The effects of thermal capsulorrhaphy of medial parapatellar capsule on patellar lateral displacement

Arthroscopic electrothermal collagen shrinkage for partial scapholunate ligament tears, isolated or with associated triangular fibrocartilage complex injuries: a prospective study

BACKGROUND

To present the outcomes of arthroscopic electrothermal shrinkage for partial scapholunate (SL) ligament tears, isolated or with associated triangular fibrocartilage complex (TFCC) injuries.

METHODS

A prospective study of 20 patients with symptomatic instability of SL ligament (14 of them also with TFCC wrist injuries) treated with arthroscopic electrothermal shrinkage was conducted using a monopolar radiofrequency probe. No patient showed radiologic signs of static dissociation (mean SL interval 2.2 ± 0.6 mm; mean SL angle 41.4° ± 6.7°) before surgery. All patients underwent follow-up at our clinic regularly for an average of 50.6 months (range 29-80 months).

RESULTS

The modified Mayo wrist score improved from a mean of 59 ± 17.1 points preoperatively to 88.3 ± 16.2 points at the final follow-up. At the final clinical examination, a painful Watson scaphoid shift test was found in 3 patients (15%). The mean flexion-extension arc was unchanged (132° ± 19°), and mean grip strength improved 12 kg. No patient showed radiologic signs of arthritis or instability after surgery (mean SL interval 1.9 ± 0.7 mm; mean SL angle 42.7° ± 7.3°). Of the 14 patients with combined TFCC injuries, 3 patients continued complaining of ulnar-sided point tenderness. At the end of the follow-up, 80% of the subjects were satisfied or very satisfied.

CONCLUSIONS

SL ligament and TFCC electrothermal shrinkage effectively provided pain relief and grip strength increase for most of the patients treated.

LEVEL OF EVIDENCE

Level IV.

Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instablity

Background

To the present day, literature has only discussed how to treat extensive plantar plate and collateral ligament lesions, with gross joint subluxation and obvious clinical instability. The treatment options for early stages of the disease with minor injuries and subtle instabilities have not been described. The main purpose of this prospective study is to evaluate the efficacy of the combination of the arthroscopic radiofrequency shrinkage and distal Weil osteotomy in the treatment of subtle metatarsophalangeal joint instability.

Method

Prospective data (clinical, radiological, and arthroscopic findings) of 19 patients, with a total of 35 slightly unstable joints, was collected. The physical examination defined the hypothesis for plantar plate lesions (grades 0 and 1), which was confirmed during the diagnostic step of the arthroscopic procedure.

Results

Among our patients, 73 % were females and 63 % reported wearing high heels. The average age was 59 years and post-operative follow-up was 20 months. In the initial sample frame, 62 % of joints showed spread-out toes with increased interdigital spacing. The mean American Orthopedic Foot and Ankle Society score rose from 53 points pre-operatively to 92 points post-operatively and a visual-analog pain scale average value of eight points pre-operatively decreased to zero post-operatively. During the pre-operative evaluation, none of the patients had stable joints and over 97 % were classified as having grade 1 instability (<50 % subluxation). After treatment, 83 % of the joints became stable (degree of instability 0) and over 97 % were congruent. All studied parameters showed statistically significant improvements in the post-operative period (p < 0.001) showing the efficiency of the treatment in pain relief, while restoring the joint stability and congruity.

Conclusion

Arthroscopic radiofrequency shrinkage in combination with distal Weil osteotomy promotes functional improvement, pain relief, and restores the joint stability in the plantar plate lesion grades 0 and 1.

Prospective outcomes of stage III thumb carpometacarpal arthritis treated with arthroscopic hemitrapeziectomy and thermal capsular modification without interposition

PURPOSE

To prospectively evaluate the subjective and objective results of Eaton stage III thumb carpometacarpal arthritis treated with arthroscopic hemitrapeziectomy and thermal capsular modification without interposition.

METHODS

Twenty-three patients with Eaton stage III thumb carpometacarpal arthritis had arthroscopic hemitrapeziectomy without interposition and were evaluated with regard to grip and pinch strength, digital and wrist motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, analog pain scores, and radiographic findings before surgery, 3 months after surgery, and at a minimum of 4 years after surgery.

RESULTS

At 3 months after surgery, average DASH score improved from 61 to 10, and pain scores decreased from 8.3 to 1.5. Grip and key pinch strength improved 6.8 kg and 1.9 kg, respectively, and wrist and digital motion were unchanged. Proximal migration of the first metacarpal averaged 3 mm, and translation decreased from 30% to 10%. Nineteen of 23 patients were pleased with their overall outcomes. After 3 months, DASH scores, grip and pinch strengths, motion, patient satisfaction, and radiographic subsidence and translation remained unchanged for a minimum of 4 years.

CONCLUSIONS

Arthroscopic hemitrapeziectomy and thermal capsular modification offers patients with Eaton stage III arthritis a minimally invasive alternative that can provide increased function and decreased pain by 3 months after surgery. These results appear to last for a minimum of 4 years and are comparable to those reported for open techniques involving complete trapeziectomy. Substance interposition does not appear to be necessary.