedures and products in cartilage repair, compare and contrast their outcomes, and evaluate the issues that must be overcome in order to improve patient efficacy in the future.
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Affiliation(s)
- Craig Willers
- Department of Orthopaedics, School of Pathology and Surgery, University of Western Australia, 2nd Floor, M-block, QEII Medical Centre, Nedlands, Perth, WA 6009, Australia.
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Wieser K, Erschbamer M, Neuhofer S, Ek ET, Gerber C, Meyer DC. Controlled laboratory testing of arthroscopic shaver systems: do blades, contact pressure, and speed influence their performance? Arthroscopy 2012; 28:1497-503. [PMID: 22683374 DOI: 10.1016/j.arthro.2012.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 03/02/2012] [Accepted: 03/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were (1) to establish a reproducible, standardized testing protocol to evaluate the performance of different shaver systems and blades in a controlled, laboratory setting, and (2) to determine the optimal use of different blades with respect to the influence of contact pressure and speed of blade rotation. METHOD A holding device was developed for reproducible testing of soft-tissue (tendon and meniscal) resection performance in a submerged environment, after loading of the shaver with interchangeable weights. The Karl Storz Powershaver S2 (Karl Storz, Tuttlingen, Germany), the Stryker Power Shaver System (Stryker, Kalamazoo, MI), and the Dyonics Power Shaver System (Smith & Nephew, Andover, MA) were tested, with different 5.5-mm shaver blades and varied contact pressure and rotation speed. For quality testing, serrated shaver blades were evaluated at 40× image magnification. Overall, more than 150 test cycles were performed. RESULTS No significant differences could be detected between comparable blade types from different manufacturers. Shavers with a serrated inner blade and smooth outer blade performed significantly better than the standard smooth resectors (P < .001). Teeth on the outer layer of the blade did not lead to any further improvement of resection (P = .482). Optimal contact pressure ranged between 6 and 8 N, and optimal speed was found to be 2,000 to 2,500 rpm. Minimal blunting of the shaver blades occurred after soft-tissue resection; however, with bone resection, progressive blunting of the shaver blades was observed. CONCLUSIONS Arthroscopic shavers can be tested in a controlled setting. The performance of the tested shaver types appears to be fairly independent of the manufacturer. For tendon resection, a smooth outer blade and serrated inner blade were optimal. CLINICAL RELEVANCE This is one of the first established independent and quantitative assessments of arthroscopic shaver systems and blades. We believe that this study will assist the surgeon in choosing the optimal tool for the desired effect.
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Affiliation(s)
- Karl Wieser
- Orthopaedic Department, University of Zurich, Balgrist Hospital, Zurich, Switzerland.
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Kaplan LD, Lu Y, Snitzer J, Nemke B, Hao Z, Biro S, Albiero W, Stampfli HF, Markel M, Popkin C, Baum SZ. The effect of early hyaluronic acid delivery on the development of an acute articular cartilage lesion in a sheep model. Am J Sports Med 2009; 37:2323-7. [PMID: 19723621 DOI: 10.1177/0363546509339579] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Partial-thickness articular cartilage lesions occur with knee trauma and may progress to osteoarthritis. This study evaluates the effectiveness of hyaluronic acid on cartilage healing after acute knee injury in sheep. HYPOTHESIS Early administration of hyaluronic acid to an acute cartilage injury will prevent chondrocyte death and improve cartilage metabolism. STUDY DESIGN Controlled laboratory study. METHODS A 10 x 10 mm partial-thickness articular cartilage lesion was created on the medial condyle of 16 adult sheep stifles (hindlimbs). Eight sheep received intra-articular hyaluronic acid injections at days 0, 8, and 15, and 8 controls received saline. Contralateral stifles were nonoperated controls. All sheep were sacrificed at 12 weeks after surgery. Synovial fluid was drawn before surgery and after euthanasia for collagen II, nitric oxide, and interleukin-1 beta analysis. The medial condyle was analyzed by gross appearance, confocal laser microscopy for cell viability, histologic analysis for cartilage morphology, and dimethylmethylene blue assay for proteoglycan. RESULTS At 12 weeks, histologic analysis revealed that the hyaluronic acid group had significantly better scores than the saline group (P = .001). The hyaluronic acid group had significantly greater glycosaminoglycan content than the saline group (P = .011), and showed a trend of reduced chondrocyte death compared with the saline group (P = .07). Synovial fluid showed no significant differences between the groups in collagen II, nitric oxide, and interleukin-1 beta levels. CONCLUSION The results demonstrated that early administration of hyaluronic acid shows a significant improvement in cartilage histologic analysis and increased glycosaminoglycan content after acute traumatic cartilage injury. CLINICAL RELEVANCE Early hyaluronic acid treatment for acute partial-thickness articular cartilage lesions may decrease or delay articular degeneration.
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Affiliation(s)
- Lee D Kaplan
- Division of Sports Medicine, Department of Orthopaedics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Solomon DJ, Navaie M, Stedje-Larsen ET, Smith JC, Provencher MT. Glenohumeral chondrolysis after arthroscopy: a systematic review of potential contributors and causal pathways. Arthroscopy 2009; 25:1329-42. [PMID: 19896056 DOI: 10.1016/j.arthro.2009.06.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE This systematic review provides (1) a synthesis of existing clinical evidence that helps identify factors associated with the development of glenohumeral chondrolysis after arthroscopy (PAGCL), (2) a consolidated conceptualization of potential causal pathways that elucidate proposed mechanisms leading to PAGCL, and (3) a summary of implications for practice, policy, and future research. METHODS A computerized literature review using an iterative search process identified 245 publications in English between January 1960 and April 2009. After we applied inclusion and exclusion criteria, 35 articles were stratified into 4 categories of factors related to PAGCL: (1) patient factors, (2) surgical factors (preoperative and intraoperative), (3) postoperative factors, and (4) causal pathways. RESULTS The majority of studies (61%) focused on surgical factors correlated with PAGCL, and most were laboratory based (n = 21). Publications involving human subjects were descriptive case reports (n = 15), not epidemiologic studies. A total of 88 patients (91 shoulder surgeries) with PAGCL were identified in case reports. The majority of patients (55%) was male, and the mean age was 27.9 years (range, 13.1 to 64 years). Among patients, 68% (n = 53) had implants/anchors, 67% (n = 59) received local anesthetics through a pain pump, and 45% (n = 41) had surgeries involving radiofrequency devices. The causal pathways to PAGCL likely involve initiating and secondary cartilage injury due to mechanical, thermal, or chemical events. The result is a cascade of interactive cellular responses that may include inflammation and chondrocyte apoptosis causing disturbance of cellular metabolism with subsequent loss of the gliding surface, congruity, and synovial fluid, leading to increased friction and accelerated wear that ultimately yield PAGCL. CONCLUSIONS The literature is limited to correlates, rather than true risk factors, for PAGCL. Well-designed epidemiologic studies that examine various exposures in relation to health outcomes, while controlling for potential confounders, are needed to determine relative risks that allow causal inference, thereby facilitating sound practice and policy decision making. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Daniel J Solomon
- Orthopaedic Sports Medicine and Shoulder Service, Naval Medical Center San Diego, San Diego, California, USA
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Pape D, Lorbach O, Anagnostakos K, Kohn D. [Osteonecrosis in the postarthroscopic knee]. DER ORTHOPADE 2009; 37:1099-100, 1102-7. [PMID: 18958445 DOI: 10.1007/s00132-008-1303-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Osteonecrosis of the knee is a rare complication following arthroscopic surgery. Little is known about its etiology. The most important differential diagnosis is preexisting and undiagnosed early-stage spontaneous osteonecrosis of the knee. Medicolegally, arthroscopic surgery could be wrongly regarded as the primary cause for postarthroscopic osteonecrosis. Orthopedic surgeons need to be aware of the diagnostic pitfalls in differentiating between these entities. We suggest that the descriptive term "osteonecrosis in the postoperative knee" should be used rather than the captious term "postarthroscopic osteonecrosis."
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Affiliation(s)
- D Pape
- Centre de l'Appareil Locomoteur, de Médecine du Sport et de Prévention, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg.
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Lotto ML, Wright EJ, Appleby D, Zelicof SB, Lemos MJ, Lubowitz JH. Ex vivo comparison of mechanical versus thermal chondroplasty: assessment of tissue effect at the surgical endpoint. Arthroscopy 2008; 24:410-5. [PMID: 18375272 DOI: 10.1016/j.arthro.2007.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Revised: 09/15/2007] [Accepted: 09/29/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate tissue effect (tissue removal plus underlying cell death) of two chondroplasty techniques: mechanical debridement (MD) using a rotary shaver blade and thermal chondroplasty using radiofrequency energy (RFE). METHODS Forty-eight human chondromalacic cartilage samples were treated with either MD or RFE. Pre- and post-treatment arthroscopic images of the cartilage surface were recorded. Samples were incubated with cell viability stain and visualized with confocal laser microscopy to determine tissue effect. Smoothing was quantitated by three surgeons using a visual analog scale (VAS) as well as a subjective rating regarding whether smoothing was "arthroscopically acceptable." RESULTS Tissue effect at the surgical endpoint of arthroscopically acceptable smoothing was 385 microm for MD versus 236 microm for RFE, a significant difference (P < .0001). Mean post-treatment VAS for MD was 2.8 points less smooth than for RFE (P < .0001). Overall, arthroscopically acceptable smoothing was achieved in 90% of RFE samples compared to 49% of MD samples. CONCLUSIONS Our results shown that chondroplasty using a RFE probe results in greater smoothing of chondromalacic cartilage in fewer treatment passes and with decreased total tissue effect than MD using a rotary shaver blade. CLINICAL RELEVANCE If safety and efficacy can be shown in vivo, thermal chondroplasty may represent an alternative for treatment of symptomatic chondromalacia.
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Affiliation(s)
- Marie L Lotto
- Endoscopy Division, Smith & Nephew, Andover, Massachusetts, USA
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Kaplan LD, Royce B, Meier B, Hoffmann JM, Barlow JD, Lu Y, Stampfli HF. Mechanical chondroplasty: early metabolic consequences in vitro. Arthroscopy 2007; 23:923-9. [PMID: 17868830 DOI: 10.1016/j.arthro.2007.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 03/30/2007] [Accepted: 04/02/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the depth of penetration from mechanical chondroplasty and metabolic consequences of this procedure on the remaining articular cartilage. METHODS Mechanical chondroplasty was performed in vitro on a portion of fresh grade I or II articular cartilage from 8 human knee arthroplasty specimens. Treated and control (untreated) explants (approximately 30 mg) were cut from the cartilage. The explants were divided into 2 groups, day 1 and day 4, placed separately in a 48-well plate containing media, and incubated at 37 degrees C for 24 hours. After the 24-hour incubation, the explants were weighed on day 1 and day 4, and explant media were removed and tested for total proteoglycan synthesis and aggrecan synthesis. At time 0, 2 sets (2.6 mm each) of treated and control cartilage slices were cut with a precision saw. One set was stained for confocal laser microscopy via a cytotoxicity stain to determine cell viability. The second set was stained with H&E to determine depth of penetration. RESULTS The mean depth of penetration was 252.8 +/- 78 microm. There was no significant difference (P > .25) between total proteoglycan synthesis for control versus treatment groups on day 1 or 4. Aggrecan synthesis was significantly reduced on day 1 when normalized for tissue weight (P = .019) and double-stranded deoxyribonucleic acid (P = .004). On day 4, no significant difference was detected. Confocal laser microscopy did not show cell death below the zone of treatment. CONCLUSIONS There was no significant metabolic consequence caused by chondroplasty to the remaining articular cartilage, and the zone of injury was limited to the treatment area. CLINICAL RELEVANCE Mechanical chondroplasty causes no significant metabolic consequences to articular cartilage under these conditions.
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Affiliation(s)
- Lee D Kaplan
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinic, Madison, Wisconsin, USA.
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Pape D, Seil R, Anagnostakos K, Kohn D. Postarthroscopic osteonecrosis of the knee. Arthroscopy 2007; 23:428-38. [PMID: 17418337 DOI: 10.1016/j.arthro.2007.02.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 02/20/2007] [Accepted: 02/20/2007] [Indexed: 02/02/2023]
Abstract
Little is known about the etiology of postarthroscopic osteonecrosis of the knee. Its prevalence is probably very low. The most important differential diagnosis is pre-existing and undiagnosed early-stage spontaneous osteonecrosis of the knee. From the medicolegal point of view, orthopaedic surgeons need to be aware of the diagnostic pitfalls in differentiating between postarthroscopic osteonecrosis of the knee and spontaneous osteonecrosis of the knee, and they must understand that both may be unpreventable conditions. The purpose of this report is to review the presumable pathophysiology and the clinical and radiographic features as well as the pitfalls in diagnosing postarthroscopic osteonecrosis of the knee.
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Affiliation(s)
- Dietrich Pape
- Department of Orthopaedic Surgery, University of Saarland, Homburg/Saar, Germany.
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