Search

Knee arthroscopy is among the most popular surgical procedures performed worldwide. Following knee arthroscopy, complications are infrequent, with vascular damage being extremely rare. We present a case of a 16-year-old man with a superior lateral genicular artery pseudoaneurysm of his right knee. The pseudoaneurysm developed after arthroscopic irrigation and debridement for septic arthritis following previous arthroscopic meniscal repair. Diagnosis was confirmed by computed tomography angiography and the patient underwent intravascular embolization. We conducted a literature review to demonstrate the incidence of vascular injuries following knee arthroscopy, vessels that are more at risk, clinical presentation and current treatment options. Although vascular injuries following knee arthroscopy are uncommon, high clinical suspicion can lead to early detection and treatment of this severe complication. [ABSTRACT FROM AUTHOR]

Purpose: The Knee Injury Osteoarthritis Outcome Score (KOOS)-Child questionnaire is one of the frequently child-friendly measures used in pediatric studies. The aim of this study was to transculturally adapt the Greek version of KOOS-Child and evaluate its clinimetric properties in children with knee disorders. Methods: Children visiting the Outpatients Orthopaedic Clinic of a Greek Paediatric General Hospital were considered eligible if they were aged 8–14 years, had a knee soft tissue injury and associated physical limitations. The transcultural adaptation was based on a multistage backward translation approach. Participants completed the KOOS-Child at their first visit to the orthopedic specialist (baseline), 2 weeks and 3 months after baseline. Content validity of the KOOS-Child was evaluated using general QoL measures (KIDSCREEN and Kid-KINDL) and construct validity was explored by correlating relevant items. Responsiveness was evaluated according to the children's response on the given orthopeadic treatment. Results: Sample consisted of 59 children (30 males), aged: 11 ± 1.8 years. The KOOS-Child showed high internal consistency (Cronbach's a: 0.80–0.96). Adequate convergent validity with > 75% relevant a priori hypotheses was confirmed. Construct validity was moderate to strong (Pearson's r correlations between related KOOS and Kid-KINDL subdimensions: 0.54–0.62). KOOS and KIDSCREEN subdimensions correlations were fair (Pearson's r correlations: 0.32–0.65). KOOS-Child's diagnostic accuracy was high. Factor analysis extracted height factors accounting for 76.15% of the total variance, confirmed by the scree plot. Responsiveness was moderate to high with Cohen's d from 0.6 to 1.4. Conclusion: The Greek version of the KOOS-Child demonstrated excellent internal consistency, good construct validity, diagnostic accuracy and interpretability as well as good responsiveness. The measure could be used across Greek children with orthopaedic knee problems. Generalisability of findings is limited due to the relatively limited cohort. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: To compare accuracy, patient discomfort, and clinical outcome of ultrasound-guided versus palpation-guided corticosteroid injections to the bicipital groove in patients with long head of biceps (LHB) tendinosis.Materials and Methods: Forty-four patients with primary LHB tendinosis were randomized into two groups (group A, n = 22; group B, n = 22). All patients underwent treatment with a single corticosteroid injection to the bicipital groove. Injections in group A were performed under ultrasound-guidance, while in group B using a palpation-guided technique. The duration of each procedure was recorded. To assess accuracy, ultrasound examination was performed in both groups after injection. Patient discomfort was evaluated with visual analogue scale (VAS) for pain. The clinical outcome was assessed comparing the VAS, the Single Assessment Numeric Evaluation (SANE) score and the QuickDASH score before treatment and after 4 weeks and 6 months.Results: The mean duration of the procedure was 64 ± 6.87 s in group A and 81.91 ± 8.42 s in group B (p < 0.001). Injection accuracy in group A was 100% and in group B 68.18%. Discomfort was lower in group A, as compared to group B (22.10 vs. 35.50; p < 0.001). Symptoms, as measured by VAS, SANE and QuickDASH scores, improved in both groups at 4 weeks and 6 months (p < 0.05). Superior clinical improvement was recorded in group A in both time points (p < 0.05).Conclusions: Corticosteroid injections are an effective treatment for primary LHB tendinosis. Under ultrasound guidance, injections to the bicipital groove are faster and produce lower discomfort. Superior accuracy and clinical outcomes can be achieved using the ultrasound-guided technique.Level Of Evidence: Level II; Prospective Randomized Comparative Study. [ABSTRACT FROM AUTHOR]

Purpose: Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature.Methods: A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool.Results: Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III.Conclusions: Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place. [ABSTRACT FROM AUTHOR]

The growing importance of the service economy during the last 40 years has raised the need for new tools for designing and managing services. As a result, several authors have developed service classification systems, in order to better understand the nature of service operations and provide methods and tools to improve service efficiency and quality. This paper exploits the work resulting from service classification systems and identifies the principal attributes to be considered in service management. The tool introduced for this purpose is the Service Attribute-Process Matrix (SAPM), which uses selected results from existing service classification schemes to investigate the importance of the significant service attributes to major processes of the service life cycle. [ABSTRACT FROM AUTHOR]

The purpose of this study is to present our experience with the technique, the problems and the potential pitfalls of arthroscopically assisted retrograde femoral nailing for supracondylar femoral fractures. In a 2-year period, nine patients (seven women, two men, average age 72 years) with supracondylar femoral fractures were treated in our department with a retrograde nailing under arthroscopic control. The mean operative time was 63.8 min (42-84 min) and the mean follow up period was 34.5 months (ranged 12-52). Solid union of the fracture was achieved in all patients without additional intervention, in 14 weeks (range 12-18). There was no malalignment (more than 5 degrees in any plane) or implant failure. In conclusion we believe that the arthroscopically assisted technique is a very good method to treat supracondylar fractures of the femur. It has very low morbidity since the knee is not opened through the operation, and the surgeon has the ability to inspect the joint for any additional damage. It is very helpful in multitrauma patients and in young patients, where the precision of the entry point is critical. However, we do not recommend the technique in intraarticular fractures because the reduction is difficult and the fixation is performed with safety only under direct vision. [ABSTRACT FROM AUTHOR]

We evaluated the outcome in 10 young patients, ages ranging from 15 to 26, with types III and IV osteochondritis dissecans of the knee, treated with Herbert screws fixation and reverse guided drillings. The disease involved the medial femoral condyle in eight patients and the lateral in two. Diagnosis and preoperative planning based on plain radiographs (AP, lateral and tunnel view) and MRI (in seven patients). Fixation of the fragment with Herbert screws using a mini-arthrotomy technique and additional reverse drillings behind the crater of the lesion using the ACL aiming devise were performed in all patients. Post-operatively, no weight bearing was recommended for at least three months. The follow-up ranged from 15 months to 38 months (mean 27 months). According to the subjective questionnaire of the International Cartilage Repair Society (ICRS) scale, seven patients had normal knees, two had nearly normal knees and one abnormal. The Lysholm Knee score ranged 65-96 points (mean 88 points). All patients except one returned to their previous activities and they were satisfied with the result. Radiological union of the fragment was found in 9/10 patients (six grade III, three grade IV). Progressive flattening of the injured femoral condyle was noticed in two patients (grade III). Securing the lesion using Herbert screws in combination with reverse guided drillings seems to be an effective treatment choice for detached or displaced osteochondral fragments. [ABSTRACT FROM AUTHOR]

A case of chondral lesion of the medial femoral condyle caused by a bioabsorbable Mitek RapidLoc meniscal repair implant is presented. Meniscal repair was quite successful, but migration of one of the implanted fixation devices resulted in chondral damage, 12 months postoperatively. All orthopaedic surgeons using these new devices should be aware of the possibility of chondral damage of the adjacent femoral condyles. [ABSTRACT FROM AUTHOR]