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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.

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...

Arthroscopic excision of synovial osteochondromatosis of the hip is commonly performed. However, when the lesion extends to the extra-articular space of the hip joint, excision using arthroscopy becomes difficult. Although surgical dislocation of the hip with a trochanteric flip osteotomy is commonly used, manual access to the inferomedial portion of the acetabulum remains difficult. In this case report, we describe arthroscopic resection followed by open surgery using an anterior approach with or without surgical dislocation to excise a synovial osteochondromatosis of the hip that had extended to the extra-articular space and formed a herniation sac. Excision was completed without complications. An anterior approach with or without surgical dislocation should be considered as a surgical option for the treatment of a massive synovial osteochondromatosis of the hip joint.

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.

Bipartite patella (BP) is uncommon and is usually an incidental finding. Painful BP occurs rarely and is usually associated with post-traumatic anterior knee pain. When nonoperative treatment fails, fragment resection is indicated. A systematic review shows a potentially increased risk of complications with open surgery. The purpose of this Technical Note is to demonstrate a simple arthroscopic technique for treating painful BP through resection of the bone fragment.

Introduction: Painful Synovial Plicae (SP) in the posterolateral corner of the radiohumeral joint may be confused with lateral epicondylitis. The SP may impinge between the radial head and the humeral capitellum causing pain and snapping. The aim of this study was to evaluate the short-term results after arthroscopic plica resection of the elbow. Methods: In this case series, we included a consecutive series of 64 arthroscopies (60 patients) with arthroscopic plica resection of the elbow. Inclusion criteria were six months of lateral elbow pain and unsuccessful conservative treatment. Patients had either ultrasonography verified plicae or pain on palpation of the plica. Patients were evaluated with an Oxford Elbow Score (OES) preoperatively, after three months and after mean 22 months (range: 12–31) of follow-up. Furthermore, baseline characteristics were recorded including, gender, age, body mass index (BMI), occupation, smoking and cartilage damage. Results: The mean age was 44 years (range: 18–66). In 13 elbows, International Cartilage Repair Society (ICRS) grade 1 lesions were present in association with the plica. Preoperatively the mean OES was 19 (95% CI: 17–20). At three and 22 month follow-up the OES increased to 33 (95% CI: 30–36) and 35 (95% CI: 32–38), respectively (p

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: 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.

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.

A too-long anterior process (TLAP) of the calcaneus is an elongated anteromedial process of the calcaneus impinging the navicular or the talar head. TLAP can cause recurrent ankle sprain, peroneal muscle spasm, or persistent tarsal pain in adolescents. Arthroscopic resection is indicated if the symptoms do not respond to conservative treatment. It has the advantage of assessment of completeness of bone resection and treatment of associated lesions of the adjacent joints. The purpose of this technical note is to report an arthroscopic approach of the resection of the TLAP with the lateral midtarsal portal as the viewing portal.

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.

Arthroscopic resection of bucket handle tears of the meniscus is difficult owing to the obstructed view of the posterior horn. It often requires an additional portal for access or additional tools. We describe a technique involving conventional tools including grasper, shaver, and basket forceps. No additional portal is required. The basket forceps are used to cut the anterior attachment of the tear, and the bucket handle is shaved to a suitable size. The grasper is then used to hold the remaining meniscus and move it to the posterior space. The posterior corner of the meniscus is then turned over so that its posterior horn can be seen and accessible for cutting. This technique is primarily for medial meniscectomy. For lateral meniscectomy, the conventional technique may suffice, as the lateral compartment can be easily expanded between the femur and tibia.

There has been an interesting series of commentaries based on the initial paper by Pan et al. 1–4 I note with interest the suggestion by Binks et al 4 that to preserve the infrapatellar fat pad (IPFP) and perform later arthroscopic resection on a case by case basis may be a viable option for management of anterior knee pain (AKP) after total knee arthroplasty (TKA). This is contrary to the solution offered by Han et …

A rthroscopic procedures have recently gained importance in orthopaedic practice, and the advantages are now well established in the hip. Hip arthroscopy is being performed more frequently because it allows precise diagnosis and a direct approach; has low morbidity; does not require dislocation of the joint, which reduces the risk of vascular damage to the femoral head; requires shorter hospitalization time and allows faster rehabilitation. The indications for hip arthroscopy also are expanding mainly because of improvements in diagnostic means, surgical instruments and the expertise of the surgeons. Arthroscopic resection of osteoid osteomas in the hip previously has been described in two independent case reports with good results. The aim of this paper was to describe the technique for arthroscopic en bloc resection of an osteoid osteoma in the hip and to report four patients treated with this technique.