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Purpose To determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified. Methods From 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together. Results In total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) (P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% (P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% (P < .001 and .001). Conclusions Anterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus. Level of Evidence Level III, diagnostic study.

To gain regulatory approval for the clinical use of knee biologics and devices in humans, translational large-animal studies are typically required. Animal models that permit second-look arthroscopy are valuable because they allow for longitudinal assessment of the treated tissue without needing to sacrifice the animal. The minipig is an ideal preclinical animal model for the investigation of therapies for the knee, in part because arthroscopy can be performed in its stifle (knee) joint with the use of standard surgical equipment used in humans. The purpose of this Technical Note is to describe a reproducible technique for diagnostic arthroscopy of the minipig stifle (knee) joint., Technique Video Video 1 Diagnostic arthroscopy of the right minipig stifle (knee) joint. An anterolateral portal is established, the arthroscope is introduced through the anterolateral portal and into the medial compartment, and an anteromedial portal is established under spinal needle localization. The medial compartment, intercondylar notch, lateral compartment, and distal trochlea can be visualized. Visualization of the lateral compartment can be enhanced by placing the arthroscope through the anteromedial portal. The proximal portion of the patellofemoral joint can be difficult to visualize through the anterior portals because of its elongated morphology and inability to fully extend the minipig knee. Visualization of the proximal patellofemoral joint can be performed through a separate superior portal if necessary.

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. Smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased use of arthroscopic fluid. Differences in the technology, such as a 0° optic and less rigid instrumentation, necessitate a modified technique to accommodate thorough diagnostic arthroscopy as well as modified approaches to therapeutic procedures. This article introduces our preferred approach to diagnostic arthroscopy of the glenohumeral joint and subacromial space with needle arthroscopy and small-bore instruments. This technique could increase efficiency and decrease operative time with certain arthroscopic procedures, and it may improve patient outcomes.

Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology. Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed. Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight. Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology. Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs. Level of Evidence Not applicable.

Impingement of the LHB can directly lead to articular‐sided supraspinatus tears. When pain persists despite arthroscopic debridement, we recommend taking the arm out of traction intraoperatively and placing it in the 90‐90 position.

Objective: To assess the diagnostic accuracy of direct wrist MR arthrography (MRA) compared to conventional MRI in diagnosis of different pathologic entities causing chronic wrist pain. Materials and methods: 37 consecutive patients 22 males and 15 females, with age range from 16 to 49 years ''mean age 28 years'' complaining of unexplained chronic wrist pain were prospectively examined by using MRI and MRA with arthroscopic correlation in 25 of them. Findings were divided into 5 main groups of lesions including triangular fibrocartilage complex (TFCC) lesions, ligamentous injuries, osseous lesions, tendon pathology and ganglion. Results: MRA picked up more ligamentous injuries and triangular fibrocartilage complex (TFCC) lesions that couldn`t be detected on MRI study while both were equal in detection of other types of lesions. TFCC lesions were the most common pathologic findings in both MRI and MRA. Arthroscopic correlation in 25 suspected TFCC lesions (clinically, radiologically or both) revealed that the sensitivity / specificity / accuracy of MRI and MRA were 87.5% / 100% / 96% and 100% / 100% / 100% respectively for central lesions while were 71.4% / 81.3% / 76% and 100% / 90.9% / 96% respectively For peripheral lesions. Extra-capsular lesions, like tenosynovitis and fracture hook of hamate couldn`t be confirmed arthroscopically. Conclusion: MRA can replace both MRI and diagnostic arthroscopy in detecting causes of chronic wrist pain. Keywords: Chronic wrist pain, MRI, MRA, Arthroscope

Shoulder arthroscopy is the second most common orthopaedic procedure. Diagnostic arthroscopy of the shoulder requires an efficient and reproducible technique. In this Technical Note, we describe a step-wise approach to diagnostic arthroscopy of the shoulder. This technique is performed using a posterior viewing portal. It can be performed from the beach chair or the lateral decubitus position. This technique uses a 2-circle approach: the surgeon first evaluates the glenoid aspect of the joint space, followed by the humeral aspect of the joint space. This method ensures a complete and consistent evaluation of the glenohumeral joint.

Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called “scapholunate complex” has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).

Background:Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined.Purpose:To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded.Results:Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy.Conclusion:Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. The smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased arthroscopic fluid use. Differences in the technology, such as a 0-degree optic and less rigid instrumentation necessitate a novel technique to accommodate thorough diagnostic arthroscopy as well as new approaches to therapeutic procedures. This manuscript introduces our preferred approach to diagnostic arthroscopy and partial medial meniscectomy with NA and small-bore instruments. The minimally invasive nature of this technology may decrease postoperative pain and improve return of comfort and function.

Knee arthroscopy has evolved greatly from its inception in the twentieth century. Of the many arthroscopic knee surgeries, meniscectomy is the most commonly performed. Arthroscopic meniscectomy is the most common orthopaedic surgical procedure performed in the United States. We continue to develop more minimally invasive procedures, and the NanoScope has provided a new generation of possibilities. The system does not require the use of a standard incision or portal, and with the use of nanoinstruments, we can perform treatments as well as diagnostic arthroscopy without incisions. This technique provides an updated incisionless option to perform a partial medial meniscectomy.

Introduction. Cysts associated with the cruciate ligaments are rare with an incidence of less than 1%. Most are asymptomatic and detected as incidental findings, but some are symptomatic presenting with knee pain and restricted range of motion. Case report. A 33-year-old female presented with pain and restriction of terminal flexion at the knee. No history of trauma was present. Clinically no diagnosis could be established. MRI showed a cyst located between the femoral attachments of cruciate ligaments which was further confirmed by diagnostic arthroscopy. Rupture of the cyst was done arthroscopically. Postoperatively, patient was relieved of the pain. There were no subsequent recurrences. Conclusion. Cysts between the cruciate ligaments must be kept as a differential while dealing with a patient of knee pain, with no antecedent history of trauma and where clinically no diagnosis can be made. Arthroscopic excision or rupture has a good success rate with no recurrences.

Objectives: Although there is a lack of information on the use of arthroscopy for the diagnosis of PPSI, it may be an additional tool to improve pre-revision diagnostics. The aim of the present study was to analyze the utility of arthroscopic biopsies for detection of periprosthetic infection in painful[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

The authors report a case of a late repair of a missed, large, osteochondral fracture of the femoral trochlea in a 14-year-old boy due to lateral patellar dislocation after a twisting injury of the knee a year ago. The late-1 year after the knee injury-imaging assessment of the patient regarding radiograph images, CT scan, and MRI was misleading, misinterpreted, and failed to reveal this osteochondral fracture. The free osteochondral fragment was detected during diagnostic arthroscopy. Open reduction and fixation of the osteochondral fragment with bioabsorbable pins were done, and healing was achieved within an acceptable time. The patient's clinical and imaging examination with knee MRI, a year after the surgical treatment, was highly satisfactory. Fixation with bioabsorbable pins showed to be a worthwhile option in this case. The technique used was straightforward, with excellent short- and long-term results. Bioabsorbable pins may be used to restore successfully even an old, large osteochondral fracture in the immature skeleton.

Separation of the posteromedial meniscocapsular junction (PMC) is a unique injury seen in patients with disruption of the anterior cruciate ligament. PMC tears may go unrecognized despite preoperative magnetic resonance imaging and diagnostic arthroscopy of the medial compartment. Unrepaired lesions may lead to persistent laxity of the knee after anterior cruciate ligament reconstruction. Inside-out repair techniques risk iatrogenic injury to the articular cartilage during needle passage and require dissection of the posteromedial knee for suture retrieval. Previous all-inside techniques have required specialized implants and repaired PMC lesions with direct visualization of the tear. The presented all-inside technique is an easily reproducible, cost-effective means to anatomically repair separation of the PMC. The technique provides the surgeon direct visualization and full arthroscopic access to the lesion, making repair technically easy and efficient.

In recent years, arthroscopy has gained popularity as a preferred treatment of a multitude of pathologies affecting the elbow. Since its initial description in 1985, many modifications have been made as our knowledge and technology have advanced. Currently, the majority of arthroscopic procedures are performed in either the lateral decubitus or supine suspended position. In this work, we discuss the history, patient positioning, and key steps for performing elbow arthroscopy in the lateral decubitus position. In addition to key steps, a number of strengths and limitations of this set up are discussed in detail. When properly executed, elbow arthroscopy can be performed in a safe and efficient manner with minimal risk to patients.

The field of elbow arthroscopy has evolved significantly since the procedure was first introduced more than 30 years ago. As our knowledge and understanding grows, numerous technical modifications have been made to improve the safety and efficacy of elbow arthroscopy. One of the most significant modifications is the change from the supine hanging position to the supine-suspended position with the use of a mechanical arm holder. Currently, the supine-suspended and lateral decubitus positions are the 2 most commonly used techniques. In this work, we discuss the history of the supine position, provide key points for proper patient positioning, and detail the steps of diagnostic elbow arthroscopy. It is our hope that this work will serve as an up-to-date review and summary of the most critical components of this procedure for emerging elbow arthroscopists.

[Introduction][1] Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft is performed to anatomically reconstruct the glenoid and reestablish glenohumeral stability in patients with chronic anteroinferior shoulder instability and substantial osseous defects[1][2]-[3][3]. [Indications & Contraindications][4] [Step 1: Patient Positioning][5] Place the patient in the lateral decubitus position and prepare the arm and ipsilateral iliac crest. [Step 2: Diagnostic Arthroscopy and Portal Placement][6] Perform a diagnostic arthroscopy via the posterior portal and establish an anteroinferior, an anterosuperior, and a deep anteroinferior portal. [Step 3: Capsulolabral Complex Release and Scapular Neck Preparation][7] Depending on the pathology and morphology of the defect, release the capsulolabral complex from the scapular neck and prepare the glenoid rim and scapular neck with a motorized burr to ensure adequate osseous healing. [Step 4: Harvesting and Preparation of the Iliac Crest Bone Block][8] Harvest an autologous tricortical iliac crest bone block from the ipsilateral side and contour it appropriately for an anatomic reconstruction of the glenoid. [Step 5: Graft Insertion and Positioning][9] Enlarge the passage for the graft through the rotator interval, insert the bone block, and position it anatomically at the scapular neck. [Step 6: Graft Fixation][10] With the aid of a drill sleeve, temporarily stabilize the graft using Kirschner wires and then definitively attach it to the scapular neck using 2 Bio-Compression screws. [Step 7: Capsulolabral Repair][11] Reattach the capsulolabral complex to the original glenoid, inferior and superior to the bone block, using 2 knotless suture anchors to complete the anatomic reconstruction of the glenoid. [Step 8: Rehabilitation and Postoperative Treatment][12] Immobilize the arm for 6 weeks postoperatively and limit flexion and external rotation during this time period. [Results][13] Fifteen patients with a mean age of 31.4 years (range, 17 to 49 years) with anteroinferior glenohumeral instability and substantial glenoid defects underwent arthroscopic iliac crest bone-grafting and were prospectively evaluated for an average period of 20.6 months (range, 12 to 65 months)[12][14]. [Pitfalls & Challenges][15] [Introduction][1] Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft is performed to anatomically reconstruct the glenoid and reestablish glenohumeral stability in patients with chronic anteroinferior shoulder instability and substantial osseous defects[1][2]-[3][3]. [Indications & Contraindications][4] [Step 1: Patient Positioning][5] Place the patient in the lateral decubitus position and prepare the arm and ipsilateral iliac crest. [Step 2: Diagnostic Arthroscopy and Portal Placement][6] Perform a diagnostic arthroscopy via the posterior portal and establish an anteroinferior, an anterosuperior, and a deep anteroinferior portal. [Step 3: Capsulolabral Complex Release and Scapular Neck Preparation][7] Depending on the pathology and morphology of the defect, release the capsulolabral complex from the scapular neck and prepare the glenoid rim and scapular neck with a motorized burr to ensure adequate osseous healing. [Step 4: Harvesting and Preparation of the Iliac Crest Bone Block][8] Harvest an autologous tricortical iliac crest bone block from the ipsilateral side and contour it appropriately for an anatomic reconstruction of the glenoid. [Step 5: Graft Insertion and Positioning][9] Enlarge the passage for the graft through the rotator interval, insert the bone block, and position it anatomically at the scapular neck. [Step 6: Graft Fixation][10] With the aid of a drill sleeve, temporarily stabilize the graft using Kirschner wires and then definitively attach it to the scapular neck using 2 Bio-Compression screws. [Step 7: Capsulolabral Repair][11] Reattach the capsulolabral complex to the original glenoid, inferior and superior to the bone block, using 2 knotless suture anchors to complete the anatomic reconstruction of the glenoid. [Step 8: Rehabilitation and Postoperative Treatment][12] Immobilize the arm for 6 weeks postoperatively and limit flexion and external rotation during this time period. [Results][13] Fifteen patients with a mean age of 31.4 years (range, 17 to 49 years) with anteroinferior glenohumeral instability and substantial glenoid defects underwent arthroscopic iliac crest bone-grafting and were prospectively evaluated for an average period of 20.6 months (range, 12 to 65 months)[12][14]. [Pitfalls & Challenges][15] [1]: #sec-14 [2]: #ref-1 [3]: #ref-3 [4]: #sec-15 [5]: #sec-18 [6]: #sec-19 [7]: #sec-20 [8]: #sec-21 [9]: #sec-22 [10]: #sec-23 [11]: #sec-24 [12]: #sec-25 [13]: #sec-26 [14]: #ref-12 [15]: #sec-27

BACKGROUND: Meniscus tears are the most common injury of the knee. The McMurray's test and Joint line tenderness for diagnosing meniscus tear have been widely tested, but results reported by different authors vary. The wide variations reported have an impact on clinical decision concerning whether to go for other diagnostic tests before going for diagnostic arthroscopy, which is considered as the gold standard.The purpose of this study was to determine the diagnostic value of Joint line tenderness and McMurray’s test, as clinical signs, to diagnose underlying medial meniscus tears.METHODS: This was a prospective observational study done in Tribhuwan University Teaching Hospital. Patients undergoing knee arthroscopy were included in the study period of one year (from February 2011 to January 2012). Each patient was clinically examined with McMurray’s test and joint line tenderness. The findings were then matched by the arthroscopic findings. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were then calculated.RESULTS: The sensitivity, specificity, positive predictive value , negative predictive value and accuracy for medial joint line tenderness in diagnosing medial meniscus tear were 50%, 61.7%, 51.8%, 60% and 56.45% respectively. The result was insignificant (p value=0.352). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for McMurray's test for diagnosing medial meniscus tear were 54%, 79%, 68% , 67.50% and 67.74% respectively. The result was significant (p value=0.007). CONCLUSION: Clinical tests like McMurray and joint line tenderness have low diagnostic value when applied individually. They may be useful when combined together with the background of clinical history. The decision to scope the knee should not be solely taken on the results of clinical tests.KEYWORDS: Medial meniscus, McMurray’s test, Joint line tenderness

Purpose A proximal avulsion of the radiocarpal capsule (PARC) is a cause of persisting posttraumatic wrist pain. This lesion is often overlooked and left untreated during wrist arthroscopy. Materials and Methods A record review was performed on 13 patients with this lesion who underwent diagnostic wrist arthroscopy after failed conservative treatment. We retrospectively reviewed the results of an arthroscopic repair method in 13 patients. Results In 11 of the 13 consecutive cases the lesion was sutured using an arthroscopic dorsal capsule-ligamentous repair technique. Postoperatively, all high-demand patients were able to return to their previous sports. Discussion The PARC lesion is usually overlooked during diagnostic arthroscopy since it may be covered by synovial or fibrous tissue. It often coexists with scapholunate ligament or triangular fibrocartilage complex injuries. This lesion is amenable to an arthroscopic repair with satisfactory clinical results.

We report a case of neglected multiligamentous injury that developed a complete thrombotic popliteal artery block following arthroscopic surgery. A 56-year-old man, a farmer, presented with an 8-month history of instability of the right knee. Examination revealed ipsilateral anterior (ACL)/posterior cruciate ligament (PCL) injuries. MRI and diagnostic arthroscopy confirmed complete ACL/PCL tear. Single-stage arthroscopic ACL/PCL reconstruction was performed. Postsurgery, the operated limb appeared swollen, firm and cold, without sensation or toe movement. Angiogram revealed complete thrombotic block of left popliteal artery. Fogarty's catheterism was performed and distal vascularity re-established. At 28 months, the patient was back at work with good functional outcome. We failed to examine the patient preoperatively in spite of his advanced age, history of beedi smoking and tobacco use, and presence of feeble vascular pulsations with thickened skin over leg and foot. Thus, in multiligamentous injuries, patient selection and thorough detailed clinical examination are the keys to successful arthroscopic procedures.

Objectives: Anterior labroligamentous periosteal sleeve avulsion lesions (ALPSA) have been identified as a potential risk factor for failure of an arthroscopic labral repair. The objective of this study was to compare the failure rates and clinical outcomes of arthroscopic ALPSA repair to arthroscopic Bankart repair. Additionally, the role of glenoid bone loss on failure rates was analyzed within each group. Methods: This was a retrospective review of 72 consecutive patients with anterior shoulder instability (73 shoulders) who underwent an anterior arthroscopic labral repair at a single military institution by one of three Sports medicine fellowship trained orthopaedic surgeons. At the time of surgery, a diagnostic arthroscopy identified 13 (17.8%) ALPSA lesions and 60 (82.2%) isolated Bankart lesions. All lesions were repaired and placed on standard post-operative protocol. Data was collected on demographics, the Western Ontario Shoulder Instability (WOSI) score, SANE score, and recurrence rates. Failure was defined as recurrent dislocation. Additionally, glenoid bone loss in all patients was calculated using a standardized technique on preoperative images. Outcomes were analyzed by type of initial lesion. The effect of bone loss on failure rate was analyzed between and within groups. Results: The average age at surgery was 26.3 years (range, 20-42) with an average follow-up of 53.3 months (range, 28-63). There were 13 distinct ALPSA lesions and 60 Bankart lesions identified on diagnostic arthroscopy. There were no significant differences between groups with respect to any demographic data. There was 1 failure (7.7%) in the ALSPA group and 8 failures (13.3%) in the Bankart group (p=0.10). There was no significant difference between groups for WOSI or SANE scores. There was no significant difference in glenoid bone loss between groups. The ALPSA group had 13.1% glenoid bone loss compared to 13.5% in the Bankart group (p=0.88). Conclusion: Contrary to previously published data, we did not find patients with ALPSA lesions to be at an increased risk for failure of an arthroscopic repair compared to an isolated Bankart repair, nor was there a difference in functional outcomes between groups. Finally, the presence of an ALPSA lesion was not predictive on increased glenoid bone loss in this population.

Many advances have been made in knee imaging, particularly in the field of magnetic resonance imaging (MRI). Today, MRI of the knee is the most frequently requested MR examination of the musculoskeletal system. It is common practice to acquire an MRI after clinical examination and radiographs in the workup of suspected knee derangement. Frequently, it is the definitive examination, providing critical information regarding the decision to treat conservatively or surgically. These factors have led to the wide acceptance by the clinical community of MR knee studies as a noninvasive replacement for diagnostic arthroscopy.

Acetabular notch osteophytes are often encountered during routine diagnostic arthroscopy of the hip. It has been our observation that when notch osteophytes are present, there is often corresponding chondral damage to the anterosuperior femoral head and ligamentum teres degeneration. We propose that removal of the notch osteophyte and decompression of the articulating surface offer an effective method of delaying the progression of arthritis. This article describes in detail the technique used to perform arthroscopic acetabular notchplasty, and a companion video, demonstrating the procedure, is included. Our experience suggests that decompression of the acetabular notch can remove offending structural abnormalities that can potentially cause further chondral damage and may hasten the progression of arthritis.

Between December 1983 and March 1991 , 2200 knee artnroscopies were performed at the Department of Orthopaedics and Traumatology of İstanbul University, İstanbul Faculty of Medicine. Ouring the last four years, over 500 surgical arthroscopies were performed and 63 in 62 patients were arthroscopic meniscectomies of the middle and posterior parts of the medial and lateral menisci for isolated meniscallesions without any instability. The mean age was 38, 8 (15-58) years. The right knee was involved in 34 and 41 were men. The medial meniscus was involved in 42, while the Iateral meniscus was affected in 11 knees. One knee had involvement of both menisci. The most frequent configuration of the tears was a longitudinallesion in 26. All patients were evaluated objectively and subjectively. it is concluded that, due to Iesser morbidity and lesser complication rate, easier and shorter rehabilitation and sooner return to sports, arthroscopic operations have significant advantages over conventional open techniques. Aiso our three-portal technique, with scope in the anterolateral, grasping instrument or probe in the anteromedial and kinife in the transpatellar portals, which was used in the majority of cases and its advantages over other techniques are described in details., 1983 Aralık ve 1991 Mart tarihleri arasında istanbul Üniversitesi İstanbul Tıp Fakültesi Ortopedi ve Travmatoloji bölümünde 2200 diz artroskopisi uygulanmıştır. Son 4 yıl boyunca 500'ün üstünde cerrahi artroskopi uygulanmıştır ve 63 hastadan 62'sine instabilitesiz izole meniskallezyonlu medial ve lateral menisklerin orta ve arka parçalarına artroskopik menisektomi uygulandı. Yaş ortalaması 30.8 (15-58) idi. 41 erkekten 34'ünde sag diz tutulmuştu. 31 dizde lateral meniskler etkilenmişken, 42'sinde medial meniskler tutulmuştu. Bir dizde de her iki menisk tutulmuştu. Yırtıkların en sık konfigürasyonu 26'sında longitudinallezyondu. Tüm hastalar objektif ve subjektif olarak incelenmiştir. Artroskopik operasyonların, diger convensional açık tekniklerden daha az morbidite ve daha az komplikasyon orammn olması, daha kolay ve daha kısa rehabilitasyon gerektirmesi ve daha kısa zamanda spora dönebilmesi açısından çok belirgin avantajlarının oldugu saptanmıştır. Vakaların büyük bir kısmında kullanılan 3 girişli teknigimizde anterolateralde skop, anteromedialde prob veya tutma cihazı, transpatellar girişe kesici cihaz kullanımının diğer teknikler üzerindeki avantaj ve dezavantajları detaylı biçimde açıklanmıştır.

Diagnostic arthroscopy was applied in the knee of 45 cases who had sports injury the Department of Orthopaedic Surgeıy and Traumatology of Akdeniz University between the years of 1985-1988. Mean age of the patients was 23 years and 41 were male, 4 were female. 34 of cases were licensed (amateur of professional) sportsman and 11 cases were injuried during sportİve acivities. In our study, the results of diagnostic arthroscopy were presented and clinical and arthroscopical findings were discussed in the view of diagnostic accuracy., Akdeniz Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalında, 1985-1988 yılları arasında, spor travması nedenli diz yakınmalarıyla başvuran 41’i erkek 45 olguda (yaş ort.23) tanısal artroskopi yapılmıştır.Olguların 34’ü lisanslı sporcu olup, 11’de ise yaralanma sportif aktivite esnasında olmuştur. Bu çalışmada elde edilen artroskopi sonuçları, menisküs lezyonlarıyla birlikte bulunan patolojiler ve klinik-artroskopik tanısal doğruluk oranı açısından yorum sunulmuştur.

[Introduction][1] Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability. ![Figure][2] ![Figure][2] ![Figure][2] [Step 1: Anterior Capsulolabral Mobilization and Glenoid Preparation][3] Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the “engaging” nature of the Hill-Sachs defect. [Step 2: Preparation of the Hill-Sachs Defect][4] With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus. ![Figure][2] ![Figure][2] [Step 3: Remplissage with the Posterior Aspect of the Capsule and Infraspinatus Tendon][5] Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm). ![Figure][2] ![Figure][2] ![Figure][2] [Step 4: Anterior Bankart Repair][6] Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair. ![Figure][2] [Step 5: Postoperative Rehabilitation Protocol][7] Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months. [Results][8] In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively. [Indications][9] [Contraindications][10] [Pitfalls & Challenges][11] [Introduction][1] Arthroscopic Hill-Sachs remplissage describes the fixation of the posterior aspect of the capsule and the infraspinatus tendon into a posterosuperior humeral head impaction fracture in cases of recurrent anteroinferior glenohumeral instability. ![Figure][2] ![Figure][2] ![Figure][2] [Step 1: Anterior Capsulolabral Mobilization and Glenoid Preparation][3] Perform diagnostic arthroscopy through a standard posterior portal to rule out additional pathology and document the “engaging” nature of the Hill-Sachs defect. [Step 2: Preparation of the Hill-Sachs Defect][4] With the camera remaining in the posterior portal, the assistant provides visualization of the Hill-Sachs defect by translating the humeral head anteriorly over the glenoid rim with direct pressure on the proximal part of the humerus. ![Figure][2] ![Figure][2] [Step 3: Remplissage with the Posterior Aspect of the Capsule and Infraspinatus Tendon][5] Transfer the camera to the anterior portal and leave a switching stick in the posterior portal; under direct visualization, withdraw the posterolateral cannula from the posterior aspect of the capsule and the infraspinatus tendon until it rests in the subdeltoid space (∼1 cm). ![Figure][2] ![Figure][2] ![Figure][2] [Step 4: Anterior Bankart Repair][6] Transition the camera back to the standard posterior portal over a switching stick in order to perform the Bankart repair. ![Figure][2] [Step 5: Postoperative Rehabilitation Protocol][7] Patients wear a brace and perform pendulum exercises for four weeks, and then initiate range-of-motion exercises; they avoid strengthening for eight weeks and sports for three to six months. [Results][8] In our recently published series of forty-seven patients (forty-two male and five female; average age, twenty-nine years), the use of Bankart repair combined with Hill-Sachs remplissage performed according to the above algorithm resulted in 98% of the patients being satisfied or very satisfied with their surgical result and a recurrent instability rate of only 2% at a mean of twenty-four months postoperatively. [Indications][9] [Contraindications][10] [Pitfalls & Challenges][11] [1]: #sec-8 [2]: pending:yes [3]: #sec-9 [4]: #sec-10 [5]: #sec-11 [6]: #sec-12 [7]: #sec-13 [8]: #sec-14 [9]: #sec-16 [10]: #sec-17 [11]: #sec-18

Knee arthroscopy is an important diagnostic and therapeutic tool in the management of disorders of the knee. In a series of 4 articles, the basics of knee arthroscopy are reviewed. In this article (part 3), step-by-step diagnostic arthroscopy is reviewed. Diagnostic arthroscopy is a crucial skill for diagnosing intra-articular disorders of the knee including meniscal, synovial, ligamentous, and articular cartilage pathology. Mastery of the basic diagnostic arthroscopy is a critical tool for orthopaedic surgeons treating disorders of the knee.

Arthroscopy enables direct inspection of the articular surface, but provides no information on deeper cartilage layers. Optical coherence tomography (OCT), based on measurement of reflection and backscattering of light, is a diagnostic technique used in cardiovascular surgery and ophthalmology. It provides cross-sectional images at resolutions comparable to that of low-power microscopy. The aim of this study was to determine if OCT is feasible for advanced clinical assessment of lesions in equine articular cartilage during diagnostic arthroscopy. Diagnostic arthroscopy of 36 metacarpophalangeal joints was carried out ex vivo. Of these, 18 joints with varying degrees of cartilage damage were selected, wherein OCT arthroscopy was conducted using an OCT catheter (diameter 0.9 mm) inserted through standard instrument portals. Five sites of interest, occasionally supplemented with other locations where defects were encountered, were arthroscopically graded according to the International Cartilage Repair Society (ICRS) classification system. The same sites were evaluated qualitatively (ICRS classification and morphological description of the lesions) and quantitatively (measurement of cartilage thickness) on OCT images. OCT provided high resolution images of cartilage enabling determination of cartilage thickness. Comparing ICRS grades determined by both arthroscopy and OCT revealed poor agreement. Furthermore, OCT visualised a spectrum of lesions, including cavitation, fibrillation, superficial and deep clefts, erosion, ulceration and fragmentation. In addition, with OCT the arthroscopically inaccessible area between the dorsal MC3 and P1 was reachable in some cases. Arthroscopically-guided OCT provided more detailed and quantitative information on the morphology of articular cartilage lesions than conventional arthroscopy. OCT could therefore improve the diagnostic value of arthroscopy in equine orthopaedic surgery.