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

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

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

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

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

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

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

The article discusses the life and achievements of orthopaedic surgeon Masaki Watanabe from Japan. It highlights that Watanabe is rightly considered "father of arthroscopy" for pioneering the development of modern arthroscope which works on the basis of fiberoptic illumination. It also discusses specific features of the arthroscope developed by Watanabe which was a specialized endoscopes derives from a rudimentary cystoscope.

Background: The Foot and Ankle Outcome Score (FAOS) is a patient-reported questionnaire measuring symptoms and functional limitations of the foot and ankle. Aim is to translate and culturally adapt the Dutch version of the FAOS and to investigate internal consistency, validity, repeatability and responsiveness. Methods: According to the Cross Cultural Adaptation of Self-Report Measures guideline, the FAOS was translated into Dutch. Eighty-nine patients who had undergone an ankle arthroscopy, ankle arthrodesis, ankle ligament reconstruction or hallux valgus correction completed the FAOS, FFI, WOMAC and SF-36 questionnaires and were included in the validity study. Sixty-five of them completed the FAOS a second time to determine repeatability. Responsiveness was analysed in an additional 15 patients who were being treated for foot or ankle problems. Results: Internal consistency of the FAOS is high (Cronbach's alphas varying between 0.90 and 0.96). Repeatability can be considered good, with ICC's ranging from 0.90 to 0.96. Construct validity can be classified as good with moderate-to-high correlations between the FAOS subscales and subscales of the FFI (0.55 to 0.90), WOMAC (0.57 to 0.92) and SF-36 subscales physical functioning, pain, social functioning and role-physical (0.33 to 0.81). Low standard response means were found for responsiveness (0.0 to 0.4). Conclusions: The results of this study show that the Dutch version of the FAOS is a reliable and valid questionnaire to assess symptoms and functional limitations of the foot and ankle. [ABSTRACT FROM AUTHOR]

Background: Soft tissue injuries associated with distal radius fractures have been reported by some authors. Arthroscopy can be used to evaluate the condition of the articular surface and intracarpal soft tissues and as an aid to treatment. There are three intracarpal soft tissues of particular importance: the triangular fibrocartilage complex (TFCC), the scapholunate interosseous ligament (SLIL), and the lunotriquetral interosseous ligament (LTIL). The purpose of this study was to evaluate intracarpal soft tissue injuries and their relationships with fracture types during arthroscopic surgical treatment of distal radius fractures. Methods: Eighty-nine patients in our hospital underwent surgical treatment by arthroscopy for a fracture of the distal end of the radius. They ranged in age from 17 to 92 years (mean, 62.2 years), and comprised 20 men (mean age, 45.6 years) and 69 women (mean age, 66.5 years). The AO classification data on plain radiographs indicated A2 fracture in four patients, A3 fracture in 10 patients, C1 fracture in two patients, C2 fracture in 24 patients, and C3 fracture in 49 patients. Wrist arthroscopy was performed with vertical traction, and intracarpal soft tissues were examined. For assessment of the TFCC in the radiocarpal space, the Palmar classification was used. For assessment of the SLIL and LTIL in the midcarpal space, the Geissler classification was used. Results: TFCC injury was present in 59% of cases, SLIL injury in 54.5% of cases, and LTIL injury in 34.5% of cases. Only 17.1% of patients (14/82 patients) were negative for all three types of injury. In 81% of cases (72/89 patients), some intracarpal soft tissue injury was present in association with the fracture. Conclusions: The fracture was complicated by TFCC injury in 59% of patients, SLIL injury in 54.5% of patients, and LTIL injury in 34.5% of patients, irrespective of the fracture type. [ABSTRACT FROM AUTHOR]

In order to solve the nursing problems of local anesthesia patients under arthroscopy, a nursing method and experience based on local anesthesia patients under arthroscopy was proposed. From June 2019 to May 2021, 478 patients who underwent knee arthroscopy under spinal anesthesia or local anesthesia were retrospectively investigated, including 186 cases (38.9%) under local anesthesia and 292 cases (61.1%) under spinal anesthesia. 2% lidocaine plus epinephrine was injected locally and intra-articular in patients with local anesthesia, and 0.75% bupivacaine in patients with spinal anesthesia. It was found that in the local anesthesia group and spinal anesthesia group, 94.1% (175/186) and 98.3% (287/292) patients did not feel pain during operation. 93.0% (173/186 cases) and 96.2% (281/292 cases) of patients in the two groups were satisfied or very satisfied with the effect of anesthesia, respectively. The experimental results showed that local anesthesia was a simple and effective anesthesia method for knee arthroscopy, which was more reliable and safer than spinal anesthesia. Local anesthesia could be used for knee arthroscopy or cleaning and rinsing, free body removal, or even common meniscinoplasty., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Xiaowei Zhang et al.)

Background: Every orthopedist everyday encounter with at least one patient with anterior knee pain and for further evaluation will request radiography, especially axial knee radiography. This descriptive study was planned to determine the sensitivity, specificity, positive predictive value and negative predictive value of axial knee view respect to arthroscopic finding, as gold standard technique for evaluation of patellofemoral malalingnment. Methods: In convenient manner from 61 patients who was candidate for arthroscopy, irrespective to initial diagnosis, axial view was done and reported by radiologist and according to his report, patient was classified to lateral tilt positive, lateral subluxation positive or negative. Then, patellofemoral joint was studied arthroscopically from anterolateral portal to determine if central ridge of patella seat in trochlear groove before 450 of knee flexion or not? If seating was not occur 450 of knee flexion, the patella was consider arthroscopically positive for patellofemoral malalignment. Then radiographic findings, based on arthroscopic finding, were classified to true positive, true negative, false positive, false positive and false negative. Finding: Sensitivity, specificity, positive predictive value and negative predictive value were 71%, 38%, 60% and 50%, respectively. Sensitivity and specificity of positive tilt axial view compare to arthroscopy were 56% and 41%, respectively. Conclusion: Based on the results of this study, the most valuable diagnostic method for patellofemoral malalingnment was physical examination; however, axial view has good correlation to arthroscopy. [ABSTRACT FROM AUTHOR]

Introduction: Femoroacetabular impingement leads to limited hip motion, pain and progressive damage to the labrum. Assessment of the amount and location of excessive ossification can be difficult, and removal does not always lead to pain relief and an increase of function. One of the challenges ahead is to discover why certain cases have poor outcomes.Case Presentation: The technical and clinical results of two consecutive arthroscopic shavings of an osseous cam protrusion are described in our patient, a 50-year-old Caucasian man with complaints of femoroacetabular impingement. At 12 weeks after the first arthroscopic shaving, our patient still experienced pain. Using a range of motion simulation system based on computed tomography images the kinematics of his hip joint were analyzed. Bone that limited range of motion was removed in a second arthroscopic procedure. At six months post-operatively our patient is almost pain free and has regained a range of motion to a functional level.Conclusion: This case demonstrates the relevance of range of motion simulation when the outcome of primary arthroscopic management is unsatisfactory. Such simulations may aid clinicians in determining the gain of a second operation. This claim is supported by the correlation of the simulations with clinical outcome, as shown in this case report. [ABSTRACT FROM AUTHOR]

Background: We present a simple technique of arthroscopic rotator cuff repair using a spinal needle and suture loop. Methods: With the arthroscope laterally, a spinal needle looped with PDS is inserted percutaneously into the shoulder posteriorly and penetrated through the healthy posterior cuff tear margin. Anteriorly, another spinal needle loaded with PDS is inserted percutaneously to engage the healthy tissue at the anterior tear margin. The suture in the anterior needle is then delivered into the suture loop of the posterior needle using a suture retriever. The posterior needle and loop are then pulled out carrying the anterior suture with it. The two limbs of this suture are then retrieved through a cannula for knotting. The same procedure is then repeated for additional suturing. Suture anchors placed over the greater tuberosity are used to complete the repair. Conclusion: This is an easy method of rotator cuff repair using simple instruments and lesser time, hence can be employed at centers with less equipment and at reduced cost to the patient. [ABSTRACT FROM AUTHOR]

Morphological and spatial abnormalities of the proximal femur and acetabulum have been recently recognized as causes of femoroacetabular impingement. During joint motion in hips with femoroacetabular impingement, abnormal bony contact occurs, and soft tissue structures (chondral and labral) often fail. Femoroacetabular impingement has been reported to be a contributor to early-onset joint degeneration. Ganz et al have described good midterm success with an open surgical dislocation approach to reconstruct normal joint clearance. The purpose of this report is to discuss relevant literature and describe an arthroscopic approach to treat femoroacetabular impingement. This approach has particular relevance in high-demand patients, particularly in athletes seeking to return to high-level sport. [ABSTRACT FROM AUTHOR]

Background: A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability. Hypothesis: Arthroscopic capsulolabral reconstruction is effective in alleviating pain and restoring stability and function in athletes with glenohumeral instability due to the type VIII superior labrum anterior posterior lesion. Study Design: Case series; Level of evidence, 4. Methods: From 2003 to 2006, 23 shoulders in 23 athletes were diagnosed with a type VIII superior labrum anterior posterior lesion by physical examination, magnetic resonance arthrography, and arthroscopy. All were treated with an arthroscopic capsulolabral reconstruction. Ten patients were involved in rehabilitation less than 9 months after surgery and were not included in this study. Thirteen remaining shoulders in 13 athletes with a mean age of 27.8 ± 10.9 years were analyzed at a mean follow-up of 24 months. Shoulders were evaluated preoperatively and postoperatively using the American Shoulder and Elbow Surgeons scoring system and standard subjective scales for stability, strength, function, and range of motion. Results: Athletes most commonly participated in sport at the recreational level (n = 8), followed by collegiate (n = 3) and high school (n = 2). The most common activity was weight lifting (n = 4). Eight athletes (62%) participated in contact sports, most commonly football and wrestling. Two patients (15%) had a partial-thickness articular-sided supraspinatus tendon tear that was debrided at the time of surgery. Mean American Shoulder and Elbow Surgeons score improved from 51.4 to 90.0 (P < .001). There were significant improvements in stability, pain, function, and range of motion based on standardized subjective scales (P < .001). No shoulder required revision surgery for recurrent instability. All patients were able to return to sports, with 9 (69%) able to return to their highest level before surgery. Conclusion: Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for glenohumeral instability due to a type VIII superior labrum anterior posterior lesion in the contact, noncontact, and throwing athlete. Successful postoperative return to sport is a reasonable expectation. [ABSTRACT FROM AUTHOR]

Background: Achilles tendon ruptures are difficult to repair, and the healing rate is low due to this structures anatomic and physiological characteristics. It is essential to develop new techniques to increase the healing rate and decrease the rate of complications. Objective: To propose and evaluate a new percutaneous method of repairing fresh closed Achilles tendon ruptures by Kessler's suture under arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients were followed at least 12 months in this study. First, the torn ends of the Achilles tendon were debrided during arthroscopy. Then percutaneous repair of the Achilles tendon was performed using Kessler's suture by an inside-out technique. All cases were followed up for an average range of 21 months (range, 12-36 months). All patients were evaluated by clinical examination, magnetic resonance imaging, and the Lindholm scale. Results: The torn ends were well aligned and sutured after the debridement under arthroscopy. According to the Lindholm scale, excellent results were seen in 15 cases and good in 5 cases. No patients had complications such as nerve injury, infection, or re-rupture at follow-up. Magnetic resonance imaging results showed that the ruptured Achilles tendons were repaired and remodeled very well in all patients. Conclusion: The present method is an effective surgical technique for repair of a closed rupture of the Achilles tendon. The short-term follow-up results were good, and recovery time was short. Few complications were found in our study cases. [ABSTRACT FROM AUTHOR]

Background: Six classification systems have been proposed for describing rotator cuff tears designed to help understand their natural history and make treatment decisions. Purpose: To assess the interobserver variation for these classification systems and identify the method with the best interobserver agreement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Six rotator cuff tear classification systems were identified in a literature search. The components of these systems included partial-thickness rotator cuff tears and classification by size, shape, configuration, number of tendons involved, and by extent, topography, and nature of the biceps. Twelve fellowship-trained orthopaedic surgeons who each perform at least 30 rotator cuff repairs per year reviewed arthroscopy videos from 30 patients with a random assortment of rotator cuff tears and classified them by the 6 classification systems. Interobserver variation was determined by a kappa analysis. Results: Interobserver agreement was high when distinguishing between full-thickness and partial-thickness tears (0.95, κ = 0.85). The investigators agreed on the side (articular vs bursal) of involvement for partial-thickness tears (observed agreement 0.92, κ = 0.85) but could not agree when classifying the depth of the partial-thickness tear (observed agreement 0.49, κ = 0.19). The best agreement for full-thickness tears was seen when the tear was classified by topography (degree of retraction) in the frontal plane (observed agreement 0.70, κ = 0.54). Conclusion: With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. Researchers should consider describing full-thickness rotator cuff tears by topography (degree of retraction) in the frontal plane. [ABSTRACT FROM AUTHOR]

Diagnosis and treatment of intra-articular hip problems in young patients present a challenge to hip surgeons. Previous studies have shown that non-invasive investigations such as radiography, computed tomography and magnetic resonance imaging provide limited help. Non-operative treatment is likely to result in persistent symptoms, and surgical options for intra-articular hip problems involve open arthrotomy of the hip joint, which carries potential risks associated with joint dislocation. Arthroscopy of the hip joint, therefore, seems to be an attractive option. It was once thought that introduction of a straight arthroscope into the ball-and-socket hip joint was almost impossible. Hip arthroscopy has seen several advances since then, and the speed at which it developed in recent years directly corresponded to the rate at which the conditions affecting the hip joint were identified. Athletes and other young individuals with hip injuries are increasingly being diagnosed with an ever evolving series of conditions. Many of these conditions were previously unrecognised and thus left untreated, resulting in premature ends to the patients' competitive careers. Hip arthroscopy, as with any procedure, is not without risks. The procedure is not widely available as it requires specialist equipment and takes a long time to learn. Complications are few, occurring in <5% of patients. [ABSTRACT FROM AUTHOR]

Background: A new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking. Hypothesis: The RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Retrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years' follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 arthrometry readings. Patients with symptoms consistent with meniscal repair failure underwent magnetic resonance arthrography and repeat arthroscopy. Results: Twenty patients with 21 meniscal tears were excluded, resulting in 54 meniscal tears in 46 patients. At a mean follow-up of 34.8 months, the clinical success rate for meniscal repair was 90.7% (49/54), with 5 failures requiring meniscectomy. Univariate analysis revealed predictive variables for failure: bucket-handle configuration, multiplanar tears, tear length greater than 2 cm, and chronicity longer than 3 months. Nonpredictive variables included compartment, zone, ligament graft choice, gender, age, follow-up, and visual analog scale score. Analysis of healed patients revealed a negative correlation between chronicity of tear and International Knee Documentation Committee score. Conclusions: The RapidLoc has an acceptable intermediate-term clinical healing rate in patients undergoing concurrent anterior cruciate ligament reconstruction. Predictive variables for failure should be considered during operative decision making. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic release of the vastus lateralis tendon for treatment of recurrent patellar dislocation has been criticized on the grounds that it may weaken the quadriceps. Hypothesis: Quadriceps strength and outcome measures improve after arthroscopic release of the vastus lateralis tendon in patients with documented patellar dislocation. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients who had recurrent patellar dislocation underwent arthroscopic lateral retinacular release that included a complete release of the vastus lateralis tendon from the superior pole of the patella and were observed prospectively. Bilateral quadriceps strength was tested preoperatively and at follow-up with an isokinetic dynamometer. Patients also completed the International Knee Documentation Committee Subjective Knee Form and the Short Form-36 preoperatively and postoperatively. Results: Follow-up averaged 27 months (range, 24-43 months). There were no redislocations. Mean quadriceps strength improved by a mean of 28% (from 32.3 to 41.4 N.m). The mean quadriceps torque ratio (involved/uninvolved) improved signify- scantly from a preoperative value of 63% (31/51 N.m) to 80% (42/52 N.m) at follow-up (P = .017). Fourteen patients (70%) increased quadriceps torque, and 6 patients (30%) decreased quadriceps torque. Only 1 patient failed to improve on International Knee Documentation Committee and Short Form-36 scores. The International Knee Documentation Committee scores improved from 45 points preoperatively to 76 points at follow-up (P = .001). The Short Form-36 physical component summary scores improved from 38 points preoperatively to 50 points at follow-up (P = .007), and the Short Form-36 physical functioning subscale scores improved from 53 points to 86 points (P = .015). Conclusion: Arthroscopic release of the vastus lateralis tendon and lateral patellar retinaculum in patients with recurrent patellar dislocation can improve quadriceps strength and knee function. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. Objective: To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). Results: Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive post- operatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. Conclusion: Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls. [ABSTRACT FROM AUTHOR]

Background: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition. Purpose: To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population. Study Design: Case series; Level of evidence, 4. Methods: Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3-24.5 months). At a mean follow-up of 33.8 months (range, 24-65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score. Results: Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3-9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery. Conclusion: Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play. [ABSTRACT FROM AUTHOR]

Background: Although our understanding of superior labral anterior posterior lesions has grown, the physical diagnosis remains imperfect. Study Design: Cohort study (diagnostic); Level of evidence, 2. Purpose: To determine the most effective provocative maneuver with which to diagnose superior labral anterior posterior lesions. Methods: A series of 132 consecutive patients scheduled to undergo diagnostic shoulder arthroscopy were examined preoperatively over a 6-month period, and the final diagnosis in each case was made arthroscopically. The following assessments were included: active compression (O'Brien), anterior slide, pain provocation, crank, Jobe relocation, Hawkins, Neer, Speed, and Yergason tests. Results: The most sensitive diagnostic tools for type II superior labral lesions were the active compression, Hawkins, Speed, Neer, and Jobe relocation tests. When type I and type II lesions were combined, the results were similar. However, none of the sensitive tests were specific for either type I or type II lesions. Conclusions: The authors' results contradict the current literature regarding provocative testing for both stable and unstable superior labral lesions. There is no single maneuver that can accurately diagnose superior labral anterior posterior lesions; arthroscopy remains the standard by which to diagnose such lesions. [ABSTRACT FROM AUTHOR]

Summary: Objective: High tibial osteotomy (HTO) for the treatment of unicompartmental knee osteoarthritis in the presence of axial malalignment is recognized as an effective treatment for young and active patients. The aim of this study was to identify HTO prognostic factors. Methods: A total of 94 patients who had undergone HTO with additive arthroscopy were scored using the “knee injury and osteoarthritis outcome score” (KOOS). A KOOS of less than 114 points was judged as a poor outcome. Results: A total of 84 patients were available for follow-up after a time-interval of 45.9±7.6 (range 34–60) months. The KOOS increased from 46.1±11.1 to 120.3±40.8. The preoperative varus angle in all patients was 7.5°±1.9 (range 5–14°). In follow-up the patients had a mean valgus angle of 3.7°±2.5. Twenty-three patients (27.4%) had suffered a loss of correction (0.8°, range 0–2°). A loss of correction correlated with a minor result in tendency. A total of 25 patients (29.8%) had a poor KOOS. Factors associated with a poor HTO outcome were a patient history of more than 24 months, a preoperative KOOS>50 points, obesity, and smoking. However, the results were also influenced by radiological findings, such as medial tibial exophyte, a medial joint space width of less than 5mm, and intraarticular damage, such as a degree IV cartilage defect of the tibia. Gender was also a minor prognostic factor. Patient''s age and the event of prior surgery did not influence the outcome. Conclusion: This study identified relevant factors that significantly influenced HTO results. It was possible to create a “predictive score” for HTO patients. Patients with more than 4 of the poor prognostic factors should chose primary arthroplasty. [Copyright &y& Elsevier]

Background: No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff. Hypothesis: There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons. Study Design: Descriptive laboratory study. Methods: A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection. Results: In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendihous structures. Conclusion: There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament. Clinical Relevance: According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy. [ABSTRACT FROM AUTHOR]

Objective: During minimally invasive arthroscopy, surgeons use probes as diagnostic tools to detect tissue anomalies. Improving tactile sensitivity during this activity would be valuable. Materials and Methods: We developed an enhanced probe that could enhance the tactile sensations experienced while probing objects. It operated by detecting the acceleration signal resulting from the interaction of the tool tip with surfaces and by magnifying it for tactile and auditory reproduction. The instrument consisted of an accelerometer and an actuator arranged such that the sensing direction was orthogonal to the actuating direction so as to decouple input from output. Using the instrument, subjects were asked to detect cuts under four conditions: with no amplification, with enhanced tactile feedback, with sound feedback, and with passive touch. Results: We found that for tactile reproduction, the current prototype could amplify the signals by 10 dB on average. Results from statistical methods showed significant improvements in performance in the case of tactile and auditory feedbacks. Conclusion: We developed a surgical probe with tactile and auditory feedbacks. Despite the moderate system gain achievable with the initial prototype, the system could measurably improve users' ability to detect small cuts in cartilage-like elastic surfaces. [ABSTRACT FROM AUTHOR]

Oblique-viewing endoscopes (oblique scopes) are widely used in medical practice. They are essential for certain procedures such as laparoscopy, arthroscopy and sinus endoscopy. In an oblique scope the viewing directions are changeable by rotating the scope cylinder. Although a camera calibration method is necessary to apply augmented reality technologies to oblique endoscopic procedures, no method for oblique scope calibration has yet been developed. In the present paper, we formulate a camera model and a calibration procedure for oblique scopes. In the calibration procedure, Tsai's calibration is performed at zero rotation of the scope cylinder, then the variation of the external camera parameters corresponding to the rotation of the scope cylinder is modeled and estimated as a function of the rotation angle. Accurate estimation of the rotational axis is included in the procedure. The accuracy of this estimation was demonstrated to have a significant effect on overall calibration accuracy in the experimental evaluation, especially with large rotation angles. The projection error in the image plane was approximately two pixels. The proposed method was shown to be clinically applicable. [ABSTRACT FROM AUTHOR]

The article presents information on various studies related to spine research conducted by various researchers. One of the study focused on the results of fifty consecutive patients who underwent endoscopic removal of herniated lumbar disc by interlaminar extra-dural approach. The indication for surgery was single level, unilateral sciatica. After localising the disc space by X-ray, two 5 mm portals were made, one for an arthroscope and the other for working instruments. The spinal canal was entered through the interlaminar route and under direct vision the herniated disc was removed. The researchers concluded that this technique was a minimally invasive procedure with results comparable to conventional disc surgery.

The author comments on an article "Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites?" by physician Thomas Sherman and colleagues, which appeared in the January 2015 issue of the periodical is presented. Topics include the use of ultrasound for rotator cuff pathology, treatment of tendinitis and evolution of visualization and diagnostic capabilities of arthroscope.

Background: The indications and efficacy after arthroscopic partial meniscectomy (APM) for degenerative medial meniscus lesions (DMMLs) have been controversial. The purpose of this study was to identify predictors of unfavorable clinical and radiologic outcomes after APM for DMMLs and to choose appropriate indications and improve treatment efficacy., Methods: A total of 86 patients with DMMLs undergoing APM were retrospectively reviewed. The mean follow-up time was 32.1 months. Clinical outcomes (including Lysholm score) and radiographic results (including Kellgren-Lawrence grade (K-L grade: 0/1/2/3/4) were evaluated at preoperative and final follow-up. Preoperative prognostic factors, including gender, age, Body Mass Index (BMI), Hip-Knee-Ankle (HKA), Medial Posterior Tibial Slope (MPTS), Medial Meniscus Extrusion (MME), K-L grade, occupational kneeling, and cartilaginous condition (Outerbridge grade ≤ 2, VS ≥ 3), for relatively unfavorable (fair or poor grade) Lysholm and progression of K-L grade, were investigated by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify a cutoff point for the extent of medial meniscal extrusion that was associated with the final Lysholm score., Results: A significantly improved postoperative Lysholm score (84.5 ± 9.7) compared with the preoperative score (63.8 ± 9.3) (P < 0.001), but a progression of K-L grade (20/36/30/0/0-15/27/25/19/0) (P < 0.001). The adverse prognostic factor of Lysholm score was the advancing age (OR 1.109, P = 0.05) and HKA (OR 0.255, P < 0.001). The adverse prognostic factor of K-L grade progression was MME (OR 10.327, P < 0.001). The cutoff point for the relative value of preoperative medial meniscal extrusion associated with relatively unfavorable Lysholm scores was 2.05 mm (Area = 0.8668, P value < 0.0001, Sensitivity = 62.16%, Specificity = 93.88%)., Conclusions: Clinically, varus alignment, large MME, and older age were found to predict a poor prognosis after APM for DMMLs. The preoperative extent of MME can be used as a predictive factor for osteoarthritis in APM. Patients with varus and MME should avoid APM. High tibial osteotomy may be an effective treatment strategy., (© 2022. The Author(s).)