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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.

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.

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.

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.

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.

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.

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 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.

The Hoffa’s disease is a rare and little-known cause of anterior knee pain. It was first reported by Albert Hoffa in 1904. It is due to chronic impingement of fat pad Hoffa between the femur and the tibia during knee extension. The formation of the Hoffa’s...

A case of painful right shoulder in a 39 year old Thai female. She had a painful range of motion due to forward flexion and adduction with no any limit active range of motion for 5 months. The diagnosis was confirmed with incisional biopsy for tissue pathological report. 9-months after treated with arthroscopic coracoclavicular joint resection, she regained a pain-free range of motion.

Im Rahmen arthroskopischer Behandlungsmoglichkeiten des Handgelenks hat sich mittlerweile auch die Resektion dorsaler Handgelenksganglien etabliert. Als Vorteile der arthroskopischen Ganglionresektion gegenuber dem offenen Vorgehen werden die Minimalinvasivitat mit niedriger Komplikationsrate und eine niedrige Morbiditat mit geringen postoperativen Schmerzen, fruhzeitiger Mobilisierung und damit verbundener geringerer postoperativer Bewegungseinschrankung sowie eine kurzere Arbeitsunfahigkeitsdauer diskutiert. Als weiterer Vorteil wird die Moglichkeit der Beurteilung begleitender Gelenkpathologien gesehen. Hinsichtlich der Rezidivrate scheint sich heute abzuzeichnen, dass sie bei arthroskopischem und offenem Vorgehen gleich ist. Die Identifizierung eines sogenannten Ganglionstiels scheint nicht die Bedeutung zu haben, die ihr bisher beigemessen wurde. Diskutiert wird vorrangig die Lage und Grose des anzulegenden Kapselfensters und die Notwendigkeit der mediokarpalen Arthroskopie zusatzlich zur radiokarpalen. Uneinigkeit besteht hinsichtlich der Erfolgsaussichten bei der Behandlung von Rezidivganglien. Die eigenen Erfahrungen und die einiger anderer Autoren sind hierzu aber positiv. In der Literatur finden sich kaum Angaben zur Behandlung okkulter dorsaler Handgelenksganglien, die aber aus Sicht der Autoren sehr wohl als moglich und auch erfolgreich einzuschatzen ist.

The infrapatellar fat pad (IFP), also known as Hoffa's fat pad, may be a common site of pain in the knee because of its susceptibility to injury and its vast innervation and vascular supply. Patients who have trauma to the IFP may undergo a process of hemorrhage, inflammation, and fibrosis that may become painful. Patients with Hoffa's disease in whom conservative treatment with medications, physical therapy, and injections has failed may receive significant pain relief and benefit from undergoing arthroscopic subtotal removal of the IFP. We describe a safe and effective way to perform this procedure allowing excellent visualization through the use of a superolateral viewing portal.

Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is mostly observed in middle-aged patients with knee pain and limited range of motion. Although arthroscopic resection of the degenerated ACL is the treatment of choice following the failure of conservative management, the extent of the excision and subsequent ACL reconstruction for postoperative knee instability remains controversial. Case reports: We present four cases of mucoid degeneration of the ACL in patients aged

Dorsal wrist ganglions are one of the most frequently encountered problems of the wrist and often are associated with intraarticular disorders. However, it is unclear whether coexisting intraarticular disorders influence persistent pain or recurrence after arthroscopic resection of dorsal wrist ganglions.We investigated (1) which intraarticular disorders coexist with dorsal wrist ganglions and (2) whether they influenced pain, function, and recurrence after arthroscopic ganglion resection.We retrospectively reviewed 41 patients with primary dorsal wrist ganglions who underwent arthroscopic resection. We also obtained VAS pain scores and the Mayo Wrist Scores (MWS) preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter postoperatively. Minimum followup was 24 months (mean, 38.9 months; range, 24-60 months).Twenty-one patients had other coexisting intraarticular disorders: 18 triangular fibrocartilage complex tears and nine intrinsic ligament tears. All coexisting disorders were treated simultaneously. Two years after surgery, the mean VAS pain score decreased from 2.4 to 0.6, and mean grip strength increased from 28 to 36 kg of force. The mean active flexion-extension showed no change. The mean MWS improved from 74 to 91. Three ganglions recurred. There was no difference in mean VAS pain score and MWS preoperatively and at 2 years after surgery or recurrence of ganglions between patients with or without coexisting lesions.Intraarticular disorders commonly coexist with ganglions but we found they were unrelated to pain, function, and recurrence after arthroscopic resection of the ganglion when the intraarticular disorders were treated simultaneously.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Background Symptomatic tarsal coalitions failing conservative treatment are traditionally managed by open resection. We describe an arthroscopic technique for excising talocalcaneal coalitions and present a retrospective two-surgeon case series of the first eight patients (nine feet). Methods Outcome measures include restoration of subtalar movements, return to work and sports, visual analogue pain scales and Sports Athlete Foot and Ankle Scores (SAFAS). Follow-up ranges from 1 to 5.5 years. Results Pain and SAFAS improved in 7 patients. Subtalar movements were improved in all feet. All patients achieved early good function but one relapsed requiring subsequent fusions. One posterior tibial nerve was damaged. Conclusions Minimal destruction of bone and soft tissues allows early mobilization and minimizes pain. Patient selection and preoperative planning are crucial to avoid relapse and complication. This series from two independent surgeons supports the feasibility and effectiveness of this technique.

We report a rare case of localized pigmented villonodular synovitis (xanthoma) of the knee. Awareness about this condition is crucial to its diagnosis. Arthroscopic complete resection of this benign tumor was successfully done. Technical tips of arthroscopic surgery are described herewith.

Les kystes mucoïdes du ligament croisé antérieur (LCA) sont rares. Ils sont souvent asymptomatiques et méconnus. Leur expression clinique est polymorphe et c'est l'imagerie par résonnance magnétique qui permet de poser le diagnostic qui est confirmé par l'histologie. La résection arthroscopique constitue le traitement de référence. On rapporte un cas de kyste mucoïde du LCA traité par résection arthroscopique.The Pan African Medical Journal 2016;24

The ganglion is the most common soft tissue mass of the hand and wrist. Over the past 10 to 15 years, there has been a growing interest in arthroscopic treatment of dorsal wrist ganglions. Proposed advantages of arthroscopy include greater motion (particularly wrist flexion), improved cosmesis, and potential to identify/treat other intra-articular pathology. Despite the documented clinical success of arthroscopic ganglion excision, limitations include inconsistent identification of the ganglion stalk. Our described technique offers a means by which to improve visualization of the ganglion stalk intra-articularly to produce a more effective and efficient arthroscopic ganglion excision. During the procedure, a small volume of methylene blue solution is injected into the cyst. Its communication with the joint is apparent arthroscopically, thus identifying the location of the stalk. With the ability to precisely identify the ganglion stalk using an injection of methylene blue, the surgeon can direct the arthroscopic debridement toward the appropriate pathologic tissue. Unnecessary debridement of uninvolved tissue can be avoided with the technique. This also allows for optimal portal placement and, in particular, indicates whether a midcarpal portal should be employed. This should result in fewer recurrences, decreased operative time, and less iatrogenic injury.

The discoid meniscus is a common meniscal anomaly. Symptomatic discoid menisci treated by arthroscopic surgery were examined preoperatively and postoperatively by magnetic resonance imaging (MRI). Aim of this study was to quantify the amount of meniscal resection when treating discoid meniscus in children by partial meniscectomy. The hypothesis was that partial meniscectomy left sufficient amounts of meniscal tissue.A quantitative evaluation of meniscal size comparing preoperative and postoperative data after partial meniscectomy was performed by MRI (n = 6). The anteroposterior meniscal diameter and anterior and posterior thickness were measured. The relative postoperative thickness to preoperative thickness was defined. All patients were graded according to Lysholm score and Ikeuchi knee scale.The quantitative MRI evaluation showed a pronounced reduction of the anteroposterior meniscal diameter (42%) and anterior thickness (41%) after partial meniscectomy, whereas the posterior thickness showed a mean increase of 50%. According to Ikeuchi, all clinical postoperative findings were excellent and displayed an increase in Lysholm score.MRI findings showed that the amount of remaining tissue after partial meniscectomy was smaller than aspired. Especially in the anterior joint, the final size of remaining meniscal tissue was overestimated intraoperatively. It may be concluded that in arthroscopic partial meniscectomy, the final meniscal size, especially in the anterior part of the joint, is difficult to assess. As it is known that the extent of meniscal resection plays a crucial role in the clinical course of discoid menisci, these data claim retentiveness in resecting meniscal tissue.

Laboratory investigations demonstrate the theoretical feasibility of utilizing CO2 laser energy for arthroscopic resection of the knee meniscus. Infrared light of 10.6 μm wavelength is sufficiently absorbed by fibrocartilage with byproducts of heat, water vapor, and a small residue of carbon ash. The remaining meniscus rim demonstrates viable chondrocytes in close proximity to the margin of resection, and gross collagen fiber architecture is preserved. The depth of penetration of the laser beam can be controlled by limiting the duration of exposure. Arthroscopic application of CO2 laser energy requires a gas medium. Carbon dioxide and nitrogen have proven to be satisfactory insufflation agents, with no lasting untoward effects noted in a clinical series of diagnostic arthroscopic procedures. The cost of laser generators and the lack of an ideal delivery system are limiting factors in clinical applications of this cutting mode for meniscectomy.