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Bast N, Zimmerman R, Schlechter J. An Overview of Pediatric Knee Arthroscopy With Use of the NeedleScope. Arthrosc Tech 2024; 13:102813. [PMID: 38312861 PMCID: PMC10837811 DOI: 10.1016/j.eats.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/26/2023] [Indexed: 02/06/2024] Open
Abstract
As sports-related injuries are becoming more common among children, there has been an increased need for knee arthroscopies in the pediatric population. Nevertheless, pediatric knee arthroscopy exposure is varied among orthopaedic surgeons, especially during residency training. There is a considerable difference in knee arthroscopy case volume between the adult and the pediatric population among orthopaedic residents. Although the fundamentals of adult knee arthroscopy have been well delineated, there is a paucity of literature surrounding basic pediatric knee arthroscopy. Our goal is to further explain the fundamentals needed to perform successful arthroscopic surgery in the pediatric knee. Through discussing proper patient positioning, instrumentation, including the utility of the 1.9-mm small-bore needle arthroscope (NanoScope; Arthrex, Naples, FL), subtle tips and tricks, as well as advantages and disadvantages of arthroscopy in children, this Technical Note along with the corresponding video are designed to help elucidate the intricacies of the pediatric knee. It will serve as educational material targeted to the resident trainee or any orthopaedic practitioner interested in gaining an introductory foundation to pediatric knee arthroscopy.
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Affiliation(s)
- Nicholas Bast
- Department of Orthopaedic Surgery, Riverside University Health System—Medical Center, Moreno Valley, California, U.S.A
| | | | - John Schlechter
- Department of Orthopaedic Surgery, Riverside University Health System—Medical Center, Moreno Valley, California, U.S.A
- CHOC Children’s Hospital, Orange, California, U.S.A
- Pediatric Orthopedic Specialists of Orange County, Orange, California, U.S.A
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Limone B, Zambianchi F, Cacciola G, Seracchioli S, Catani F, Tarallo L. Management and Outcomes of Tibial Eminence Fractures in the Pediatric Population: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1379. [PMID: 37628378 PMCID: PMC10453829 DOI: 10.3390/children10081379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Tibial eminence fractures (TEF) of Meyers-McKeever type II-III-IV usually require surgical management. No consensus in the literature has been achieved regarding the best treatment option. The aims of the present systematic review were (1) to analyze the current literature and describe the outcomes of surgical treatment for TEF; and (2) to compare the outcomes of different surgical options using arthroscopic reduction and internal fixation (ARIF) with sutures or screws and open reduction and internal fixation (ORIF). METHODS A search was carried out with Pubmed, Medline, and Cochrane. Key terms were used "tibial" AND "eminence" or "spine" or "intercondylar" AND "paediatric" or "children" AND "fracture" or "avulsion" AND "treatment". Twelve articles met the inclusion criteria. Demographic data, clinical outcomes, and complication rates were evaluated for each study. Means/standard deviation and sum/percentage were used for continuous and categorical variables, respectively. Chi-square or t-student tests were applied. A p-value < 0.05 was considered statistically significant. RESULTS ORIF showed superior clinical outcomes (Tegner (p < 0.05) and Lysholm (p < 0.001) scores) relative to ARIF and a lower incidence of arthrofibrosis (p < 0.05) and implant removal (p < 0.01). The Tegner, IKDC, and Lysholm scores showed statistically significant superior results following arthroscopic sutures compared to arthroscopic screws (p < 0.001). The incidence of arthrofibrosis was higher after arthroscopic sutures (p < 0.05), the implant removal was higher after screw fixation (p < 0.001) Conclusions: Better clinical results with low complication rates were achieved with ORIF surgery rather than ARIF; arthroscopic suture fixation resulted in higher clinical results compared to arthroscopic screw fixation and reduced the incidence of postoperative complications.
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Affiliation(s)
- Beatrice Limone
- Department of Traumatology, Orthopaedic and Occupational Medicine, CTO Hospital, University of Study of Turin, 10124 Turin, Italy
| | - Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, 41121 Modena, Italy
| | - Giorgio Cacciola
- Department of Traumatology, Orthopaedic and Occupational Medicine, CTO Hospital, University of Study of Turin, 10124 Turin, Italy
| | - Stefano Seracchioli
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, 41121 Modena, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, 41121 Modena, Italy
| | - Luigi Tarallo
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, 41121 Modena, Italy
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Thomas ND, Ayala S, Rohde M, Gupta A, Sanchez M, Ellis H, Tompkins M, Wilson P, Sherman S, Green D, Ganley TJ, VandenBerg C, Yen YM, Shea KG. Distance to the Neurovascular Bundle for Iliotibial Band Graft Passage During Anterior Cruciate Ligament Reconstruction: A Pediatric Cadaveric Study. Orthop J Sports Med 2022; 10:23259671221113832. [PMID: 35990874 PMCID: PMC9386874 DOI: 10.1177/23259671221113832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The Micheli technique for anterior cruciate ligament (ACL) reconstruction (ACLR) has proven to be a reliable method with a minimal risk for growth disturbance among skeletally immature patients. Purposes: To evaluate the Micheli technique of iliotibial band (ITB) graft passage for ACLR using cadaveric knee models and to measure the distance between the surgical instrument tip and the neurovascular bundle in the posterior knee joint: specifically, the peroneal nerve, tibial nerve, and popliteal artery. Study Design: Descriptive laboratory study. Methods: Gross dissection was performed on 17 pediatric cadaveric knees (12 male and 5 female) aged between 4 and 12 years. To simulate ITB graft passage, we passed a curved-tip hemostat clamp through the posterior capsule, with the knee flexed from 90° to 100°. Next, clinical photographs were taken, and digital imaging software was used to measure the distance in centimeters from the clamp tip to each respective neurovascular structure. Results: The mean distances from the clamp tip to the tibial nerve, popliteal artery, and peroneal nerve were 0.875 cm (range, 0.468-1.737 cm), 0.968 cm (range, 0.312-1.819 cm), and 1.149 cm (range, 0.202-2.409 cm), respectively. Mean values were further calculated for age groups of ≤8, 9-10, and 11-12 years. The mean distance from the clamp tip to the peroneal nerve was 1.400 cm larger for 11- to 12-year-old specimens than for ≤8-year-old specimens (95% CI, 0.6-2.2 cm; P = .005). Conclusion: The neurovascular structures in the posterior knee were in close proximity to the path of graft passage, with distances <1 cm in many specimens in this study. When passing the graft through the knee for an over-the-top position, surgeons should consider these small distances between the path of graft passage and critical neurovascular structures. Clinical Relevance: As the incidence of ACL tears is continuously increasing within the pediatric population, there are a larger number of ACLR procedures being performed. Although neurovascular injuries during ACLR are rare, this study clarifies the close proximity of neurovascular structures during ITB graft passage using the Micheli technique of ACLR.
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Affiliation(s)
- Nicholas D Thomas
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Salvador Ayala
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Matthew Rohde
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Anshal Gupta
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Mark Sanchez
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Henry Ellis
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Marc Tompkins
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Phil Wilson
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Seth Sherman
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Green
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Theodore J Ganley
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Curtis VandenBerg
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Yi-Meng Yen
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
| | - Kevin G Shea
- Investigation performed at Stanford University School of Medicine, Stanford, California, USA
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Asopa V, Atkinson H. Complications in knee surgery. ORTHOPAEDICS AND TRAUMA 2019; 33:372-377. [DOI: 10.1016/j.mporth.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Schachne JM, Heath MR, Yen YM, Shea KG, Green DW, Fabricant PD. The Safe Distance to the Popliteal Neurovascular Bundle in Pediatric Knee Arthroscopic Surgery: An Age-Based Magnetic Resonance Imaging Anatomic Study. Orthop J Sports Med 2019; 7:2325967119855027. [PMID: 31321247 PMCID: PMC6624919 DOI: 10.1177/2325967119855027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The close proximity of the popliteal neurovascular bundle to the posterior
horn of the lateral meniscus puts it at risk of compromise during lateral
meniscal repair. This is particularly important in smaller pediatric
patients, who are commonly treated for lateral meniscal abnormalities in
isolation (discoid meniscus) or concomitantly with anterior cruciate
ligament reconstruction. Purpose: To quantify the distance between the posterior horn of the lateral meniscus
and the popliteal neurovascular bundle along the path of meniscal repair and
to investigate for associations with age, sex, height, weight, body mass
index (BMI), and skeletal maturity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 144 magnetic resonance imaging scans were evaluated in a cohort of
patients aged 10 to 18 years without meniscal or ligament abnormalities.
Measurements were made along a line from the anterolateral portal between
the popliteal neurovascular bundle and the free edge, midpoint, and
meniscocapsular junctions of the posterior horn of the lateral meniscus. In
addition to descriptive statistics of these distances by age and sex,
analyses of variance and linear regression analyses were performed to
investigate for associations with age, sex, height, weight, BMI, and
skeletal maturity. Results: Male participants had a significantly larger mean free edge distance (14.4 ±
2.5 vs 13.1 ± 2.5 mm, respectively; P = .005) and midpoint
distance (9.6 ± 2.2 vs 8.9 ± 1.8 mm, respectively; P =
.011) than female participants but not a significantly larger
meniscocapsular distance (5.2 ± 1.6 vs 4.6 ± 1.4 mm, respectively;
P = .096). Linear regression analyses revealed
significant associations between these distances and age, height, weight,
and BMI (P < .001 for all). There were statistically
significant pairwise differences for free edge and midpoint distances to the
neurovascular bundle between patients with open and closed physes. Conclusion: The distance between the posterior horn of the lateral meniscus and the
popliteal vasculature along a trajectory from the standard anterolateral
arthroscopic portal increases linearly throughout development between the
ages of 10 and 18 years. There were also significant associations between
height, weight, BMI, and skeletal maturity and these anatomic distances.
Knowing the safe distance to the popliteal vasculature will increase the
safety of arthroscopic lateral meniscal repair in children, especially with
all-inside devices that require setting the penetration depth for the
advancement of a sharp delivery device beyond the posterior capsule.
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Affiliation(s)
- Jonathan M Schachne
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Madison R Heath
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel W Green
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Peter D Fabricant
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Operative Time as an Independent and Modifiable Risk Factor for Short-Term Complications After Knee Arthroscopy. Arthroscopy 2019; 35:2089-2098. [PMID: 31227396 DOI: 10.1016/j.arthro.2019.01.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine whether operative time is an independent risk factor for 30-day complications after arthroscopic surgical procedures on the knee. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried between 2005 and 2016 for all arthroscopic knee procedures including lateral release, loose body removal, synovectomy, chondroplasty, microfracture, and meniscectomy. Cases with concomitant procedures were excluded. Correlations between operative time and adverse events were controlled for variables such as age, sex, body mass index, patient comorbidities, and procedure using a multivariate Poisson regression with robust error variance. RESULTS A total of 78,864 procedures met our inclusion and exclusion criteria. The mean age of patients was 51.0 ± 14.3 years; mean operative time, 31.2 ± 18.1 minutes; and mean body mass index, 31.0 ± 7.8. Arthroscopic lateral release (coefficient, 5.8; 95% confidence interval [CI], 4.8-6.8; P < .001), removal of loose bodies (coefficient, 4.2; 95% CI, 3.2-5.3; P < .001), synovectomy (coefficient, 1.8; 95% CI, 1.2-2.3; P < .001), and microfracture (coefficient, 6.5; 95% CI, 5.8-7.2; P < .001) had significantly greater durations of surgery in comparison with meniscectomy. The overall rate of adverse events was 1.24%. After we adjusted for demographic characteristics and the procedure, a 15-minute increase in operative duration was associated with an increased risk of transfusion (relative risk [RR], 1.5; 95% CI, 1.3-1.8; P < .001), death (RR, 1.6; 95% CI, 1.2-2.1; P = .005), dehiscence (RR, 1.6; 95% CI, 1.2-2.2; P = .002), surgical-site infection (RR, 1.3; 95% CI, 1.2-1.3; P = .001), sepsis (RR, 1.3; 95% CI, 1.2-1.4; P < .001), readmission (RR, 1.1; 95% CI, 1.1-1.2; P < .001), and extended length of stay (RR, 1.4; 95% CI, 1.3-1.4; P < .001). CONCLUSIONS Marginal increases in operative time are associated with an increased risk of adverse events such as surgical-site infection, sepsis, extended length of stay, and readmission. Efforts should be made to maximize surgical efficiency. LEVEL OF EVIDENCE Level IV, retrospective database study.
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The Importance of a Standardized Screening Tool to Identify Thromboembolic Risk Factors in Pediatric Lower Extremity Arthroscopy Patients. J Am Acad Orthop Surg 2019; 27:335-343. [PMID: 30624305 DOI: 10.5435/jaaos-d-18-00390] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Deep vein thrombosis and pulmonary embolism are major complications that can occur in common orthopaedic procedures such as knee arthroscopy. The purpose of this study is to determine the incidence of venous thromboembolism (VTE) risk factors in adolescent patients undergoing elective lower extremity arthroscopy. A second objective is to determine whether a targeted, standardized screening tool is both cost- and clinically effective in the identification of VTE risk factors in adolescents. METHODS A standardized VTE screening tool was prospectively administered to all elective arthroscopic procedures in a pediatric sports medicine practice. A comparison cohort that did not complete the screening tool was isolated through a retrospective chart review identifying VTE risk factors. The incidence and cost between the two cohorts were compared. RESULTS Of 332 subjects who did not receive a targeted screening (TS) tool, 103 risk factors were noted. One pulmonary embolism case was identified with a total incidence of 0.15% over 3 years. With TS, we identified 325 subjects with 134 identifiable risk factors. Six patients (1.8%) were noted to be very high risk, requiring consultation with hematology. No VTEs were reported. When compared with the retrospective review, TS identified 30% more risk factors. A significant increase in the identification of family history of blood clots (P < 0.001), history of previous blood clot (P = 0.059), recurrent miscarriages in the family (P = 0.010), and smoking exposure (P = 0.062) was found. Additionally, the total cost of screening was less than the cost of prophylaxis treatment with no screening ($20.98 versus $23.51 per person, respectively). DISCUSSION Risk factors for VTE may be present in 32.5% of elective adolescent arthroscopic patients. A TS model for VTE identified 30% more risk factors, especially a significant family history, and was shown to be a cost-effective way to safely implement a VTE prevention program. LEVEL OF EVIDENCE Level II.
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Abstract
BACKGROUND The frequency of knee arthroscopy procedures is increasing in pediatric and adolescent patients. In general, complications after these procedures in adolescents are uncommon. The purposes of this study are to report the incidence of venous thromboembolism (VTE) in adolescent patients after knee arthroscopy procedures, as well identify risk factors in this patient population. METHODS Medical records were reviewed in all pediatric and adolescent patients (≤19 y) who underwent an arthroscopic knee procedure from 2010 to 2014 and were diagnosed with a symptomatic VTE in the postoperative period. Demographic features were recorded, and included age, sex, body mass index, clinical characteristics (diagnosis, type of surgical intervention, tourniquet time), VTE risk factors [family history of VTE, obesity (body mass index >30), oral contraceptive use, and smoking use/exposure] and treatment (anticoagulation type/duration). RESULTS Out of 2783 patients who underwent knee arthroscopy during the 5-year study period, 7 patients (3 males, 4 females, mean age, 16.9 y, range, 15 to 18) developed a symptomatic postoperative VTE (incidence, 0.25%, 95% confidence interval, 0.11%-0.54%). There were 6 unilateral deep venous thrombosis, and 1 bilateral deep venous thrombosis. Arthroscopic procedures performed in this cohort included anterior cruciate ligament reconstruction (3), isolated lateral release (1), meniscectomy (2), and patellar realignment with arthroscopic lateral release, open tibial tubercle osteotomy, and open proximal medial retinacular reefing (1). VTE was diagnosed an average of 9 days following surgery (range, 3 to 16). All patients were initially treated with low-molecular-weight heparin, and 2 were converted to warfarin. Mean duration of anticoagulation treatment was 64 days (range, 28 to 183). All patients had at least 1 identifiable medical or surgical risk factor, including oral contraceptive use (2), smoking (2), obesity (2), an arthroscopically assisted open procedure (4), or tourniquet time >60 minutes (3). CONCLUSIONS VTE after adolescent knee arthroscopy has not been well described. The incidence is ∼0.25%. Previously established risk factors for VTE were present in 100% of the affected population. Low-molecular-weight heparin was used to successfully treat this complication. LEVEL OF EVIDENCE Level IV.
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Dodwell ER, Pathy R, Widmann RF, Green DW, Scher DM, Blanco JS, Doyle SM, Daluiski A, Sink EL. Reliability of the Modified Clavien-Dindo-Sink Complication Classification System in Pediatric Orthopaedic Surgery. JB JS Open Access 2018; 3:e0020. [PMID: 30882054 PMCID: PMC6400510 DOI: 10.2106/jbjs.oa.18.00020] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background There is no standardized complication classification system that has been evaluated for use in pediatric or general orthopaedic surgery. Instead, subjective terms such as major and minor are commonly used. The Clavien-Dindo-Sink complication classification system has demonstrated high interrater and intrarater reliability for hip-preservation surgery and has increasingly been used within other orthopaedic subspecialties. This classification system is based on the magnitude of treatment required and the potential for each complication to result in long-term morbidity. The purpose of the current study was to modify the Clavien-Dindo-Sink system for application to all orthopaedic procedures (including those involving the spine and the upper and lower extremity) and to determine interrater and intrarater reliability of this modified system in pediatric orthopaedic surgery cases. Methods The Clavien-Dindo-Sink complication classification system was modified for use with general orthopaedic procedures. Forty-five pediatric orthopaedic surgical scenarios were presented to 7 local fellowship-trained pediatric orthopaedic surgeons at 1 center to test internal reliability, and 48 scenarios were then presented to 15 pediatric orthopaedic surgeons across the United States and Canada to test external reliability. Surgeons were trained to use the system and graded the scenarios in a random order on 2 occasions. Fleiss and Cohen kappa (κ) statistics were used to determine interrater and intrarater reliabilities, respectively. Results The Fleiss κ value for interrater reliability (and standard error) was 0.76 ± 0.01 (p < 0.0001) and 0.74 ± 0.01 (p < 0.0001) for the internal and external groups, respectively. For each grade, interrater reliability was good to excellent for both groups, with an overall range of 0.53 for Grade I to 1 for Grade V. The Cohen κ value for intrarater reliability was excellent for both groups, ranging from 0.83 (95% confidence interval [CI], 0.71 to 0.95) to 0.98 (95% CI, 0.94 to 1.00) for the internal test group and from 0.83 (95% CI, 0.73 to 0.93) to 0.99 (95% CI, 0.97 to 1.00) for the external test group. Conclusions The modified Clavien-Dindo-Sink classification system has good interrater and excellent intrarater reliability for the evaluation of complications following pediatric orthopaedic upper extremity, lower extremity, and spine surgery. Adoption of this reproducible, reliable system as a standard of reporting complications in pediatric orthopaedic surgery, and other orthopaedic subspecialties, could be a valuable tool for improving surgical practices and patient outcomes.
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Affiliation(s)
| | - Rubini Pathy
- Shriners Hospitals for Children-Springfield, Springfield, Massachusetts
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Schmiddem U, Hawi N, Suero EM, Meller R. Combined Fluoroscopic and Arthroscopic Detection and Removal of a Foreign Body Lost During Elective Shoulder Arthroscopy: A Case Report. J Orthop Case Rep 2017; 7:78-81. [PMID: 28819609 PMCID: PMC5553844 DOI: 10.13107/jocr.2250-0685.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: We report a case of a lost metal platelet from a radiofrequency ablation probe (VAPR VUE Radiofrequency System, Cool Pulse 90, DePuy, Synthes, Switzerland) in the shoulder joint during elective arthroscopic cuff repair. To the best of our knowledge, this kind of an incident during elective arthroscopy has not been described in the literature so far. In addition, we present an algorithm on how to deal with such an incident. Case Report: A 69-year-old woman underwent an arthroscopic subacromial decompression and rotator cuff repair for a torn supraspinatus tendon. While performing the subacromial decompression and after swapping the portals from lateral to posterior, the metal platelet of the electrocautery device got detached from the instrument and lost in the operation field. Several attempts to visualize the lost platelet with the camera failed. Finally, intraoperative fluoroscopic imaging was used to detect the platelet. To confirm the definitive whereabouts of the platelet, two spinal needles were positioned perpendicular to another under x-ray control, both pointing at the missing platelet. After determining the exact location, the platelet could finally be visualized with the camera and removed. Due to this incident, the operation time was extended extensively, and the patient as well as the theatre team was exposed to an unnecessary amount of radiation. Conclusion: This report indicates that an extraordinary incident such as the detachment of a component of the arthroscopic equipment during surgery is possible and should be kept in mind by the surgeon. Therefore, we believe that it is essential to perform a test of integrity at least at the end of every operation. In addition, we are presenting an algorithm on how to deal with the situation of a lost foreign body during arthroscopy, which can be applied to any joint.
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Affiliation(s)
| | - N Hawi
- Trauma Department, Medical School Hannover, Germany
| | - E M Suero
- Trauma Department, Medical School Hannover, Germany
| | - R Meller
- Trauma Department, Medical School Hannover, Germany
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Balato G, Di Donato SL, Ascione T, D'Addona A, Smeraglia F, Di Vico G, Rosa D. Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate. JOINTS 2017; 5:107-113. [PMID: 29114639 PMCID: PMC5672874 DOI: 10.1055/s-0037-1603901] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Purpose
Septic knee arthritis following arthroscopy is a rare but dreaded complication. Definition and management of knee deep infections are quite discussed in literature. In this review, literature regarding infections after knee arthroscopy is analyzed highlighting the incidence, causative bacteria, risk factors as well as clinical outcomes.
Methods
We performed a review of the literature matching the following key words: “septic arthritis” OR “infection” AND “arthroscopy” AND “knee.” Knee arthroscopic procedures, such as debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release, were considered. Complex procedures, such as ligament reconstruction, fractures, or complex cartilage repair techniques, were not included.
Results
Thirteen studies were included in this review. Incidence of infection ranged from 0.009 to 1.1% in patients undergoing simple arthroscopic procedures. Staphylococci are the most commonly isolated organisms from postarthroscopy infection. Use of intraoperative intra-articular steroids, smoking, obesity, male sex, diabetes, number of procedures performed during surgery, time of surgery, and tourniquet time of more than 60 minutes have been certified as risk factors for knee infection.
Conclusion
Postarthroscopy septic arthritis of the knee causes significant morbidity, usually requiring readmission to the hospital, at least one additional operation, and prolonged antibiotic therapy, both intravenous and oral. Prompt diagnosis and treatment are associated with a high success rate.
Level of Evidence
Level IV, systematic review of I-IV studies.
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Affiliation(s)
- G Balato
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - S L Di Donato
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - T Ascione
- Department of Infectious Diseases, D. Cotugno Hospital, Naples, Italy
| | - A D'Addona
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - F Smeraglia
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - G Di Vico
- Orthopaedic Unit, S. Michele Clinic, Caserta, Italy
| | - D Rosa
- Orthopaedic Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Hinds RM, Gottschalk MB, Strauss EJ, Capo JT. Trends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log Data. Arthroscopy 2016; 32:645-50. [PMID: 26821961 DOI: 10.1016/j.arthro.2015.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/03/2015] [Accepted: 11/03/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze orthopaedic resident case log data to report temporal trends in performing arthroscopic procedures and to assess variability in arthroscopic case volume among residents. METHODS Accreditation Council for Graduate Medical Education orthopaedic surgery resident case logs were reviewed from 2007 to 2013. The mean number of wrist, elbow, shoulder, knee, and ankle arthroscopic procedures performed by graduating residents was analyzed. The median number of arthroscopic procedures reported by the 70th and 30th percentiles of graduating residents (by arthroscopic case volume) was also recorded. Temporal trends were assessed using a linear regression model. RESULTS From 2007 to 2013, there were significant increases in the mean number of wrist (5.8 to 6.3; P = .038), elbow (2.5 to 3.2; P < .001), shoulder (93.5 to 133.8; P < .001), knee (170.6 to 185.1; P = .011), and ankle (5.8 to 7.4; P < .001) arthroscopies performed per resident. Residents in the 70th percentile of caseload performed significantly more wrist (7 v 2; P < .001), elbow (3.3 v 1; P < .001), shoulder (134.1 v 70.6; P < .001), knee (205 v 128.7; P < .001), and ankle (7.9 v 2.9; P < .001) arthroscopies than residents in the 30th percentile. CONCLUSIONS Our findings indicate that arthroscopic caseload is increasing among orthopaedic residents. However, resident experience performing arthroscopic procedures is substantially disparate. Although the educational implications of this disparity are not well understood, our findings may aid in efforts to optimize arthroscopic training during orthopaedic residency.
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Affiliation(s)
- Richard M Hinds
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A..
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A
| | - John T Capo
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York, U.S.A
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Luo TD, Ashraf A, Dahm DL, Stuart MJ, McIntosh AL. Femoral nerve block is associated with persistent strength deficits at 6 months after anterior cruciate ligament reconstruction in pediatric and adolescent patients. Am J Sports Med 2015; 43:331-6. [PMID: 25466410 DOI: 10.1177/0363546514559823] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral nerve block (FNB) has become a popular method of postoperative analgesia for anterior cruciate ligament (ACL) reconstruction in pediatric and adolescent patients. Successful rehabilitation after surgery involves return of quadriceps and hamstring strength. PURPOSE To compare knee strength and function 6 months after ACL reconstruction in pediatric and adolescent patients who received FNB versus patients with no nerve block. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients 18 years or younger who underwent primary ACL reconstruction between 2000 and 2010 at a single institution were identified. If the patient was skeletally immature, a transphyseal ACL reconstruction was performed. Of these patients, 68% underwent reconstruction with a patellar tendon autograft, and in 32% of patients a hamstring autograft was utilized. There were 124 patients who met the study inclusion criteria, including 62 in the FNB group (31 males, 31 females) and 62 patients in the control group (25 males, 37 females). All study patients participated in a comprehensive rehabilitation program that included isokinetic strength and functional testing at 6 months postoperatively. RESULTS Univariate analysis showed a significantly higher deficit at 6 months in the FNB group with respect to fast isokinetic extension strength (17.6% vs 11.2%; P = .01) as well as fast (9.9% vs 5.7%; P = .04) and slow (13.0% vs 8.5%; P = .03) isokinetic flexion strength. There was no difference in slow isokinetic extension strength deficit between the 2 groups (FNB, 22.3% vs control, 18.7%; P = .20). With respect to function, there were no differences in deficit for vertical jump (FNB, 9.4% vs control, 11.3%; P = .30), single hop (7.6% vs 7.5%; P = .96), or triple hop (8.0% vs 6.6%; P = .34) between the 2 groups. A significantly higher percentage of patients in the control group met functional and isokinetic criteria for return to sports at 6 months (90.2% vs 67.7%; odds ratio, 4.37; P = .002). CONCLUSION Pediatric and adolescent patients treated with FNB for postoperative analgesia after ACL reconstruction had significant isokinetic deficits in knee extension and flexion strength at 6 months when compared with patients who did not receive a nerve block. Patients without a block were 4 times more likely to meet criteria for clearance to return to sports at 6 months.
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Affiliation(s)
| | - Ali Ashraf
- Texas Tech University Health Sciences, Center, Lubbock, Texas, USA
| | | | | | - Amy L McIntosh
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
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