Advances in arthroscopic surgery: indications and outcomes

Global research in arthroscopy of the anterior cruciate ligament: A bibliometric and visualized study

Purpose

To carry out a bibliometric analysis of the scientific articles that address the topic of arthroscopy of the anterior cruciate ligament (ACL).

Methods

A bibliographic search of the original articles published in orthopedics journals indexed in the Web of Science database until 2020 was carried out. Evaluation of compliance with the inclusion criteria was carried out in the Rayyan web application. The Bibliometrix package in the R programming language and VOSviewer were used to perform the bibliometric analysis.

Results

2249 articles published in 87 journals were included. The first publication on the subject was in 1980, and the highest number of publications was registered in 2020 (151) (annual percentage growth rate of 5.7). Fu FH was the author with the highest number of published articles, and the institutional affiliation with the highest number of original articles was the University of Pittsburgh. The most cited article was the study by Peterson et al. (2000) and the journal with the highest number of publications was Arthroscopy: the journal of arthroscopic and related surgery. United States had the highest frequency of publications and the highest number of total citations received by country. It was found on the network that the largest number of published studies had keywords such as: injuries and follow-up, whereas, in the most recent articles, the most common terms were risk-factors and outcomes.

Conclusions

There is a sustained increase in scientific production on ACL arthroscopy among the world scientific community. Our results can be used for collaborative research purposes and by professionals seeking training in this topic.

Efficacy of intra-articular ketorolac for pain control in arthroscopic surgeries: a systematic review and meta-analysis

BACKGROUND

The current systematic review and meta-analysis aimed to synthesize evidence on the efficacy of intra-articular ketorolac for patients undergoing arthroscopic surgeries.

METHODS

PubMed, Embase, ScienceDirect, and Google Scholar databases were searched for randomized controlled trials assessing the analgesic effect of intra-articular ketorolac for arthroscopic surgery of hip/knee or shoulder joint.

RESULTS

Six studies were included. Two studies were on shoulder arthroscopy, while others were on knee joint. Meta-analysis revealed that patients receiving intra-articular ketorolac had significantly lower pain scores at 2-4 h (MD: - 0.58 95% CI: - 0.88, - 0.19 I2 = 49% p = 0.002), 6-8 h (MD: - 0.77 95% CI: - 1.11, - 0.44 I2 = 31% p < 0.00001), 12 h (MD: - 0.94 95% CI: - 1.21, - 0.67 I2 = 0% p < 0.00001), and 24 h (MD: - 1.28 95% CI: - 1.85, - 0.71 I2 = 84% p < 0.00001) as compared to the control group (Certainty of evidence: low-moderate). Analysis of three studies revealed a tendency of reduced analgesic consumption in patients receiving intra-articular ketorolac, but the difference did not reach statistical significance (MD: - 0.53 95% CI: - 1.07, 0.02 I2 = 55% p = 0.06).

CONCLUSIONS

Preliminary evidence from a limited number of studies indicates that additional intra-articular ketorolac to multimodal analgesia results in reduced pain scores up to 24 h after arthroscopic surgery. The clinical relevance of small changes in pain scores is debatable. Also, scarce data suggest that consumption of analgesics may not be reduced with intra-articular ketorolac. Since pain scores can be influenced by the primary diagnosis and dose of ketorolac, the results should be interpreted with caution. The certainty of the evidence is low-moderate. There is a need for future RCTs to further strengthen current evidence.

The incidence of infection in routine knee arthroscopy without the use of prophylactic antibiotics is low

Background:

The use of prophylactic antibiotics in routine knee arthroscopy remains prevalent despite previous evidence suggesting that it may not be necessary, and may indeed carry more risks than benefits. This study aims to determine the incidence of surgical site infections in patients undergoing routine knee arthroscopy without prophylactic antibiotics.

Methods:

This is a retrospective review of 553 consecutive patients who underwent routine knee arthroscopy from 2004 to 2013 by a single fellowship-trained sports surgeon in a single institution. The spectrum of cases included arthroscopic meniscectomy, meniscal repair, microfracture, chondroplasty, removal of loose bodies and lateral retinacular release. No patient received any prophylactic antibiotics. Patient demographics and comorbidities were reviewed and all patients were followed up postoperatively for a minimum of two years. All postoperative complications were recorded.

Results:

There were 349 male and 204 female patients. The mean age was 41.8 years (SD 14.8) and mean operative time was 30.4 minutes (SD 12.3). Two healthy young patients developed postoperative superficial wound infection within one week after surgery, but recovered with outpatient oral antibiotic treatment. The overall infection rate was 0.36%. No cases of deep infection were reported.

Conclusion:

This study showed a very low rate of surgical site infections, comparable with known rates following such operations. This suggests that prophylactic antibiotics are not necessary and avoids the known risks associated with their use.

Underwater robotic suturing

BACKGROUND

Laparoscopic and robotic surgeries have become popular, and this popularity is increasing. However, the environment in which such surgeries are performed is rarely discussed. Similar to arthrosurgery performed in water, artificial ascites could be a new environment for laparoscopic surgery. This study was performed to determine whether robotic surgery is applicable to complicated suturing underwater.

MATERIAL AND METHODS

A da Vinci Surgical System S was used. A weighted fabric sheet was placed at the bottom of a tank. Identical sets were made for each environment: One tank was dry, and the other was filled with water. The suturing task involved placement of a running silk suture around the perimeter of a small circle. The task was performed eight times in each environment. The task time and integrity score were determined. The integrity score was calculated by evaluating accuracy, tightness, thread damage, and uniformity; each factor was evaluated using a five-point scale.

RESULTS

Although statistically significant differences were not shown in either task time or integrity score between the underwater and air environments, robotic suturing underwater is not inferior to performance in air.

CONCLUSIONS

The feasibility of robotic suturing underwater was confirmed under the herein-described experimental conditions.

Branching patterns of the superficial peroneal nerve: implications for ankle arthroscopy and for anterolateral surgical approaches to the ankle

Ankle arthroscopic procedures offer less postoperative morbidity with faster healing times than open surgical procedures but still have associated risks. Complication rates as high as 17% have been reported. One of the most commonly reported complications is iatrogenic damage to the superficial peroneal nerve, which can result in numbness, tingling, or painful neuralgia. In the present study, we attempted to better assess the location of the superficial peroneal nerve at the ankle to improve preoperative planning and reduce complication rates. Fifty ankle specimens were dissected. A concerted effort was made to classify the location of the superficial peroneal nerve according to the Takao branching pattern, zones of the ankle, and distance to anatomic landmarks. Through our dissections, we found that most ankles have 2 nerve branches at the level of the ankle joint (Takao type II) and that the location of the superficial peroneal nerve branches at the ankle correlated directly with the ankle width. Additionally, 68% of specimens contained a nerve branch located in zone 1, where the anterolateral portal is placed, and 12% had a branch in zone 5, the location of the anteromedial portal site. The results of the present study have confirmed the wide variation in nerve location at the level of the ankle joint and serve to highlight the need for extreme caution during surgical procedures at the ankle.

Achievements during the Bone and Joint Decade 2000-2010

Musculoskeletal diseases continue to produce major disability around the world. Advances in therapy - particularly for the inflammatory diseases - have the potential to eradicate the inflammation and thus prevent joint destruction. Surgical advances include minimally invasive and computer-assisted robotic surgery, and advances in arthroscopic surgery. The development of new musculoskeletal tissues - tendons, cartilage and bone using nanotechnology and stem cells - has the potential to revolutionise the way we approach these chronic destructive diseases as well as major trauma. With the rapid increase in these conditions with an ageing population, new models of care will need to be developed to ensure that the right care is delivered at the right time by the most appropriately trained health professional and at a reasonable cost. The Bone and Joint Decade has played a significant role in focussing researchers, clinicians and health educators on these diseases and also in drawing them to the attention of Governments around the globe. While there is still much to be done, the journey has commenced and will continue into the future with education, research and service delivery into these important conditions being further enhanced.

Evidence-based practice in arthroscopic knee surgery

Knee arthroscopy is a minimally-invasive technique that allows intra-articular assessment and treatment of knee joint pathology. It has proven benefits of reduced patient morbidity, earlier recovery and mobilisation, and it is cost-effective. In this paper we review the anatomy of the knee joint, indications and contra-indications to knee arthroscopic use, and consider the main techniques of knee arthroscopy including types of anaesthetic, prophylactic antibiotics, theatre setup and arthroscopic portals, and post-operative care.

Delayed rupture of the extensor hallucis longus and extensor digitorum communis tendons after breaching the anterior capsule with a radiofrequency probe during ankle arthroscopy: a case report

A 40-year-old man with early arthritis, loose bodies, and anterolateral joint impingement symptoms in his left ankle, which was refractory to noninvasive therapeutic modalities for 1 year, underwent ankle arthroscopy and radiofrequency thermal ablation. The anterior capsule of the ankle joint was breached by the radiofrequency probe while the loose bodies were removed from the anterior recess, exposing the extensor tendons and resulting in a delayed spontaneous rupture of the extensor hallucis longus tendon and extensor tendons to the second and third toes. The extensor hallucis longus tendon was repaired with a semitendinosus tendon graft, and extensor digitorum tendons underwent primary repair. The patient regained full function and was symptom free 1 year after surgery.

2009 survey results: surgeon practice patterns regarding arthroscopic surgery

A survey was conducted to collect information on the surgical management and practice preferences of the audience members at a recent continuing medical education conference. Participants were polled on a variety of surgical topics, and their responses were recorded using a wireless audience response system. The answers were tabulated and are presented in this report. The majority of respondents preferred an arthroscopic repair for rotator cuff tears (52%) and shoulder instability (71%). Most (50%) perform single-row repair; 33% perform double-row repair. For simple knee arthroscopy, most use preoperative antibiotics (85%), no tourniquet (53%), and no chemical anticoagulation or only compression boots (69%). For cruciate ligament reconstruction, the majority preferred only a preoperative antibiotic (67%), no chemical anticoagulation or only compression boots (56%), and single-bundle reconstruction (88%) using a transtibial femoral tunnel (78%). Most (47%) prefer an all inside suture-based meniscus repair device.

Variations in serum electrolyte concentrations and renal function after therapeutic hip arthroscopy: a pilot study

PURPOSE

The purpose of this study was to analyze changes in serum electrolyte concentration and renal function after hip arthroscopy.

METHODS

We studied 10 consecutive patients (4 men and 6 women; median age, 30.5 years [range, 20 to 50 years]) undergoing hip arthroscopy. Operating time, traction time, and perfusion volume of lactated Ringer solution (in milliliters) were recorded. Preoperative and postoperative levels of sodium (Na(+)), potassium (K(+)), cloride (Cl(-)), calcium (Ca(2+)), magnesium (Mg(2+)), phosphorous (P), creatinine, and blood urea nitrogen (BUN) were compared.

RESULTS

The median operating time was 80 minutes (range, 60 to 150 minutes). The median perfusion volume of lactated Ringer solution was 15,000 mL (range, 6,000 to 30,000 mL). The median traction time was 37.5 minutes (range, 30 to 105 minutes). None of the patients had postoperative complications develop. With a mean decrease of 0.84 +/- 0.68 mg/dL, only serum calcium levels were found to decrease significantly (P = .01). There was a mean decrease of 1.50 +/- 2.07 mEq/L in sodium concentrations (P = .06). Hip arthroscopy was associated with a mean postoperative decrease in creatinine and BUN concentrations of 0.05 +/- 0.06 mg/dL (P = .19) and 9.84 +/- 10.36 mg/dL (P = .13), respectively. Although the mean decrease in BUN concentration was important, this was not shown to be significant. No correlations were found between operating time, perfusion volume, and postoperative changes.

CONCLUSIONS

Lengthy therapeutic hip arthroscopy under high intra-articular pressure has only a minimal effect on electrolyte balance and renal function. We therefore conclude that performing routine preoperative and postoperative blood analysis of electrolyte concentrations and renal function is unnecessary.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.