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Objective: To retrospectively evaluate clinical outcomes, including function and pain, of patients after our all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis procedure; factors influencing results were also evaluated. Given the frequent association of rotator cuff tear with long head of biceps lesion and the need for effective combined treatment strategies, this study aims to evaluate the efficacy of our technique and compare it with established methods. We hypothesized that our technique would significantly improve function and reduce pain in patients with rotator cuff tears and biceps pathology. Methods: This is a retrospective study that included patients older than 20 years who underwent all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis procedures for concomitant rotator cuff tear and long head biceps pathology, from 2016 to 2020. Patients were evaluated preoperatively and at a minimum of 2 years of follow‐up using the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores paired t‐tests were used for analysis and statistical significance was set at p < 0.05(two‐tailed). The satisfaction rate and complications were also evaluated. Results: After an average follow‐up of 2.3 years, 118 patients demonstrated significant improvement in both the ASES score (from 36.13 to 95.01, p < 0.001) and VAS score (from 6.81 to 0.89, p < 0.001). Ninety‐four percent of the patients reported satisfaction with the surgical outcome. No complications related to Popeye deformity, biceps cramping pain, or ipsilateral shoulder reoperation were observed. Factors such as age, sex, body mass index (BMI), smoking status, alcohol consumption, hypertension, and diabetes did not influence the results. Patients showed significant improvement in both the ASES and VAS scores (p < 0.001). Conclusion: At a mean follow‐up time of 2.3 years, the all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis is a therapeutic and efficient procedure. The procedure revealed a satisfactory functional outcome, reduced pain, and minimal complications and reoperations. [ABSTRACT FROM AUTHOR]

Background: Bone marrow stimulation (BMS) has been proposed to augment healing at the time of arthroscopic rotator cuff repair (ARCR) by creating several bone marrow vents in the footprint of the rotator cuff, allowing mesenchymal stem cells, platelets, and growth factors to cover the area as a "crimson duvet." Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes after BMS and a control for those undergoing ARCR. Study Design: Meta-analysis; Level of evidence, 1. Methods: A literature search of 3 databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing BMS and a control for ARCR were included. Clinical outcomes were compared, and a P value <.05 was considered to be statistically significant. Results: A total of 7 RCTs with 576 patients were included. Overall, 18.8% of patients treated with BMS and 21.0% of patients treated with a control had a retear (I 2 = 43%; P =.61). With BMS, the mean Constant score was 88.2, and with the control, the mean Constant score was 86.7 (P =.12). Additionally, there was no significant difference in the American Shoulder and Elbow Surgeons score (94.3 vs 93.2, respectively; P =.31) or visual analog scale score (0.9 vs 0.9, respectively; P =.89). Conclusion: The level 1 evidence in the literature did not support BMS as a modality to improve retear rates or clinical outcomes after ARCR. [ABSTRACT FROM AUTHOR]

Posterior shoulder instability is a distinct subcategory of shoulder instability with an incidence higher than previously reported. Pain is typically the primary complaint, with pathology due to repetitive microtrauma being more common that a specific traumatic event. If nonoperative treatment fails, arthroscopic posterior capsulolabral repair has been shown to result in excellent outcomes and return to sport, with American football players having the best outcomes and throwers being slightly less predictable. Risk factors for surgical failure include decreased glenoid bone width, rotator cuff injury, female gender, and the use of less than 3 anchors. [ABSTRACT FROM AUTHOR]

Background: Several studies have investigated factors affecting patient satisfaction after arthroscopic rotator cuff repair (ARCR); however, it is unknown if these factors vary according to age. Therefore, this study aimed to evaluate the factors associated with satisfaction of ARCR in individuals 70 years and older versus younger patients. Methods: Among 319 consecutive patients who underwent ARCR, 173 were included. Patients were divided into an old age group (≥70 years) and a young age group (<70 years), and the two age groups were further divided into satisfied and unsatisfied subgroups. Patient satisfaction was evaluated at the final follow-up visit using a binary question (yes or no). Clinical outcomes were assessed preoperatively and at the final follow-up. Results: Satisfaction rates in the older and younger age groups were 75.41% and 79.47%, respectively. Mean changes in Constant and American Shoulder and Elbow Surgeons scores were significantly different between the satisfied and unsatisfied subgroups (P=0.031 and P=0.012, respectively) in the young patients. In the old patients, there was a significant difference in the mean change in depression subscale of the Hospital Anxiety and Depression Scale (P=0.031) and anxiety subscale of the Hospital Anxiety and Depression Scale (P=0.044) scores between the satisfied and unsatisfied subgroups. Conclusions: Factors affecting patient satisfaction after ARCR differed according to age. Psychological improvement was more important to elderly patients, whereas restoration of function was more important to younger patients. Pain relief was important for both age groups. Level of evidence: III. [ABSTRACT FROM AUTHOR]

For most shoulder surgeons, addressing massive rotator cuff tears that have retracted ends poses a significant challenge. This study introduces a technique, termed the "sandwich augmentation technique," which incorporates the long head of the biceps tendon (LHBT) into a single-row rotator cuff repair. The procedure, performed arthroscopically with the patient in the lateral decubitus position, involves attaching the LHBT and rotator cuff tissues together to the greater tuberosity. This effectively sandwiches them within the rotator cuff footprint. The goal of this technique is to enhance the thickness of the fully interposed cuff margin, thereby providing better support for the repair. The sandwich augmentation technique, which integrates the biceps into the rotator cuff repair, has demonstrated positive clinical outcomes and moderate anatomical results. It also prevents superior migration of the humeral head in cases of large or massive rotator cuff tears. Further research is required to assess the long-term effectiveness of this procedure. [ABSTRACT FROM AUTHOR]

Objective To retrospectively evaluate clinical outcomes, including function and pain, of patients after our all arthroscopic “whole layer” rotator cuff repair technique with simultaneous biceps tenodesis procedure; factors influencing results were also evaluated. Given the frequent association of rotator cuff tear with long head of biceps lesion and the need for effective combined treatment strategies, this study aims to evaluate the efficacy of our technique and compare it with established methods. We hypothesized that our technique would significantly improve function and reduce pain in patients with rotator cuff tears and biceps pathology. Methods This is a retrospective study that included patients older than 20 years who underwent all arthroscopic “whole layer” rotator cuff repair technique with simultaneous biceps tenodesis procedures for concomitant rotator cuff tear and long head biceps pathology, from 2016 to 2020. Patients were evaluated preoperatively and at a minimum of 2 years of follow‐up using the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores paired t‐tests were used for analysis and statistical significance was set at p

Background: In order to do arthroscopic surgery on medial meniscus injuries, there must be enough joint space and good visibility for instrumentation. There is a possibility of iatrogenic cartilage damage if the medial joint space is reduced. Therefore, a medial collateral ligament (MCL) releasing procedure may be necessary for the majority of individuals with medial knee tightness. The MCL residual laxity after pie-crusting release during arthroscopic medial meniscus repair in medial knee tightness were studied in this study. Methods: Between July 2022 and June 2023, fourteen patients (4 male, 10 female) underwent medial meniscus surgery with pie-crusting release of the superficial MCL. Mean age was 50 ± 10 years (range, 35–63 years). Medial meniscal lesions were meniscus root tear in 10 cases (71.5 %), longitudinal tear in 2 (14.5 %), horizontal tear in 1 (7 %) and radial tear in 1 (7 %). Preoperatively, valgus stress radiographs were obtained. During surgery if arthroscopic exploration revealed medial joint space narrowing after applying valgus force with the knee in 20 degrees of flexion, pie-crusting MCL release was performed. At the 3-month follow-up, valgus stress radiographs were obtained. Residual MCL laxity was assessed by comparing preoperative and 3-month follow-up medial joint space width measurements. Result: At the 3-month follow-up, no significant increase in the medial joint space width on valgus stress radiograph was observed in comparison to the preoperative. The medial joint space width on valgus stress radiograph was 7.42 ± 1.16 mm preoperatively and 7.47 ± 1.15 mm at 3-month postoperatively (p value = 0.914). All patients had no intraoperative iatrogenic cartilage injury and no saphenous nerve injury after operation. Conclusions: The magic point pie-crusting MCL release is a reliable and useful procedure to arthroscopic surgery in patients with medial meniscal injury and medial knee tightness. Furthermore, percutaneous pie-crusting MCL release had no effect on residual valgus laxity at the last follow-up.

BACKGROUND: The optimal surgical technique for treating posterior cruciate ligament tibial attachment point avulsion injuries is debatable. With the application and maturity of arthroscopic surgery, it has great prospects in the diagnosis and treatment of posterior cruciate ligament tibial attachment point avulsion fractures. OBJECTIVE: To summarize the application and progress of arthroscopic technology in the treatment of posterior cruciate ligament tibial attachment point avulsion fractures, including different arthroscopic treatment methods, surgical approach, tibial tunnel design, suture material selection, and internal fixation implant selection. METHODS: Relevant literature was retrieved from PubMed, Web of Science, and ScienceDirect databases through computers. The search period was from January 2003 to November 2023. Chinese search terms were "posterior cruciate ligament, posterior cruciate ligament, avulsion fracture, arthroscopy". English search terms were "posterior cruciate ligament, injury, fracture, tibia, arthroscopic, operation, fixation, treatment". Totally 97 articles were included for review. RESULTS AND CONCLUSION: Arthroscopic technology provides a reliable treatment for posterior cruciate ligament tibial attachment point avulsion fractures. Arthroscopic treatment for avulsion fractures of the tibial attachment point of the cruciate ligament can be divided into several categories based on the type of approach, suture material, and the number of approaches used for suture and fixation of the tibial tunnel: arthroscopic suture fixation combined with autologous graft enhancement and reconstruction, arthroscopic multi cross band suture bridge fixation, arthroscopic strong thread fixation, and arthroscopic direct anterior posterior suture suspension fixation. In various studies, commonly used outcome measures include knee range of motion, Lysholm scale, International Knee Documentation Committee, and KT-2000 arthrometer. Studies have shown that at the last follow-up, the score results showed significant improvement compared to surgery. In the radiological follow-up results of various arthroscopic techniques, all studies have shown satisfactory results. During the follow-up process, all types of patients who received arthroscopic treatment for cruciate ligament tibial attachment point avulsion fractures did not experience serious complications, such as traumatic arthritis, neurovascular injury, perioperative wound infection, thrombosis, and nonunion of fractures. [ABSTRACT FROM AUTHOR]

Objectives: The evaluation of the outcomes of patients undergoing arthroscopic unilateral meniscus repair on receiving intra-articular injection (IAI) of dexmedetomidine (DXM) alone in dose of 2 µg/kg or in dose of 1 µg/kg with other analgesics. Patients & Methods: 150 patients were randomly distributed between 5-groups: C-Group received saline, Study Group I (SI-Group) received DXM 2 µg/kg, SII, SIII and SIV groups received DXM 1 µg/kg with ketamine 0.5 mg/kg, dexamethasone (DXA) 8-mg or ketorolac 30-mg, respectively, with bupivacaine. Bupivacaine spinal anesthesia was provided, and IAI was injected through an arthroscopic port as a single shot. The study outcome is the efficacy of IAI of DXM as judged by pain scores, duration till requesting morphine, times of requesting, and total dose of morphine used during 12-h after IAI. Results: Pain scores and the cumulative scores were significantly lower in the study groups with lower frequency of requests and the total dose of morphine compared to the C-Group with insignificant difference between study groups. The incidence of adverse events was significantly lower in SIII-Group than in other groups. Patients' and surgeons' satisfaction was higher in the study groups than C-Group. Conclusion: The IAI of DXM alone or in combination with any other analgesic is an effective and safe analgesic modality for post-arthroscopic surgeries. All additives were effective in terms of reduction of pain score and opioid consumption, but the side effects of ketamine and duration of analgesia of ketorolac are questionable. However, DXA is an efficient analgesic with minimal side effects. [ABSTRACT FROM AUTHOR]

Background Several studies have investigated factors affecting patient satisfaction after arthroscopic rotator cuff repair (ARCR); however, it is unknown if these factors vary according to age. Therefore, this study aimed to evaluate the factors associated with satisfaction of ARCR in individuals 70 years and older versus younger patients. Methods Among 319 consecutive patients who underwent ARCR, 173 were included. Patients were divided into an old age group (≥70 years) and a young age group (

Abstract Background We report a rare case of posterior cruciate ligament (PCL) calcification, which has only been reported in two case studies on PubMed. Case presentation A 71-year-old man developed left popliteal pain in the morning without any history of trauma and the pain became severe that night. On the following day, he presented to our department. The patient could not flex his left knee at all due to pain and swelling. CT and MRI scans showed calcification behind the PCL with mild osteoarthritic changes and accumulation of synovial fluid in the joint. Synovial fluid analysis did not reveal any crystals. Blood tests at first admission showed inflammation, hyperglycemia, and low blood uric acid levels. Although the patient’s knee joint was injected with steroids, his symptoms did not improve. Thus, we performed arthroscopic surgery two days after symptoms had appeared. Intraoperatively, we observed a white, soft tissue in the synovial membrane behind the PCL. Part of this tissue was collected for histological analysis, which revealed sparse fibers with calcium deposits. Immediately after surgery, the patient’s symptoms were completely gone. Afterward, the patient remained asymptomatic one month after surgery. Conclusion This is the first reported case of debridement of PCL calcification and ossification that was performed soon after symptoms appeared. In addition, we demonstrated that early debridement led to complete recovery.

Objective Weight is an influential factor in knee osteoarthritis (KOA). However, the effect of abnormal body weight on chitosan's efficacy in treating KOA is unclear. This study aimed to explore the differences in the effectiveness of arthroscopic surgery combined with intra‐articular chitosan injection for KOA in patients with abnormal body weight. Methods Patients with stage II‐III KOA (Kellgren–Lawrence rating, K‐L) undergoing arthroscopic surgery were recruited for this clinical study from January 2020 to September 2021. Based on body mass index (BMI) and intra‐articular chitosan injection, patients with KOA undergoing arthroscopic surgery (138 patients) were divided into four groups: low‐weight‐non‐injection (Lw‐N, BMI 0.05). The proportion of patients undergoing subsequent knee arthroplasty during the 2‐year follow‐up period was significantly higher in the Ow‐CS group (20/35) than in the Lw‐CS group (12/39) (p 0.05). Conclusion Arthroscopic surgery combined with intra‐articular chitosan injection shows short‐term positive effects in treating KOA. Intra‐articular chitosan injection appears to have a greater short‐term pain relief effect in obese patients.

Background: We report a rare case of posterior cruciate ligament (PCL) calcification, which has only been reported in two case studies on PubMed. Case presentation: A 71-year-old man developed left popliteal pain in the morning without any history of trauma and the pain became severe that night. On the following day, he presented to our department. The patient could not flex his left knee at all due to pain and swelling. CT and MRI scans showed calcification behind the PCL with mild osteoarthritic changes and accumulation of synovial fluid in the joint. Synovial fluid analysis did not reveal any crystals. Blood tests at first admission showed inflammation, hyperglycemia, and low blood uric acid levels. Although the patient's knee joint was injected with steroids, his symptoms did not improve. Thus, we performed arthroscopic surgery two days after symptoms had appeared. Intraoperatively, we observed a white, soft tissue in the synovial membrane behind the PCL. Part of this tissue was collected for histological analysis, which revealed sparse fibers with calcium deposits. Immediately after surgery, the patient's symptoms were completely gone. Afterward, the patient remained asymptomatic one month after surgery. Conclusion: This is the first reported case of debridement of PCL calcification and ossification that was performed soon after symptoms appeared. In addition, we demonstrated that early debridement led to complete recovery. [ABSTRACT FROM AUTHOR]

Objective: Weight is an influential factor in knee osteoarthritis (KOA). However, the effect of abnormal body weight on chitosan's efficacy in treating KOA is unclear. This study aimed to explore the differences in the effectiveness of arthroscopic surgery combined with intra‐articular chitosan injection for KOA in patients with abnormal body weight. Methods: Patients with stage II‐III KOA (Kellgren–Lawrence rating, K‐L) undergoing arthroscopic surgery were recruited for this clinical study from January 2020 to September 2021. Based on body mass index (BMI) and intra‐articular chitosan injection, patients with KOA undergoing arthroscopic surgery (138 patients) were divided into four groups: low‐weight‐non‐injection (Lw‐N, BMI <18.5); low‐weight‐chitosan injection (Lw‐CS, BMI <18.5); overweight‐non‐injection (Ow‐N, BMI ≥25); overweight‐chitosan injection (Ow‐CS, BMI ≥25). A 2‐year follow‐up was conducted to evaluate various indicators, including the visual analogue scale (VAS) and the Western Ontario and McMaster Universities osteoarthritis index score (WOMAC). Statistical analyses were performed using relevant parametric or non‐parametric tests. Results: In total, 138 patients with KOA were included in this study. There were no significant differences in gender, age, and incidence of chronic residual pain after arthroscopy among the four groups (p > 0.05). The proportion of patients undergoing subsequent knee arthroplasty during the 2‐year follow‐up period was significantly higher in the Ow‐CS group (20/35) than in the Lw‐CS group (12/39) (p < 0.05). The K‐L rating showed an overall increasing trend over time, with the K‐L rating in the Ow‐N and Ow‐CS groups significantly higher than that in the Lw‐CS group at the final follow‐up (p < 0.05). VAS and WOMAC scores significantly decreased at 1 and 3 months post‐arthroscopy and then increased. One month after arthroscopy, VAS was significantly lower (p < 0.05) in the intra‐articular chitosan injection groups (Lw‐CS and Ow‐CS) compared with the non‐injection groups (Lw‐N and Ow‐N). VAS was lower in the Ow‐CS group than in the Lw‐CS group (p < 0.05). There was no significant difference in WOMAC between the intra‐articular chitosan injection and non‐injection groups at each time point (Lw‐N vs. Lw‐CS, Ow‐N vs. Ow‐CS, p > 0.05). Conclusion: Arthroscopic surgery combined with intra‐articular chitosan injection shows short‐term positive effects in treating KOA. Intra‐articular chitosan injection appears to have a greater short‐term pain relief effect in obese patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare clinical scores and imaging outcomes of bony Bankart lesions that underwent single‐point and modified double‐pulley fixation after at least 2 years of follow‐up. Methods: Patients who underwent surgery to treat bony Bankart injuries were included and divided into groups A and B. A total of 69 patients were included (32 in group A and 37 in group B). Patients in group A underwent arthroscopic modified double‐pulley fixation and patients in group B underwent arthroscopic single‐point fixation. Three‐dimensional computed tomography (3D‐CT) was used to assess glenoid reduction one day after surgery. Postoperative bony union was assessed using 3D‐CT and multiplanar reconstruction images 6 months after surgery. Constant–Murley, Rowe rating system, visual analogue scale and University of California at Los Angeles and American Shoulder and Elbow Surgeons scores were recorded before and after surgery. Results: In terms of imaging measurements, there was no significant group difference in the preoperative size of the glenoid defect, the size of the bony fragment or the expected postoperative size of the glenoid defect. The sizes of the actual postoperative glenoid defects differed significantly between the groups (p = 0.027), as did the absolute difference between the expected and actual glenoid defect sizes (p < 0.001). At 6 months postoperatively, 50.0% of group A patients and 24.3% of group B patients exhibited complete bony union (p = 0.027); the rates of partial union were 37.5% and 56.8%, respectively. At the final follow‐up, all clinical scores were significantly better than the preoperative scores (all p < 0.05), with no significant group differences (not significant). Conclusions: The use of the modified double‐pulley technique with two anchors to treat bony Bankart injuries provides a better reduction of bone fragments than single‐point fixation with two anchors and was associated with a higher rate of early bone union. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate mid‐ to long‐term clinical outcomes after arthroscopic bucket‐handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). Methods: A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty‐five patients with an average follow‐up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post‐operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. Results: The failure rate was 9%. Medial BHMT repair showed superior post‐operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post‐operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow‐up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post‐operative outcome measures was observed but did not reach statistical significance for most items. Conclusion: Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow‐up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level of Evidence: Level IV (retrospective case series). [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of knee arthroscopic surgery combined with orthopedic brace treatment on perioperative indexes, knee function and joint range of motion in patients with knee osteoarthritis. Methods: A total of 116 patients with knee osteoarthritis from January 2020 to January 2023 were divided into observation and matched groups with 58 patients in each group. The matched group underwent knee arthroscopy alone, and the observation group used knee arthroscopy combined with orthopedic brace to compare the perioperative index, the rate of knee function and the range of joint mobility. Results: There was no difference between the two groups in the perioperative indexes related to operation time, intraoperative bleeding, incision length and hospital stay (P>0.05); There was no difference between the two groups in the knee joint assessment (HSS) and the American Knee Association score (KSS) of the American Special Surgery Hospital before treatment (P>0.05). Post-treatment, the HSS score and KSS score of the two groups in- creased, and the observation group was higher than the matched group (P<0.05); The total incidence of complications such as arthritis progression, joint bleeding and fibrosis, pad dislocation, prosthesis loosening and infection in the observation group was lower than the matched group (P<0.05); There was no difference between the two groups in terms of the maximum joint extension angle, maximum joint flexion and extension range of motion, tibial plateau caster angle and tibiofemoral angle before treatment (P>0.05). Post-treatment, the maximum joint extension angle, tibial plateau caster angle and tibiofemoral angle of the two groups decreased. The observation group was lower than the matched group, and the maximum joint flexion and extension range of motion increased, and the observation group was different with matched group (P<0.05). Conclusion: The treatment of knee osteoarthritis with knee arthroscopic surgery and orthopedic brace can reduce and improve the recovery level of knee function, reduce postoperative complications, and improve the range of motion of knee joint [ABSTRACT FROM AUTHOR]

ObjectivesTo identify risk factors for tendon healing failure following arthroscopic rotator cuff repair (ARCR) in patients with small to medium-sized rotator cuff tears (RCTs).MethodsA retrospective study was conducted on 320 patients with RCTs who underwent arthroscopic repair between June 2018 and June 2021. All patients had at least 2 years of postoperative follow-up, with MRI scans at the final assessment. Based on MRI results, patients were categorized into the healing success group (Group A: types I–III) or the healing failure group (Group B: types IV–V). Variables associated with rotator cuff healing, including patient characteristics, baseline symptoms, imaging data, and surgery-related factors, were analyzed using univariate and multivariate logistic regression.ResultsHealing failure occurred in 54 of the 320 patients (16.9%). Functional status improved significantly across all patients (P

Osgood-Schlatter disease (OSD), a form of traction apophysitis, predominantly affects adolescents engaged in high-impact activities. While conservative management is often effective, surgical intervention becomes necessary in refractory cases. This case report details an innovative arthroscopic approach to treat adult OSD, where traditional methods failed. A 29-year-old male athlete with persistent OSD symptoms underwent arthroscopic surgery after unsuccessful non-surgical treatments. The procedure, utilizing a unique combination of portals, demonstrated positive clinical and radiological outcomes. Arthroscopic removal of the bony particle was undertaken using six portals with a novel setting (consisting of medial and lateral superior, standard, and inferior portals) to minimize the damage to the patellar tendon and intermeniscal ligaments. This setting of portals also obviates the need for fluoroscopy since it provides adequate visualization for confirmation of complete removal of the bony particle. The lower portals also provide more convenient access to the bony particle, minimizing the possibility of incomplete removal and persistence of symptoms. The patient experienced complete resolution of anterior knee pain and prominence within six months post-surgery. Arthroscopic removal of the ossicle involved the use of superior portals for optimal access and visualization. Low portals were strategically employed to eliminate the need for fluoroscopy, offering a unique advantage. Postoperative rehabilitation included immobilization followed by a gradual return to weight-bearing and full range of motion. Arthroscopic removal remains the preferred method for treating OSD, emphasizing fewer complications. However, challenges related to limited access and anatomical restoration persist.

Abstract Purpose To compare the difference in analgesic effect between femoral triangle block (FTB) and adductor canal block (ACB) during arthroscopic knee surgery. Methods Patients who underwent arthroscopic knee surgery were randomized preoperatively to FTB group or ACB group. For each group, 20 mL of 0.1% ropivacaine was injected. Primary outcomes: The numeric rating score (NRS) at 12 h after surgery at rest and during movement. Secondary outcome: (1) The NRS at post anesthesia care unit (PACU) and 2, 24 h after surgery at rest and during movement; (2) The quadriceps muscle strength at PACU and 2, 12, 24 h after surgery; (3) Consumption of Rescue analgesia; (4) Incidence of adverse reactions. Results The NRS at 12 h after surgery at rest and during movement of ACB group were higher than FTB group. Among secondary outcomes, the NRS at PACU at rest and during movement, 2 h after surgery during movement of FTB group lower than ACB group; the quadriceps muscle strength at 2 h after surgery of FTB group stronger than ACB group. After multiple linear regression model analysis, the data showed additional statistically significant reduction NRS at 24 h after surgery at rest (0.757, p = 0.037) in FTB group. Other outcomes were similar between two groups. Conclusions The FTB appears to provide superior pain control after knee arthroscopy than ACB, the FTB is superior to the ACB in quadriceps muscle strength at 2 h after surgery. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2300068765). Registration date: 28/02/2023.

Resumen: El adecuado control del dolor posquirúrgico en pacientes intervenidos de artroscopia de rodilla resulta de suma importancia para permitir una movilización precoz, y con ello, el inicio de la rehabilitación. Método: Setenta pacientes fueron intervenidos de artroscopia de rodilla los cuales fueron asignados aleatoriamente en 2 grupos (n = 35). El grupo RD recibió ropivacaína 1,5 mg/kg más dexmedetomidina 1μg/kg por vía intraarticular. El grupo R recibió ropivacaína 1,5 mg/kg por vía intraarticular. Se evaluó el efecto analgésico midiendo la intensidad del dolor (puntuación de Escala Visual Análoga) y la duración de la analgesia. Resultados: Mayor duración analgésica en el grupo RD (655 min) comparado con el grupo R (318 min), siendo esta diferencia estadísticamente significativa (p = 0,03). Conclusión: La dexmedetomidina como adyuvante de la ropivacaína por vía intraarticular mejora la calidad y la duración de la analgesia posquirúrgica en pacientes intervenidos de artroscopia de rodilla. Abstract: The effective relief of postsurgical pain in patients undergoing knee arthroscopy is important to allow the initiation of activities of daily living. The objective of this study is to demonstrate the analgesic efficacy of dexmedetomidine as an adjuvant added to ropivacaine by the intra-articular route. Method: Seventy patients underwent knee arthroscopy which were randomly assigned into two groups (n = 35). The RD group received ropivacaine 1.5 mg/kg plus dexmedetomidine 1 μg/kg intra-articularly. Group R received ropivacaine 1.5 mg/kg intra-articularly. The analgesic effect was evaluated by measuring the intensity of pain (VAS score) and the duration of analgesia. Results: A longer duration of the analgesic effect was observed in the RD group (655 min) compared to the R group (318 min) being statistically significant (p = 0.03). Conclusion: Dexmedetomidine as an adjuvant to intra-articular ropivacaine improves the quality and duration of postoperative analgesia in patients undergoing knee arthroscopy.

Objective While the incidence of peroneal tendon dislocation (PTD) is relatively low, it is frequently underdiagnosed in clinical practice, and the misdiagnosis or improper treatment of this condition may lead to a decline in patients' quality of life. Currently, the surgical treatment options for PTD mainly include open and arthroscopic surgery. However, in order to evaluate the advantages and disadvantages of these two surgical approaches, further comparative research is needed. Therefore, the aim of this study is to investigate the early clinical outcomes of arthroscopic and open surgery in the treatment of Ogden type 1–2 PTD. Methods We conducted a comprehensive analysis of 46 patients diagnosed with PTD who underwent surgery at our institution between January 2017 and January 2023. The patients were divided into two groups: the open surgery group, consisting of 26 cases, and the arthroscopic surgery group, consisting of 20 cases. To compare the effectiveness of the surgical approach, we evaluated several parameters, including the integrity of the superior peroneal retinaculum on MRI images, functional scores, pain interference scores, and ankle eversion muscle strength. These assessments are conducted respectively before the surgery, 1 month after the surgery, 3 months after the surgery, and at the final follow‐up for each group of patients (at least 6 months post‐surgery). Demographics and intergroup comparisons of the two groups of data were analyzed by t‐test or the Mann–Whitney U test. Intragroup comparisons of the two groups of data were analyzed by one‐way analysis of variance (ANOVA) or the Kruskal–Wallis test, followed by post hoc multiple comparisons. Results In the intragroup comparisons, both the arthroscopic surgery and the open surgery group demonstrated significant improvement in functional scores, pain interference scores, muscle strength, and MRI findings at the final follow‐up postoperatively (p

For most shoulder surgeons, addressing massive rotator cuff tears that have retracted ends poses a significant challenge. This study introduces a technique, termed the “sandwich augmentation technique,” which incorporates the long head of the biceps tendon (LHBT) into a single-row rotator cuff repair. The procedure, performed arthroscopically with the patient in the lateral decubitus position, involves attaching the LHBT and rotator cuff tissues together to the greater tuberosity. This effectively sandwiches them within the rotator cuff footprint. The goal of this technique is to enhance the thickness of the fully interposed cuff margin, thereby providing better support for the repair. The sandwich augmentation technique, which integrates the biceps into the rotator cuff repair, has demonstrated positive clinical outcomes and moderate anatomical results. It also prevents superior migration of the humeral head in cases of large or massive rotator cuff tears. Further research is required to assess the long-term effectiveness of this procedure.

Background The dimensions of popliteus muscle and its tendon are subjected to variability in the origin, mode of insertion, innervation patterns and vascular supply. The aim of this study was to measure the length, thickness and width of the popliteus muscle and its tendon at its different parts. The objectives were to study the topographic anatomy of the neurovascular structures of the popliteus and also to determine the dimensions of the popliteo-fibular ligament. Methods This descriptive cross sectional institutional based study included 50 formalin embalmed adult lower limb specimens. The measurements were performed by using the digital Vernier caliper. Results The length of the popliteus muscle belly along the upper and lower border were 44.2±6.63 mm and 89.26±14.41 mm, width of the muscle belly at midpoint, musculotendinous junction and insertion were 28.45±6.85 mm, 11.7±3.5 mm and 75.95±10.7 mm. The thickness of muscle belly at the midpoint was 2.55±0.55 mm. The length of popliteal tendon, width at origin and at musculotendinous junction were 24.85±2.15 mm, 7.55±1.55 mm and 8.5±1.15 mm. The thickness of tendon of popliteus was 2.6±0.75 mm. The length of nerve to popliteus was 50.44±8.66 mm and its origin was located 27.54±6.18 mm from the intercondylar line. The distance of origin of medial and lateral geniculate arteries from the intercondylar line were 26.26±10.47 mm and 20.76±5.19 mm. The distance of division of popliteal artery was 49.44±16.26 mm from the intercondylar line. The length and width of the popliteo-fibular ligament was 17.84±3.43 mm and 7.36±1.9 mm individually. Conclusions This study offered detailed morphometric data of the popliteus and it is believed that the data of this anatomical research is enlightening to orthopedic surgeons particularly in the field of arthroscopic and plastic surgery. The data can be considered as the database from our population.

Purpose: To compare the difference in analgesic effect between femoral triangle block (FTB) and adductor canal block (ACB) during arthroscopic knee surgery. Methods: Patients who underwent arthroscopic knee surgery were randomized preoperatively to FTB group or ACB group. For each group, 20 mL of 0.1% ropivacaine was injected. Primary outcomes: The numeric rating score (NRS) at 12 h after surgery at rest and during movement. Secondary outcome: (1) The NRS at post anesthesia care unit (PACU) and 2, 24 h after surgery at rest and during movement; (2) The quadriceps muscle strength at PACU and 2, 12, 24 h after surgery; (3) Consumption of Rescue analgesia; (4) Incidence of adverse reactions. Results: The NRS at 12 h after surgery at rest and during movement of ACB group were higher than FTB group. Among secondary outcomes, the NRS at PACU at rest and during movement, 2 h after surgery during movement of FTB group lower than ACB group; the quadriceps muscle strength at 2 h after surgery of FTB group stronger than ACB group. After multiple linear regression model analysis, the data showed additional statistically significant reduction NRS at 24 h after surgery at rest (0.757, p = 0.037) in FTB group. Other outcomes were similar between two groups. Conclusions: The FTB appears to provide superior pain control after knee arthroscopy than ACB, the FTB is superior to the ACB in quadriceps muscle strength at 2 h after surgery. Trial registration: The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2300068765). Registration date: 28/02/2023. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively. Methods: In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark. Results: Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2–15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups. Conclusion: The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels. [ABSTRACT FROM AUTHOR]

Objective: While the incidence of peroneal tendon dislocation (PTD) is relatively low, it is frequently underdiagnosed in clinical practice, and the misdiagnosis or improper treatment of this condition may lead to a decline in patients' quality of life. Currently, the surgical treatment options for PTD mainly include open and arthroscopic surgery. However, in order to evaluate the advantages and disadvantages of these two surgical approaches, further comparative research is needed. Therefore, the aim of this study is to investigate the early clinical outcomes of arthroscopic and open surgery in the treatment of Ogden type 1–2 PTD. Methods: We conducted a comprehensive analysis of 46 patients diagnosed with PTD who underwent surgery at our institution between January 2017 and January 2023. The patients were divided into two groups: the open surgery group, consisting of 26 cases, and the arthroscopic surgery group, consisting of 20 cases. To compare the effectiveness of the surgical approach, we evaluated several parameters, including the integrity of the superior peroneal retinaculum on MRI images, functional scores, pain interference scores, and ankle eversion muscle strength. These assessments are conducted respectively before the surgery, 1 month after the surgery, 3 months after the surgery, and at the final follow‐up for each group of patients (at least 6 months post‐surgery). Demographics and intergroup comparisons of the two groups of data were analyzed by t‐test or the Mann–Whitney U test. Intragroup comparisons of the two groups of data were analyzed by one‐way analysis of variance (ANOVA) or the Kruskal–Wallis test, followed by post hoc multiple comparisons. Results: In the intragroup comparisons, both the arthroscopic surgery and the open surgery group demonstrated significant improvement in functional scores, pain interference scores, muscle strength, and MRI findings at the final follow‐up postoperatively (p < 0.01). However, the open surgery group exhibited significant improvements in these outcomes at the final follow‐up, while the arthroscopic surgery group showed significant improvement at 3 months postoperatively. In intergroup comparisons, the arthroscopic surgery group outperformed the open surgery group in functional scores, pain interference scores, and muscle strength 3 months after the surgery, with statistically significant differences (p < 0.01). Conclusion: Arthroscopic surgery offers advantages in early clinical outcomes, such as pain relief, function, and muscle strength improvement. However, over time, both approaches provide similar results regarding effectiveness. [ABSTRACT FROM AUTHOR]

This technical note aimed to present a straigthforward method for harvesting quadriceps tendon autografts with the use of a simple vaginal speculum and direct visualisation of a scope. Anterior cruciate ligament reconstruction with quadriceps tendon autografts has gained popularity in recent years, with many harvesting techniques that use different harvesting systems available on the market. These techniques vary from transverse to longitudinal skin incisions and from open to minimally invasive approaches and have a learning curve, as with the majority of surgical procedures. The technique proposed in this technical note is minimally invasive, can be easily reproduced by any surgeon irrespective of their experience, has a short learning curve, requires no additional cost or technical support during the procedure and creates a stable working space that allows for freedom of manipulation of surgical instruments and the arthroscope. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic rotator cuff repair (ARCR) is one of the most commonly performed orthopaedic procedures; however, it is unclear how to manage patients with symptomatic retears. Purpose: To perform a systematic review to evaluate the outcomes of revision ARCR in the literature. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed utilizing the Embase, MEDLINE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on revision rotator cuff repair. Clinical outcomes were recorded. Results: The 17 included studies were composed of 888 shoulders in 885 patients. The mean age of the 885 patients was 58.6 ± 9.1 years, with a mean follow-up of 28.1 ± 22.1 months. The mean visual analog scale score was 2.1 ± 1.8, the mean American Shoulder and Elbow Surgeons score was 75.0 ± 18.3, and the mean Constant score was 67.4 ± 16.6. The overall rate of retears after revision was 25.3%, with an 8.0% reoperation rate including 2.7% undergoing reverse shoulder arthroplasty and 2.0% undergoing subsequent rotator cuff repair. Finally, the complication rate was 8.6%. Conclusion: Revision ARCR improved patient-reported outcomes, with 92% of patients free from reoperations at a mean follow-up of 2 years. Overall, 78.4% of patients were satisfied at final follow-up; however, the rate of retears was found to be higher than after primary ARCR. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of gender on dosage of remimazolam and quality of recovery in patients undergoing ambulatory arthroscopic surgery at 24 hours postoperatively. Methods Fifty patients who underwent elective arthroscopic meniscus repair in a daytime surgery center were divided into two groups according to gender: 25 males (group M) and 25 females (group F). The remimazolam dogages of loss of consciousness and anesthesia maintenance were recorded, and the effects of gender on the quality of recovery at 24 hours postoperatively and sleepquality were observed by using QoR-15 scale and Athens Insomnia Scale (AIS). Results The doses of remimazolam at the time of loss of consciousness and anesthesia maintenance for patients were (0.13 and 0.15) mg/kg and 0.80 (0.60 and 0.96) mg/ (kg·h) in group M, and 0.14 (0.12 and 0.16) mg/kg and 0.90 (0.79 and 1.12) mg/ (kg·h) in group F. There were no statistical differences in the doses of remimazolam between the two groups (P > 0.05). AIS scores did not differ on postoperative day one between the two groups (P > 0.05), but there was a statistically significant difference on final awakening earlier than expectation in the female patients (P < 0.05). Female patients had lower total QoR-15 scores and physiological comfort scores, and higher incidences of hypotension and PONV than male patients (P < 0.05). Conclusions Gender had no significant effects on dosage of remimazolam during anesthesia induction and anesthesia maintenance in the patients receiving daytime arthroscopy. Female patients had final awakening earlier than expectation, and male patients had higher quality of recovery at 24 hours postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the clinical outcomes, patient-reported outcomes, and recurrence rate of patients diagnosed with ankle gouty arthritis who underwent arthroscopic surgery based on the new classification. Methods: A total of 51 patients diagnosed with ankle gouty arthritis were included in this retrospective study. A new classification was proposed based on the location and extent of MSU crystal deposition under an arthroscopy view. Patients are classified into different types and underwent arthroscopic surgery accordingly. The primary outcome measure was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. The secondary outcomes included the visual analog pain scale (VAS), serum uric acid levels, and the recurrence rate of ankle gouty arthritis at one year postoperatively. Results: Based on the new classification, five patients were Type I, 24 patients were Type II, five were Type III A, six were Type III B, and 11 were Type IV. The average follow-up time was 23.5 ± 10.9 months. The AOFAS hindfoot-ankle score improved significantly from 70.3 ± 15.9 to 85.6 ± 13.0 (p < 0.01). The mean serum uric acid level was significantly decreased from 442.0 ± 109.2 to 540.5 ± 132.4 (p < 0.01). The average VAS scale decreased from 3.8 ± 1.9 to 1.4 ± 1.7 (p < 0.01). The median of recurrences in one year postoperatively was significantly decreased from 1.5 (1, 3.75) to 0 (0, 0.75) (p < 0.01). Conclusion: A new classification strategy for ankle gouty arthritis based on arthroscopic view was proposed. Patients with ankle gouty arthritis showed significant improvement in ankle function and pain relief after undergoing arthroscopic surgery driven by the new classification. [ABSTRACT FROM AUTHOR]

Background: In recent years, arthroscopic lateral ankle ligament repair has become increasingly popular. However, reports on the clinical outcomes of arthroscopic ankle stabilization for skeletally immature patients remain scarce. This study investigated the clinical outcomes of arthroscopic lateral ankle ligaments repair in skeletally immature patients compared to skeletally mature patients. Methods: Our retrospective analysis compared skeletally immature patients and skeletally mature adults who underwent arthroscopic repair of the ankle lateral ligaments with a modified lasso-loop stitch using a suture anchor. Skeletal immaturity was defined as patients whose epiphyseal line of the distal fibula remained open on plain radiography. Clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at 2 years after surgery. The time to postoperative walking, jogging, and return to full sports activities were also evaluated. Results: Sixty-four skeletally immature patients (IM group) and 103 skeletally mature adults (M group) were included. No significant differences were observed during both walking and jogging after surgery between the groups; however, return to full athletic activities was significantly earlier in IM group (P =.05). The mean scores in all SAFE-Q subscales significantly improved in both groups after surgery (P <.001). There were also no statistically significant differences between the groups in the mean postoperative SAFE-Q scores for all subscales. All patients in the IM group returned to playing sports at their preinjury levels postoperatively. Conclusion: We found that skeletally immature patients with chronic lateral ankle instability had generally similar responses to arthroscopic lateral ankle as skeletally mature adult patients at minimally 2 years' follow-up with a high rate of successful return to sport. Level of Evidence: Level III, retrospective case control study. [ABSTRACT FROM AUTHOR]

Background: The stability of the hindfoot greatly relies on the integrity of the talonavicular joint. Pathologies affecting this joint often necessitate fusion. Our study explores the risks posed to neurovascular and tendon structures during simulated percutaneous talonavicular joint preparation for fusion. Methods: In 9 fresh cadaver specimens, the talonavicular joint was accessed through two portals. A 2-mm Shannon burr was employed for joint surface preparation with distraction provided by a pin-based distractor. Dissections were performed to assess potential damage to critical structures, including the dorsalis pedis artery, superficial and deep peroneal nerves, extensor hallucis longus (EHL), and tibialis anterior (TA) tendons. Results: The dorsal portal site was found to be significantly closer to important structures compared to the medial portal site. The Shannon burr made contact with various structures, with a single transection identified for both deep and superficial peroneal nerve branches. During the dorsal portal site approach, potential injury to the EHL tendon was identified as concern. Conclusion: This study sheds light on the potential risks associated with percutaneous dorsal and medial joint preparation approaches using a Shannon burr. Level of Evidence: Level V, mechanism-based reasoning.. [ABSTRACT FROM AUTHOR]

Background: The long head of the biceps tendon (LHBT) is a well-known source of pain in the shoulder, especially in active patients. Purpose: To evaluate the outcomes and return-to-sports rate after all-arthroscopic suprapectoral tenodesis of the LHBT using a small knotless anchor. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, 27 patients—who underwent all-arthroscopic tenodesis of the LHBT using a 2.7-mm knotless polyether ether ketone anchor—were evaluated. Sports activities, the return-to-sports rate, and other sports-related parameters (eg, pain during sports, level of sports) were examined. Sports-related data, the Constant score with isometric force (at 90° of abduction in the scapular plane), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, the visual analog scale (VAS) score for satisfaction, range of motion, and the presence of a Popeye deformity were assessed at a mean follow-up of 15.3 ± 8.7 months. The data were initially analyzed using descriptive statistics. Results: The postoperative ASES, Constant, and SST scores were 81.61, 85.74 and 8.85, respectively. Of the 27 patients, 4 patients (14.8%) showed a Popeye deformity. Preoperatively, 25 patients (92.6%) participated regularly in some type of sports activity. All 25 patients (100.0%) were able to return to sports activities after surgery. 24 (96.0%) returned to the same level preoperatively, with 88.0% (22/25) within 6 months. Patient satisfaction with the outcome was high (VAS score: 2.15 ± 2.78). Neither bicipital groove pain nor cramping was reported. There were no signs of osteolytic bone around the anchor or a fracture of the humeral bone. Conclusion: Our clinical results after using a 2.7-mm knotless anchor for LHBT tenodesis as well as the return-to-sports rate were satisfying. Using an anchor this size can lower the risk of cortical bone damage and therefore the risk of fractures of the humeral head while still enabling patients to perform at a high level. [ABSTRACT FROM AUTHOR]

Background and Objectives: Few studies have investigated the socioeconomic factors associated with retear after rotator cuff repair. This study aimed to identify the risk factors, including socioeconomic factors, for rotator cuff retear in patients who underwent arthroscopic rotator cuff repair. Materials and Methods: This retrospective study included 723 patients diagnosed with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair from March 2010 to March 2021. The outcome variable was rotator cuff retear observed on postoperative magnetic resonance imaging or ultrasonography. Sex, age, obesity, diabetes, symptom duration, and tear size were the independent variables. Socioeconomic variables included occupation, educational level, type of medical insurance, and area of residence. We compared patients with and without retear and estimated the effects of the independent factors on retear risk. Results: The mean age of the patients, symptom duration, and tear size were 62.4 ± 8.0 years, 1.8 ± 1.7 years, and 21.8 ± 12.5 mm, respectively. The age, type of medical insurance, diabetes, tear size, and symptom duration differed significantly between patients with and without retearing (p < 0.05). Age, occupation, type of medical insurance, diabetes, initial tear size, and symptom duration significantly affected the risk of retear. Patients who performed manual labor had a significantly higher retear rate (p = 0.005; OR, 1.95; 95% CI, 1.23–3.11). The highest retear risk was seen in patients with Medicaid insurance (p < 0.001; OR, 4.34; 95% CI, 2.09–9.02). Conclusions: Age, initial tear size, and symptom duration significantly affect retear risk after arthroscopic rotator cuff repair. Occupation and type of medical insurance were also risk factors for retear. Socioeconomically vulnerable patients may be at a greater risk of retear. Proactive efforts are required to expand early access to medical care. [ABSTRACT FROM AUTHOR]

Background: Lateral clavicle fractures represent approximately 10–15% of all clavicle fractures. However, controversy exists regarding the optimal surgical treatment because of instability associated with the coracoclavicular (CC) ligament injury and a small lateral fragment. The purpose of this study was to evaluate the radiological and clinical outcomes of arthroscopically assisted CC stabilization using a suture button device for lateral clavicle fractures accompanied by CC ligament injury. Methods: A retrospective observational study involved six patients with modified Neer type IIB fractures, which were treated with the technique and followed for 12 months. Postoperative range of motion (ROM) and X-rays were evaluated every 3 months. Shoulder functional scores (University of California Los Angeles score, Japanese Orthopedics Association score) and visual analog scale (VAS) scores for pain (at rest, at night, and during motion) and for satisfaction were analyzed 12 months after surgery. Results: Early phase ROM recovery and excellent outcomes were achieved. All patients achieved bone union. Slight superior clavicle displacement and bone hole dilation occurred with no critical complications. Conclusions: Arthroscopically assisted CC stabilization with a suture button device for unstable lateral clavicle fractures can produce satisfactory radiological and clinical results. [ABSTRACT FROM AUTHOR]

The addition of epinephrine in irrigation fluid and the intravenous or local administration of tranexamic acid have independently been reported to decrease bleeding, thereby improving surgeons' visualization during arthroscopic shoulder procedures. No study has compared the effect of intravenous tranexamic acid, epinephrine in the irrigation fluid, or the combination of both tranexamic acid and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. We hypothesized that intravenous tranexamic acid is more effective than epinephrine mixed in the irrigation fluid in improving visualization during shoulder arthroscopy, with no additive effect when both are used. Patients aged ≥18 years undergoing shoulder arthroscopy were randomized into one of 4 study arms: (1) saline irrigation fluid (placebo); (2) epinephrine (0.33 mL of 1:1000 per liter) mixed in irrigation fluid (EPI); (3) 1 g intravenous tranexamic acid (TXA); and (4) epinephrine and tranexamic acid combined (TXA + EPI). Visualization was rated intraoperatively on a scale from 0, indicating poor clarity, to 3, indicating excellent clarity, every 15 minutes and overall. The primary outcome measure was the overall rating of visualization. A stepwise linear regression was performed using visualization as the dependent variable and independent variables including presence or absence of epinephrine and tranexamic acid, surgery duration, complexity, mean arterial pressure, increase in pump pressure, and volume of irrigation fluid. One hundred twenty-eight patients (mean age 56 years) were randomized. Mean visual clarity for the placebo, TXA, EPI, and TXA + EPI groups were 2.0 (±0.6), 2.0 (±0.6), 2.6 (±0.5), and 2.7 (±0.5), respectively (P <.001). The presence or absence of epinephrine was the most significant predictor of visual clarity (P <.001). Tranexamic acid presence or absence had no effect. No adverse events were recorded in any of the groups. Intravenous tranexamic acid is not an effective alternative to epinephrine in irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries, and there is no additive effect when both are used. [ABSTRACT FROM AUTHOR]

In this study, an innovative exploration of leveraging bionics and continuum robotics principles to develop a novel solution for arthroscopic surgery is embarked on. Inspired by the flexibility and adaptability of organisms like snakes and octopuses, the continuum robot concept aims to address the inherent challenges in traditional arthroscopy, including lower precision, manual tremors, and long surgeon learning curves. The implementation of these principles in the human body, however, faces significant obstacles, particularly achieving high‐performance motion control amid strong nonlinearity and coupling between modules. This research focuses on intelligent integration and enhanced safety in human‐machine interaction, aiming for improved control precision and flexibility in arthroscopic procedures. A thorough literature review of endoscopic continuum robots is conducted, highlighting current advancements in actuation, structure, sensing, and control technologies. The study concludes with an assessment of these technologies, their limitations, and future potential, in light of the unique demands of arthroscopic continuum robots. This comprehensive review bridges bionics and robotics, presenting the opportunities and challenges in applying continuum robotics to arthroscopic surgery. The goal is to encourage further research in this area, contributing to the development of prototype robots that enhance the precision and safety of arthroscopic surgery. [ABSTRACT FROM AUTHOR]

Purpose: High success rates and minimal complications have consolidated arthroscopy as the therapeutic alternative of choice for minimally invasive treatment of internal disorders (ID) of the temporomandibular joint (TMJ). However, there is no certainty regarding the demographic and clinical factors associated with the technique's success or failure. This study was performed to analyze the effectiveness of arthroscopy regarding pain and the mandibular dynamics and also to determine whether variables such as age, sex, and preoperative Wilkes stage influence the results. Methods: A retrospective study was conducted involving 92 patients with ID of the TMJ between September 2017 and February 2020. In all cases, a first stage of intra-articular lysis and lavage was executed. As needed, a phase of operative arthroscopy or arthroscopic discopexy was implemented. Results: A total of 152 arthroscopies were performed. Both the variation in pain and mouth opening in patients with ID of the TMJ treated were statistically significant for the follow-up periods studied. Better results were observed for patients with lower Wilkes stages. No association with age was found. Conclusion: Based on the results, we recommend early intervention as soon as an ID in the TMJ is detected. [ABSTRACT FROM AUTHOR]

ObjectiveTo observe the effect of light walking combined with arthroscopic surgery on the efficacy and Bone Mineral Density (BMD) of patients with ankle arthritis. Methods 180 patients with ankle arthritis were retrospectively selected, who were divided into a control group (Group A) and an experimental group (Group B) according to treatment methods, with 90 patients in each group. Group A was treated with conventional open surgery and Group B was treated with light walking combined with arthroscopic surgery. The two groups were compared before and after treatment on scales such as the AOFAS ankle hindfoot score. Meanwhile, the patients' BMD and levels of inflammatory factors such as tumor cell necrosis factor-α (TNF-α) were compared before and after treatment. Results The Kofoed and AOFAS scale scores were higher for mild walking combined with arthroscopic surgery than for conventional treatment (P

Abstract Purpose To evaluate mid‐ to long‐term clinical outcomes after arthroscopic bucket‐handle meniscal tear (BHMT) repair and to assess the impact of concurrent anterior cruciate ligament reconstruction (ACLR). Methods A comparative retrospective case series with blinded outcome assessment was conducted. All consecutive patients treated with arthroscopic BHMT repair with or without concurrent ACLR between 2001 and 2021 were eligible for inclusion. Fifty‐five patients with an average follow‐up of 7.3 ± 3.4 years were included in the analysis. Outcome measures comprised post‐operative IKDC Subjective Knee Form, Lysholm Score, Tegner Activity Scale, KOOS, and visual analogue scale (VAS) for satisfaction. Additionally, failure and reoperation rates were assessed. Results The failure rate was 9%. Medial BHMT repair showed superior post‐operative IKDC scores compared to lateral meniscus repair (p = 0.038). Concurrent ACLR did not demonstrate any impact on post‐operative KOOS, IKDC, Tegner or patient satisfaction. The mean IKDC score at final follow‐up across both groups was 80.4 ± 17.8. The mean Lysholm score was 86.9 ± 16.7. Mean KOOS scores were (i) symptoms: 83.6 ± 18.3, (ii) pain: 90.2 ± 14.4, (iii) activities of daily living: 93.6 ± 15.1, (iv) sports: 78.3 ± 26.0 and (v) quality of life: 70.5 ± 24.5. Mean patient satisfaction (VAS) was 7.9 ± 2.5. The mean Tegner score was 4.9 ± 1.9. A consistent positive correlation between the number of sutures used and post‐operative outcome measures was observed but did not reach statistical significance for most items. Conclusion Arthroscopic BHMT repair achieved good clinical outcomes and an acceptable failure rate of 9% at a mean follow‐up of 7 years, supporting the clinical value of meniscal repair, including large BHMTs. Concurrent ACLR showed no impact on clinical outcomes. Level of Evidence Level IV (retrospective case series).

Background The dimensions of popliteus muscle and its tendon are subjected to variability in the origin, mode of insertion, innervation patterns and vascular supply. The aim of this study was to measure the length, thickness and width of the popliteus muscle and its tendon at its different parts. The objectives were to study the topographic anatomy of the neurovascular structures of the popliteus and also to determine the dimensions of the popliteo-fibular ligament. Methods This descriptive cross sectional institutional based study included 50 formalin embalmed adult lower limb specimens. The measurements were performed by using the digital Vernier caliper. Results The length of the popliteus muscle belly along the upper and lower border were 44.2±6.63 mm and 89.26±14.41 mm, width of the muscle belly at midpoint, musculotendinous junction and insertion were 28.45±6.85 mm, 11.7±3.5 mm and 75.95±10.7 mm. The thickness of muscle belly at the midpoint was 2.55±0.55 mm. The length of popliteal tendon, width at origin and at musculotendinous junction were 24.85±2.15 mm, 7.55±1.55 mm and 8.5±1.15 mm. The thickness of tendon of popliteus was 2.6±0.75 mm. The length of nerve to popliteus was 50.44±8.66 mm and its origin was located 27.54±6.18 mm from the intercondylar line. The distance of origin of medial and lateral geniculate arteries from the intercondylar line were 26.26±10.47 mm and 20.76±5.19 mm. The distance of division of popliteal artery was 49.44±16.26 mm from the intercondylar line. The length and width of the popliteo-fibular ligament was 17.84±3.43 mm and 7.36±1.9 mm individually. Conclusions This study offered detailed morphometric data of the popliteus and it is believed that the data of this anatomical research is enlightening to orthopedic surgeons particularly in the field of arthroscopic and plastic surgery. The data can be considered as the database from our population.

Over the past two decades, advances in arthroscopic and minimally invasive surgical techniques have led to significant growth in sports medicine surgery. Implants such as suture anchors, interference screws, and endo-buttons are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers, absorbable bioceramics, and absorbable metals. In this paper, we will provide a comprehensive summary of these absorbable materials from the perspective of clinicians, and discuss their clinical applications and related research in sport medicine.

Background The dimensions of popliteus muscle and its tendon are subjected to variability in the origin, mode of insertion, innervation patterns and vascular supply. The aim of this study was to measure the length, thickness and width of the popliteus muscle and its tendon at its different parts. The objectives were to study the topographic anatomy of the neurovascular structures of the popliteus and also to determine the dimensions of the popliteo-fibular ligament. Methods This descriptive cross sectional institutional based study included 50 formalin embalmed adult lower limb specimens. The measurements were performed by using the digital Vernier caliper. Results The length of the popliteus muscle belly along the upper and lower border were 44.2±6.63 mm and 89.26±14.41 mm, width of the muscle belly at midpoint, musculotendinous junction and insertion were 28.45±6.85 mm, 11.7±3.5 mm and 75.95±10.7 mm. The thickness of muscle belly at the midpoint was 2.55±0.55 mm. The length of popliteal tendon, width at origin and at musculotendinous junction were 24.85±2.15 mm, 7.55±1.55 mm and 8.5±1.15 mm. The thickness of tendon of popliteus was 2.6±0.75 mm. The length of nerve to popliteus was 50.44±8.66 mm and its origin was located 27.54±6.18 mm from the intercondylar line. The distance of origin of medial and lateral geniculate arteries from the intercondylar line were 26.26±10.47 mm and 20.76±5.19 mm. The distance of division of popliteal artery was 49.44±16.26 mm from the intercondylar line. The length and width of the popliteo-fibular ligament was 17.84±3.43 mm and 7.36±1.9 mm individually. Conclusions This study offered detailed morphometric data of the popliteus and it is believed that the data of this anatomical research is enlightening to orthopedic surgeons particularly in the field of arthroscopic and plastic surgery. The data can be considered as the database from our population.

Background: To explore the value of two-dimensional color ultrasonography (US) in the evaluation of treatment effect of arthroscopic humeral insertion displacement for massive rotator cuff tears (MRCTs). Materials and Methods: From February 2021 to April 2022, 42 patients diagnosed as MRCTs by shoulder magnetic resonance imaging (MRI) were selected and separated into the control group (CG, n=21) and study group (SG, n=21). Patients in the SG received rotator cuff humeral insertion displacement and patients in the CG were treated with traditional suture bridge. The reliability of US imaging was examined and the clinical outcomes in two groups were compared. Results: The sensitivity and specificity of two-dimensional color ultrasonography reached 87.1% and 100% in detecting postoperative repair of MRCTs. Three months after surgery, compared with the CG, the university of California at Los Angeles shoulder rating scale (UCLA) scores in the SG were elevated (P<0.05), and the visual analogue scale (VAS) scores in the SG were declined (P<0.05). Degrees of external rotation, internal rotation, back extension and forward flexion of shoulder joint in both groups were increased after surgery, and those in the SG were higher relative to the CG (P<0.05). The retear rate of the SG was reduced compared with the CG (P<0.05). SG showed higher patient satisfaction rate compared with the CG (P<0.05). Conclusion: Two-dimensional color ultrasonography is a reliable approach to evaluate the repair of MRCT after arthroscopic rotator cuff internal displacement, which can reduce shoulder pain, improve patient life quality, and is valuable for promotion. [ABSTRACT FROM AUTHOR]

The objective of study was verifying the impact of changing position and general anesthesia on internal carotid artery peak systolic velocities in patients undergoing shoulder arthroscopic surgery. Methods. A total of 85 American Society of Anesthesiologist (ASA) physical status I–II patients of median age (33.0 ± 11.3) y. o. underwent shoulder arthroscopy under general anesthesia. The primary measures were systolic blood pressure, diastolic blood pressure), MAP, and ICA PSV. The main measurements were taken in the next time points. The first one (initial data — I) in the supine position on a table before induction, the second one — 3 min after induction to anesthesia in supine position and the third one in the beach chair position (BCP). BCP was declared as a trunk elevation to 80°. An induction and maintenance of general anesthesia were performed by propofol and fentanyl. Results. The initial level of the SBP before induction was (143.7 ± 22.1) mm Hg, after induction to general anesthesia SBP (р = 0.001) decreased to (125.1 ± 26.7) mm Hg, after positioning changed in the same manner. The initial level of DBP was (87.6 ± 11.2) mm Hg, then it dropped (p = 0.013) to (77.6 ± 20.2) mm Hg with statistically significant (p = 0.005) decreasing to (66.1 ± 17.7) mm Hg. MAP showed statistically changes from initial level of (113.3 ± 20.0) mm Hg to (101.3 ± 23.1) mm Hg (p = 0.015) after induction to anesthesia and to (86.5 ± 21.6) mm Hg after positioning (p = 0.015). After positioning to BCP ICAPSV reduced significantly from (81.5 ± 15.1) cm/sec to (69.5 ± 16.8) cm/sec (p = 0.001). The overall drop in ICAPSV was (16.9 ± 19.0) cm/ sec. Conclusion. SBP, DBP and MAP were decreased after induction to general anesthesia and after subsequent patient positioning to the BCP, however post-induction hypotension does not provoke changes in ICA PSV. Though, further positioning of patients to the BCP leads to decreasing of ICA PSV. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic dislocation of shoulder leads to labral detachment from the glenoid and also the capsule and periosteum from anterior surface of the neck of scapula, a so-called Bankart lesion. Unless a surgical procedure interrupts the cycle of recurrence, the patient will likely continue to have dislocation or limitation of his activities for fear of dislocation. We report a study and results on 25 patients treated with Bankart's repair. Material and Methods: Twenty-five patients with recurrent anterior instability of shoulder operated between February 2005 and January 2010, were included in the study. The patient between the age group of 15 to 45 years having traumatic unidirectional anterior instability of shoulder due to Bankart lesion with or without associated lesions those were identified radiologically or arthroscopically were included in the study. The diagnosis was made on the basis of combination of symptoms, signs, radiological and arthroscopic findings. Results: The mean age of the patients was 32.8 years (range, 17 to 43 years). The mode of injury was fall in eighteen patients (72%) and Road Traffic Accident in seven patients (28%). The average number of instability episodes was 4.4 (range, 0 to 25). The patients were followed up for a mean duration of 26.32 months with UCLA mean of 31.5. The results were analyzed after a minimum follow up of 2 years. Conclusion: Arthroscopic Bankart repair is a reliable method for treatment of recurrent anterior glenohumeral instability. This method is able to yield a good clinical outcome in terms of excellent postoperative shoulder motion and low recurrence rate and low incidence of complications. [ABSTRACT FROM AUTHOR]