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Tarsal coalitions are anomalous connections between two or more bones in the hindfoot or midfoot secondary to embryonic failure of segmentation and differentiation of the mesenchyme. Calcaneonavicular and talocalcaneal coalitions are the most common. Although it is a congenital deformity, presentation is usually in adolescence which coincides with ossification of the coalition. Patients typically present with diffuse foot pain, calf muscle pain, recurrent ankle ligament sprains and a rigid hindfoot valgus deformity. Initial management is non-operative and may involve activity reduction, a trial of immobilization in a walking boot or cast, physiotherapy, corticosteroid injections and regular analgesia. Close to a third of patients experience symptom relief but the remaining patients with persistent symptoms will require operative intervention. Patients without degenerative joint disease undergo resection of the coalition. It is now established that an associated severe hindfoot valgus foot should be addressed at this stage to prevent inevitable future joint degeneration. The indications for joint fusion remain unclear and the tendency is to postpone this when possible until a later age. In recent years, arthroscopic resection of talocalcaneal coalitions has gained popularity, despite being technically demanding. It gives good visualization of the coalition, better postoperative pain relief and quicker improvement of the hindfoot stiffness. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic resection of the talocalcaneal coalition (TCC) has been reported to be associated with good short-term outcomes. However, the midterm outcomes of this approach remain uncertain. Methods: We performed a retrospective study of patients who underwent arthroscopic resection for symptomatic TCC. The patients were divided into 2 groups (group P, patients with isolated posterior facet coalition; and group MP, patients with both middle and posterior facet coalition). The preoperative and postoperative visual analog scale (VAS) scores for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scale scores were calculated. The postoperative AOFAS and VAS scores between the 2 groups were analyzed. Patient satisfaction was also assessed. Results: Thirty-two patients were included in this study. The mean age at the time of surgery was 26.0±8.5 years, and the mean follow-up period was 56.9±18.0 months. Thirteen (41%) patients were in group P, whereas 19 (59%) patients were in group MP. Postoperative VAS and AOFAS scores improved more significantly than preoperative scores. At the final follow-up, excellent and good subjective outcomes were attained in 26 patients (81%), fair and poor outcomes in 6 patients (19%). There were no statistical differences in the postoperative AOFAS (91.0±7.0 vs 85.8±10.8, P =.532) and VAS score (2.1±1.7 vs 4.0±2.6, P =.537) between patients with the ratio of coalition/posterior facet more than or less than 50%. There were no statistical differences in postoperative VAS score (1.8±1.3 vs 2.6±2.2, P =.236) and AOFAS score (92.5±5.6 vs 89.2±8.7, P =.297) between group P (n=13) and group MP (n=19), either. Three patients (9.4%) had complications, including these notable findings: 1 patient complained of restricted dorsal flexion, 1 with computed tomography–proven coalition recurrence, and 1 with partial tibial nerve injury. Conclusion: We found that TCC arthroscopic resection was generally associated with reasonable outcomes at midterm follow-up. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

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.

Introduction: The purpose of this study was to perform a meta-analysis comparing open and arthroscopic surgical techniques for distal clavicle resection.Methods: A systematic review of Medline, Embase, Scopus, and Google Scholar identified relevant publications in the English and German literature between 1997 and 2017. All included studies were levels I-IV, describing both treatments, with a minimum of 12 month follow-up, had at least one validated outcome score and documented patient recruitment, study design, demographic details, and surgical technique. Studies were excluded if they were only abstracts or conference proceedings, involved revision procedures, or the loss to follow-up exceeded 20%. Publication bias and risk of bias were assessed using the Cochrane Collaboration tools, and heterogeneity was assessed using the I2 statistic.Results: Four studies (n = 319 patients) met the criteria for inclusion. The pooled estimate for clinical outcomes (Constant, ASES) demonstrated no significant differences (SMD 0.323, I2 = 0%, p = 0.065) between open and arthroscopic resection, although the analysis favored open resection. The pooled estimate for clinical outcomes (SST) also demonstrated no significant differences (SMD 0.744, I2 = 49.82%, p = 0.144) between open and arthroscopic resection, but the analysis again favored open resection. The pooled estimate for VAS assessment of pain demonstrated no differences (SMD 0.217, I2 = 58.96%; p = 0.404) between open and arthroscopic resection.Conclusion: The results of this study suggest that similar functional and clinical outcomes can be achieved with either open or arthroscopic distal clavicle resection. The observed trend that open resection may have a more favorable outcome warrants further investigation.Level Of Evidence: Level 3; systematic review and meta-analysis. [ABSTRACT FROM AUTHOR]

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Background: Arthroscopic resection of tenosynovial giant cell tumor (TS-GCT) presents favorable outcomes. However, there are reportedly higher recurrence rates in patients who had incomplete resection. To minimize incomplete resection, we established a multiple portal approach depending on the location of the disease. In this study, we aimed to retrospectively evaluate the clinical outcomes of arthroscopic resection for both localized and diffuse types of TS-GCT of the knee., Methods: From 2009 to 2019, 13 patients who underwent arthroscopic synovectomy of the knee and were histologically diagnosed with TS-GCT were included in this study. The pre- and postoperative range of motion (ROM) of the knee was measured. The Japanese Orthopaedic Association (JOA) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were assessed at the final follow-up examination. Magnetic resonance imaging was performed to detect incomplete resection or local recurrence., Results: Among the 13 patients, seven and six had localized and diffuse type TS-GCT, respectively. Regarding the knee ROM, preoperative knee flexion in patients with the localized type was limited compared with that in those with the diffuse type. However, the ROM was significantly improved in patients with both types postoperatively. The JOA score and KOOS of patients with both types at the final follow-up were favorable, and there were no significant differences between both types. There was neither recurrence nor incomplete resection in any patient for both types., Conclusion: All patients, regardless of the TS-GCT type, achieved favorable outcomes after arthroscopic surgery; especially, the failure rate was 0%., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The purpose of this study is to audit the clinical and functional outcomes of arthroscopic ganglionectomy (AG) in our centre. Methods: A retrospective study was conducted on all 29 patients who underwent AG from 2007 to 2012 with a mean clinic and telephone follow-up duration of 6 months and 32 months respectively. Results: A total of 29 patients (17 women and 12 men) with a mean age of 38 years underwent AG. 15 patients (52%) had associated pain with the lump, 24 out of 29 patients (83%) had preoperative ultrasound to confirm the diagnosis. All patients had preoperative wrist radiographs that showed no chronic carpal instability and bony pathology. 26 out of 29 patients (90%) had dorsal wrist ganglions and 3 patients (10%) had volar wrist ganglions. 15 out of 24 ganglions (62.5%) were multiloculated. Mean ganglion size clinically and through wrist ultrasound was 2.5 cm and 1.8 cm respectively. During arthroscopy, ganglion stalk was identified in 14 patients (48%). Average operating time was 69.5 minutes. Intraoperatively, 24 out of 29 patients (83%) had wrist synovitis and 26 patients (90%) had associated carpal ligament laxity. 97% of cases were successfully resected arthroscopically. Recurrence rate was 10% (3 cases). There was no significant difference between preoperative and postoperative range of motion of wrists - the mean wrist flexion ranged from 63 to 59 degrees pre and postoperatively, and the mean wrist extension ranged from 66 to 64 degrees pre and postoperatively. Overall grip strength improved from 27 kg to 32 kg (), and there was also a significant improvement in pain scores pre and post-operatively from visual analogue scale (VAS) score of 0.8 to 0.3 (). No major intra or post-operative complications occurred. All patients were satisfied in terms of cosmesis. Conclusions: AG is a safe and reliable alternative to open resection of wrist ganglions. In addition, it can be used as a diagnostic and therapeutic tool for other wrist conditions. [ABSTRACT FROM AUTHOR]

Background: Shoulder pain in general and acromioclavicular joint (ACJ) pain specifically is common after acceleration‑deceleration injury following road traffic accident (RTA). The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases. Materials and Methods: Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29‑46 years). All presented with normal X‑rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI). Arthroscopic ACJ excision arthroplasty was performed in all patients. Results: At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10. Conclusion: Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration‑deceleration injury. [ABSTRACT FROM AUTHOR]

Background  Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with cosmetic concerns. The tumoral lesion should be arthroscopically decompressed or drained toward the inside of the joint through pedicle opening and resection of a small portion of the capsule. Hence, the cyst pedicle must be found for the success of this technique. Description of Technique  Some tricks have already been described to facilitate SC location during arthroscopy. We describe an indirect technique that employs an 18-G needle to enhance SC pedicle location and drainage. The technique involves a puncture on the interval of the carpal extrinsic ligaments where the pedicle is suspected to be remain. When found, cyst is drained with a single-puncture motion of the need which promotes cyst content extravasation due to pressure toward the joint. Patients and Methods  This method has been employed in 16 patients, including 9 with dorsal cysts, and seven with volar cysts. Results  All patients presented complete recovery and symptom improvement in up to 30 days, with total disappearance of the cyst. There were no relapses or severe complications within the 12-month follow-up. Conclusion  This is a safe, useful technique that facilitates location of intra-articular cyst pedicle, thus avoiding unnecessary damage in healthy tissues with no increased costs., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Purpose  The aim of this study was to compare the rates of recurrence and wound infection in patients with primary dorsal wrist ganglion treated with aspiration (with or without an injection of an additive), open excision, or arthroscopic resection. Methods  This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered on PROSPERO. Systematic electronic searches in PubMed (MEDLINE), EMBASE, Web of Science, and the Cochrane Library of Controlled Trials were performed on May 5, 2020, and June 1, 2021, respectively. All clinical studies written in English determining the recurrence and wound infection rates after treatment of primary dorsal wrist ganglion with aspiration, open excision, or arthroscopic resection in patients over the age of 16 years were eligible for inclusion. Quality assessment was guided by the Cochrane Collaboration's tool for randomized controlled trials (RCTs) and the methodological index for nonrandomized studies (MINORS) tool for observational studies. Results  The literature searches resulted in 1,691 studies. After screening, five RCTs, enrolling 233 patients, and six observational studies, enrolling 316 patients with primary dorsal wrist ganglions were included. Quality assessment of the included RCTs and observational studies determined the existing level of evidence pertaining to primary dorsal wrist ganglion treatment to be low. About 11 studies reported on recurrence rate, which ranged between 7 and 72% for patients initially treated with aspiration (with or without an injection of an additive). In comparison, the recurrence rate for the open excision and arthroscopic resection groups ranged between 6 to 41% and 0 to 16%, respectively. Four studies investigated wound-related complications, for which zero infections were reported, irrespective of treatment. Conclusion  The evidence summarized in this systematic review demonstrates a considerable variability in recurrence rate following aspiration and open or arthroscopic resection of a primary dorsal wrist ganglion. The greatest variability in recurrence was displayed among studies on aspiration. The overall infection rate after treatment of dorsal wrist ganglions seems to be low regardless of the treatment type. However, the divergent results of individual studies highlight a pressing need for prospective controlled trials assessing outcomes following dorsal wrist ganglion treatment. Level of Evidence  Systematic review on level 1 to 4 clinical therapeutic studies., Competing Interests: Conflict of Interest K.S. is a member in the Board of Directors for Getinge AB. The other authors have nothing to declare., (Thieme. All rights reserved.)

Abstract: Background: Calcaneonavicular coalition represents abnormal coalescence between calcaneus and navicular bone. It is a congenital anomaly, sometimes becoming symptomatic in young adolescent. This is managed conservatively initially, failing which surgical excision, open or arthroscopic, is considered. We present our arthroscopic technique via a modified sinus tarsi approach, with early results in two adolescent and two young adult patients. Method: The patient is placed in a 45° “saggy” lateral position, and entry points for portals are marked around sinus tarsi area. The adequacy of resection is checked with image intensifier at the end of procedure. Patients complete subjective scoring forms, Manchester–Oxford Foot Questionnaire and Visual Analogue Scale, pre operatively and at follow-ups. Paired t test was performed to assess statistical significance. Results: The results of early follow-up of these patients have confirmed complete excision, non-recurrence and symptomatic improvement. The mean difference in MOXFQ scores pre and post surgery is 39.33, with a two-tailed p value of 0.0187. Similarly, the mean difference in VAS score is 5.67 with a two-tailed p value of 0.0034. These are statistically significant and confirm symptomatic improvement at an early follow-up. Conclusion: The arthroscopic technique provides better access allowing wide excision and causes minimal soft tissue trauma leading to early recovery and mobilisation. [Copyright &y& Elsevier]

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. Level of evidence: Therapeutic case series, Level IV. [ABSTRACT FROM AUTHOR]

Our aim was to compare two methods of treatment of ganglia on the volar aspect of the wrist (the open excision done through a longitudinal volar skin incision and the arthroscopic resection through two or three dorsal ports), to see if arthroscopy could reduce the risks of operating in this area and the time to healing. Twenty radiocarpal and five midcarpal volar ganglia were operated on by open approach and an equivalent group was treated by arthroscopy. Fifteen radiocarpal and five midcarpal ganglia were treated with good results in the open group and 18 radiocarpal and one midcarpal ganglia in the arthroscopic group (no visible or palpable ganglion, a full range of active wrist movement, grip strength equal to preoperatively, no pain, and a cosmetically acceptable scar). In the open group there were four injuries to a branch of the radial artery, two cases of partial stiffness of the wrist associated with a painful scar, one case of neuropraxia, and one recurrence (all of which were among the 20 radiocarpal ganglia). In the arthroscopic group there was one case of neuropraxia, one injury to a branch of the radial artery, and three recurrences (three of the complications were among the five midcarpal ganglia). The mean functional recovery time was equal to 15 (6) days in the open group and 6 (2) days in the arthroscopic group. The mean time lost from work was equal to 23 (11) days in the open group and 10 (5) days in the arthroscopic group. Our results suggest that arthroscopic resection is a reasonable alternative to open excision in treating radiocarpal volar ganglia because it has less postoperative morbidity and a better cosmetic result. Midcarpal volar ganglia, however, should still be treated by open operation. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to assess the effects of a distal clavicle resection of less than 5 mm on bony contact and compliance in the acromioclavicular (AC) joint and to localize areas of persistent contact in the AC joint. The hypothesis of this study was that AC contact can be avoided by excising less than 5 mm of bone from the distal clavicle. Methods: Ten human AC joints underwent compressive loading of the distal clavicle into the acromion after the following: disk excision, distal clavicle resection of 2.5 mm, and distal clavicle resection of 5 mm. The joint resistance force, stiffness, and presence and location of contact were monitored. Results: Excising 2.5 mm or less resulted in no bone-to-bone abutment in 6 of 10 specimens. A 5-mm resection resulted in successful decompression in all specimens. The specimens that required a 5-mm resection had minimal contact after the 2.5-mm resection (inferior-posterior quadrant only). AC joint stiffness decreased significantly with increasing amounts of clavicular resection (P = .01). Conclusions: A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness. Persistent contact occurred only in the inferior-posterior quadrant of the joint after a 2.5-mm resection. Clinical Relevance: These findings support the efficacy of a 5-mm distal clavicle resection for eliminating bony contact but suggest that there is a bony contribution to AC joint stiffness. A resection of 2.5 to 5.0 mm could be adequate if care is taken to excise a greater depth of bone in the inferior-posterior quadrant. [Copyright &y& Elsevier]

Abstract: Medial shelf or “plica” syndrome is a pathological condition of the knee that often follows knee injury in young athletes, the symptoms of which often mimic other internal derangements of the knee. Its anatomy, pathomechanics, and clinical presentation along with treatments suggested in the orthopedic literature are reviewed here. Two-year follow-up studies on the treatment of this syndrome by arthroscopic resection in 51 knees in 42 patients are presented as well. [Copyright &y& Elsevier]