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Tan CHB, Huang XO, Tay ZQ, Bin Abd Razak HR. Arthroscopic and open approaches for autologous matrix-induced chondrogenesis repair of the knee have similar results: a meta-analysis. J ISAKOS 2024; 9:192-204. [PMID: 37839704 DOI: 10.1016/j.jisako.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/24/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Cartilage defects are debilitating injuries that can reduce quality of life in patients. However, the poor regenerative properties of cartilage mean that cartilage repair remains challenging, and many methods have arisen to address that. Autologous matrix-induced chondrogenesis (AMIC®) is a popular technique to manage cartilage defects. Recent advances have allowed AMIC® to be done arthroscopically, instead of a mini-open arthrotomy approach. This systematic review and meta-analysis aims to investigate whether the arthroscopic approach to AMIC® provides better clinical outcomes than does the mini-open approach, in hopes of delineating a gold standard in cartilage repair. METHODS With reference to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search of the following databases (PubMed, Embase, Scopus, and Cochrane Library) was performed on 26th October 2022 using a combination of the following search terms: "autologous matrix induced", "chondrogenesis", and "knee". A total of 390 studies were identified, of which, 24 studies were included in our final analysis. RESULTS The arthroscopic approach achieves lower Visual Analogue Scale for pain scores. The International Knee documentation Committee) score and Knee Injury and Osteoarthritis Outcome Score were comparable between arthroscopic and open approaches. The open approach achieves a higher Magnetic Resonance Observation of Cartilage Repair Tissue score. Incidence of reported postoperative complications of revision surgery and knee stiffness was higher for the open approach than for the arthroscopic approach, whereas deep vein thrombosis was higher in the arthroscopic approach. CONCLUSION The AMIC® repair outcomes indicate that the arthroscopic approach does not hold a distinct advantage over the open approach. The choice of approach should consider surgeon expertise, location of lesion, and patient-specific factors. LEVEL OF EVIDENCE Systematic review and meta-analysis; Level III.
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Affiliation(s)
- Chin Hong Ben Tan
- Yong Loo Lin School of Medicine, National University of Singapore, S117597, Singapore
| | - XinYao Oliver Huang
- Yong Loo Lin School of Medicine, National University of Singapore, S117597, Singapore
| | - Zhi Quan Tay
- Yong Loo Lin School of Medicine, National University of Singapore, S117597, Singapore
| | - Hamid Rahmatullah Bin Abd Razak
- Department of Orthopaedic Surgery, Sengkang General Hospital, S544886, Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, S169857, Singapore.
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Rinaldi A, Pilla F, Chiaramonte I, Pederiva D, Vita F, Schilardi F, Gennaro A, Faldini C. Arthroscopic surgery for scaphoid nonunion: a 10-year systematic literature review. Musculoskelet Surg 2024:10.1007/s12306-023-00805-x. [PMID: 38340306 DOI: 10.1007/s12306-023-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/21/2023] [Indexed: 02/12/2024]
Abstract
The purpose of the study was to investigate whether arthroscopic treatment of carpal scaphoid nonunions by osteosynthesis with bone grafting represents a successful surgical technique. This systematic literature review, conducted following the PRISMA guidelines, explores the past 10 years of clinical studies concerning the arthroscopic treatment of scaphoid nonunions. The most relevant keywords were used to search the databases, and the Downs and Black 27-item checklist has been used as quality assessment tool. Twelve papers that meet the premised eligibility criteria have been identified. These studies demonstrate the efficacy of this surgical solution, achieving a postoperative union rate of 96% in the average time of 13.5 weeks. Regardless of the method of synthesis and the origin of the graft used, excellent results were obtained. Patients who underwent this procedure reported a pain reduction of almost 80% compared to the preoperative level, improvement in grip strength close to 40%, and recovery in wrist function during daily activities. Arthroscopy has numerous advantages compared to the open approach. These are technically recognized by the surgeon and by the patient. Some disadvantages include a longer intraoperative time and considerable significant technical difficulty. Arthroscopic treatment of scaphoid nonunion by osteosynthesis with bone graft achieves a 96% union rate of the treated scaphoid with satisfying clinical results.
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Affiliation(s)
- Alberto Rinaldi
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
| | - Federico Pilla
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Ilaria Chiaramonte
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Davide Pederiva
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Fabio Vita
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Francesco Schilardi
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Andrea Gennaro
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
| | - Cesare Faldini
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
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Wu J, He H, Yuan L, Ma T. Surgical treatment of posterior cruciate-ligament tibial avulsion fractures using arthroscopic wire combined with NICE ligation: A case series. Asian J Surg 2024; 47:1071-1072. [PMID: 38036369 DOI: 10.1016/j.asjsur.2023.10.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Jinqiu Wu
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China
| | - Hairong He
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China.
| | - Lingwei Yuan
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China
| | - Tao Ma
- Department of Sports Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street, NO.418, Lanzhou, Gansu Province, 730000, China
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Yeo MHX, Seah SJS, Lee M, Lie DTT. Different types of rotator cuff tear morphology do not affect post-repair clinical outcomes in large to massive tears. J ISAKOS 2024; 9:25-33. [PMID: 37925105 DOI: 10.1016/j.jisako.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES The primary aim of this current study is to evaluate the effects of rotator cuff tear morphology on clinical outcomes in large to massive tears, using a modified version of the existing classification system, with specific focus on tear symmetry and use of margin convergence. METHODS Patients who underwent arthroscopic repair of large to massive, full thickness rotator cuff tears were retrospectively analysed. The tear pattern was classified at the time of surgery as Type IA, Type IB, Type IIA, and Type IIB according to tear symmetry and direction of maximum tear diameter, with Type I being symmetrical and Type II being asymmetrical. Type IA (U-shaped) had greater mediolateral (ML) than anteroposterior (AP) diameter while Type IB (crescent shaped) had greater AP than ML diameter. Type IIA tears have an anterior extension towards the rotator interval while IIB tears have a posterior extension into the infraspinatus, similar to AP L-shaped tears established in the literature. Type I tears were typically repaired from medial to lateral while Type II tears were repaired diagonally. All types were repaired using double row technique, with the addition of margin convergence for Types IA and IIB, which had larger tears in the medial and lateral directions. Primary outcome measures were Oxford Shoulder Score, Constant Shoulder Score, University of California at Los Angeles Shoulder Score followed-up at 6, 12, and 24-months as well as retear rates at latest follow-up. RESULTS In total, 109 patients were included in the study with a mean age of 65.5 ± 9.4. The prevalence of each tear morphologies from Type IA to IIB was 22.0 %, 34.9 %, 27.5 %, and 15.6 %, respectively. All four groups showed statistically significant improvement from pre-operative scores in all 3 outcome measures at 24 months (p < 0.001 for all). No significant difference in primary outcome measures or retear rates was detected between all 4 groups. CONCLUSION This study found that different types of cuff tear morphology, despite affecting surgical repair technique, does not influence clinical outcomes post-arthroscopic rotator cuff repair at mid-term follow-up. LEVEL OF EVIDENCE Retrospective Cohort study, Level III.
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Affiliation(s)
- Mark H X Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore, 169608, Singapore
| | - Shawn J S Seah
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore, 169608, Singapore
| | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore, 169608, Singapore
| | - Denny Tjiauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 1 Outram Road, Singapore, 169608, Singapore.
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Wang M, Bai YP, Sun WB, Sun J. Two years follow-up of patients with knee varus deformity and medial meniscus extrusion after medial opening wedge high tibial osteotomy and arthroscopic meniscus centralization. Int Orthop 2024; 48:481-486. [PMID: 37725151 DOI: 10.1007/s00264-023-05959-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE This is a retrospective study and aims to investigate the clinical outcomes of patients with knee varus deformity and extruded medial meniscus who underwent arthroscopic meniscus centralization and medial opening wedge high tibial osteotomy. METHODS A total of 24 patients were included in the trial, and arthroscopy intraoperative photographs and standing preoperative and postoperative radiographs were taken to analyze the mechanical tibiofemoral angle and tibial plateau inclination. Postoperative complications and knee motion were recorded, and the surgical results were evaluated using the knee society score. RESULTS The study observed four cases of surgery-related complications among all patients, but no major complications were reported. The surgery significantly improved knee flexion degrees and total knee range of motion. Satisfactory outcomes were shown in postoperative radiographs and secondary intraoperative photographs. The knee score increased from 39.6 ± 10.0 to 80.1 ± 9.0, and the functional score improved from 48.1 ± 6.9 to 89.4 ± 5.5. The preoperative tibial plateau inclination was 5.3 ± 0.7, while the postoperative data showed a decrease to 4.2 ± 0.7. The preoperative mechanical tibiofemoral angle was - 7.7 ± 1.0, and it improved in all patients postoperatively to 2.8 ± 0.9. CONCLUSION By alternating the knee biomechanics and significantly improving symptoms and quality of life, arthroscopic medial meniscus centralization and medial open wedge high tibial osteotomy units are confirmed to be an effective alternative treatment for knee varus deformity.
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Affiliation(s)
- Miao Wang
- Jiading Branch of Shanghai General Hospital, Jiading District Jiangqiao Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yun-Peng Bai
- Jiading Branch of Shanghai General Hospital, Jiading District Jiangqiao Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei-Bing Sun
- Jiading Branch of Shanghai General Hospital, Jiading District Jiangqiao Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jian Sun
- Jiading Branch of Shanghai General Hospital, Jiading District Jiangqiao Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Dannaway J, Sharma G, Raniga S, Graham P, Bokor D. Is preoperative elevated glycated hemoglobin (HbA1c) a risk factor for postoperative shoulder stiffness after posterior-superior rotator cuff repair? JSES Int 2024; 8:47-52. [PMID: 38312295 PMCID: PMC10837722 DOI: 10.1016/j.jseint.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Postoperative shoulder stiffness (POSS) affects a large number of patients undergoing rotator cuff repair (RCR). Diabetes may increase the risk of POSS. Preoperative glycated hemoglobin (HbA1c) is a convenient measure of glucose control in this group. The aim of the present study was to determine a relationship between preoperative HbA1c and POSS in patients undergoing postero-superior RCR. Methods Two hundred fifty patients with full-thickness postero-superior rotator cuffs who underwent RCR were followed for 6 months. Pre- and post-operative external rotation with arm by the side at 3 and 6 months were measured. Patient demographics, tear characteristics, preoperative HbA1c level, and surgical details were recorded. Patients with subscapularis tears, concomitant instability, partial thickness tears, arthritis, and irreparable rotator cuff tears were excluded. Univariate and multivariate logistic regression were used to determine the association between patient characteristics and POSS at 6 months. Results At the end of 6 months, 16% (41/250) of patients had POSS. Multivariate analysis demonstrated an elevated preoperative HbA1c level was a statistically significant predictor of POSS at 6 months (odds ratio 7.04, P < .01) after posterior superior RCR. Lower preoperative external rotation (P = .02) and female sex (P < .01) were also risk factors associated with POSS. Age, hand dominance, worker's compensation claim status, etiology, and size of the tear, surgical technique, and additional treatments were not statistically significant predictors. Conclusion Elevated preoperative HbA1c level is associated with POSS after RCR. Measuring HbA1c preoperatively may assist clinicians to identify patients at risk of POSS. HbA1c is a modifiable parameter that could then be optimized preoperatively in order to improve outcomes.
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Affiliation(s)
- Jasan Dannaway
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Gaurav Sharma
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sumit Raniga
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Petra Graham
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Desmond Bokor
- Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
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7
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Li D, Chen S, Mao J, Deng T. Arthroscopic-assisted reduction and internal fixation for the treatment of tibial plateau fractures. Asian J Surg 2023; 46:5966-5967. [PMID: 37690895 DOI: 10.1016/j.asjsur.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Dezhi Li
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Da Qian Street NO.696, Neijiang, 641000, Hebei Province, China.
| | - Shengwen Chen
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Da Qian Street NO.696, Neijiang, 641000, Hebei Province, China
| | - Jun Mao
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Da Qian Street NO.696, Neijiang, 641000, Hebei Province, China
| | - Ting Deng
- Department of Orthopaedics, Neijiang Hospital of Traditional Chinese Medicine, Da Qian Street NO.696, Neijiang, 641000, Hebei Province, China
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Zhao B, Sun Q, Xu X, Liu Y, Zhao Y, Gao Y, Zhou J. Comparison of arthroscopic and open Brostrom-Gould surgery for chronic ankle instability: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:866. [PMID: 37964306 PMCID: PMC10644443 DOI: 10.1186/s13018-023-04292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/15/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Approximately 20% of acute ankle sprains progress to chronic lateral ankle instability (CLAI) requiring surgical intervention. There has been growing interest among surgeons regarding whether arthroscopic techniques can replace open Brostrom-Gould surgery in treating CLAI. The purpose of this study was to pool the results of multiple studies comparing the treatment effects of these two fixation approaches. METHODS Our study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on CLAI that were repaired using the arthroscopic or open Broström-Gould technique. Through a comprehensive meta-analysis, we evaluated several outcomes, including post-operative function, radiological measurements, complications, and time efficiency. RESULT A total of 686 patients from 11 studies were included in the analysis. Among them, 351 patients underwent open repair, and 335 underwent arthroscopic Brostrom-Gould surgery. The present study revealed that arthroscopic and open Brostrom-Gould techniques demonstrated no significant differences in talar tilt, talar anterior translation, complication rate, and time to return to previous level of activity. Furthermore, no significant differences were observed in AOFAS, K-P, VAS, and Tegner scores at the 2-year follow-up. However, significant differences were noted between the two surgical approaches in terms of early weight-bearing (WMD = - 1.33 weeks, 95% CI = [- 1.91, - 0.76], P = 0.17, I2 = 40%), as well as AOFAS scores (WMD = 1.00, 95% CI = [0.05, 1.95], P = 0.73, I2 = 0%), K-P scores (WMD = 1.57, 95% CI = [0.49, 2.64], P = 0.15, I2 = 47%), and VAS scores (WMD = - 0.15, 95% CI = [- 0.60, 0.29], P < 0.08, I2 = 61%) within the first postoperative year. CONCLUSIONS Our findings support that arthroscopic repair yields comparable outcomes to open surgery. Consequently, we advocate for adopting arthroscopic repair as a preferred alternative to the conventional open Broström-Gould procedure for treating chronic lateral ankle instability.
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Affiliation(s)
- Binzhi Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Qingnan Sun
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Xiaopei Xu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yanrui Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yulin Gao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People's Republic of China.
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DeVries JG, Scharer BM. The Ankle Joint: Updates on Ankle Fusion Approaches and Fixation. Clin Podiatr Med Surg 2023; 40:681-701. [PMID: 37716745 DOI: 10.1016/j.cpm.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Ankle fusion is a well-studied, classical procedure for conditions affecting the ankle joint, and has a long history with predictable results. Although there are many different approaches available, a few options are commonly used. The two main focuses of modern literature are on anterior plating versus traditional screw fixation, and on arthroscopic versus open techniques for fusion. This article discusses recent literature and then presents cases and techniques that are commonly used today. This includes arthroscopic ankle arthrodesis, traditional transfibular approach, anterior plating, and the indications and application of external fixation. Standard recovery and complications are discussed.
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Affiliation(s)
- Jason George DeVries
- Orthopedics and Sports Medicin - BayCare Clinic, 1110 Kepler Drive, Green Bay, WI 54311, USA.
| | - Brandon M Scharer
- Orthopedics and Sports Medicin - BayCare Clinic, 1110 Kepler Drive, Green Bay, WI 54311, USA
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Wu Y, Qi Y, Li X, Luo W. Arthroscopic treatment of synovial hemangioma of the knee: A case report. Asian J Surg 2023; 46:3825-3826. [PMID: 37012158 DOI: 10.1016/j.asjsur.2023.03.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Yunbiao Wu
- The First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Yang Qi
- The First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Xingyong Li
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenyuan Luo
- Department of Orthopedics, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Medvedev G, Collins LK, Cole MW, Weldy JM, George ER, Sherman WF. The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery. J Hand Surg Glob Online 2023; 5:624-629. [PMID: 37790837 PMCID: PMC10543806 DOI: 10.1016/j.jhsg.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery. Methods Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared. Results Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; P < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; P < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; P < .001) and release (0.46% vs 0.37%; OR, 1.24; P < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both P < .001), a higher percentage of women (both P<.001), and more likely to have had a preoperative nerve block (both P < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index (P < .001) and more comorbidities. Conclusions This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Gleb Medvedev
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Lacee K. Collins
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Matthew W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - John M. Weldy
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | | | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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12
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Zhao L, Fu C, Lu M, He L, Shen Z, Xing J, Wang C, Hou S. Remodeling process and clinical outcomes following all- arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and 1-tunnel double Endobutton fixation system. J Shoulder Elbow Surg 2023; 32:1825-1837. [PMID: 36907316 DOI: 10.1016/j.jse.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Arthroscopically modified Eden-Hybinette procedures for glenohumeral stabilization have been used for a long time. With the advancement of arthroscopic techniques and the development of sophisticated instruments, a double Endobutton fixation system has been used clinically to secure bone graft to the glenoid rim placed through a specifically designed guide. The purpose of this report was to evaluate clinical outcomes and serial glenoid remodeling process following all-arthroscopic anatomical glenoid reconstruction using autologous iliac crest bone grafting technique through 1-tunnel fixation. METHODS Forty-six patients with recurrent anterior dislocations and significant glenoid defects greater than 20% underwent arthroscopic surgery with a modified Eden-Hybinette technique. Instead of firm fixation, autologous iliac bone graft was fixed to the glenoid by double Endobutton fixation system through 1-tunnel placed in the glenoid surface. Follow-up examinations were performed at 3, 6, 12, and 24 months. The patients were followed up for a minimum of two years using the Rowe score, the Constant score, the Subjective Shoulder Value, and the Walch-Duplay score; patient satisfaction with the procedure outcome was also rated. Graft positions, healing, and absorption were evaluated postoperatively with computed tomography imaging. RESULTS At a mean follow-up of 28 months, all patients were satisfied and had a stable shoulder. The Constant score improved from 82.9 to 88.9 points (P < .001), the Rowe score, improved from 25.3 to 89.1 points (P < .001), the Subjective Shoulder Value improved from 31% to 87% (P < .001), and the Walch-Duplay score improved from 52.5 to 85.7 points (P < .001). One donor-site fracture occurred during the follow-up period. All grafts were well-positioned and achieved optimal bone healing with zero excessive absorption. The preoperative glenoid surface (72.6% ± 4.5%) increased significantly immediately after surgery to 116.5% ± 9.6% (P < .001). After a physiological remodeling process, the glenoid surface remained significantly increased at the last follow-up (99.2% ± 7.1%) (P < .001). The glenoid surface area appeared to decrease serially when compared between the first 6 months and 12 months postoperatively, while there was no significant interval change between 12 and 24 months postoperatively. CONCLUSION Patient outcomes were satisfactory following the all-arthroscopic modified Eden-Hybinette procedure using an autologous iliac crest grafting technique through one-tunnel fixation system with double Endobutton. Graft absorption mostly occurred on the edge and outside the ''best-fit'' circle of the glenoid. Glenoid remodeling occurred within the first year after all-arthroscopic glenoid reconstruction with an auto iliac bone graft.
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Affiliation(s)
- Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China.
| | - Chuying Fu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Zhaoxiong Shen
- 6th Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Senrong Hou
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
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Lu Y, Li Y, Zhang H, Li X, Li F, Jiang C. The Correlation between Variation of Labral Attachment and Lesions of the Long Head of the Biceps Tendon in Patients with Rotator Cuff Tears. Orthop Surg 2023; 15:1967-1974. [PMID: 36458404 PMCID: PMC10432495 DOI: 10.1111/os.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE There was no universally accepted classification system that describes LHBT lesions as a type of its' pathology in patients with shoulder pain. This study aimed to determine the correlation of anatomic variants of glenoid labrum attachment of long head of biceps tendon (LHBT) and to assess their association, if any, with its lesions in rotator cuff tear (RCT) patients. METHODS All RCT patients from January 2016 to December 2019 were assessed arthroscopically to classify the LHBT labrum attachment according to its' anatomical location. A simplified classification was created to describe the LHBT as normal, tendinitis, subluxation or dislocation, partial tear and superior labral tear from anterior to posterior (SLAP) lesion beyond type II The RCT were classified as three types as partial, small to medium and large to massive. The correlation of variants of LHBT labral attachment with type of LHBT lesions in different RCT groups was evaluated. RESULTS In total, 669 patients were included for evaluation. The attachment of the LHBT was entirely posterior in 23 shoulders (3.4%), posterior-dominant in 81 shoulders (12.1%), and equal in 565 shoulders (84.4%). In equal distribution LHBT attachment group, age > 60 (odds ratio: 2.928, P < 0.001) and size of RCT (P < 0.001) were significant risk factors of LHBT lesions. In the analysis of all patients, comparing with the partial thickness rotator cuff tear (PTRCT), the odds ratio of small to medium RCT and large to massive RCT was 2.398 and 6.606 respectively. In addition, age > 60 (odds ratio: 2.854, P < 0.001) and size of RCT (P < 0.001) were significant risk factors of LHBT lesions. In posterior dominant group, size of RCT was a significant risk factor of LHBT lesions but not any others (P < 0.001). In entirely posterior group, no risk factor of LHBT lesions was found. It showed that the variation of LHBT attachment was not a significant risk factor of LHBT lesions in rotator cuff repaired patients (p = 0.075). CONCLUSIONS There are three types of LHBT labrum attachment in RCT patients on arthroscopic observation. 84.4% were equal distribution of LHBT attachment on glenoid labrum, followed by posterior-dominant (12.1%) and entirely posterior type (3.4%) in present study. Although the variation of LHBT attachment was not a significant risk factor of LHBT lesion in rotator cuff repaired(RCR) patients, there were different risk factors among three LHBT labral attachment types. In RCR patients, age > 60 and RCT size were significant risk factors of LHBT lesions.
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Affiliation(s)
- Yi Lu
- Department of Sports MedicineBeijing Ji Shui Tan Hospital, 4 Affiliated Hospital of Peking UniversityBeijingChina
| | - Yue Li
- Department of Sports MedicineBeijing Ji Shui Tan Hospital, 4 Affiliated Hospital of Peking UniversityBeijingChina
| | - Hailong Zhang
- Department of Sports MedicineBeijing Ji Shui Tan Hospital, 4 Affiliated Hospital of Peking UniversityBeijingChina
| | - Xu Li
- Department of Sports MedicineBeijing Ji Shui Tan Hospital, 4 Affiliated Hospital of Peking UniversityBeijingChina
| | - Fenglong Li
- Department of Sports MedicineBeijing Ji Shui Tan Hospital, 4 Affiliated Hospital of Peking UniversityBeijingChina
| | - Chunyan Jiang
- Department of Sports MedicineBeijing Ji Shui Tan Hospital, 4 Affiliated Hospital of Peking UniversityBeijingChina
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Li Y, Guo S, Li S, Yang G, Lu Y. Is There any Difference in Clinical Outcome between Open and Arthroscopic Treatment for Tennis Elbow? A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:1931-1943. [PMID: 36444948 PMCID: PMC10432432 DOI: 10.1111/os.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
There is considerable controversy regarding the optimal approach (open vs arthroscopic) of releasing and/or debridement for the treatment of tennis elbow (TE). The aim of this study was to determine the clinical outcomes of the two techniques by quantitatively synthesizing outcome data. The study was performed by searching the PubMed, EMBASE, Ovid, and Elsevier databases between January 1995 and April 2022 for a minimum follow-up of 6 months. The searching strategy was "(tennis elbow [Title/Abstract] OR lateral epicondylitis [Title/Abstract]) AND (open [Title/Abstract] OR arthroscopic [Title/Abstract] OR release [Title/Abstract] OR debridement [Title/Abstract] OR surgery [Title/Abstract])". The quality of each study was investigated using the Coleman Methodology Score. In total, 1411 (693 open, 718 arthroscopic) elbows in 1392 patients who underwent releasing and debridement for tennis elbow were identified. The mean Coleman Methodology Score for the included studies was 55.2 ± 8.6 (open: 55.0 ± 9.4, arthroscopic: 55.8 ± 8.2). Improved clinical results were achieved after treatment with either open or arthroscopic treatment. The surgical success rate was 95.6% in open surgery and 92.4% in arthroscopic management. The complication rates were 2.2% and 1.5% for open and arthroscopic procedures, respectively. Similar subjective and objective outcomes, and surgical success rate were observed in patients with both techniques. Patients who had undergone arthroscopic release seemed to return to work earlier (5.3 weeks vs 7.1 weeks). To draw more definite conclusions, high-quality long-term follow-up randomized controlled trials are needed.
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Affiliation(s)
- Yue Li
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Siyi Guo
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Shangzhe Li
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Guang Yang
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
| | - Yi Lu
- Department of Sports MedicineBeijing Jishuitan HospitalBeijingChina
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Yeo MHX, Lie D, Cheong T, Wonggokusuma E, Mak WK. Anatomic risk factors for arthroscopic Bankart repair failure: A case-control study comparing failure and non-failure groups in an Asian population. J Orthop 2023; 41:73-78. [PMID: 37362959 PMCID: PMC10285502 DOI: 10.1016/j.jor.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Post-arthroscopic Bankart repair failure/re-dislocation rates are influenced by several risk factors, including anatomic defects. There is limited evidence on the role of anatomic defects, especially for Hill-Sachs size in on-track lesions. This study aimed to assess glenoid bone loss, Hill-Sachs lesion and labral tear size and evaluate their contribution to post-operative instability after a primary repair. Material and methods Across 169 patients with on-track Bankart lesions who underwent primary arthroscopic Bankart repair from 2010 to 2015, this study matched 14 failure with 14 non-failure cases based on age/gender. Patient demographics, pre-operative radiological parameters (including size of glenoid bone loss and Hill-Sachs lesion) and labral tear size were compared between the failure and non-failure groups. Result All patients were male with a mean age of 21.01 ± 4.97. Significantly greater glenoid bone loss (p = 0.024) and labral tear size (p = 0.039) were found in the failure group. However, there was no significant difference in mean volume of Hill-Sachs lesion between the two groups (p = 0.739). Conclusion Extensive glenoid bone loss and labral tears are risk factors for post-arthroscopic Bankart failure. However, the size of Hill-Sachs lesion is not a risk factor for failure, in a specific group of on-track Hill-Sachs lesions. Level of evidence Retrospective Study, Level IV.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Teddy Cheong
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
| | - Erick Wonggokusuma
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Wai Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
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Lanzerath F, Wegmann K, Hackl M, Uschok S, Ott N, Müller LP, Leschinger T. Surgical arthrolysis of the stiff elbow: a systematic review. Arch Orthop Trauma Surg 2023; 143:2383-2393. [PMID: 35482109 PMCID: PMC10110632 DOI: 10.1007/s00402-022-04442-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stiffness after elbow injuries can severely limit daily life. If adequate conservative treatment does not result in satisfactory improvement of elbow function, surgical intervention should be considered. Whether an open or arthroscopic procedure is preferable is still a topic of debate and a systematic review of functional outcomes is lacking. MATERIALS AND METHODS We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and EMBASE, for studies published between 2013 and 2021. Primary objective was to compare open and arthroscopic arthrolysis' functional outcomes, respectively, especially ROM and MEPS, as well as the accompanied complications. The PRISMA guidelines were applied. RESULTS 27 studies comprising 1666 patients were included. 1059 patients (63.6%) were treated with open arthrolysis, and 607 patients (36.4%) were treated with arthroscopic arthrolysis. The results presented indicate satisfactory outcomes in open and arthroscopic arthrolysis with regard to functional outcome parameters. Treatment success, defined as excellent or good results according to the Mayo Elbow Performance Score, among the patients treated with an open procedure was 88.8%; 6.3% required revision whereas 18.1% had complications without the need for revision surgery. Within the cohort of arthroscopically treated patients, treatment success was 91.8%. Revisions and complications without further surgical intervention were significantly less frequent than in the open cohort, at 1.6% and 9.1%, respectively. CONCLUSIONS Both open and arthroscopic arthrolysis provide good to excellent functional outcomes. Since the number of complications and revision increases with the invasiveness of the treatment, an arthroscopic procedure might be favored if feasible by indication. The role of forearm rotation and the use of a hinged external fixator remains of interest. STUDY DESIGN Level IV; Systematic review.
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Affiliation(s)
- Fabian Lanzerath
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany.
| | - Kilian Wegmann
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Michael Hackl
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Stephan Uschok
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Nadine Ott
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Lars P Müller
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - Tim Leschinger
- Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany
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Kjaer M, Rasmussen JV, Gvozdenovic R. Arthroscopic versus open cancellous bone grafting for scaphoid delayed/nonunion in adults (SCOPE-OUT): study protocol for a randomized clinical trial. Trials 2023; 24:273. [PMID: 37060040 PMCID: PMC10103438 DOI: 10.1186/s13063-023-07281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Scaphoid non-union results in pain and decreased hand function. Untreated, almost all cases develop degenerative changes. Despite advances in surgical techniques, the treatment is challenging and often results in a long period with a supportive bandage until the union is established. Open, corticocancellous (CC) or cancellous (C) graft reconstruction and internal fixation are often preferred. Arthroscopic assisted reconstruction with C chips and internal fixation provides minimal trauma to the ligament structures, joint capsule, and extrinsic vascularization with similar union rates. Correction of deformity after operative treatment is debated with some studies favouring CC, and others found no difference. No studies have compared time to union and functional outcomes in arthroscopic vs. open C graft reconstruction. We hypothesize that arthroscopic assisted C chips graft reconstruction of scaphoid delayed/non-union provides faster time to union, by at least a mean 3 weeks difference. METHODS Single site, prospective, observer-blinded randomized controlled trial. Eighty-eight patients aged 18-68 years with scaphoid delayed/non-union will be randomized, 1:1, to either open iliac crest C graft reconstruction or arthroscopic assisted distal radius C chips graft reconstruction. Patients are stratified for smoking habits, proximal pole involvement and displacement of > / < 2 mm. The primary outcome is time to union, measured with repeated CT scans at 2-week intervals from 6 to 16 weeks postoperatively. Secondary outcomes are Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), visual analogue scale (VAS), donor site morbidity, union rate, restoration of scaphoid deformity, range of motion, key-pinch, grip strength, EQ5D-5L, patient satisfaction, complications and revision surgery. DISCUSSION The results of this study will contribute to the treatment algorithm of scaphoid delayed/non-union and assist hand surgeons and patients in making treatment decisions. Eventually, improving time to union will benefit patients in earlier return to normal daily activity and reduce society costs by shortening sick leave. TRIAL REGISTRATION ClinicalTrials.gov NCT05574582. Date first registered: September 30, 2022. Items from the WHO trial registry are found within the protocol.
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Affiliation(s)
- Morten Kjaer
- Gentofte Hospitalsvej 1, Opg. 17 St, 2900, Hellerup, Denmark.
- Department of Orthopedic Surgery, Hand Surgery Unit, Copenhagen University Hospital Herlev/Gentofte, 2900, Hellerup, Denmark.
| | - Jeppe Vejlgaard Rasmussen
- Gentofte Hospitalsvej 1, Opg. 17 St, 2900, Hellerup, Denmark
- Department of Orthopedic Surgery, Shoulder and Elbow Surgery Unit, Copenhagen University Hospital Herlev/Gentofte, 2900, Hellerup, Denmark
| | - Robert Gvozdenovic
- Gentofte Hospitalsvej 1, Opg. 17 St, 2900, Hellerup, Denmark
- Department of Orthopedic Surgery, Hand Surgery Unit, Copenhagen University Hospital Herlev/Gentofte, 2900, Hellerup, Denmark
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Barbosa F, Titchener A, Tambe A, Espag M, Cresswell T, Clark D. Clinical Outcomes of Arthroscopic Revision Rotator Cuff Repair. Indian J Orthop 2023; 57:490-494. [PMID: 36825272 PMCID: PMC9941391 DOI: 10.1007/s43465-022-00811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/22/2022] [Indexed: 02/15/2023]
Abstract
Aims Multiple studies have shown excellent clinical results in primary rotator cuff repairs; however, not much evidence is available in the literature on the outcomes of arthroscopic revision rotator cuff repairs. The purpose of this study was to report a cohort of patients who underwent revision arthroscopic rotator cuff repair and identify factors that may influence its outcomes. Methods We examined a cohort of 62 patients which underwent revision arthroscopic rotator cuff repair in a single UK institution with a minimum of 24 months follow-up. Active shoulder movements including forward flexion, abduction and external rotation were evaluated, as well as Oxford Shoulder Score (OSS). Further subgroup analysis was performed looking of the effects of age, size of tear, obesity and diabetes mellitus had on clinical outcomes. Results 59 patients were available for final review. 39 male and 23 were female. The mean age was 64 years. Overall, significant improvements were seen in terms of OSS (p < 0.05), active forward flexion (p < 0.05), active abduction (p < 0.05) and active external rotation (p < 0.05). Our study showed that a significant proportion of patients undergoing arthroscopic revision rotator cuff repair achieve good outcomes. Repairing small- and medium-size tears was successful, diabetics had no post-operative improvements, obese patients achieved significant improvement in range of movement and age was not a predictor of surgical success. Conclusion Overall, arthroscopic revision surgery is a successful option; however, appropriate patient selection and counselling is paramount.
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Affiliation(s)
- Francisco Barbosa
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Andrew Titchener
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Amol Tambe
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Marius Espag
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - Tim Cresswell
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
| | - David Clark
- Department of Trauma and Orthopaedics, Royal Derby Hospital, Uttoxeter New Road, Derby, DE22 3NE UK
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Zhou M, Zhou C, Cui D, Long Y, Yan Y, Zheng Z, Meng K, Zhang J, Hou J, Yang R. Biomechanical Analysis of Lark-Loop, Lasso-Loop and Krackow Suture Technique in Tenodesis. Orthop Surg 2023; 15:1136-1143. [PMID: 36852476 PMCID: PMC10102316 DOI: 10.1111/os.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE Strong tendon grasping is vital to the success of a tenodesis operation. The purpose of this study was to evaluate the initial tendon-fixation strength of the Lark-Loop technique in arthroscopic suprapectoral biceps tenodesis and compare it with others commonly used techniques. METHODS Thirty-three porcine superficial flexor digitorum tendons were harvested from a local slaughterhouse and randomly divided into three groups to perform three tendon fixation techniques (Lasso-Loop stich group, Lark-Loop stich group or Krackow stich group; 11 tendons each group) with a No. 2 suture, respectively. Each tendon was pre-tensioned in 5°N for 2 min and then cyclically loaded 5 to 30°N for 500 cycles to assess displacement. After cyclic loading, the tendon was loaded to ultimate tendon-suture configuration failure at the rate of 1 mm/s. Finally, the mode of failure and the construct stiffness of the tendon were recorded and calculated. RESULTS After cyclical loading, the displacement of the Lark-Loop group was equivalent to the Krakow group (P > 0.9999) but significantly smaller than the Lasso-Loop group (P = 0.0009). The ultimate load to failure for the Lark-Loop was equivalent to the Krakow technique group (P = 0.1463) but significantly greater than the Lasso-Loop group (P < 0.0001). The stiffness for the Lark-Loop was equivalent to the Krakow group (P = 0.4718) but significantly greater than the Lasso-Loop technique group (P < 0.0001). In the Lark-Loop and Krackow group, all the tendons failed by suture breakage, while all the tendons failed by suture cutting through the tendon in the Lasso-Loop technique group. CONCLUSION Lark-Loop suture technique has biomechanical properties comparable to Krackow and superior to the Lasso-Loop in terms of suture displacement, ultimate load to failure, and stiffness. Therefore, the Lark-Loop suture fixation technique may be beneficial for arthroscopic biceps tenodesis.
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Affiliation(s)
- Min Zhou
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Chuanhai Zhou
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Dedong Cui
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Yi Long
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Yan Yan
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Zhenze Zheng
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Ke Meng
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China.,Department of Orthopaedic Surgery, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Jinming Zhang
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Jingyi Hou
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedic Surgery, Sun Yat-Sen University 2nd Affiliated Hospital, Guangzhou, China
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Monir JG, Astolfi MM, Sholder D, Kocovic N, Horneff JG, Abboud JA, Schoch BS. Early revision rotator cuff repair: an analysis of outcomes and function. Eur J Orthop Surg Traumatol 2023; 33:321-326. [PMID: 35064337 DOI: 10.1007/s00590-021-03182-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Rotator cuff repair (RCR) is commonly performed and can have good functional outcomes. However, failure of RCR surgery can be challenging for both patient and surgeon alike. This study examines the outcomes of early revision RCR for the management of clinically failed RCRs. METHODS Thirty-six patients undergoing revision RCR within 1 year of primary surgery were evaluated. Range of motion (ROM) and patient-reported outcomes (PROMs) were assessed at baseline, post-primary RCR, and post-revision RCR. RESULTS Patients with a documented repair failure after primary RCR failed to improve in both ROM and PROMs compared to before primary RCR. Following early revision, RCR SANE (p = 0.024, p < 0.001), ASES (p = 0.004, p < 0.001), and SST (p < 0.001, p = 0.001) scores improved significantly compared to pre-primary and pre-revision scores, respectively. Documentation of a new traumatic injury did not affect clinical or functional outcomes compared to atraumatic re-tears. Number of tendons torn was positively correlated with higher SANE scores (r = 0.638, p = 0.008) and negatively correlated with SST score (r = -0.475, p = 0.03) and improvement in forward elevation (r = -0.368, p = 0.03) after primary RCR. There were significant correlations between number of tendons torn and improvement in SANE (r = 0.664, p = 0.007) and ASES scores (r = 0.468, p = 0.043) from post-primary RCR to post-revision RCR. CONCLUSION Early revision after failed RCR can lead to clinically significant improvement in functional outcomes. The presence of a traumatic re-injury does not appear to affect revision RCR outcomes as it does in the primary setting. Patients with early clinical failures of primary RCR may benefit from early revision RCR. LEVEL OF EVIDENCE III: Retrospective Case Series.
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Affiliation(s)
- Joseph G Monir
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Matthew M Astolfi
- Department of Orthopaedics, Beaumont Royal Oak Hospital, Royal Oak, MI, USA
| | | | - Nikola Kocovic
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Gabriel Horneff
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bradley S Schoch
- Department of Orthopedics, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Jeon YS, Kim MK, Kwon DG, Lee SS, Park JW, Kang DS, Ryu DJ. Palliative arthroscopic debridement with continuous irrigation for infected total knee arthroplasty in high mortality risk patients. Int Orthop 2023; 47:175-186. [PMID: 36401020 DOI: 10.1007/s00264-022-05632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This study aimed to evaluate the infection control rate of palliative arthroscopic debridement, antibiotics, and implant retention (DAIR) for the high mortality risk or terminal cancer stage patients. METHODS From March 2018 to August 2021, 21 patients met the following inclusion criteria: old age of more than 80, diagnosed as a terminal stage of cancer, high risk of mortality and morbidity representing as Charlson comorbidity index (CCI) ≥ 5, low daily activity with disabled extremity, and re-infection after two-stage revision. Each patient underwent arthroscopic DAIR and additional continuous irrigation for 48 hours. The need for subsequent re-arthroscopic DAIR or two-stage revision was determined by the post-operative trends of C-reactive protein (CRP) levels. Infection control was defined as continuing controlled status of infection based on clinical and laboratory results by one or two times of arthroscopic DAIR within initial two months. Treatment failure was defined as more than three times arthroscopic debridement, two-stage revision surgery, or expired due to uncontrolled infection. RESULTS Arthroscopic DAIR controlled the infection in 19 (90.5%) of the 21 cases. The other knee underwent a total of three times of re-arthroscopic DAIR and the other one underwent two-stage revision. Although five patients expired during the follow-up period due to worsening medical problems or terminal cancer, there were no deaths from uncontrolled infection, sepsis, or surgery-related complications. CONCLUSIONS Arthroscopic debridement with continuous irrigation for the infection TKA with high mortality risk or terminal cancer patients showed a 90.5% infection control rate. For high-risk patients, arthroscopic debridement with continuous irrigation can be an alternative treatment to improve the quality of life during survival.
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Affiliation(s)
- Yoon Sang Jeon
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea
| | - Myung Ku Kim
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea
| | - Dae Gyu Kwon
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea
| | - Sung-Sahn Lee
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyang-Si, Korea
| | - Joo Won Park
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea
| | - Dong Seok Kang
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea
| | - Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Inhang-Ro 27, Jung-Gu, Incheon, 22322, South Korea.
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Li D, Tang Q, Liu Q, Hu J, Mao M, Deng T, Liao L, Zhu W. Arthroscopic anterior talofibular ligament repair with Internal Brace and lasso-loop technique for chronic ankle lateral instability. Int Orthop 2022; 46:2821-2828. [PMID: 36069956 DOI: 10.1007/s00264-022-05541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To introduce the surgical technique and clinical outcomes of arthroscopic anterior talofibular ligament (ATFL) repair using the Internal Brace and lasso-loop technique for chronic ankle lateral instability. METHODS A retrospective study was performed on 29 patients who underwent all-arthroscopic ATFL repair with the Internal Brace and lasso-loop technique from January to August 2020. The patients included 24 males and five females, with a mean age of 30.17 years. Through the accessory anterolateral (AAL) portal, we drilled the bone tunnels and fixed the tape with 4.75 mm and 3.5 mm "SwiveLock" anchors and reattached the torn ligament by the lasso-loop technique. RESULTS All 29 patients underwent all-arthroscopic procedures smoothly without serious complications, such as infection and important nerve or vessel injuries. There were eight cases of lateral malleolar avulsion fractures and ten cases of talus cartilage injury. The visual analog scale (VAS), Karlsson-Peterson, Tegner, and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the clinical consequences. All the patients were followed up for 18.66 ± 4.85 months on average. The average pre-operative VAS score was 4.69 ± 1.04, which was significantly higher than the average post-operative VAS score of 1.14 ± 1.56. At the final follow-up appointments, the averages of Karlsson-Peterson, AOFAS, and Tenger scores were 75.83 ± 9.44, 88.31 ± 6.81, and 6.93 ± 1.79, respectively, which was significantly higher than that before the operation. CONCLUSION This arthroscopic anterior talofibular ligament repair with the Internal Brace and lasso-loop technique achieves satisfactory clinical outcomes with the benefits of high safety and reliability for chronic ankle lateral instability.
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Affiliation(s)
- Ding Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Qi Tang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Qian Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Junjiao Hu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Minzhi Mao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ting Deng
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Lele Liao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
| | - Weihong Zhu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
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23
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Panagopoulos G, Picca G, Adamczyk A, Leonidou A, Consigliere P, Sforza G, Atoun E, Rath E, Levy O. The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03426-5. [PMID: 36350404 DOI: 10.1007/s00590-022-03426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. METHODS The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7-13-year follow-up). RESULTS Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. CONCLUSION The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. LEVEL OF EVIDENCE Level IV; Case series; Treatment study.
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Affiliation(s)
- Georgios Panagopoulos
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK.
| | - Girolamo Picca
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Aleksandra Adamczyk
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
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Liu J, Chen M, Xu T, Tian Z, Xu L, Zhou Y. Functional results of modified Mason-Allen suture versus horizontal mattress suture in the arthroscopic Broström-Gould procedure for chronic ankle instability. J Orthop Surg Res 2022; 17:459. [PMID: 36266690 PMCID: PMC9585854 DOI: 10.1186/s13018-022-03354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The arthroscopic Broström–Gould procedure (ABG) gained particular attention among clinicians and researchers due to its high rate of satisfactory results. There is a lack of evidence regarding the differences in clinical outcomes for the various suture techniques. The purpose of this study was to compare the differences in clinical effect in patients treated with one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture for chronic ankle instability (CAI). Methods This retrospective cohort study examined CAI patients who underwent either one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture ABG between January 2018 and January 2020. Patients were divided into two groups based on the suture knot type used and the associated number of anchors. The operative time, surgical cost, Visual Analog Scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) Score, Karlsson Ankle Functional Score (KAFS), the rate of return to sports, complications, and measured biomechanical strength using standardized equipment were compared between groups. Results Sixty-four CAI patients were included (one-anchor modified Mason–Allen suture group n = 30, two-anchor horizontal mattress suture group n = 34). Compared to the two-anchor horizontal mattress suture group, the one-anchor modified Mason–Allen suture group had significantly shorter operative time (p < .001) and lower surgical cost (p < .001). There were no postoperative complications in the two groups, and no significant differences in the VAS, AOFAS, KAFS, and rate of return to sports in postoperative follow-up between the two groups at 1 and 2 years after surgery. There was no statistically significant difference in biomechanical strength anterior drawer test displacement (p > .05) between the one-anchor modified Mason–Allen suture and two-anchor horizontal mattress suture at 2 years after surgery. Conclusion ABG using a one-anchor modified Mason–Allen suture showed comparable clinical results to a two-anchor horizontal mattress suture in the treatment of CAI at intermediate-term follow-up time. However, one-anchor modified Mason–Allen suture may be a faster, simpler, cost-effective substitute technology. Level of evidence Level III, comparative study.
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Affiliation(s)
- Jinlang Liu
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Mingliang Chen
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Tao Xu
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Zhipeng Tian
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Liuhai Xu
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - You Zhou
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China.
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25
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Tawfeek W, Addosooki A, Elsayed M. Arthroscopic rotator interval release for frozen shoulder, comparative study between diabetic and non-diabetic patients. SICOT J 2022; 8:35. [PMID: 35984241 PMCID: PMC9390058 DOI: 10.1051/sicotj/2022036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/30/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The objective of this study is to evaluate the outcomes of arthroscopic rotator interval release for the treatment of frozen shoulder and compare the results in patients with and without diabetes. METHODS thirty-two patients with frozen shoulders were divided into two groups; 19 diabetics and 13 non-diabetics. All patients underwent arthroscopic rotator interval release. The VAS and UCLA score were assessed pre-operatively and post-operatively; after 1, 3, and 12 months and compared between groups. RESULTS The VAS and UCLA score was significantly improved in both groups during follow-up intervals (p < 0.01). There was no significant difference between diabetic and non-diabetic patients in VAS and UCLA scores during follow-up times (p-values > 0.05). CONCLUSION Arthroscopic rotator interval release provides significant improvement of frozen shoulder with no difference in results between diabetic and non-diabetic patients. LEVEL OF EVIDENCE Level 2; Prospective Comparative study.
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Affiliation(s)
- Wessam Tawfeek
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
| | - Ahmad Addosooki
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
| | - Moustafa Elsayed
- Orthopaedic Department, Sohag University Hospital, 82524 Sohag, Egypt
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26
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Nie S, Li HB, Hua L, Tang ZM, Lan M. Comparative analysis of arthroscopic-assisted Tight-rope technique and clavicular hook plate fixation in the treatment of Neer type IIB distal clavicle fractures. BMC Musculoskelet Disord 2022; 23:756. [PMID: 35933337 PMCID: PMC9356490 DOI: 10.1186/s12891-022-05724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to compare the clinical efficacy of arthroscopic-assisted fixation using the Tight-rope system and clavicular hook plate fixation in the treatment of Neer IIB distal clavicle fractures. METHODS We enrolled 48 consecutive patients with Neer IIB distal clavicle fractures who were treated at our institution from February 2016 and August 2020. These patients were divided into 2 groups based on the fixation method (16 cases with Tight-rope system and 32 cases with clavicular hook plate), and demographics and clinical characteristics of patients in different groups were compared. RESULTS All 48 patients had functional outcome scores of the affected shoulder available at a mean of 23.8 ± 5.1 months, and there was a statistically significant improvement in the constant score, American shoulder and elbow surgeons (ASES) score, visual analogue scale (VAS) score at the end of follow-up (p < 0.001 respectively). However, the smaller length of skin incision, less estimated blood loss and shorter hospital stay were detected in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.001, respectively). Furthermore, the constant score, ASES score and VAS score were significantly improved in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.05, respectively). CONCLUSIONS Both Tight-rope technique and clavicular hook plate fixation can provide satisfactory clinical and radiological results in the treatment of distal clavicular Neer IIB fracture. However, arthroscopic-assisted fixation using the Tight-rope technique showed better results in terms of length of hospital stay, surgical trauma, clinical scores, and diagnose and treat concomitant glenohumeral pathologies. LEVELS OF EVIDENCE III, Case-control study Retrospective comparative study.
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Affiliation(s)
- Si Nie
- Department of Radiology, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Hong-Bo Li
- Department of Orthopedics SurgeryDonghu DistrictJiangxi Province, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), 330006. No. 92 Aiguo Road, Nanchang, People's Republic of China
| | - Li Hua
- Department of Nursing Science, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), Nanchang, 330006, People's Republic of China
| | - Zhi-Ming Tang
- Department of Orthopedics SurgeryDonghu DistrictJiangxi Province, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), 330006. No. 92 Aiguo Road, Nanchang, People's Republic of China
| | - Min Lan
- Department of Orthopedics SurgeryDonghu DistrictJiangxi Province, Jiangxi Provincial People's Hospital, (The First Affiliated Hospital of Nanchang Medical College), 330006. No. 92 Aiguo Road, Nanchang, People's Republic of China.
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27
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Hong IS, Rao AJ, CarlLee TL, Meade JD, Hurwit DJ, Scarola G, Trofa DP, Schiffern SC, Hamid N, Connor PM, Fleischli JE, Saltzman BM. Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis. World J Orthop 2022; 13:631-643. [PMID: 36051376 PMCID: PMC9302032 DOI: 10.5312/wjo.v13.i7.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/30/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rotator cuff pathology is a very common source of shoulder pain. Similarly, osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms. Surgical management can be indicated for both pathologies, however, outcomes data is limited when examining rotator cuff repair (RCR) in the setting of glenohumeral arthritis (GHOA). Thus, this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.
AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.
METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017. Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity. Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis. Patients included had a minimum two year follow-up. Rate of conversion to total shoulder arthroplasty, complication rates following initial surgery, and patient-reported outcome measures were collected.
RESULTS A total of 142 patients were included. The number of patients that required total shoulder arthroplasty within two years after index surgery was low. 2/71 (2.8%) patients with GHOA, and 1/71 (1.4%) without GHOA. Following rotator cuff repair, both groups showed favorable patient-reported outcomes.
CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.
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Affiliation(s)
- Ian S Hong
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Allison J Rao
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Tyler L CarlLee
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Joshua D Meade
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Daniel J Hurwit
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - Gregory Scarola
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York City, NY 10032, United States
| | - Shadley C Schiffern
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
| | - Nady Hamid
- Department of Sports Medicine, Orthocarolina Research Institute, Charlotte, NC 28207, United States
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC 28207, United States
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - Patrick M Connor
- Department of Orthopedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, United States
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - James E Fleischli
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
| | - Bryan Michael Saltzman
- Department of Orthopedic Surgery, OrthoCarolina Sports Medicine Center, Charlotte, NC 28207, United States
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Allahabadi S, Johnson B, Whitney M, Oji D, Chou L, Lau BC. Short-term outcomes following dehydrated micronized allogenic cartilage versus isolated microfracture for treatment of medial talar osteochondral lesions. Foot Ankle Surg 2022; 28:642-649. [PMID: 34366249 DOI: 10.1016/j.fas.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/08/2021] [Accepted: 07/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteochondral lesions of the talus (OLTs) have been traditionally treated with bone marrow stimulation techniques such as microfracture. However, conventional microfracture results in a biomechanically weaker repair tissue of predominantly type I collagen. Acellular micronized cartilage matrix (MCM) serves as a bioactive scaffold to restore hyaline cartilage. The purpose was to compare short-term outcomes after microfracture with and without augmentation with MCM for medial-sided OLTs. METHODS A retrospective review was performed between 2010-2019 for medial-sided OLTs undergoing treatment with either microfracture augmented with MCM or isolated microfracture. The MCM was hydrated with either bone marrow aspirate concentrate (BMAC) or platelet-rich plasma (PRP). Outcomes included visual analogue scale (VAS) pain scores, Foot and Ankle Activity Measure (FAAM) scores, return-to-daily activities, and return-to-sport. RESULTS 48 patients (14 MCM with PRP, 6 MCM with BMAC; 28 isolated microfracture) with average age 35.5 years (range: 13.8-67.2 years) and mean follow-up 4.0 ± 3.4 years (range,.13-10.7) were included. There was no difference in average lesion size between MCM and microfracture groups (64.0 ± 49.4 mm2 versus 57.3 ± 44.2 mm2, P = .63) and a trend toward larger lesion size for BMAC compared to PRP (106.5 ± 59.2 versus 45.9 ± 32.1 mm2, P = .056). There was no difference in time to return-to-activity (83.5 ± 18.8 versus 87.3 ± 49.1 days) or return-to-sports (151.9 ± 62.2 versus 165 ± 99.2 days) with MCM versus isolated microfracture. However, the MCM group had a significantly greater improvement in VAS pain score at final follow-up (4.9 ± 2.2 versus 2.7 ± 2.6, P = .0032) and significantly higher post-operative FAAM-Activities of Daily Living subscale scores (97.2 ± 8.2 versus 79.7 ± 32.8, P = .033). CONCLUSIONS Augmenting microfracture with MCM hydrated with PRP or BMAC may result in beneficial changes in pain scores and activities of daily living, but similar return-to-activities and return-to-sport times compared to microfracture alone in management of medial OLT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sachin Allahabadi
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA
| | - Brianna Johnson
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - Malinda Whitney
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - David Oji
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - Loretta Chou
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA
| | - Brian C Lau
- Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
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Issac RT, Thomson LE, Khan K, Allen P, Best A, Mangwani J. Do degree of coronal plane deformity and patient related factors affect union and outcome of Arthroscopic versus Open Ankle Arthrodesis? Foot Ankle Surg 2022; 28:635-641. [PMID: 34340904 DOI: 10.1016/j.fas.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to analyse if union and outcome of Arthroscopic Ankle Arthrodesis (AAA) versus Open Ankle Arthrodesis (OAA) were influenced by the extent of coronal plane deformity and to report if patient related factors influence union. METHODS A total of 122 ankle arthrodesis procedures were included in the study. These were divided into two groups; Group A (n = 99) with deformity less than 15° and Group B (n = 23) with deformity greater than or equal to 15°. Data was collected on patient demographics, medical comorbidities (smoking, diabetes, obesity) and time to union. Patient reported outcome measures (PROMs) evaluated were Manchester Oxford Foot Questionnaire, EuroQol-5D and EuroQol visual analogue health thermometer (EQ-VAS). RESULTS The mean follow-up in Group A and B was 74.87 and 89.17 months respectively. The average deformity in Group A was 4.9° for AAA and 5.8° for OAA. In Group B it was 18.9° (maximum 28° varus) for AAA and 22.1° (maximum 41° valgus) for OAA. The overall union rate was 95% in Group A (AAA-94%; OAA-100%; [p = 0.20]) and 87% in Group B (AAA-100%; OAA-67%; [p = 0.02]). Mean time to union was 13.2 weeks in Group A (AAA-13.3 weeks; OAA-12.8 weeks; [p = 0.73]) compared to 12.4 weeks for Group B (AAA-12.9 weeks; OAA-11.8 weeks; [p = 0.56]). Irrespective of the extent of deformity and type of surgery, smokers had a 10 times higher likelihood of non-union (p = 0.03). In Group A, none of the PROMs showed significant difference between AAA and OAA. In Group B, EQ-VAS score reached statistical significance (p = 0.03) in favour of AAA whereas other PROMs showed no difference. CONCLUSION AAA is reproducible in achieving union in end stage ankle arthritis and good PROMs can be expected even in ankles with larger deformities. Regardless of the type of surgery and extent of deformity, smoking is a significant risk factor for non-union. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Renjit Thomas Issac
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - Lauren Elizabeth Thomson
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Kinza Khan
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Patricia Allen
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Alistair Best
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Jitendra Mangwani
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Yuan L, Shi R, Chen Z, Ding W, Tan H. The most economical arthroscopic suture fixation for tibial intercondylar eminence avulsion fracture without any implant. J Orthop Surg Res 2022; 17:327. [PMID: 35752828 PMCID: PMC9233839 DOI: 10.1186/s13018-022-03219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Avulsion fracture of the tibial intercondylar eminence is a rare injury, which mainly occurs in adolescents aged 8–14 years and in those with immature bones. The current commonly used surgery may result in severe surgical trauma, affecting knee joint function and accompanied by serious complications. In this study, we described an all-inside and all-epiphyseal arthroscopic suture fixation technique for a patient to treat tibial intercondylar eminence fracture. Methods ETHIBOND EXCEL-coated braided polyester sutures were used for fixation. Three ETHIBOND sutures were passed through the ACL at 2, 6 and 10 o’clock of the footprint of the ACL and made a cinch-knot loop separately. Under the guidance of ACL tibial locator, three corresponding tibial tunnels were drilled with K-wires at 2, 6 and 10 o’clock of the fracture bed, and the two ends of the suture were pulled out through the tunnel with double-folded steel wire heads. After reduction of the tibial eminence, three sutures were tightened and tied to the medial aspect of the tibial tubercle. Results After all the surgical treatments surgically performed by this method and following a standard postoperative protocol, our patient's ROM, stability, and functional structural scores all improved significantly. Conclusion This three-point suture technique provides a suitable reduction and stable fixation and is suitable for patients with all types of avulsion fractures of the tibial intercondylar eminence.
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Affiliation(s)
- Libo Yuan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China
| | - Rongmao Shi
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China
| | - Zhian Chen
- Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wei Ding
- College of Medicine Technology, Yunnan Medical Health College, Kunming, 650106, Yunnan, China
| | - Hongbo Tan
- Department of Orthopaedics, People's Liberation Army Joint Logistic Support Force 920Th Hospital, No. 212 Daguan Road, Xi Shan District, Kunming, 650032, Yunnan, China.
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Byrne KJ, Hughes JD, Gibbs C, Vaswani R, Meredith SJ, Popchak A, Lesniak BP, Karlsson J, Irrgang JJ, Musahl V. Non-anatomic tunnel position increases the risk of revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1388-95. [PMID: 33983487 DOI: 10.1007/s00167-021-06607-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/05/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) graft failure is a complication that may require revision ACL reconstruction (ACL-R). Non-anatomic placement of the femoral tunnel is thought to be a frequent cause of graft failure; however, there is a lack of evidence to support this belief. The purpose of this study was to determine if non-anatomic femoral tunnel placement is associated with increased risk of revision ACL-R. METHODS After screening all 315 consecutive patients who underwent primary single-bundle ACL-R by a single senior orthopedic surgeon between January 2012 and January 2017, 58 patients were found to have both strict lateral radiographs and a minimum of 24 months follow-up without revision. From a group of 456 consecutive revision ACL-R, patients were screened for strictly lateral radiographs and 59 patients were included in the revision group. Femoral tunnel placement for each patient was determined using a strict lateral radiograph taken after the primary ACL-R using the quadrant method. The center of the femoral tunnel was measured in both the posterior-anterior (PA) and proximal-distal (PD) dimensions and represented as a percentage of the total distance (normal center of anatomic footprint: PA 25% and PD 29%). RESULTS In the PA dimension, the revision group had significantly more anterior femoral tunnel placement compared with the primary group (38% ± 11% vs. 28% ± 6%, p < 0.01). Among patients who underwent revision; those with non-traumatic chronic failure had statistically significant more anterior femoral tunnel placement than those who experienced traumatic failure (41% ± 13% vs. 35% ± 8%, p < 0.03). In the PD dimension, the revision group had significantly more proximal femoral tunnel placement compared with the primary group (30% ± 9% vs 38% ± 9%, p < 0.01). CONCLUSION In this retrospective study of 58 patients with successful primary ACL-R compared with 59 patients with failed ACL-R, anterior and proximal (high) femoral tunnels for ACL-R were shown to be independent risk factors for ACL revision surgery. As revision ACL-R is associated with patient- and economic burden, particular attention should be given to achieving an individualized, anatomic primary ACL-R. Surgeons may reduce the risk of revision ACL-R by placing the center of the femoral tunnel within the anatomic ACL footprint. LEVEL OF EVIDENCE Level III.
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Abstract
End-stage ankle arthritis typically affects an active younger patient population as compared with hip and knee arthritis. The optimal surgical treatment depends on several patient-specific factors. Open ankle arthrodesis has achieved reliable outcomes for this condition over years; however, arthroscopic techniques seem to be advantageous and feasible even in cases with significant intraarticular deformity. This article describes the surgical technique of arthroscopic ankle arthrodesis and discusses the outcome compared with that of open ankle fusion and total ankle replacement.
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Affiliation(s)
- Anna-Kathrin Leucht
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Brauerstrasse 15, Winterthur 8401, Switzerland
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British, Footbridge Center for Integrated Foot and Ankle Care, Footbridge Clinic, Unit 221, 181 Keefer Place, Vancouver, British Columbia V6B6C1, Canada.
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Maia Dias C, Leite MJ, Ribeiro da Silva M, Granate P, Manuel Teixeira J. Arthroscopic Anatomical Acromioclavicular Joint Reconstruction using a Button Device and a Semitendinosus Graft. Orthop Surg 2022; 14:605-612. [PMID: 35142045 PMCID: PMC8927023 DOI: 10.1111/os.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To report a new technique for anatomical acromioclavicular (AC) joint reconstruction. Methods In order to minimize such complications, the authors describe a new anatomical and biological AC joint repair. This technique aims to provide greater stability by using two anatomically placed clavicular tunnels and a combined construct with a double endobutton cortical fixation for primary stabilization, and to be biologically advantageous by using an autologous semitendinosus (ST) tendon graft. Additionally, the coracoclavicular ligament reconstruction is complemented with an AC joint cerclage and capsular reinforcement, which will protect the biological construction in its initial stage of healing. Results This technique provides adequate primary and secondary biomechanical stability by passing both a semitendinosus autogenous graft and a double endobutton device, through anatomically placed and small diameter clavicle holes, without the need for coracoid drilling. Our technique showed encouraging results regarding pain resolution, range of motion, and function. At final follow‐up we experienced excellent results with average pain score of 1.6, and average ROM of 159° of forward flexion, 160° of abduction, 68° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 87 and a Subjective Shoulder Value of 89 points. This technique also achieved perfectly acceptable radiographic results, with an average coracoclavicular distance increase of 0.8 mm. Regarding complications, our sample showed one case of AC join subluxation, two cases of internal saphenous nerve injury, and two partial graft tears at the suture‐button interface, with none of these requiring surgical revision. Conclusion This technique is advantageous in treatment of acromioclavicular joint dislocation and can be performed in both the subacute and chronic setting.
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Affiliation(s)
- Carlos Maia Dias
- Hospital da Luz Lisboa, Lisbon, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Lisboa, Lisbon, Portugal.,Hospital CUF Santarém, Santarém, Portugal
| | | | - Manuel Ribeiro da Silva
- Centro Hospitalar Universitário São João, Porto, Portugal.,Hospital CUF Porto, Porto, Portugal
| | - Pedro Granate
- Hospital da Luz Lisboa, Lisbon, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Lisboa, Lisbon, Portugal
| | - José Manuel Teixeira
- Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.,Unidade Cuidados Médicos de Acidentes Fidelidade Porto, Porto, Portugal
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Zhao YJ, Deng XQ, Cao HY, Zhu XD. Clinical outcome of open reduction and internal fixation combined with arthroscopic surgery in the treatment of old ankle joint fracture. Asian J Surg 2022; 45:924-925. [PMID: 35034808 DOI: 10.1016/j.asjsur.2021.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yong-Jie Zhao
- Binzhou Medical University Hospital, 661 Huanghe 2 road, Binzhou, China
| | - Xiao-Qiang Deng
- Xing'anmeng People's Hospital, 66 Hanshan West Street, Ulanhot, Inner Mongolia, China
| | - Hai-Yan Cao
- Binzhou Medical University Hospital, 661 Huanghe 2 road, Binzhou, China.
| | - Xiao-Dong Zhu
- Binzhou Medical University Hospital, 661 Huanghe 2 road, Binzhou, China.
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Newman S, Ahmed H, Rehmatullah N. Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging? J Exp Orthop 2022; 9:2. [PMID: 34978625 PMCID: PMC8724325 DOI: 10.1186/s40634-021-00442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Radiographs and MRI scans are commonly used imaging techniques in the assessment of knee osteoarthritis. However, it currently remains uncertain how good a representation of the actual condition of the knee joint these investigations provide. By comparing them against arthroscopic findings the aim of our study was to conclude how accurate these imaging techniques are at grading knee osteoarthritis. Methods This was a retrospective study looking at knee arthroscopies performed at a tertiary centre over a 5 year period. The Outerbridge grade given at arthroscopy was correlated with pre-operative radiograph and MRI scores, so as to assess the reliability of these imaging techniques at predicting the actual severity of knee osteoarthritis seen. Results Kellgren-Lawrence (KL) grading of radiographs was moderately correlated with Outerbridge grades from arthroscopy for the medial compartment of the knee (Spearman’s rho (SR) 0.483, p < 0.001), with a milder correlation in the lateral compartment (SR 0.218, p = 0.003). MRI reporting of knee osteoarthritis was moderately correlated with Outerbridge grades in the medial compartment (SR 0.451, p < 0.001), mildly correlated for both the lateral (SR 0.299, p < 0.001) and patellofemoral joint compartments (SR 0.142, p = 0.054). KL and MRI grading was moderately correlated for the medial compartment (SR 0.475, p < 0.001) and mildly correlated for the lateral compartment (SR 0.277, p < 0.001). Conclusion The ability of radiographs to represent the actual condition of knee osteoarthritis is underestimated. KL grading especially best represents the disease seen in the medial compartment of the knee joint, with a moderate correlation to Outerbridge scores given on arthroscopic assessment. We suggest that whilst MRI is a useful tool in the investigation of knee symptoms, it is often unnecessarily used in patients with OA, when in fact, radiographs alone would be sufficient. Evidence level III
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Affiliation(s)
- Samuel Newman
- Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK.
| | - Huzefah Ahmed
- Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK
| | - Nader Rehmatullah
- Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan Lane, Wigan, WN1 2NN, UK
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Solarino G, Bortone I, Vicenti G, Bizzoca D, Coviello M, Maccagnano G, Moretti B, D'Angelo F. Role of biomechanical assessment in rotator cuff tear repair: Arthroscopic vs mini-open approach. World J Orthop 2021; 12:991-1000. [PMID: 35036341 PMCID: PMC8696602 DOI: 10.5312/wjo.v12.i12.991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rotator cuff (RC) tears are one of the most frequent pathologies within the shoulder girdle. Hand dominance and older age are associated with RC tears. Two different surgical procedures, the mini-open (MO) and all-arthroscopic (AA) approach, represented the standard of treatment.
AIM To compare the clinical and biomechanical outcomes of two surgical techniques (AA vs MO procedure) performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.
METHODS Eighty-eight participants, 50 following RC repair with AA and 38 with MO approach, were recruited in the present cross-sectional case-control study (ORTHO-SHOULDER, Prot. 0054602). All patients underwent postoperative clinical evaluation for pain (Visual analogic scale), impairment, and disability (disability of the arm, shoulder, and hand) and limitation in daily activity (Constant-Murley score). Patients’ shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal (abduction/adduction) and sagittal (flexion-extension) planes.
RESULTS No statistically significant differences between the two procedures were observed in either main clinical score or range of motion. A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.
CONCLUSION In terms of clinical scores, our findings were in line with previous results. However, the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.
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Affiliation(s)
- Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari 70124, Italy
| | - Ilaria Bortone
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari 70124, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari 70124, Italy
| | - Davide Bizzoca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari 70124, Italy
| | - Michele Coviello
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari 70124, Italy
| | - Giuseppe Maccagnano
- Orthopaedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, General Hospital, Foggia 76545, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari 70124, Italy
| | - Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST Sette Laghi, Department of Biotechnologies and Life Sciences, Università degli Studi dell'Insubria, Varese 21100, Italy
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Baraza N, Robinson MP, Sakaleshpura Chandrashekar NK, Perry JA, Regan WD. Extra-articular arthroscopic release of lateral epicondylitis: a prospective study. JSES Rev Rep Tech 2021; 1:398-401. [PMID: 37588709 PMCID: PMC10426635 DOI: 10.1016/j.xrrt.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Operative management of lateral epicondylitis can be managed with percutaneous, arthroscopic, or open surgical release. Extraarticular arthroscopic release is a new technique, and no study has compared its outcomes and risk profile. Methods A 26-patient cohort was reviewed before and after extraarticular arthroscopic release, which was performed by the senior author. The Mayo Elbow Performance Scores were used as a functional outcome score and obtained via a phone interview. Results were analyzed using a paired t-test with a statistical significance set at P < .05. Results Of the 26 patients, 10 were being treated under workers compensation. Preoperative Mayo Elbow Performance Score was 47.5, and the postoperative score was 90.2 with a significant difference of 42.7 (P value = .05). The workers compensation group scored 13.3 points lower postoperatively than the remainder of patients, which was shown to also be significant with a P value of .002. Discussion and Conclusion The advantage of extraarticular arthroscopic release was better visualization of affected structures, which improved accuracy of debridement, and a small capsulotomy, which decreased the risk of a transient radial nerve palsy. Overall, extraarticular arthroscopic results were found to be good and comparable to the results of other operative techniques with the added advantage of a lower risk profile.
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Affiliation(s)
- Njalalle Baraza
- Fellow, Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Mark P. Robinson
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | | | - Jessica A. Perry
- UoN, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - William D. Regan
- University of British Columbia, Department of Orthopedics, Vancouver, BC, Canada
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Forlenza EM, Wright-Chisem J, Cohn MR, Apostolakos JM, Agarwalla A, Fu MC, Taylor SA, Gulotta LV, Dines JS. Arthroscopic distal clavicle excision is associated with fewer postoperative complications than open. JSES Int 2021; 5:856-862. [PMID: 34505096 PMCID: PMC8411067 DOI: 10.1016/j.jseint.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background The rate of complications of open compared to arthroscopic distal clavicle excision remain poorly studied. Therefore, the purpose of this investigation was to (1) Identify most recent national trends in the usage of open vs. arthroscopic approaches for distal clavicle excision (DCE) from 2007 to 2017; (2) to identify and compare the complication rates for both approaches, and to identify patient-specific risk factors for complications; (3) to identify and compare the revision rate for both approaches; and (4) to identify and compare the reimbursement of each approach. Methods The PearlDiver database was reviewed for patients undergoing DCE from 2007 to 2017. Patients were stratified into 2 cohorts: those undergoing arthroscopic DCE (n = 8933) and those undergoing open DCE (n = 2295). The rate of postoperative complications within 90 days was calculated and compared. The revision rate and reimbursement of the arthroscopic and open approach were compared. Statistical analysis included chi-square testing to compare the rates of postoperative complications and multivariate logistic regression analysis to identify risk factors for complications within 90 days. Results were considered significant at P < .05. Results The percentage of DCEs performed arthroscopically has significantly increased from 53.9% in 2007 to 69.8% in 2016, with a concomitant decrease in the use of open DCE from 46.1% in 2007 to 30.2% in 2016. The open approach was associated with significantly more postoperative complications, including a significantly greater incidence of surgical site infection (1.9% vs. 0.3%; P < .001), wound disruption (0.3% vs. 0.1%; P < .001), hematoma (0.9% vs. 0.2%; P = .001), and transfusion (0.6% vs. 0.1%; P < .001), than arthroscopic DCE. Several risk factors, including open approach, diabetes, heart disease, tobacco use, chronic kidney disease, and female gender, were identified as independent risk factors for complications after DCE. There was no significant difference in revision rate between open and arthroscopic approaches (P = .126). The reimbursement of open and arthroscopic DCE procedures were comparable, with median reimbursements of $5408 and $5,447, respectively (P = .853). Conclusion Both arthroscopic and open DCE techniques were found to have similar reimbursement amounts, with a low rate of complications, although the open technique had a higher rate of early complications such as surgical site infection. Over the study period, there was an increase in the utilization of arthroscopic DCE, while the incidence of the open technique remained constant.
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Affiliation(s)
| | | | | | | | | | - Michael C Fu
- Hospital for Special Surgery, Shoulder Service, New York, NY, USA
| | - Samuel A Taylor
- Hospital for Special Surgery, Shoulder Service, New York, NY, USA
| | | | - Joshua S Dines
- Hospital for Special Surgery, Shoulder Service, New York, NY, USA
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Chitten JJ, Arora M. A Prospective Observational Study on Short-Term Functional Outcome of Arthroscopic Anterior Cruciate Ligament Repair of Proximal Tears Using Knotless Single Suture Anchor Technique. Indian J Orthop 2022; 56:437-44. [PMID: 35251507 DOI: 10.1007/s43465-021-00487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/13/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the clinical outcomes in patients with anterior cruciate ligament (ACL) proximal tears undergoing arthroscopic primary repair with knotless single suture anchor technique. METHODS The first twenty-two consecutive patients with proximal ACL tears (Sherman types I and II and high-grade partial tears) treated with arthroscopic primary repair with single suture anchor technique were evaluated until 6 months post-operatively. Patients were evaluated with validated functional outcome measures (IKDC and Lysholm scores) and clinical tests for ACL stability. RESULTS At 6-month follow-up, 91% of patients (n = 20) achieved excellent outcome measures for IKDC and Lysholm scores and had complete stability of the ACL to clinical testing. Two patients with poor outcomes at six weeks; one with subjective instability and the other underwent revision surgery represented a failure rate of 9%. The median Lysholm score was 96 (IQ range, 96-100) and median IKDC subjective score was 87.40 (IQ range, 78.20-88.50) at 6-month follow-up. The improvement in Lysholm and IKDC scores over a period of six months post-operatively was statistically significant when compared to preoperative scores (p ≪ 0.0001). Maximum improvement in clinical outcomes is achieved in the first 6 weeks post-surgery with a slower increase thereafter, a time interval which may be considered as a figurative yield point for future work in this field. CONCLUSION Arthroscopic ACL primary repair with knotless single suture anchor technique provides excellent short-term clinical outcomes in a carefully selected subset of patients with proximal ACL tears. More powered and longer duration studies are needed to understand longer term outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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40
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long-term results. ACTA ACUST UNITED AC 2021. [PMID: 34112445 DOI: 10.1016/j.recote.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Arthroscopic stabilisation is a well-recognised surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilisation for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognised in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent/good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favourable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Hughes JD, Gibbs CM, Drummond M, Vaswani R, Ayinon C, Fongod E, Godshaw BM, Popchak A, Lesniak BP, Lin A. Failure rates and clinical outcomes after treatment for long-head biceps brachii tendon pathology: a comparison of three treatment types. JSES Int 2021; 5:630-635. [PMID: 34223407 PMCID: PMC8245991 DOI: 10.1016/j.jseint.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypothesis/Background Treatment options for the biceps brachii tendon include tenotomy, arthroscopic tenodesis, and open tenodesis. Few studies to date have compared all treatment options in the context of a rotator cuff repair. Methods A retrospective review of 100 patients who underwent arthroscopic supraspinatus repair between 2013 and 2018 with a minimum of one-year follow-up was performed. Patients were separated into the following 4 groups: (1) 57 had isolated supraspinatus repair with no biceps tendon surgery (SSP); (2) 16 had supraspinatus repair and biceps tenotomy; (3) 18 had supraspinatus repair and arthroscopic biceps tenodesis; (4) 9 had supraspinatus repair and an open biceps tenodesis (SSP + OT). The primary outcome was operative time. The secondary outcomes were cost analysis, complications, patient-reported outcome measures, range of motion, and strength testing. Results The operative time for the SSP + OT group was significantly longer than that of the SSP group (P < .05) but was not significantly longer than that of the other groups. The cost for the SSP group was significantly less than the cost for the SSP + OT and supraspinatus repair and arthroscopic biceps tenodesis groups (P < .05 for both), whereas the cost for the supraspinatus repair and biceps tenotomy group was significantly less than the cost for the SSP + OT group (P < .05). There were no significant differences between groups for complications, all patient-reported outcome measues, all range of motion, and all strength parameters. Discussion/Conclusion Operative time is the longest in open biceps tenodesis and is significantly longer than that of isolated supraspinatus repair. No significant differences in operative times or costs were identified in patients undergoing arthroscopic vs. open biceps tenodesis. All patients, irrespective of the type of biceps tendon procedure, had excellent clinical and functional outcomes at least one year after surgery. There was no difference in clinical or functional outcomes, or complications, among the 4 groups.
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Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher M Gibbs
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mauricio Drummond
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ravi Vaswani
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caroline Ayinon
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edna Fongod
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian M Godshaw
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam Popchak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
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Hu J, Cox M, Yang A. A rare case of pulmonary embolus after arthroscopic meniscus surgery. J Surg Case Rep 2021; 2021:rjab101. [PMID: 33936586 PMCID: PMC8062117 DOI: 10.1093/jscr/rjab101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Although there is consensus that thromboprophylaxis is necessary for major orthopedic surgeries such a joint replacement, there is no widespread consensus on the need for thromboprophylaxis for minor arthroscopic surgery. Here, we present a case of deep vein thrombosis (DVT) and pulmonary embolism (PE) after a common arthroscopic meniscectomy in a healthy 20-year-old female collegiate athlete. The patient had no risk factors except for prior use of combined oral contraceptive pills (COCPs). Twenty hours after an uncomplicated right knee meniscectomy, patient presented to ED with right calf pain and cramping, and DVT was confirmed using ultrasound. One week later, patient presented again to ED with dyspnea and chest pain. PE was diagnosed on CT angiography. Despite the rarity of thromboembolic complications in minor arthroscopy surgery, the broadened use of thromboprophylaxis in patients with even few risk factors could prevent thromboembolic complications from occurring.
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Affiliation(s)
- Janie Hu
- St. George's University School of Medicine, True Blue, Grenada
| | - MaKayla Cox
- Chemistry Department, University of Illinois Springfield, Springfield, IL 62703, USA
| | - Alexander Yang
- Center for Integrative Metabolic and Endocrine Research, Detroit, MI 48202, USA.,Center for Molecular Medicine and Genetics, Wayne State University of Medicine, Detroit, MI 48202, USA
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Abstract
BACKGROUND The last decade has seen a large increase in rotator cuff surgery and arthroscopic surgery. We were asked to define the relevance of open rotator cuff repair in 2021. PURPOSE To define whether there are proven advantages to arthroscopic or open rotator cuff repair surgery. METHOD We reviewed the recent literature regarding recent trends, anaesthetic time, rehabilitation, post-operative pain, complications, economic considerations, the learning curve and outcomes. We outlined the senior authors' technique preferences, rationale and patient reported outcomes. RESULTS There is no clear evidence of proven advantage in arthroscopic rotator cuff repair compared to open rotator cuff repairs, with regard to outcomes or the other aspects reviewed. There were no differences in the outcomes of arthroscopic and open repairs in the senior authors practice with his procedure indications. CONCLUSIONS Open rotator cuff repair surgery remains a valid option and has some appeal in specific indications and in settings where arthroscopic resources are limited. We believe surgeons should learn both techniques and the principles of good patient selection, tissue handling, and fixation techniques are of paramount importance in both arthroscopic and open rotator cuff surgery.
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Affiliation(s)
- Khalid D. Mohammed
- grid.410864.f0000 0001 0040 0934Department of Orthopaedic Surgery, Canterbury District Health Board, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Richard F. W. Lloyd
- grid.410864.f0000 0001 0040 0934Department of Orthopaedic Surgery, Canterbury District Health Board, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Department of Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - Jegan Krishnan
- grid.414925.f0000 0000 9685 0624Department of Orthopaedic Surgery, Flinders Medical Centre and Repatriation General Hospital, Adelaide, SA Australia ,grid.1014.40000 0004 0367 2697Department of Orthopaedic Surgery, Flinders University, Adelaide, SA Australia
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García-Vega M, De La Cuadra-Virgil P, Jiménez-Cristobal J, Occhi-Gómez B, Boserman-Pérez-de Villaamil M. Arthroscopic bankart repair for the management of anterior shoulder instability: Mid- and long- term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33773949 DOI: 10.1016/j.recot.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Arthroscopic stabilization is a well-recognized surgical technique with a variable rate of failure reported between 0-35%. The aim of this study was to evaluate the outcome of this technique and our second aim was to identify risk factors that could be associated to recurrence rate. MATERIAL AND METHODS 41 patients that underwent arthroscopic shoulder stabilization for glenohumeral instability between 2001-2015 were included. Different items such as epidemiologic, recurrence, age at first dislocation, preoperative sport practice, and number of fixation devices used were collected. The results were evaluated using functional scales (WOSI, Rowe y Walch-Duplay) and radiological study was assessed using the Samilson-Prieto score. Data from the medical history were recognized in order to assess possible risk factors. RESULTS The overall redislocation rate was 9.4%. The average follow-up was 83 months. The 54.3% of the patients achieved excellent / good results in the functional assessment scales. The range of motion was complete in 90% of the cases. On the radiographs, only 4.88% of the patients present advanced osteoarthritis. It was not possible to identify risk factors related to a worse outcome after surgery. CONCLUSION The arthroscopic Bankart repair with suture anchors is considered the gold standard for treatment of anterior glenohumeral instability. The long-term follow-up shows a favorable outcome, with a redislocation rate of 9% and low complication rate.
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Affiliation(s)
- M García-Vega
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | | | | | - B Occhi-Gómez
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Chinnakkannu K, McKissack H, Alexander B, Jha AJ, Pinto M, Rush Jones J, Desai R, Shah AB. Subtalar joint preparation using the Two Portal posterior arthroscopic technique versus the sinus tarsi Open approach: A cadaver study. Foot (Edinb) 2021; 46:101690. [PMID: 33333433 DOI: 10.1016/j.foot.2020.101690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. The procedure can be performed arthroscopically or through the open lateral sinus tarsi (LST) approach. The arthroscopic technique is less invasive and is associated with rapid recovery, but it is more technically challenging. One of the most important aspects of fusion is adequate preparation of the joint via denudation of articular cartilage. This study compares the efficacy of subtalar joint preparation between the lateral sinus tarsi approach and the posterior two-portal arthroscopic technique using cadaveric specimens. MATERIALS AND METHODS Nineteen below-knee fresh-frozen cadaver specimens were used. The subtalar joints of nine specimens were prepared through the LST approach, while ten were prepared arthroscopically. After preparation, all ankles were dissected at the subtalar joint and photographs were taken of the posterior facets of the calcaneus and talus. Total and prepared surface areas of the articular surfaces for both approaches were measured using ImageJ software and compared. RESULTS The LST technique resulted in significantly greater percent preparation of the posterior facet of the calcaneus, as well as of the subtalar joint as a whole. Overall, 92.3% of the subtalar joint surfaces (talus and calcaneus combined) were prepared using the LST technique, compared to 80.4% using the arthroscopic technique (p = 0.010). The posterior facet of the calcaneus was 94.0% prepared using the open technique, while only 78.6% prepared using the arthroscopic technique (p = 0.005). CONCLUSION The LST approach for subtalar arthrodesis provides superior articular preparation compared to the two-portal posterior arthroscopic technique. Given that joint preparation is a critical component of fusion, maximizing prepared surface area is desirable and the open approach may be more efficacious for fusion. When using the arthroscopic approach, it may be advisable to use an accessory portal if there is poor visualization or limited access to the joint space secondary to severe arthritis. LEVEL OF EVIDENCE V.
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McLeod A, Delaney R. Outcomes of the arthroscopic Bankart procedure in Irish collision sport athletes. Ir J Med Sci 2021; 191:239-245. [PMID: 33624227 DOI: 10.1007/s11845-021-02524-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/20/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND While there is an abundance of research examining the outcomes of the arthroscopic Bankart repair in collision athletes, very few studies have involved the unique Irish collision sport athlete population. The previously held belief that collision athletes need to be treated with open surgery, due to the high traumatic forces the shoulder is subjected to in these sports, may no longer be true in the context of modern arthroscopic techniques and implants. AIMS To report the outcomes of the arthroscopic Bankart procedure in the unique Irish collision athlete population. METHOD Retrospective review conducted in 2018. Data was obtained from collision sport athletes using customised questionnaires and validated, standardised outcome measure tools. Participants were selected using inclusion and exclusion criteria. RESULTS Fifty-four patients were included in the study. The average age at primary injury was 19.9 years (range 13-35 years). The rate of recurrent dislocation was 21% (12/57) with a mean follow up time of 24 months (range 7 to 48 months). The mean patient reported outcome measure (PROM) scores were as follows: ASES = 90.8, WOSI = 316.4, SSV = 79%. Six patients failed to return to their sport. Eighty-seven percent of the cohort returned to their sport, with a mean time to return of 7.25 months. Patients who experienced recurrent instability after arthroscopic Bankart had a younger age at primary dislocation (P = 0.0005) and lower ASES (P = 0.0056) and WOSI scores (0.00132) at latest follow-up, compared to those who remained stable postsurgery. CONCLUSION The arthroscopic Bankart procedure has a high rate of recurrence of dislocation in Irish collision sport athletes. The current international literature suggests that the arthroscopic Bankart has similar rates of recurrence to the open procedure in collision athletes; however, this may not hold true for Irish collision sport athletes. Further research is required to determine the optimum surgical procedure for anterior shoulder instability in this population, particularly those patients with subcritical bone loss.
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Affiliation(s)
- André McLeod
- University College Cork College of Medicine and Health, Cork, Ireland.
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Sivasubramanian H, Chua CXK, Lim SY, Manohara R, Ng ZWD, V PK, Poh KS. Arthroscopic capsular release to treat idiopathic frozen shoulder: How much release is needed? Orthop Traumatol Surg Res 2021; 107:102766. [PMID: 33333264 DOI: 10.1016/j.otsr.2020.102766] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/31/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder. MATERIALS AND METHODS The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months. RESULTS Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01). CONCLUSION This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques. LEVEL OF STUDY II; Meta-analysis and systematic review.
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Affiliation(s)
- Harish Sivasubramanian
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Chen Xi Kasia Chua
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore.
| | - Sheng Yang Lim
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Ruben Manohara
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Zhao Wen Dennis Ng
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Prem Kumar V
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
| | - Keng Soon Poh
- University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228 Singapore, Singapore
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Medancic N, Spanic M, Marinic TB, Klobucar H, Cicak N. Arthroscopic removal of arch-shaped rotator cuff calcifying tendinitis without rotator cuff repair and acromioplasty is an excellent treatment regarding pain relief and function. Int Orthop 2021; 45:1003-1007. [PMID: 33495892 DOI: 10.1007/s00264-020-04930-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study is to evaluate clinical outcome for arthroscopic removal of calcium deposit without acromioplasty and rotator cuff repair for patients with ultrasound-diagnosed arch-shaped calcifying tendinitis of the rotator cuff (type I), homogenic (x-ray) with chronic pain. METHODS We retrospectively reviewed 50 patients with homogenous, arch-shaped calcifying tendinitis, suffering from chronic pain and who underwent arthroscopic treatment and 50 patients with the same type of tendinitis treated conservatively. All patients had calcium deposit located in supraspinatus tendon, pre-operatively and post-operatively evaluated by ultrasound. Clinical outcome was assessed by using Quick DASH, UCLA, and VAS score. RESULTS There were 29 male and 71 female patients; none had bilateral involvement. We divided patients into group A-operatively treated-and group B-conservatively treated-by shock wave therapy. Patients from group A had higher improvement of all used tests, QDash (from 19.3 to 2.7), UCLA (from 10 to 34), and VAS score (from 3 to 0) when compared with group B. CONCLUSION Patients with arch-shaped calcium deposits and acoustic shadow have better results after arthroscopic treatment than the conservative one. There was no need for acromioplasty or tendon repair. The lack of performing the same did not have any impact on the post-operative rehabilitation and recovery.
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Affiliation(s)
- Nenad Medancic
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia.
| | - Mario Spanic
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
| | - Tea Budimir Marinic
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
| | - Hrvoje Klobucar
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
| | - Nikola Cicak
- AKROMION, Special Hospital for Orthopaedic Surgery, Ljudevita Gaja 2, 49217, Krapinske Toplice, Croatia
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Hadi H, Tadros BJ, Kochhar T, Dhinsa BS. The role of interscalene brachial plexus block anaesthesia in arthroscopic shoulder surgery; a prospective study. J Clin Orthop Trauma 2021; 16:154-156. [PMID: 33717951 PMCID: PMC7919973 DOI: 10.1016/j.jcot.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
The choice of anaesthetic in shoulder surgery is an evolving field of research which has important implications for patient outcomes. We have performed a prospective study to assess the usability of an interscalene brachial plexus block (ISBPB) with sedation as the primary anaesthetic and analgesic for arthroscopic shoulder surgery. Our study assessed the requirements of analgesia peri-operatively and post operatively and found that patients had no requirement (n = 30) and minimal requirements with a low pain score (visual analogue score; mean 2.4, range 2-5) respectively. We also found that patients spent a short amount of time in recovery (31 min mean, range 21-48 min) and were able to be discharged on the same day. Our findings suggest that ISBPB with sedation is a viable option in arthroscopic shoulder surgery for a variety of procedures with positive effects for patient outcomes and mobility.
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Affiliation(s)
- Hosain Hadi
- Corresponding author. 22a Stuart Road, Gravesend, DA11 0BZ, United Kingdom.
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Apostolakos JM, Wright-Chisem J, Gulotta LV, Taylor SA, Dines JS. Anterior glenohumeral instability: Current review with technical pearls and pitfalls of arthroscopic soft-tissue stabilization. World J Orthop 2021; 12:1-13. [PMID: 33520677 PMCID: PMC7814310 DOI: 10.5312/wjo.v12.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
The glenohumeral joint (GHJ) allows for a wide range of motion, but is also particularly vulnerable to episodes of instability. Anterior GHJ instability is especially frequent among young, athletic populations during contact sporting events. Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation, however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization. Determination of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns (i.e., bone loss). The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ, risk factors for recurrent instability including bony lesions, indications for arthroscopic vs open surgical management, clinical history and physical examination techniques, imaging modalities, and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.
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Affiliation(s)
- John M Apostolakos
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Joshua Wright-Chisem
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Lawrence V Gulotta
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Samuel A Taylor
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Joshua S Dines
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY 10021, United States
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