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Background Arthroscopic resection has become a favorable alternative for wrist ganglions. However, for recurrent wrist ganglions, arthroscopic resection is relatively contraindicated. The purpose of this study was to evaluate the clinical outcomes of arthroscopic resection for recurrent wrist ganglions and to identify their safety and efficacy. Methods From June 2011 to February 2017, 17 patients with recurrent wrist ganglion were treated with arthroscopic resection. We evaluated the visual analog scale, modified Mayo wrist score, and Disabilities of Arm, Shoulder and Hand Outcome Measure preoperatively and at the final follow-up. Patients were questioned for pain reduction, pain during pushups, and any difficulty in returning to work. Recurrence and complications were also assessed at each follow-up visit. Results We enrolled 17 patients and median follow-up was 58 months. The reduction in pain was significant. Only 2 of the 17 patients had residual pain after arthroscopic resection. One female patient showed recurrences 3 years later. Although 2 cases of stiffness were noted after the operation, no significant complication was present 3 months postoperatively. Most patients had good recovery and could resume work; however, 2 patients reported fair recovery. Conclusion The results of this study confirmed that arthroscopic excision could be an effective and safe treatment for recurrent ganglions; therefore, should not be contraindicated for treating recurrent wrist ganglions. Nevertheless, further prospective studies with larger patient numbers are needed to establish a stronger evidence for arthroscopic resection of recurrent wrist ganglions.

Background The efficacy of the powered rasp, a new reciprocating motion device for arthroscopic resection of osteophytes, has not been verified. The aim of this study was to compare the intraoperative efficacy of the powered rasp in arthroscopic resection of anterior ankle osteophytes to that of the conventional burr. Methods A total of 49 consecutive patients who underwent arthroscopic resection of anterior ankle osteophytes (26 patients with the conventional burr and 23 patients with the powered rasp) were retrospectively reviewed. The preoperative volume of each osteophyte was measured using computerized tomography scan and three-dimensional software. The resection time was measured by review of the individual arthroscopy video, and the estimated resection rate was calculated as the volume of osteophytes/resection time. Results The preoperative volume of osteophytes was not different between the two groups (847.8 ± 685.3 mm3 in the conventional burr and 913.3 ± 605.8 mm3 in the powered rasp, p = 0.726). The resection time was 442.4 ± 216.6 s (seconds) in the conventional burr and 386.4 ± 186.3 s in the powered rasp, and the estimated resection rate was 1.8 ± 1.0 mm3/s with the conventional burr and 2.4 ± 1.3 mm3/s with the powered rasp. These measurements were not significantly different between the two groups (p = 0.340 and 0.083, respectively). Conclusion The intraoperative efficacy of the powered rasp did not show superiority to that of the conventional burr in arthroscopic resection of anterior ankle osteophytes. Level of evidence Level III, retrospective comparative study.

Lateral heel pain can have numerous causes and many of them are intra-articular pathologies of the anterior and posterior subtalar joint. Frequently, there is not a single pathology that account for the lateral heel pain and combination of different pathologies can occur. Symptomatic too-long anterior process of the calcaneus, sinus tarsi syndrome, and subtalar arthrofibrosis can be precipitated by repeated sprain. Cases recalcitrant to conservative treatment are indicated for surgery. The purpose of this Technical Note is to report a 2-portal arthroscopic approach to address these pathologies., Technique Video Video 1 Arthroscopic resection of too-long anterior process (TLAP) of the calcaneus, anterior subtalar synovectomy, debridement of the sinus tarsi, and posterior subtalar adhesiolysis of the left foot via anterolateral subtalar and dorsolateral midtarsal portals. The patient is in the lateral position. The anterolateral subtalar portal is the viewing portal and dorsolateral midtarsal portal is the working portal. Anterior subtalar synovectomy is performed. The anterior subtalar joint is traced distally to the TLAP lesion, which is then resected with an arthroscopic acromionizer. The arthroscope is switched to the dorsolateral midtarsal portal and the sinus tarsi is debrided with the arthroscopic shaver via the anterolateral midtarsal portal. The fibrotic posterior subtalar capsule is then resected followed by synovectomy. The fibrous tissue of the lateral and anterior recesses of the posterior subtalar joint is resected. The fibrous tissue between the articular surfaces is loosened with an arthroscopic probe and then resected with the shaver. Finally, the fibrous tissue of the posterior gutter is resected.

Objective: The synovial fold is an intra-articular structure found in more than 50% of the knees, which can cause symptoms similar to meniscal injuries. These symptoms are mostly related to hypertrophy of the synovial fold resulting from inadequate physical activity. Conservative treatment with readjustment of sports activity and muscle rebalancing solves most cases. Rare cases require surgical treatment, which is indicated due to the persistence of instability, blockage and pain. We present our experience in the treatment of this pathology. Methods: 58 patients (70 knees), with 62 knees treated conservatively and 8 treated surgically exclusively for the pathological synovial fold. Results: Description of the series and treatment results are reported. Conclusion: The non-surgical treatment of the pathological synovial fold of the knee provided good results within 60 days of rehabilitation program in almost 90% of the patients. Arthroscopic resection of the synovial fold is a surgery that has a longer and laborious rehabilitation period, despite good results in most cases. Level of Evidence IV, Case series. RESUMO Objetivo: A prega sinovial é uma estrutura intra-articular encontrada em mais de 50% dos joelhos, que pode provocar sintomas semelhantes aos da lesão meniscal. Esses sintomas estão relacionados, na maioria dos casos, à hipertrofia da prega sinovial decorrente de atividade física inadequada. O tratamento conservador com a readequação da atividade esportiva e reequilíbrio muscular resolve a maioria dos casos. Raros casos demandam tratamento cirúrgico, que é indicado pela persistência de falseios, bloqueios e dor. Apresentamos nossa experiência no tratamento dessa patologia. Métodos: 58 pacientes (70 joelhos), com 62 joelhos tratados conservadoramente e 8 tratados cirurgicamente exclusivamente para a prega sinovial patológica. Resultados: São apresentados descrição da série e resultados do tratamento. Conclusão: O tratamento não cirúrgico da prega sinovial patológica do joelho propiciou bons resultados com 60 dias de programa de reabilitação em quase 90% dos pacientes. A ressecção artroscópica da prega sinovial é uma cirurgia que tem um período de reabilitação mais longo e trabalhoso, apesar do bom resultado na maioria dos casos. Nível de Evidência IV, Série de casos.

Synovial cysts are the most common condition in hand surgeon practice. Open surgical resection was a traditional method of treatment but it is associated with numerous complications. We describe our first patient follow up after arthroscopic wrist ganglion resection.

Objective To report the diagnostics, surgical treatment, and outcome of a juvenile foal with solitary osteochondroma (SO) interfering with the podotrochlear apparatus. Study design Case report ANIMAL: One 36-day-old Arabian colt. Methods Clinical, radiographic, ultrasonographic, computed tomographic, and histopathologic examinations were required to characterize and treat an SO located at the palmar aspect of the diaphysis of the second phalanx of the left forelimb. This SO caused severe distal interphalangeal joint (DIPJ) inflammation, marked interference with the podotrochlear apparatus, and associated lameness. Results Despite the small size of the foal's foot, complete resection of the SO was possible via palmar DIPJ arthroscopy by using motorized equipment. Full resolution of the lameness was achieved within 3 months of surgery. Conclusion Atypical SO located on the palmar aspect of the second phalanx can cause marked nonseptic inflammation of the DIPJ and interference with the podotrochlear apparatus and should be considered among the differential diagnoses for severe lameness in juvenile foals. Arthroscopic resection of the SO led to an excellent outcome.

Background Arthroscopic resection of tarsal coalitions is a relatively new technique. This systematic review aimed to investigate the post-operative complications and functional outcomes in arthroscopic resection of tarsal coalitions. Methods PubMed, Medline, Embase and Cochrane library were searched for studies that reported outcomes in arthroscopic resection of tarsal coalitions. Results 8 studies met the inclusion criteria. Post-operative outcomes were reported in 103 cases. The overall complication rate was 13.6%. Tibial nerve injury was reported in 1 patient. All included studies demonstrated post-operative improvement in functional outcomes. Conclusion Arthroscopic resection is a feasible and effective treatment method for symptomatic tarsal coalitions.

Objective The aim of this study was to evaluate the factors that can affect long-term results of arthroscopic resection of medial synovial plica of the knee. Design A total of 52 knees in 50 consecutive patients with medial plica syndrome (MPS) were enrolled to prospective study. Preoperatively the age, gender, level of activity, symptoms’ duration, Lysholm knee scoring scale (LKSS), Q angle, range of motion (ROM), and quadriceps output torque (QOT) were recorded. The plica was then arthroscopically excised while plica morphological type and cartilage lesions (International Cartilage Repair Society [ICRS] classification) were registered. The postoperative evaluation was done after 1 month, 3 months, 6 months, 3 years, and 10 years. The final assessment after 10 years covered LKSS, ROM, QOT, and was enriched with functional tests: the single leg squat test (SLS), the modified Ober test (MO), and the manual palpation of the vastus medialis obliquus (VMO). Results The mean LKSS increased from 52 (15-85, SD 16.479) preoperative to 80 (48-100, SD 15.711) at final follow-up examination. A significant negative correlation was found between LKSS and the patients’ age. Cartilage lesions higher than ICRS 1 significantly decreased the final LKSS. Results were significantly better in the subgroups with normal outcome of functional tests. Conclusions Clinical results of arthroscopic plica resection are better in patients without coexisting cartilage lesions. Poor neuromuscular control may contribute to abnormal patella tracking, leading to both medial plica irritation and further cartilage deterioration.

Bennett lesions, also known as “thrower's exostosis” of the shoulder, involve ossification of the posteroinferior glenoid and are not uncommon in overhead throwing athletes. The literature surrounding the optimal operative management of the symptomatic Bennett lesion is limited. The purpose of this article is to describe the arthroscopic surgical technique for the visualization and excision of the symptomatic extra-articular pathologic ossification involving the posteroinferior glenoid. Because many surgeons may not be familiar with this problem or procedure, we present a straightforward method that allows for identification and excision of the exostosis through an arthroscopic posterior arthrotomy.

Osteochondromas of the femoral neck are a rare but challenging problem because of their distal location, which is difficult to access arthroscopically. Traditional methods of osteochondroma resection used invasive open approaches to manage these lesions. More recently, advances in hip arthroscopy have allowed expanded treatment of extra-articular hip conditions with a minimally invasive approach. Reports have described the use of hip arthroscopy for osteochondroma removal; however, surgical techniques for the procedure have yet to be described. We describe a technique for arthroscopic resection of a femoral neck osteochondroma using an extended capsulotomy and osteochondroplasty with subsequent capsular plication. This technique uses contemporary hip arthroscopic techniques and constitutes a safe and effective approach to addressing this rare intra-articular pathology of the hip.

Scapholunate dissociation when left untreated commonly leads to the most common type of degenerative arthritis of the wrist known as scapholunate advanced collapse (SLAC). When nonoperative treatment fails, surgical intervention is indicated. SLAC wrist is commonly treated with either a four-corner fusion with scaphoid excision or proximal row carpectomy. Arthroscopic options for SLAC wrist have been becoming more common. The purpose of this chapter is to describe our technique of arthroscopic resection arthroplasty for SLAC wrist.

Arthroscopic radial head resection is a minimally invasive alternative to open excision in acute fractures and chronic pathology of the radiocapitellar joint. Access to the entire radial head via standard portals is difficult and the “radial head portal” devised by the author provides safe access for rapid resection and removal of large fragments. This chapter describes the arthroscopic resection technique in acute comminuted radial head fractures and in chronic radiocapitellar pathology.

Osteochondroma is the most common benign tumor of the growing bone that commonly involves the knee joint region. Hereby we present a case of an arthroscopic resection of a symptomatic intra-articular osteochondroma of the knee. A 32-year-old woman presented with diffuse and persistent pain of her right knee followed by discomfort for over three months. She did not report any history of injury or any other medical problem. Physical examination and imaging, with plain radiographs and MRI, revealed a bony mass arising from the supero-lateral aspect of her right distal femur without a stalk. This bone tumor, an osteochondroma, was arthroscopically resected and the diagnosis was confirmed by the histologic examination. The arthroscopic resection of this benign tumor led to complete relief of the symptoms of the patient and her return to daily and athletic activities in one month postoperatively. No recurrence of symptoms occurred during the seven-year follow-up period. Arthroscopic resection of a symptomatic osteochondroma is less painful, more cosmetically accepted, and can result in a quicker recovery than the traditional approach with an open incision.

Objective: To analyze the functional outcomes of patients undergoing endoscopic calcaneoplasty for the treatment of Haglund deformity. Methods: This study consists of a case series of patients undergoing endoscopic calcaneoplasty. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, was used to evaluate patients before and 12 months after the procedure, providing preoperative and postoperative scores. Results: Nineteen patients were evaluated for a total of 24 endoscopic calcaneoplasties. The American Orthopaedic Foot and Ankle Society scale provided a mean preoperative score of 31.4 and a mean postoperative score of 93.3, which shows a significantly increased score after surgery. The mean patient age was 52 years, and the youngest patient was 25 years old and the oldest patient was 73 years old. However, no significant relationship was found between age and change in the American Orthopaedic Foot and Ankle Society score. No complications were observed in the immediate or late postoperative periods. Conclusion: Arthroscopic resection is efficient in the treatment of Haglund deformity given the significant improvement in the American Orthopaedic Foot and Ankle Society score observed after the procedure. Also, no postoperative complications were seen in patients who underwent endoscopic calcaneoplasty. Level of Evidence: IV; Therapeutic Studies; Case series.

Os acetabuli (OSA) is defined as a radiopaque structure located around the acetabular rim highly related to Femoroacetabular Impingement (FAI). Its treatment depends on the perspective of post-surgical joint instability. Ossicle resection is recommended if the femoral head is covered enough by the labrum. Previous research has described the results of this technique in general population. The aim of this study is to describe the outcomes and the time and rate of return to play (RTP) after hip arthroscopy and OSA removal in soccer players.This study is a retrospective analysis of a prospective database containing all the consecutive soccer players who had undergone hip arthroscopy between 2018 and 2019. The subjects diagnosed with OSA and a center-edge angle (CEA) 25 ° were included in the analysis. All the patients were treated with arthroscopic removal of the OSA and femoral osteoplasty. Hip function was assessed using the Modified Harris Hip Score (MHHS) before and at 3 and 12 months after surgery. Rate of RTP and competitive level at RTP were assessed at a 1-year follow-up.Between 2018 and 2019, 90 soccer players were treated with hip arthroscopy in our facilities. Six of them (6.6%) were diagnosed with OSA. Mean (SD) MHHS values were 69.7 (12.1) before the surgery, 89.7 (6.7) at 3 months post-surgery and 95.7 (5.1) at 12 months post-surgery. All the subjects reported significant improvements in their MHHS scores at 3 and 12 months post-surgery compared with pre-surgery levels (p 0.01). Non-significant differences were found between 3 and 12 months post-surgery (p 0.05). All the subjects (100%) returned to previous competitive levels.After surgery, all the soccer players returned to previous competitive level. Preoperative MHHS improved significantly at 3 months maintained for up to 12 months.

Objectives (1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; (2) to define the indications of treatment for hindfoot OOs. Material and method 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. Results No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1–12 years). Discussion Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. Conclusions The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1 cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.

Introduction The synovial wrist ganglion is a particularly common pathology of which the first "complication" is recidivism. The main objective of our study was to determine the rate of recurrence of this pathology in a series of arthroscopic patients. The secondary objective was to assess patient satisfaction well after the operation. Material and methods Our study was observational and retrospective and involved 30 patients (17 dorsal and 13 palmar cases) aged 41 years on average. The patients underwent an arthroscopic procedure for a palmar or dorsal ganglion of the wrist between March 2007 and April 2013. The data were collected by re-reading the files and conducting telephone interviews. Each patient answered a questionnaire about the operation, after-treatment, and their satisfaction well after the surgery. At the end of the interview, we calculated the Patient Rated Wrist Evaluation (PRWE) score. Results The mean follow-up was 4.6 years. A recurrence was noted in 4 (13%) cases, at an average delay of 9 months (6 months–1 year). There were only 2 patients (6.7%) that experienced the complication of complex regional pain syndrome type 1. Twenty-eight (93%) patients experienced improvement in postoperative pain. For 27 (90%) patients, firm-handed activities could be practised without limitation. The average time to resumption of activities of daily living was 27.1 days (1–240 days), resumption of firm-handed activities was 56 days (15–360 days), and return to work was 47.5 days (1–360 days). The mean PRWE score was 6.9/50 (0–34) for pain and 1.38/50 (0–8) for function. Conclusion The 13% recurrence rate is on the average of what is observed in the literature. Later satisfaction with the intervention is very good, and complications remain rare.Studies tend to show a lower rate of complications and recurrence following arthroscopic treatment, but to date, no randomized comparative series between the two methods has yet revealed any significant difference in these two points. A study of this type on a large scale could make it possible to highlight one of these treatment approaches.

Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of anterior knee pain (AKP). Some case reports have been published; however, it is difficult to diagnose and is often underdiagnosed or misdiagnosed because of its pathophysiological ambiguity. We report a rare case of a patient diagnosed with bilateral mucoid degeneration of the ACL with AKP and no limited joint range of motion (ROM). A 59-year-old man with spontaneous right AKP was admitted to our hospital. He first underwent arthroscopic resection of the thickened medial plica protruding far into the medial patellofemoral joint (PFJ) but felt little effectiveness thereafter. He then had an arthroscopic release of the lateral patellar retinaculum because of valgus knee and patellar instability, which resulted in only temporary improvement. Then, the AKP relapsed, this time with limitations in the ROM. Magnetic resonance imaging (MRI0 showed a diffuse, thickened ACL with a high inhomogeneous intensity in the T2-weighted and proton density weighted images and which looked similar to a celery stalk. Based on the patient’s history and MRI findings, we suspected mucoid degeneration of the ACL and subsequently performed arthroscopic excision. At the same time, AKP appeared on the other side. Since the MRI demonstrated a similar celery stalk image as before, the same operation was performed on this side, as well. Finally, AKP and the limitation of the ROM were relieved approximately one month after surgery. Due to the patient only suffering from AKP with a preserved ROM, it took about 14 months to diagnose this disease. It should, therefore, always be considered in cases of AKP alone.

Background: Arthroscopic resection of the distal clavicle has the potential risk of inadequate resection that may be associated with residual postoperative pain. We propose a new arthroscopic technique to excise the distal clavicle precisely and reproducibly without causing impingement or instability of the acromioclavicular (AC) joint. The purpose of this study was to evaluate the clinical and radiological results of arthroscopic distal clavicle resection in patients with symptomatic AC joint osteoarthritis.Methods: We retrospectively evaluated 26 patients (mean age, 55.3 ± 16.0 years) who underwent arthroscopic distal clavicle resection between April 2010 and September 2017 with a minimum 1-year follow-up (mean follow-up, 25.3 ± 11.1 months). Nine of these patients also underwent rotator cuff repair. Clinical evaluations performed preoperatively and at final follow-up included subjective pain scores according to a visual analogue scale (VAS), range-of-motion examinations, UCLA scores, and Shoulder-36 scores. Shoulder muscle strengths were measured with a handheld dynamometer. The amount of distal clavicle resection was measured on plain radiographs. Results: No patients had AC joint tenderness. There were significant differences between the preoperative and postoperative VAS, UCLA, and Shoulder-36 scores (P < 0.05). Muscle strengths were measured preoperatively and at final follow-up in 14 patients. Elevation and internal rotation strengths were significantly greater postoperatively, but there was no significant difference in external rotation strength. The mean amount of distal clavicle resection was 14.1 ± 2.1 mm. The mean coracoclavicular distance was 8.4 ± 1.6 mm preoperatively and 8.6 ± 1.8 mm at final follow-up, with no significant difference. Conclusions: Our arthroscopic technique of distal clavicle resection for AC joint osteoarthritis resulted in successful clinical outcomes at final follow-up. Bone resection was performed according to the amount planned, as confirmed on postoperative radiographs. The technique allows resection of the distal clavicle with accurate shape and amount as planned preoperatively with no postoperative instability of the AC joint.

Arthroscopic surgery is a standard technique for removal of loose bodies in large joints. By contrast, there were a few reports of arthroscopic surgery for loose bodies in small joints. We herein report a case of a 70-year-old woman with an inextensible metacarpophalangeal joint in the right middle finger due to an intra-articular loose body that developed after osteoarthritis. Surgery proceeded under vertical traction using traction tower. Two portals were developed at dorsal aspect on the metacarpophalangeal joints. The loose body was removed under arthroscopy with a small incision of both skin and sagittal band, thereby resolving clinical symptoms, including pain and limitations to metacarpophalangeal joint motion.

Background Volar wrist ganglion is the second most common wrist mass and accounts for 20% of all cases. Surgery is the gold standard for persistent and symptomatic ganglia. Arthroscopic resection has gained popularity in the past two decades. Application of this technique to ganglia in less accessible locations, such as the scaphotrapeziotrapezoidal (STT) joint, however, remains controversial. Case Description To date, no literature has described using the STT -ulnar (STT-u) and STT -radial (STT-r) joint portals for ganglionic resection. Literature Review In this report, two cases of arthroscopic ganglionic resection utilizing the STT-u and STT-r joint portals at our institution were described. Clinical Relevance Arthroscopic resection of STT joint ganglion under portal site local anesthesia is a technically feasible, safe, and effective approach. There was no recurrence observed for both cases at 50 months of follow-up.

The infrapatellar fat pad (IFP) is an extrasynovial, intracapsular, adipose body occupying the space in the knee joint between the inferior border of the patella, the femoral condyles, tibial plateau and patellar tendon. Little is known about the anatomy and normal function of the IFP, but it has been suggested to play a role in the aetiology of Anterior knee pain syndrome, including that associated with osteoarthritis. Forty-three knees from 11 male and 15 female embalmed cadavers (mean age 84 years; range 55-97 years) were investigated. The cadavers were donated and the study performed in compliance with the provisions of the UK Human Tissue Act (2004). The quadriceps tendon and the medial and lateral patellar retinacula were dissected from the patella, which was then reflected antero-distally. The IFP was carefully excised and details of its morphology and attachments to components of the knee joint were recorded, together with the presence of articular surface pathology on the patella and femoral condyles. The principal novel findings of the current study were that 81% of IFPs were attached to the superior border of the patella by supero-medial extensions and 65% were attached by supero-lateral extensions; the supero-medial extensions were larger than the supero-lateral extensions. The superior extensions of the IFP were always attached anteriorly to the patellar retinacula and in four individuals the extensions formed a full loop around the superior border of the patella. The volume of IFPs with attachments to the superior border of the patella was significantly greater (p = .007) than those without, and the IFP was attached to the medial meniscus in significantly (p = .009) more knees with IFP attachment to the superior border of the patella than those without. All IFPs were attached to the medial anterior horn of the meniscus and the medial Kaplan's ligament. Ninety-seven per cent were attached to the lateral anterior horn of the meniscus and 97% to the lateral Kaplan's ligament. The length of IFP attachment to the lateral meniscus was significantly longer (p = .004) than that to the medial meniscus. Ninety-seven per cent of IFPs were attached to the superior portion of the patellar tendon with the mean tendon attachment being 60%. Ninety-one per cent of IFPs were attached to the inferior border of the patella. Significantly fewer knees with patellar (p = .001) and femoral (p = .002) articular surface osteophytes exhibited superior IFP extensions and these extensions were significantly shorter in knees with patellar (p = .000) and femoral (p = .006) osteophytes, compared with those without. The IFP was attached to the medial meniscus in significantly fewer knees with femoral (p = .050) and patellar (p = .023) osteophytes than those without. All IFPs not attached to the anterior horn of the lateral menisci, medial Kaplan's ligament, superior patella or inferior border of the patella, were in knees with articular surface osteophytes. This relationship between IFP morphology and knee joint pathology suggests a functional role for the IFP that requires further investigation.

This chapter analyzes the similarities and differences between knee iliotibial band friction syndrome (ITBFS) in patients after total knee arthroplasty (TKA) and in runners. Although ITBFS etiopathogenesis is different in runners than in patients who have had TKA, the management is basically the same: treatment should begin with relative rest, physical medicine and rehabilitation, oral nonsteroidal anti-inflammatory drugs, and local corticosteroid injections. For patients who do not respond to at least 3 months of the aforementioned nonsurgical treatment, surgical treatment is recommended. There are several surgical options: Z-lengthening of the iliotibial band, surgical release of the iliotibial band, multiple puncture of the iliotibial band, and arthroscopic resection of the lateral synovial recess. In most patients, all of the above surgical alternatives lead to a satisfactory outcome: runners can return to their previous sporting activity, and patients with TKA can achieve significant or total pain relief.

The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions. Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up. No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group. For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.

Background Acromioclavicular joint instability following distal clavicle resection can result in considerable pain and dysfunction. Method We present a review of 13 patients who underwent ACJ stabilization following one or more distal clavicle resection procedures. Results The mean Quick DASH and CM scores were 26(0–57) and 73(46–100) respectively. All but one patient reported an improvement in the pain component of their CM score and in the work component of the Quick DASH score. Discussion Open ACJ stabilization to treat instability following distal clavicle resection resulted in improved functional scores, pain scores and facilitated return to work in most patients. Level of evidence IV.

Background. Pigmented villonodular synovitis is a rare pathology causing hyperplasia of the synovium. It mostly affects young populations and most commonly the knee joint. It rarely affects the posterior compartment of the knee as the case presented in this study. Open surgery is usually used to treat this condition; however, in our case it was excised arthroscopically despite the anatomical challenges of the posterior knee compartment. Case Presentation. This case presents a female patient with a complaint of posterior-region pain of her left knee post direct trauma post fall. This was directly followed by knee joint blockage for 1-week duration before presentation to the hospital. On MRI, she was found to have a multiloculated hemosiderin-containing structure of synovial origin within the femoral notch, extending beyond the joint capsule displacing the popliteal vessels. The patient underwent arthroscopic resection of the lesion, which was found to be pigmented villonodular synovitis on anatomopathological examination. On 6-month follow-up, the patient showed good clinical evolution with the absence of symptoms and back-to-normal daily activities. Conclusion. This is a rare case of PVNS affecting the posterior knee joint compartment of a middle-aged woman, which was successfully excised arthroscopically, with no residual affected tissue or recurrence on 6-month follow-up.

Introduction The rate of effusion or hemarthrosis after arthroscopic operation is in the range of 0.16 – 15.7 %. Changes in the operated joint are reflected in the composition and properties of the synovium. So, the study of hemo-synovial fluid will assess the severity of pathological changes and the effectiveness of treatment. Purpose The aim of the research was to study the changes in the hemo-synovial fluid of the operated knee joint and evaluate the effectiveness of treatments applied to hemosynovitis. Materials and methods The study included 79 males between the age of 18 and 60 years. At each puncture after full evacuation, the cavity was treated by the author's method in 38 patients of group 1 (patents on invention of Russia № 2457833 and № 2460545), which consisted in the lavage of the joint cavity with an isotonic sodium hydrocarbonate solution cooled down to +5 °С until the fluid was clear followed by intraarticular introduction of 3.0 ml of the mixture consisting of solutions for injections of 5 % ascorbic acid, 5 % unithiol and 0.5 % novocain, taken in equal volumes 1:1:1. At each puncture after full evacuation in 41 patients of group 2, intraarticular introduction of 3.0 ml of 0.5 % novocain solution for injections was performed. The efficiency was studied with magnetic resonance imaging in 24 men (12 subjects from each group) on 3rd and 7th days after arthroscopy. The pH, relative density, level of lipid hydroperoxide, concentration of common SH-groups and cytosis were defined in the hemo-synovial fluid. Results It was revealed that inflammatory changes develop in the operated knee joint after arthroscopic resection of the meniscus. Discussion The treatment technique proposed for knee joint hemosynovitis reduces faster the severity of the inflammatory reaction, lipid peroxidation and increases concentration of thiol antioxidants.

Introduction Resection of acromion in case of impingement syndrome is a controversial issue. It is associated with the risk of instability of humeral head. The aim of our study was to determine the morphometry of acromion so that the decision for arthroscopic resection becomes easier in these cases. The morphometry of acromion was also correlated with other parameters of scapula. Material and methods The study was conducted in sixty one intact dry adult scapulae of unknown sex. Various parametric and nonparametric data from scapulae were taken. Result Type I (flat), Type II (curved) and Type III (hooked) were found in 24.59%, 49.18% and 26.22% scapulae respectively. The average scapular length and breadth were 135.96 ± 11.96 mm and 98.8 ± 7.56 mm respectively. Mean value of length, breath, and thickness of acromian were 41.23 mm, 22.12 mm and 7.01 mm respectively. The thickness of acromion was less than 8 mm in 86.67% of scapulae. In 13.33% cases the thickness was >8 mm. A statistically significant positive correlation was also found between the length of acromion and the length and breadth of scapula. Discussion Our study may suggest that in Indian population, 13.33% population is at risk of impingement syndrome according to the thickness of acromion. In addition, angles of acromion tilt and acromion slope are larger in Indian scapulae as compare to that of other countries. This knowledge would be useful for orthopaedic surgeons and radiologists.

Posteromedial ankle impingement is rare and uncommonly associated with a fracture. Bone resection of the fragment is the recommended treatment. In this report, we describe the step-by-step surgical technique of arthroscopic resection of a malunion of a posteromedial talus fracture to correct the impingement.

Background: Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up. Methods: We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications. Results: During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period. Conclusions: The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.

Intra-articular synovial haemangioma of the knee is a benign tumour. However, diagnostic delay leads to degenerative changes in the cartilage and osteoarthritis due to recurrent haemarthrosis. Therefore, treatment should be performed immediately. We report the case of a localized synovial haemangioma arising from the medial plica in a 38-year old female presenting with pain and restricted range of motion in the right knee joint. Initially, we diagnosed this case as a localized pigmented villonodular synovitis (LPVS) based on MRI and arthroscopic findings and performed only arthroscopic en bloc excision of the mass and synovectomy around the mass for diagnostic confirmation. Fortunately, there was no difference in the treatment approaches for LPVS and localized haemangioma and the synovial haemangioma had not recurred at the 3-month postoperative follow-up with MRI. The patient's clinical symptoms resolved and had not relapsed two years after surgery.

Arthroscopic resection of the wrist ganglion is commonly performed nowadays, and has a recurrence rate comparable to open excision. It is preferred by some surgeons due to the smaller and more cosmetic operative scar. When using the arthroscopic procedure, identification of the stalk of the ganglion can facilitate accurate resection. In order to achieve this, staining and enhancement of the ganglion through the use of surgical dye injection has been proposed by some surgeons. However, sterile surgical dye is sometimes not easily available, and leakage-related subcutaneous discoloration is sometimes a problem. We propose an easy method by using diluted surgical marking pen ink for wrist ganglion staining. Also, any subcutaneous leakage of the diluted dye, if it occurs, can be easily cleaned up during the arthroscopic ganglion resection.

Radial head fractures often require excision in the acute or chronic setting. Elbow arthroscopy is useful for removal of comminuted fragments in acute isolated radial head fractures. Similarly, arthroscopic resection of a malunited and incongruous radial head is a minimally invasive method for management of chronic radiocapitellar pathology. Arthroscopy provides access for evaluation and concurrent treatment of any associated intra-articular pathology and may also be used to retrieve any fixation implants from the radial head and capitellum [1, 2].

The medial plica (MP) is a normal anatomic structure consisting of a fold in the synovial layer of the joint. Arthroscopic resection is currently used as a gold standard procedure in patients with medial plica syndrome (MPS), but there are few prospective studies that analyze the long-term functional outcomes of plica resection. The purpose of this prospective study was to evaluate the long-term results of arthroscopic resection of the medial plicae of the knee. Between 1999 and 2014 we included 267 patients that showed MRI evidence of MP out of the 5682 knee arthroscopies that we performed. We recorded pre and post-operative Tegner Lysholm knee scale scores (TLKSS) for up to 36 (3, 6, 12, 24, 36) months. The EQ-5D questionnaire was used to measure the patients’ generic health status. The mean values of the TLKSS were 68 (61–82) pre-operative, 87 (81–94) at the 3-month follow-up and 94 (92–97) at the 6-month follow-up. The long term results (TLKSS at 12, 24, and 36 months post-operatively) were 94.8 (91–98), 94.8 (90–97), and 94.5 (92–97) respectively. The EQ-5D and EQ-VAS showed significant improvement between each of the first three data registering moments (pre-operative, 3 and 6 month follow-up). The quality of the treatment and the final functional result is directly influenced by the type of plica that creates the symptomatology. We have achieved good overall results for our patients, the ones with less cartilage damage having the fastest recovery time. The arthroscopic resection is a very good option for medial plicae that do not respond to conservative treatment, and it must be initiated as a first option when cartilage damage is suspected.

Any surgery can cause the body’s stress response, which is initiated by tissue damage, with the participation of neuroendocrine factors leading to the development of tachycardia, hypertension, increased myocardial oxygen demand, stimulating the activation of free radical oxidation processes, metabolic disorders, and myocardial energy supply. Currently there are reasons to believe that the stress reaction can both aggravate injuries caused by surgical intervention and complicate the postoperative process, reducing the overall efficiency of therapeutic measures. A clinical case of stress myocardial injury with the development of left ventricular heart failure and pulmonary edema in young men in the early postoperative period after arthroscopic resection of the medial meniscus of the right knee joint is presented. The advantage of echocardiography in the diagnosis of left ventricular systolic dysfunction, accompanied by an increase in the cavity, a significant deterioration in the global and regional myocardial contractility, as well as the development of acute valvular insufficiency is described.

Osteoid osteomas are most likely to occur in the talar neck and can be classified as cortical, cancellous, or subperiosteal according to the position of the tumor nidus. However, cases located on the bearing surface of the talus are rare. Herein, the patient presented with an osteoid osteoma on the bearing surface of the talus and achieved good curative effects with arthroscopic resection associated with autologous iliac crest graft.

Schmerzlinderung und Funktionsverbesserung des betroffenen Handgelenks durch Entfernung des Ganglions und/oder dorsale Kapselfensterung und partielle Synovialektomie. Bei sichtbaren Ganglien Berucksichtigung des asthetischen Aspekts. Sichtbare und okkulte persistierende dorsale Handgelenksganglien, offen oder arthroskopisch voroperierte Rezidivganglien, intraossare Ganglien mit extraossarem Anteil. Frische Hautlasion am Handgelenk. Standardaufbau fur die Handgelenkarthroskopie. Portale: radiokarpal 3/4 und 6R, mediokarpal radial (RMC) und mediokarpal ulnar (UMC). Arthroskop zunachst im 3/4-Portal. Bei unzureichender Sicht auf die dorsale Kapselumschlagfalte Wechsel auf das 6R-Portal. Tangentialer Blick auf die dorsale Kapsel in Hohe des skapholunaren (SL-)Bands. Bei grosem, das 3/4- oder RMC-Portal uberdeckenden Ganglion primar ulnarer Zugang. Immer Versuch der Gangliondarstellung, v. a. bei okkultem Ganglion. Bei unauffalligem radiokarpalen Befund wird die dorsale Kapsel in Hohe des SL-Bands vom UMC-Portal eingesehen. Je nach Hauptlokalisation der sichtbaren Veranderung, Ganglion oder Kapselverdickung, lokale Synovialektomie und dorsale Kapselfensterung uber dem SL-Band radiokarpal, mediokarpal oder durchgehend radiomediokarpal. Palpatorische Prufung, ob das Ganglion verschwunden ist. Arthroskop mit 30°-Optik, Durchmesser 2,4 mm, Shaver („agressive cutter“), Durchmesser 2 mm. Niedervakuumdrainage, Watteverband. Ein Arthroskop mit 70°-Optik ermoglicht einen noch besseren Blick auf die dorsale Kapsel. Sofortige freie Handgelenkmobilisierung. Keine schwere Belastung fur 3 Wochen. Falls 3 Wochen postoperativ Handgelenkbeugung nicht frei, Physiotherapie erforderlich. Von 2007 bis 2010 wurden 92 Handgelenke bei 88 Patienten arthroskopisch operiert, 44 % wegen eines okkulten Ganglions, 17 % wegen eines Rezidivs. Bei einem mittleren Follow-up von 78 % nach 29,5 Monaten war die Patientenzufriedenheit mit 90 % hoch. Als einzige Komplikation trat bei einem Patienten ein komplexes regionales Schmerzsyndrom (CRPS) auf. Die Rezidivrate betrug 12,5 %.

Symptomatic subfibular and/or lateral talocalcaneal impingement in pediatric patients may result from an accessory anterolateral talar facet (AALTF). This impingement may cause pain and disability and may limit athletic performance in high-level athletes. We report the case of a 12-year-old female competitive gymnast who had refractory, lateral-sided right ankle pain for 4 months and underwent right ankle arthroscopic resection of the AALTF causing impingement. Standard medial and anterolateral portals with the addition of an accessory anterolateral-distal portal were used in conjunction with a 30° 2.7-mm-diameter arthroscope. The AALTF was resected with a combination of a shaver and a motorized rasp. Intraoperative fluoroscopy was used to verify successful debridement of the bony facet. This case illustrates that arthroscopic debridement is a technique to treat subfibular and/or talocalcaneal impingement associated with an AALTF.

Background Isolated scaphotrapeziotrapezoid is a relatively rare condition, and there is still not complete consensus on the treatment of this pathology. Purpose The aim of the present study is to assess the utility of implant interposition after arthroscopic scaphoid distal pole resection for scaphotrapeziotrapezoid arthritis. Material and Methods The authors present a prospective study after the arthroscopic resection of the distal pole of the scaphoid in 24 patients. In a group of 11 patients, the simple resection was performed while in the other 13 patients the scaphoid resection and pyrocarbone implant interposition. Results All patients were clinically evaluated with disability of arm, shoulder, hand score. Dorsal intercalated segment instability deformity was also measured from X-ray analysis. Grip and pinch strength were measured too, and patients were also given a visual analog scale questionnaire. Both clinical and radiographic assessments were done at 24 months postoperatively. Conclusions The study showed comparable results with both the techniques. Level of Evidence II A prospective comparative study.

Introduction: It has been reported that the unicompartmental knee arthroplasty has good long-term outcomes for Western and Japanese patients. Alternatively, several reports have described reoperations after unicompartmental knee arthroplasty because of post-operative knee pain and sometimes it is difficult to diagnose the cause of pain. Case Report: We treated a patient with anteromedial knee pain caused by intra-articular scar tissue that contained residual cement fragments on the anterior surface of a femoral implant following Oxford unicompartmental knee arthroplasty. After arthroscopic resection of the scar tissue and removal of the 3 mm residual cement covered with the scar tissue, the patient’s post-operative symptoms were considerably alleviated. Conclusion: This is the first report describing a case of painful intra-articular scar tissue following unicompartmental knee arthroplasty.

Introduction Pigmented villonodular synovitis (PVS) is a synovial proliferation disorder of uncertain aetiology, with some controversy as regards its proper treatment. The purpose of the study was to evaluate the functional outcome and recurrence rate in a series of patients diagnosed with both the diffuse and the localised types of PVS and treated by arthroscopic resection. Material and methods Twenty-four patients diagnosed with PVS were retrospectively assessed. There were 11 cases with the diffuse type, and 13 cases with the localised type of PVS. They were followed-up for a median of 60 months (range, 34–204). They underwent arthroscopic synovectomy, and were functionally evaluated with IKDC, WOMET, and Kujala scores. Results There was recurrence in 8 out of 13 (61.5%) cases with the diffuse type of PVS. Two of these patients were treated with radiation. One patient underwent surgical resection with an open procedure due to extra-articular involvement. The remaining 5 patients underwent a second arthroscopic resection, and no recurrence was subsequently observed. Cases with localised PVS did not recur after a single arthroscopic resection. IKDC, WOMET and Kujala scores improved by 30.6, 37.4 and 34.03 points, respectively. Discussion Pigmented villonodular synovitis treated by arthroscopic resection showed good functional results at mid-term follow-up. A single arthroscopic resection was sufficient to treat the localised PVS, whereas the diffuse type of PVS required a second arthroscopic resection in most cases, due to its high rate of recurrence.

The lateral tibial eminence shares a close relationship with the anterior root of the lateral meniscus. Limited studies have reported traumatic injury to the anterior meniscal roots in the setting of tibial eminence fractures, and reported rates of occurrence of concomitant meniscal and chondral injuries vary widely. The purpose of this article is to describe the case of a 28-year-old woman who had a complete avulsion of the anterolateral meniscal root caused by a tibial eminence fracture with resultant malunion and root displacement. The anterolateral meniscal root was anatomically repaired following arthroscopic resection of the malunited fragment.

Fibroma of the tendon sheath most often presents around small joints and involves the tendon and tendon sheaths of the fingers, hands, and wrist. In rare instances, it presents as an intra-articular mass. It has never been described in the hip joint. In the current case presentation, this benign tumor was found to be the source of a patient’s atypical severe hip pain. Arthroscopic resection of this tumor alleviated the patient’s pain.

Acromioclavicular (AC) joint arthropathy remains one of the most common causes of shoulder pain. In the case of AC joint arthropathy resistant to conservative treatment, most authors have recognized distal clavicle resection as the gold-standard treatment. However, some challenges remain to be solved. One is the difficulty in visualization of the superior and posterior part of the distal clavicle from the midlateral portal, causing an incomplete resection of the distal clavicle. This could potentially lead to unresolved pain and therefore surgical failure. We propose a technique for arthroscopic resection of the distal clavicle and the medial portion of the acromion, without any added portal: bipolar AC joint resection. The term “bipolar” is used because both the acromion and the clavicle are resected, without injuring the superior capsule.