Search

Objective To compare and analyze the knee function and clinical prognosis of symptomatic discoid lateral meniscus (DLM) and non-DLM treated with arthroscopically in adolescent patients. Methods A total of 47 adolescent patients treated with arthroscopy in our hospital from 2015 to 2021 were retrospectively analyzed and divided into the DLM group (20 cases) and the non-DLM group (27 cases) according to whether they had DLM.The clinical features, type of surgery, and scores of the International Knee Documentation Committee (IKDC) and Physical Activity Questionnaire (PAQ) at six months, one year, and two years after surgery were compared between the two groups. Results The age and body mass index of the DLM group were lower than those of the non-DML group, and the differences were statistically significant (P＜0.05). IKDC and PAQ scores of patients in two groups were significantly improved six months after surgery, one year and two years after surgery, with statistical significance (P＜0.05), but there was no statistical significance in IKDC and PAQ scores between two groups at each time point (P＞0.05). There were no significant differences in IKDC and PAQ scores among patients with different gender, age and type of surgery (P＞0.05). Conclusion Arthroscopic surgery can effectively improve the knee function of DLM and non-DLM patients, but gender, type of surgery, age do not affect the knee function and physical recovery [ABSTRACT FROM AUTHOR]

Objective To explore the effectiveness of different knee arthroscopic medial collateral ligament release techniques in the treatment of patients with medial meniscus posterior horn injury and their prognoses. Methods A total of 54 patients with medial meniscus posterior horn injury who underwent surgical treatment at the Department of Sports Medicine in our hospital from June to August 2021 were enrolled. They were divided into group A (who underwent knee arthroscopic percutaneous outside-in, superficial release) and group B (who underwent knee arthroscopic inside-out, anteromedial release) based on the conditions and wishes of the patients. The two groups of patients were recorded and compared for surgical duration and follow-up outcomes of the following indices at 1, 3, and 12 months after surgery: local symptom duration, visual analogue score of knee pain, Lysholm score of knee joints, International Knee Documentations Committee Rating System-based score, and knee joint range of motion score. Results There was no significant difference in surgical duration between the two groups of patients (P>0.05), but the local symptom duration in group B was significantly shorter than that in group A (t=11.950,P0.05). Conclusion For patients with simple medial meniscus posterior horn injury, it is recommended to use knee arthroscopic anteromedial inside-out, superficial release if the surgeons are confident of the condition.

Objective: To investigate the feasibility and clinical effect of the treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscopy., Methods: Between June 2018 and September 2022, the medical records of 15 patients with NeerⅡb distal clavicular fracture treated with locking plate under arthroscope were retrospectively analyzed, including 9 males and 6 females, aged from 25 to 57 years old with an average of (42.50±7.75) years old, 5 left shoulder, 10 right shoulder, and duration of the disease ranged from 4 to 7 days with an average of (5.16±0.98) d. Visual analog score (VAS), Constant-Murley shoulder joint score scale and Neer standard score were used before operation, 1 month after operation and the last follow-up., Results: All patients successfully completed the treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscopy, with the operation time ranging from 0.3 to1.0 h with an average of (0.55±0.24) h. All patients were healed at stageⅠ. The follow-up time ranged from 6 to 15 months with an average of (9.2±2.8) months. The preoperative VAS score was 7.23±0.67, the Constant-Murley shoulder joint score was (19.57±0.91), and the Neer standard score was (11.27±1.12);The VAS score was (1.56±0.81), the Constant-Murley shoulder joint score was (52.62±1.54), and the Neer standard score was (61.98±2.99) in the first month after operation;At the last follow-up, the VAS was (0.42±0.54), the Constant-Murley shoulder joint score was (91.24±1.97), and the Neer standard score was (93.24±3.38). The difference between VAS, Constant-Murley shoulder joint score and Neer standard score was statistically significant at one month postoperative and preoperative ( P <0.05), and the difference between the last follow-up visit and one month postoperative was statistically significant ( P <0.05)., Conclusion: The treatment of NeerⅡb distal clavicular fracture with locking plate under arthroscope can restore the function of shoulder joint, with definite curative effect and feasibility.

Objective: To compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. Methods: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Of the patients, 42 were male, 50 were female, with a mean age of (57.1±13.2) years. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair (traditional group), and 50 underwent modified anterolateral acromioplasty (modified group). The preoperative and postoperative shoulder function of the patients in the two groups were evaluated and compared by using the University of California Los Angeles (UCLA), the rating scale of the American Shoulder and Elbow Surgeons (ASES), and the constant Murley shoulder score scale. And the preoperative and postoperative pain of patients was evaluated with visual analog scale (VAS). The incidence of rotator cuff retears 12 months after operation was counted. Results: There was no statistically significant differences in general information such as gender, age, affected side and course of disease between the two groups before the surgery (all P <0.05). All patients were followed up for (12.9±1.1) months. There was no significant differences in the UCLA score (31.4±3.0 vs 32.0±2.5), ASES score (13.1±0.7 vs 13.3±0.6), Constant Murley shoulder score (92.1±6.6 vs 94.3±4.6) and VAS score (1.5±0.8 vs 1.2±1.1) between the traditional group and the modified group 12 months after the operation (all P >0.05). The preoperative CSA (36.0°±1.7°) in the traditional group did not differ significantly from that at 12 months postoperatively (35.5°±1.2°) ( P =0.270); the postoperative CSA at 12 months (30.8°±2.5°) in the modified group was significantly smaller than that before the operation (36.5°±1.9°), and also was smaller than that in the traditional group 12 months after the operation (35.5°±1.2°) (both P <0.05). At 12 months after operation, the rate of rotator cuff tears in the traditional group and modified group was 16.7% (7/42) and 4.0% (2/50), respectively ( P =0.045). Conclusions: Traditional and modified anterolateral acromioplasty in treating total rotator cuff tears using arthroscopic rotator cuff repair can significantly improve shoulder joint function. However, modified anterolateral acromioplasty significantly reduces the CSA value and decreases the incidence of rotator cuff re-tears.

Background: In terms of the optics used for Knee arthroscopy, a large number of different endoscopes are currently available. However, the use of the 30° optics in knee arthroscopy has been established as the standard procedure for many years. As early as the 1990s, needle arthroscopy was occasionally used as a diagnostic tool. In addition to the development of conventional optics technology in terms of camera and resolution, needle arthroscopes are now available with chip-on-tip image sensor technology. To date, no study has compared the performance of this kind of needle arthroscopy versus standard arthroscopy in the clinical setting in terms of the visibility of anatomical landmarks. In this monocentric prospective feasibility study, our aim was to evaluate predefined anatomical landmarks of the knee joint using needle arthroscopy (0° optics) and conventional knee arthroscopy (30° optics) and compare their performance during knee surgery., Methods: Examinations were performed on eight cadavers and seven patients who required elective knee arthroscopy. Two surgeons independently performed the examinations on these 15 knee joints, so that we were able to compare a total of 30 examinations. The focus was on the anatomical landmarks that could be visualized during a conventional diagnostic knee arthroscopy procedure. The quality of visibility was evaluated using a questionnaire., Results: In summary, the average visibility for all the anatomic landmarks was rated 4.98/ 5 for the arthroscopy using 30° optics. For needle arthroscopy, an average score of 4.89/ 5 was obtained. Comparatively, the needle arthroscope showed slightly limited visibility of the retropatellar gliding surface in eight (4.5/ 5 vs. 5/ 5), medial rim of the patella in four (4.85/ 5 vs. 5/ 5), and suprapatellar recess in four (4.83/ 5 vs. 5/ 5) cases. Needle arthroscopy was slightly better at visualizing the posterior horn of the medial meniscus in four knee joints (4.9/ 5 vs. 4.85/ 5)., Conclusion: Needle arthroscopy is a promising technology with advantages in terms of minimally invasive access and good visibility of anatomical landmarks. However, it also highlights some limitations, particularly in cases with challenging anatomy or the need for a wide field of view., (© 2024. The Author(s).)

BACKGROUND: Discoid meniscus injury is a rare form of abnormal meniscus morphology with unknown pathogenesis. The complete disc-shaped meniscus is more prone than incomplete disc-shaped meniscus to tearing and adverse reactions such as joint degeneration and osteochondritis. Moreover, its clinical efficacy is not satisfactory. Arthroscopic meniscus surgery can enhance the stability of the meniscus and provide sufficient cushioning pressure to prevent recurrent meniscal tears.OBJECTIVE: To investigate the efficacy of arthroscopic surgery for discoid meniscus injury in knee joint and analyze risk factors that influence the efficacy of arthroscopic surgery.METHODS: This single-center, self-control study, will include 196 patients with discoid meniscus injury who will receive arthroscopic meniscus repair(Stryker) from December 2018 to December 2019 at the Department of Sports Trauma and Arthroscopy, First Affiliated Hospital of Anhui Medical University of China. This surgical procedure will include meniscus plasty and subtotal meniscectomy. After surgery, all included patients will be fol owed up for 6–18 months. Surgical efficacy will be evaluated by Lysholm score. Patients will be divided into an excellent-and-good group(Lysholm score ≥ 85) and a poor group(Lysholm score < 85). This study was approved by the Medical Ethics Committee, First Affiliated Hospital of Anhui Medical University(approval No. PJ2018-02-03) on February 5, 2018. The version of the study protocol is 1.0. Patients and their family members will volunteer to participate in this study. Written informed consent will be obtained from each patient.RESULTS AND CONCLUSION: The primary outcome measure of this study is the change in excellent-and-good rate of Lysholm score that reflects knee joint function measured at the last follow-up in patients undergoing arthroscopic meniscus surgery. Secondary outcome measures are Lysholm score; Outerbridge grade of chondral lesion; knee joint morphology by magnetic resonance images before surgery and at the last follow-up; age, sex, lesion region, and course of disease before surgery; and incidence of adverse reactions at the last follow-up.Clinical data from 115 patients with discoid meniscus injury(115 knees) who received treatment from April 2015 to September 2016 were retrospectively analyzed.(1) Six to eighteen months of follow-up of 115 patients revealed a significant difference in Lysholm scores before surgery(65.8±9.39) and at the last follow-up(89.15±7.45; P < 0.05). Postoperative Lysholm scores were excellent in 32 patients, good in 61 patients, fair in 18 patients, and poor in 4 patients, with an excellent-and-good rate of 80.9%. There were 93 excellent and good patients and22 unsatisfied patients.(2) Knee joint infection did not occur in any patient. There were four patients with lateral interstitial pain and two patients with lateral instability of the knee joint.(3) Logistic regression analysis revealed that course of disease, age, and Outerbridge grade of chondral lesion were risk factors that influenced the efficacy of arthroscopic meniscus surgery. Results from this study hope to confirm that arthroscopic surgery for discoid meniscus injury is a definitive treatment technique. Patient age and the degree of chondral lesion are closely related with efficacy, so it is recommended that patients with symptomatic discoid meniscus injury undergo surgery as soon as possible. This trial had been registered in the Chinese Clinical Trial Registry(registration number: ChiC TR1800019182) on October 30, 2018. [ABSTRACT FROM AUTHOR]

Objective: To investigate efficacy between arthroscopic popliteal cyst drainage and arthroscopic popliteal cyst resection., Methods: From January 2013 to June 2021, 54 patients with popliteal cyst (Rausching-Lindgren gradeⅠto Ⅲ) were treated with arthroscopic surgery. There were 24 males and 30 females. The age ranged from 44 to 72 years old, with a mean of (62.67±6.08) years old. The course of the disease ranged from 1 to 72 months, with a mean of(15±14) months. Twenty-four patients (group A) were underwent arthroscopic internal drainage of popliteal cyst. Thirty patients (group B) were underwent arthroscopic resection of popliteal cyst. Preoperative main symptoms included knee pain, swelling, walking pain, popliteal swelling, popliteal mass and so on. After 1, 3, 6 months and 1, 2 years of surgery, routine outpatient follow-up was conducted to observe and compare the surgical time, bleeding volume, preoperative and postoperative visual analog scale (VAS), knee Lysholm score, and complications between two groups., Results: All incisions healed at one stage after operation. All 54 patients were followed up, and the duration ranged from 6 months to 2 years, with an average of (13.89±4.29) months. There was no intraoperative vascular or nerve injury. Operation time and intraoperative blood loss of the two groups:group A of (62.08±9.55) min and (8.00±1.69) ml, group B of (69.50±6.99) min and (8.70±2.00) ml. Popliteal pain, swelling, limitation of flexion and extension were significantly relieved after operation. VAS before and one month after operation between two groups:group A of 5.38±1.21 and 2.63±0.71, group B of 5.60±1.26 and 2.80±0.81. Lysholm scores of knee joint before and 6 months after operation:group A of 62.59±4.99 and 89.74±2.90, group B of 63.87±3.23 and 89.02±2.35. Knee joint function improved significantly in both groups. In group A, 4 cases had popliteal cyst at 3 months after operation, and 2 cases had small isolated cyst at 1 year after operation. There was no recurrence of cyst in group B., Conclusion: The results between two arthroscopic treatments of popliteal cyst are satisfactory, and there is no significant difference in the amount of blood loss, safety, postoperative pain VAS score and knee function recovery. It is suggested that arthroscopic resection of the cyst wall should be performed when the technique is mature, especially for large cysts and septal cysts.

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Arthroscopic reconstruction for treatment of avulsion fracture at the tibial insertion of the knee posterior cruciate ligament (PCL) can minimize surgical trauma to the largest degree. However, its implants have relatively poor stability; therefore, functional exercise cannot be performed in the early stages after surgery, which is inconducive to knee function recovery. It is extremely challenging to perform traditional open reduction with internal fixation to repair avulsion fractures at the tibial insertion of the knee PCL. Often, the crushed bones cannot be firmly fixed, leading to a poor repair effect. OBJECTIVE: To design a new inverted “L”-shaped incision in the popliteal fossa through which bone plates were inserted to fix the crushed bones and to reconstruct PCL tension, facilitating knee function recovery; to compare the therapeutic effects of this new fixation and reconstruction method, and arthroscopic reconstruction for treating avulsion fracture at the tibial insertion of the knee PCL. METHODS: A prospective, single-center, non-randomized controlled trial. One hundred and eighty patients (knees) with avulsion fracture at the tibial insertion of the knee PCL will be assigned to two groups based on treatment methods: arthroscopic reconstruction group (n = 90; fracture fixation and repair under the arthroscope) and new method group (n = 90; bone plates will be inserted through an “L”-shaped incision in the popliteal fossa to fix the crushed bones and reconstruct PCL tension). After surgery, these patients will be followed up for 6 weeks, 6 months, and 12 months. RESULTS AND CONCLUSION: The primary outcome measure is the excellent and good rate of knee function recovery at 12 months after surgery as evaluated by Lysholm Knee Scoring Scale score (Herein referred to as Lysholm score). The secondary outcome measures are the excellent and good rate of knee function recovery before surgery, 6 weeks and 6 months after surgery; Lysholm score before surgery, 6 weeks, 6 months and 12 months after surgery; Hospital for Special Surgery (HSS) knee score, Visual Analogue Scale (VAS) score, posterior drawer test negative rate, X-ray morphology of the knee before surgery, and 6 weeks, 6 months, and 12 months after surgery and; incidence of adverse events at 6 weeks, 6 months and 12 months after surgery. Results of a preliminary study involving 62 patients (knees) with avulsion fracture at the tibial insertion of the knee PCL showed that posterior drawer test negative rate and Lysholm score were significantly higher in the new method group compared to the arthroscopic reconstruction group (P < 0.05) at 3 months after surgery. This study will be performed to compare the therapeutic effects of bone plate insertion through an “L”-shaped incision made in the popliteal fossa to fix the crushed bones and to reconstruct PCL tension, and traditional fracture fixation and repair under the arthroscope to treat avulsion fracture at the tibial insertion of the knee PCL. We believe that the former method will be superior to the latter one because it can fix the avulsion fracture more firmly, facilitating knee function recovery. This study was approved by Medical Ethics Committee of Cangzhou Central Hospital of China (approval No. 2017-120-01). This study will be performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. Participants provided signed informed consent prior to participation in the study. This study was designed in December 2017. Patient recruitment and data collection will begin in April 2018. Patient recruitment will end in June 2019. Data analysis will be performed in August 2020. The study will be completed in October 2020. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800015026). The version of this study protocol is (1.0). [ABSTRACT FROM AUTHOR]

We investigated all-inside ankle arthroscopy for Tillaux-Chaput fractures. We retrospectively evaluated 19 patients (12 males [63.2%] and 7 [36.8%] females; 11 right [57.9%] and 8 left [42.1%] ankles) treated from May 2013 to January 2016. Their mean age was 28.1 (range 10 to 55) years. Sixteen (84.2%) had single Tillaux-Chaput fractures and 3 (15.8%) had combined proximal fibular fractures; 17 (89.5%) were diagnosed radiographically and 2 (10.5%) by computed tomography. Anterolateral and anteromedial ankle arthroscopy was used for closed reduction and internal fixation with 1 or 2 Herbert screws. Joint function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. All 19 patients healed by first intention without nerve, vessel, or tendon injuries. The follow-up was 19.0 (range 12 to 25) months; fracture union was achieved by 23.5 (range 12 to 36) weeks. At the last follow-up, the 19 patients had no restrictions in ankle function and range of motion, with no ankle or walking pain. The AOFAS score changed from 52.8 to 91.7 points, with an excellent/good rate of 100%. These results suggest that anterolateral and anteromedial all-inside ankle arthroscopy is a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures. [ABSTRACT FROM AUTHOR]

BACKGROUND: This team modified the arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach to perform direct compression. Thus, the pressure of the fracture block is evenly distributed on the healing line, and the operation is convenient and fixed firmly, but its clinical effect remains to be further confirmed. OBJECTIVE: To compare the clinical outcome of arthroscopic reduction and internal fixation with canulated screw through very high-posteromedial portal approach and double bundle suture fixation for avulsion fracture of the tibial attachment of posterior cruciate ligament. METHODS: From January 2011 to May 2017, 60 cases of the avulsion fracture of posterior cruciate ligament (transverse diameter of fracture block > 10 mm) were treated operatively at the Orthopedics and Arthroscopic Ward Two, First Hospital of Qinhuangdao, China. According to different modes of operation in different periods, patients were assigned to two groups. In the canulated screw group (n=31), patients were treated with canulated screw through very high- posteromedial portal approach. In the suture group (n=29), patients were treated with double bundle suture fixation through posteromedial portal approach. General conditions were compared between the two groups. Knee function was assessed with the Intemational Knee Documentation Committee and Lysholm scores. Knee stability was evaluated with KT-2000 and posterior drawer test. RESULTS AND CONCLUSION: (1) All the patients were followed up (range 6-12 months). (2) The average operation time was (63.49±3.97) minutes in the canulated screw group and (87.28±3.46) minutes in the suture group (P < 0.05). At 3 months after surgery, all the patients were healed. (3) At the final follow-up, in the canulated screw group, the negative rate of posterior drawer test was 90%. Lysholm scores were 94.89±4.75. IKDC scores were 94.01±3.25. In the suture group, the negative rate of posterior drawer test was 90%. Lysholm scores were 95.56±3.63. IKDC scores were 95.52±4.72. No significant difference was determined between the two groups (P > 0.05). (4) KT-2000 measurement results revealed that there were no significant differences between the surgical knee and the normal knee in both groups (canulated screw group: (2.53±1.02) mm versus (2.12±0.83) mm; suture group: (2.65±0.82) mm versus (2.19±0.63) mm (P > 0.05). Moreover, no significant difference was detected in the affected knee of KT-2000 results between the two groups. (5) Both arthroscopic reduction with canulated screw through very high-posteromedial portal approach and double bundle suture fixation can achieve satisfactory clinical outcomes, but arthroscopic reduction with canulated screw through very high-posteromedial portal approach in patients with fracture block diameter > 10 mm can result in shorter operation time, more reliable fixation, and thus permit an early postoperative functional exercise. [ABSTRACT FROM AUTHOR]

BACKGROUND: Most domestic studies have shown that there are similar curative effects of allogeneic and autogenous tendons in anterior or posterior cruciate ligament reconstruction. Both of them are good grafts that can achieve satisfactory outcomes. OBJECTIVE: To compare the clinical efficacies of allogeneic and autogenous tendons in anterior and posterior cruciate ligaments reconstruction under arthroscopy. METHODS: A total of 100 patients with knee cruciate ligament rupture undergoing anterior and posterior cruciate ligament reconstruction under arthroscopy were enrolled in this study, and randomly divided into two groups (n=50 per group): autogenous tendon group and allogeneic tendon group. The joint stability and mobility of the two groups were compared before operation and at discharge. The muscle strength recovery, Werner patellofemoral pain score and the Lysholm score of the two groups were evaluated and compared at 1, 3, 6, 9 months after discharge. RESULTS AND CONCLUSION: (1) Joint stability: The Lachman test positive rates and axial shift test positive rates in the two groups after operation were significantly better than the baseline (P < 0.05). At discharge, there were no significant differences in Lachman test positive rates and axial shift test positive rates between the two groups. (2) Joint range of motion: There were no significant differences in the joint ranges of extension and flexion between the two groups after operation. (3) Follow-up visit: Muscle strength, the Werner patellar pain scores and the Lysholm scores in the two groups were significantly improved at discharge (P < 0.05), but there were no significant difference between the two groups at 1, 3, 6, 9 months after discharge. In summary, autologous hamstring tendon and allogeneic tendon have the same clinical therapeutic effects in anterior and posterior cruciate ligament reconstruction under arthroscopy, both of which can achieve good short-term outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: The evaluation for posterolateral rotatory dislocation of knee joint often relys on traditional imaging techniques to obtain static anatomical information; meanwhile, the knee function was assessed by Lysholm and the International Knee Documentation Committee scores. However, none can quantitatively evaluate the kinematic characteristics, let alone providing guidance for postoperative rehabilitation. OBJECTIVE: To analyze the gait characters of the patients with acute posterolateral rotatory dislocation of knee joint and to dynamically evaluate the postoperative kinematic parameters and displacement indicators, thereby providing guidance for rehabilitation. METHODS: Twelve patients with acute knee posterolateral rotatory dislocation were admitted in the West China Hospital, Sichuan University between January 2011 and December 2014, and all patients underwent one-stage reconstruction or repair of ligaments under arthroscopy, followed by routine rehabilitation training. Opti-Knee® analysis system was used to collect 6 degrees of freedom (movement angle and displacement) of the ipsilateral (injury group) and contralateral knee joints (normal group), the change levels were calculated, and were then compared between two groups. RESULTS AND CONCLUSION: (1) There was no significant difference in the maximum varus/valgus angles and maximum intersion/extorsion angles (P > 0.05). While, the minimum flexion angle, maximum flexion angle, as well as the change level of flexion/extension angles, varus/valgus angles and maximum intersion/extorsion angles in the injury group were significantly higher than those in the normal group (P < 0.05). (2) There was no significant difference in the maximum forward, inward and outward displacement as well as the change levels of inward/outward displacement between two groups (P > 0.05). The maximum backward, and downward displacement as well as the change levels of forward/backward displacement in the injury group were significantly higher than those in the normal group; while the maximum upward displacement and the change levels of upward/downward displacement in the injury group were significantly lower than those in the normal group (P < 0.05). (3) These results suggest that the arthroscopy-assisted one-stage treatment of the acute posterolateral rotatory dislocation of the knee joint can remarkably restore the gait. Opti-Knee® analysis system can provide objective information of motion parameters, and the change in the degree of freedom provides guidance for clinical rehabilitation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Self-healing ability of the posterior cruciate ligament is poor, and the degradation and synthesis of extracellular matrix often follow the ligament repair. The matrix metalloproteinase family plays a critical role in the dynamic equilibrium between the matrix degradation and synthesis. OBJECTIVE: To investigate the effect of arthroscopic reconstruction of the posterior cruciate ligament, and to study its correlation with matrix metalloproteinase 2 level. METHODS: Sixty patients with posterior cruciate ligament rupture were studied, including 37 cases of autologous reconstruction and 13 cases of allogeneic reconstruction. Ligament and synovial cells from traumatic amputation patients with no ligament injury in the corresponding period were collected. Lysholm and Tegner scores were detected before and after operation. The results of postoperative drawer test were analyzed. The tibial displacement of the posterior cruciate ligament after autologous reconstruction and allogeneic reconstruction was compared. The posterior cruciate ligament cells were cultured alone or co-cultured with synovial cells, and then the level of matrix metalloproteinase 2 protein was detected. In addition, operation time, incision length, postoperative fever time and gender differences were also detected and compared. RESULTS AND CONCLUSION: Tibial displacement, irrespective of genders, was higher in the allogeneic reconstruction group than the autologous reconstruction group, while there were no significant differences in the posterior drawer test between the two reconstruction groups as well as between males and females. Postoperative Lysholm and Tegner scores were both improved significantly (P < 0.01). As time went by, the level of matrix metalloproteinase 2 had an increasing trend in the posterior cruciate ligament cells cultured alone or co-cultured with synovial cells, but the level in the co-culture group was higher than that in the single culture group. For both male and female, the autologous reconstruction group showed a longer operative time (P < 0.05 or 0.01) and a longer incision length (P < 0.01), as compared with the allogeneic reconstruction group, while the time of fever was significantly longer in the allogeneic reconstruction group (P < 0.01). Results from the last follow-up show that the autologous reconstruction is better than the allogeneic reconstruction to restore the stability of posterior cruciate ligament and shorten fever time, but longer operative time and surgical incision as well as increased level of matrix metalloproteinase 2 cannot be ignored. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mesenchymal stem cells have a extreme prospect in orthopedics, which show great potential especially in the treatment of articular cartilage defect disease. Bone marrow is the main source of mesenchymal stem cells, and the iliac puncture is a conventional way to obtain bone marrow, but is restricted by the limited resources and strict technical requirements. Therefore, it is of great significance to explore new effective and convenient sources of mesenchymal stem cells. OBJECTIVE: To explore the feasibility of autologous mesenchymal stem cells derived from the joint drainage fluid after knee arthroscopy. METHODS: We selected eight patients who underwent arthroscopic surgery to collect joint drainage fluid by pre-made sterile blood bag before the wound closure. Precipitation with hydroxyethyl starch and density gradient centrifugation method were performed to isolate and culture mesenchymal stem cells from the joint drainage fluid. Cell morphology, growth curve, surface marker identification were observed and detected using flow cytometry. Then, adipogenic, chondrogenic and osteogenic differentiation of cells were induced and identified by oil red O, toluidine blue staining, and alizarin red staining, respectively. RESULTS AND CONCLUSION: The cultured cells were spindle-shaped, adherently grew and had good proliferation ability, which were positive for CD44, CD90, CD105 and CD73, but not for CD45. Under standard inductions, the cultured cells were induced to differentiate into osteoblasts, adipocytes and chondrocytes. Therefore, these cells were confirmed as mesenchymal stem cells. Mesenchymal stem cells were successfully isolated from the joint drainage fluid of eight patients and had no difference in cell morphology, proliferation and phenotypes. To conclude, the joint drainage fluid is an ideal source of mesenchymal stem cells with the guaranteed quality and quantity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although there are many studies on acute patellar dislocation in adolescents, the optimal treatment strategy is under discussion. OBJECTIVE: To summarize the clinical efficacy of reconstruction of the medial patellofemoral ligament (MPFL) in the treatment of adolescent acute patellar dislocation using “double-pulley” technique. METHODS: Thirty cases of acute patellar dislocation were enrolled and received reconstruction of the MPFL using “double-pulley” technique. We proceeded to prepare the bone bed for anchor placement at the medial point of the superior edge of the patella and at the upper 1/3 patella along the long axis of the patella using arthroscopic grinding. Two double-loaded 5.0 anchors were respectively placed at the medial point of patella and at the upper 1/3 patella parallel to the patellar articular surface, and then tied using the double-pulley technique. Long longitudinal incisions were performed at the medial condyle and at the adductor tubercle to expose these two structures, the deep fascias tunnel between two incisions were penetrated to pull the tendon weave end through the tunnel until the lateral side along a femoral tunnel; finally the tendon was fixed using screws in appropriate tightness. All patients were followed for more than 10 months, and the patellar-related parameters and knee function parameters were compared before and after operation. RESULTS AND CONCLUSION: There were 12 cases of intra-articular cartilage injury and 4 cases of meniscus injury. The patella title angle, Q-angle and outward shift distance at the last follow-up were less than those before operation. Lysholm and International Knee Documentation Committee scores at the last follow-up were higher than those before operation. The mean operation time was (90±10.5) minutes. There was one patient with knee movement angle from 0° to 30° and one patient with a patellar fracture caused by slipping and treated with internal fixation. None of patients appeared with patellar dislocation, positive apprehension test infection or poor wound healing. These results indicate that the simple and mini-invasive double-pulley technique is a good treatment strategy for acute patellar dislocation, because it is consistent with patellar anatomical stability, holds patellar trajectory visibility, quick recovery and good curative effect. Additionally, osteotomy is recommended when the simple efficacy is not satisfactory. [ABSTRACT FROM AUTHOR]

Background: To assess the incidence of venous thromboembolism (VTE) following shoulder surgery and to evaluate the role of postoperative duplex ultrasonography. Methods: The study comprised a total of 224 patients who underwent shoulder surgery, including 180 shoulder arthroscopic surgeries, 28 shoulder arthroplasties, and 16 plate fixations for proximal humerus fracture between January 2014 and December 2014. The mean age of patients was 59.0 years, and there were 81 men and 143 women. Clinical data, including body mass index, blood tests, metabolic work-up for liver and renal function, previous, and present medical history, were evaluated. Duplex ultrasonography in the operative arm was performed on 2 to 4 days after surgery. Results: The overall incidence of VTE following shoulder surgery was 0.45% (1/224). One patient with open reduction and plate fixation for proximal humerus fracture had asymptomatic deep vein thrombosis that showed complete remission after anticoagulant medication during a 2-month period. Four patients had asymptomatic superficial cephalic vein thrombosis and complete remission without any treatment. There was no case of pulmonary embolism. Conclusions: The incidence of VTE following shoulder surgery was extremely low in Asians. Duplex ultrasonography may be not considered a routine follow-up of shoulder surgery and can be selectively performed in high-risk or symptomatic patients for VTE. [ABSTRACT FROM AUTHOR]

Case History: Dogs (n = 15) that were presented to a single veterinary teaching hospital with elbow dysplasia-associated lameness between September 2021 and May 2022, and were determined to require arthroscopy based on imaging results, were prospectively recruited into the study. The median duration of lameness was 4 (min 1, max 24) months., Clinical Findings: Various breeds were represented with a median body weight of 31.6 (min 15, max 46.4) kg and median age at presentation of 14 (min 8, max 83) months. Results of imaging modalities (CT) were consistent with medial coronoid disease with fissured or fragmented medial coronoid process in all dogs., Arthroscopic Findings: Feasibility of the needle arthroscopy (NA) procedure was firstly assessed in a preliminary cadaveric study in forelimbs (n = 10) collected from 10 adult dogs euthanised for reasons unrelated to the study. Elbow exploration was performed through a medial approach beginning with NA (1.9 mm 0° angle scope) followed by standard arthroscopy (SA; 2.4 mm 30° angle scope). The quality and extent of visualisation (scored through the number of anatomical structures visualised) were recorded and statistically compared. As the cadaver study indicated that NA allowed safe inspection of all structures in medial/caudal compartments, this procedure was then used in the dogs requiring treatment. In the clinical setting, elbow exploration was successful in all dogs and the treatment (removal of osteochondral fragments) was performed without requiring conversion into SA. One month after surgery, all dogs had an improvement in their lameness score (0-5) and 12/15 dogs were no longer lame. There was a reduction in Canine Orthopaedic Index scores measured a median of 99 (min 47, max 180) days after surgery (24 (IQR 19.5-31.5)) compared to the pre-operative period (49 (IQR 46.5-57); p < 0.001)., Clinical Relevance: Needle arthroscopy-assisted removal of osteochondral fragments was performed in all dogs with satisfactory short-term clinical outcome. NA is a feasible technique for diagnosis and lesion assessment in dogs with a fissured or fragmented coronoid process. Larger clinical studies with longer follow-up are necessary to validate the NanoScope operative arthroscopy system as an alternative strategy to SA for video-assisted treatment of medial coronoid disease.

Background: Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anestheticimpaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus bl°Ck (IBPB) followed by general anesthesia vs. general anesthesia alone. Methods: Patients scheduled for arthroscopic shoulder surgery were randomly all °Cated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. Results: The initial body temperatures were 36.5 ± 0.3°C vs. 36.4 ± 0.4°C in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3°C vs. 34.9 ± 0.3° (P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3°C vs. 35.2 ± 0.2°C in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. Conclusions: The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery. [ABSTRACT FROM AUTHOR]

Objective To compare the effect of hollow screw and double suture anchors for the treatment of the intercondylar eminence fractures of tibia. Methods The data of 68 patients with intercondylar eminence fractures of tibia from January 2006 to January 2012 were retrospectively reviewed. 33 patients of them received treatment of hollow screw, 35 patients received double suture anchors. All patients had X-ray films before operation. After follow-up of 3，6，12 and 36 months, they all were examined by X-ray eminence in an appropriate position. Union time was from 6 to 12 weeks and evaluated by Lysholm system. Results After a follow-up for 24 to 43 months and the average period was 36 months. A total of 68 patients turned up. The outcome of treatment was evaluated on the basis of X-ray and clinical findings in hollow screw group and double suture anchors group. Union and average time was 8 weeks. During the follow-up time, clinical evaluation included the range of motion and knee joint stability was examined and no knee joint instability and abnormal activity were found. During the 3 months and 6 months, there were significant differences between hollow screw group and double suture anchors group （P > 0.05）. But during the follow-up from 12 to 24 months, there were significant differences between hollow screw group and double suture anchors group （P ＞0.05） according to Lysholm system，clinical evaluation including range of motion and knee pain was examined and knee pain and abnormal activity were found in this two groups. Conclusion Clinical characteristics of patients and individual requirement should be considered comprehensively before an individual treatment choice is made for the treatment of the intercondylar eminence fractures of tibia. [ABSTRACT FROM AUTHOR]

Purpose: There have been very few attempts to compare the visual fields and image distortion in arthroscopes. To better understand the images generated using existing arthroscopes, we performed image-mapping experiments to assess field of view and image distortion. The purpose of this study was to quantify and compare the visual fields obtained using 30° and 70° arthroscopes and assess image distortion in each arthroscope.Methods: A complete arthroscopy system was used in this study. To perform this quantitative analysis, we created a customized measurement device that consisted of three parts: (1) distance marker, (2) chessboard pattern, and (3) angle marker. Three observers collectively assessed the appropriate position of the arthroscope during simulation. For each scope, ten simulations were performed at distances between 1 and 3 cm. Using the obtained arthroscope images, field of view and image distortion were measured and calculated.Results: The field of view of the 70° arthroscope was 5, 10, and 15 mm wider in diameter in comparison with the 30° arthroscope at 1, 2, and 3 cm, respectively. Moreover, the 70° arthroscope had less 0.66, 0.13, and 0.26 pixels of root-mean-square distance than the 30° arthroscope at 1, 2, and 3 cm, respectively. The 70° arthroscope also contained 0.78 pixels less at the maximal error than the average 30° arthroscope. Therefore, the 70° arthroscope demonstrated less distortion than the 30° arthroscope. There was no significant difference between the two scopes with respect to median curvature measurement at 1-cm distance.Conclusion: The 70° arthroscope demonstrates technical advantages over the 30° arthroscope, including a wider field of view and a less image distortion at the periphery. A wide angle and less image distortion can help better orient the surgeon within the joint cavity when a panoramic picture is needed to repair rotator cuff tears, in case of hip arthroscopy, or while treating the lesions of posterior horn of medial meniscus. [ABSTRACT FROM AUTHOR]

Isolated cuboid fractures are very rare, since they typically occur in combination with midfoot fractures or dislocations. A 61-year-old man presented at our hospital with pain and swelling on the outside of his right foot. The lateral column of his right foot was shortened by approximately 6.5 mm on X-ray. CT showed displacement of the joint surface between the cuboid and the fourth metatarsal, with a 3.5 mm depression. An MRI revealed no other injuries. Based on these findings, we diagnosed the patient with an isolated nutcracker fracture of the cuboid. Using a 1.9 mm arthroscope, we examined the Lisfranc joint. Then the depressed fragments were elevated until the regular joint line was restored. A bone biopsy needle was then used to fill in the large defect with artificial bone. In this case, we did not plate the fracture. Six months after surgery, patient could walk without pain. We report a very rare case of isolated nutcracker fracture of the cuboid. In addition, we suggest our new treatment plan of this fracture. [ABSTRACT FROM AUTHOR]

Purpose: To compare users' hand movements in performing validated shoulder arthroscopic tasks between a 30° and a wide-angle arthroscopic system, using phantom models with an optical motion analysis system.Methods: Twelve orthopaedic residents were enrolled and randomly allocated into two groups. In order to compensate for any learning effect, a Latin square counterbalancing technique was used. An optical motion analysis system was used with markers affixed to pre-designed sites; each participant conducted four validated shoulder arthroscopic tasks using both arthroscopic systems. Each participant was instructed to perform the experiment three times with each arthroscope. The time taken, total path length, number of movements, and average acceleration were analysed.Results: Significant differences were observed for the time taken, number of movements, and average acceleration between the two arthroscopic systems (P < 0.05 for all). However, the time taken was not significant. The mean total path length measured 53 ± 38 cm with the 30° arthroscope, while the mean with the wide-angle arthroscope was significantly shorter, at 36 ± 22 cm. The mean number of movements with the 30° and wide-angle arthroscopes were 1974 ± 1305 and 1233 ± 990, respectively, while the average accelerations were 2.6 ± 1.3 and 1.2 ± 0.6 cm/s(2), respectively. The mean time taken was 13 % faster when using the wide-angle arthroscopic system, although this was not statistically significant.Conclusion: The wide-angle arthroscopic system improved the arthroscope manoeuvre in terms of the total path length, number of movements, and average acceleration required for experimental arthroscopy. This system may help surgeons triangulate the arthroscope and surgical instruments during surgery by expanding the field of view. [ABSTRACT FROM AUTHOR]

Purpose: Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR).Methods: Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2%), UCISB75 (0.75%), and UCISB20 (0.2%) according to the initial ropivacaine dose (8 ml). The background infusion (0.2% ropivacaine at 5 ml/h), bolus (3 ml of 0.2% ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively.Results: FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups.Conclusions: UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR.Level Of Evidence: Randomized controlled trials, Therapeutic study, Level I. [ABSTRACT FROM AUTHOR]

We treated a 15-year-old female patient with fracture of the post-lateral femoral condyle and the bone shifted in front of the knee. Considering that the traditional surgical approach has the shortcomings of significant trauma and poor prognosis, we designed an arthroscopic procedure, which achieved satisfactory short-term efficacy, effectively reduced and fixed the fractures, avoided damage to vascular nerves, and maximally reduced the trauma caused by surgery itself. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic osseous Bankart repair for shoulders with chronic recurrent anterior instability has been reported as an effective procedure with promising short-term outcomes. However, to date, we know of no report describing longer-term outcomes and glenoid morphologic change. The purpose of the present study was to report intermediate to long-term outcomes and glenoid morphologic change after arthroscopic osseous Bankart repair in patients with substantial glenoid bone loss.Methods: A consecutive series of eighty-five patients with traumatic anterior glenohumeral instability associated with a chronic osseous Bankart lesion underwent arthroscopic repair from January 2005 through December 2006. Forty-six patients with bone loss of >15% of the inferior glenoid diameter relative to the assumed inferior circle regardless of the fragment size were selected as candidates for this study. Thirty-eight patients (83%), including thirty-four male and four female patients, with a mean age of 23.4 years (range, fifteen to thirty-six years) at the time of surgery, were available for final follow-up at a mean of 6.2 years (range, 5.0 to 8.1 years) after surgery.Results: One patient had a redislocation during a traffic accident five months after surgery before obtaining an osseous union. The mean Rowe score and the mean Western Ontario Shoulder Instability Index improved significantly from 30.7 points preoperatively to 95.4 points postoperatively and from 26.5% to 81.5%, respectively. Although the mean preoperative fragment size was measured as only 4.7%, the mean glenoid bone loss improved from 20.4% preoperatively to -1.1% postoperatively.Conclusions: Arthroscopic osseous Bankart repair is an effective primary treatment for shoulders with substantial glenoid bone loss as it provides successful outcomes without recurrence of instability once osseous union is obtained. Glenoid morphology can be normalized during the intermediate to long-term postoperative period, even in shoulders with a smaller fragment. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical efficacy of arthroscopy with anchor treatment on acute patellar dislocation. Methods Retrospective analysis of patient with acute patellar dislocation cases who visited our hospital from March 2010 to June 2013 and were followed up for 10 months or more after being discharged. Patients all underwent physical examination and imaging examination before operations. All operations were performed under arthroscopy. Joint hematoma were first drained, then articular cartilage injury were explored and repaired. Corresponding relationship between patella and femoral condyle were observed. After that, lateral retinaculum was released and medial patellofemoral ligament was repaired by suture anchors. Finally patellar reduction and its corresponding relationship with femur were observed after operation. Results Medial patella cartilage injury and bone contusion of femoral condyle were all observed under arthroscopy. Medial patellofemoral ligament damage and tensed lateral patellar retinaculum were combined. By the time of follow-up at 10~18 months later, no dislocation was found and fear test are all positive. No recurrence of patellar dislocation was observed. Compared the conditions before operation and the last follow-up, Lysholm score (91.38±1.65 vs 60.04±3.93), Kujala score (90.62±2.08 vs 55.27±3.00), patellar camber angle (11.96°±1.43° vs 25.15°±2.13°)were all improved (P<0.01). Conclusion Arthroscopy with suture anchors present good clinical effect in the treatment of acute patellar dislocation, which includes alleviating keen pain, stabilizing joint instability and restoring knee stretching. It also present with less recurrence of patellar dislocation. [ABSTRACT FROM AUTHOR]

The surgical treatment of massive rotator cuff tears is a clinical challenge for orthopaedic surgeons. Moreover, tendon retraction, adhesions and fatty infiltration after rotator cuff tear will further increase the difficulty of surgical repair. Therefore, it has become a hotspot and difficulty to repair massive rotator cuff tears with a better way in current research. In recent years, with the continuous development of arthroscopic techniques, shoulder arthroscopic surgery has become the gold standard for the treatment of massive rotator cuff tears, but the adaptations, effects and combined application of different surgical methods are still controversial. The author believes that arthroscopic debridement of shoulder joint and acromioplasty or tuberoplasty could relieve shoulder pain in the short-term for elderly patients with lower functional requirements;long biceps tenotomy or tenodesis is effective for patients with biceps long head tendon injury; complete repair is still the first line treatment for massive rotator cuff tears, but partial repair is possible for massive rotator cuff tears that could not be completely repaired;patch augmentation technology could bring good results for young patients with high functional requirements;for patients with limited internal and external rotation of the shoulder joint and high functional requirements, tendon transfers surgery is recommended;superior capsular reconstruction is more advantageous for young patients with no obvious glenohumeral arthritis, better deltoid muscle strength and higher functional requirements. In addition, subacromial spacer implantation has become a current research hotspot due to its advantages of small trauma, low cost and relative safety, and its long-term effect still needs to be further confirmed.

Background In situ pinning of slipped capital femoral epiphysis (SCFE) results in various degrees of deformity of the femoral head-neck junction. Repetitive trauma from cam-type femoroacetabular impingement (FAI) can lead to labral tears and injury to the articular cartilage causing loss of function. Arthroscopic osteoplasty is an alternative to open procedure and to Southwick/Imhäuser-type osteotomies in symptomatic selected cases. Surgical technique The amount of bone to be resected has to be carefully planned pre-operatively. Only gentle traction is applied on a well-padded perineal support. A spherical burr is used to gradually resect the prominence. Intra-operative fluoroscopy is very useful when checking adequate reshaping of the head-neck junction is obtained. Results Arthroscopy often reveals acetabular cartilage lesions, labrum hyperhemia and fraying which rarely require repair. Arthroscopic osteoplasty provides satisfactory pain relief and, to a lesser extent, restores hip internal rotation. Conclusion Arthroscopic osteoplasty is more technically and time-demanding in post SCFE than idiopathic FAI. It requires strong arthroscopic skills and experience in hip arthroscopy. It stands as a reasonable alternative to open procedure or flexion osteotomies in symptomatic FAI post mild to moderate SCFE. It provides pain relief and to a lesser extent restores internal rotation of the hip. [ABSTRACT FROM AUTHOR]

Arthroscopic reduction and screw fixation of acetabular fractures have not been reported. In this case report, arthroscopic treatment for acetabular fracture is reported for two patients. A 49-year-old man diagnosed with acetabular posterior wall fracture was treated by arthroscopic reduction and fixation using two screws. A 20-year-old woman who diagnosed with anterior column fracture was fixed using a screw using the arthroscopic technique prior to open reduction and internal fixation in the iliac bone fracture. Arthroscopic reduction and fixation in some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. Level of evidence V. [ABSTRACT FROM AUTHOR]