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Meniscal ramp lesions are an evolving and challenging pathology within the field of orthopaedic surgery. Gold standards for diagnosis or treatment have not been firmly established. Currently, MRI and diagnostic arthroscopy exist as the most effective diagnostic techniques. Meniscal repair systems or an all-inside technique have been utilized to treat these injuries. Limited clinical studies have demonstrated efficacy and good outcomes, but more high level of evidence studies must be performed to solidify evidence-based diagnostic and treatment recommendations.

Advances in optical technology, instrumentation and implants now enable arthroscopic surgery to be performed on all large joints and most small joints of the limbs. Arthroscopic techniques are usually a development of surgical procedures previously performed through a large open incision, although the critical element of each procedure (for example removal of a torn meniscus) usually remains unchanged. The smaller size of incisions and reduction in tissue damage associated with arthroscopic surgery can reduce morbidity and complications. Therapeutic arthroscopy now encompasses excision, reconstruction and replacement of damaged or abnormal tissue. Improvements in the accuracy of MRI, CT and high-definition ultrasonography have limited the use of diagnostic arthroscopy to rare indications, but in the past 10 years the rates of some arthroscopic surgeries have increased by over 7-fold. Considerable variation in the type and utilization of arthroscopic procedures exists in practice, partly explained by the slow diffusion of new techniques and technology, but also by differences in clinician and patient beliefs and expectations. This Review reflects on both the success of arthroscopy and the general lack of evidence-based assessment of the efficacy and cost-effectiveness of arthroscopic procedures-a clear sign that more clinical trials in this field are required.

Basically 3 different positions are possible: supine position, prone position and lateral decubitus position. In all positions both open as well as arthroscopic procedures could be performed. Usually a tourniquet is applied to the proximal upper arm and inflated to a pressure of 250 mmHg.

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.

A successful surgical outcome for patients with shoulder instability requires a complete preoperative evaluation, a thorough diagnostic arthroscopy to evaluate for concomitant co-pathology, and an effective postoperative therapy program tailored to the repair strategy. In addition to the Bankart lesion, the surgeon must be aware of other co-pathologies such as the HAGL lesion, the ALPSA lesion and SLAP tears, all of which may occur in concert with capsular pathology and which present as potential barriers to a successful outcome. We have previously described the use of a posterolateral arthroscopic portal, 4 cm lateral to the posterolateral corner of the acromion. This portal simplifies and improves anchor placement, trajectory, and anatomic capsulolabral repair of the inferior glenoid. In this case, we perform a hybrid repair using the posterolateral portal to place the first suture anchor at the 6 o’clock position on the glenoid and the mid-glenoid portal to place two labral tape knotless anchors.

Our technique of diagnostic and surgical shoulder arthroscopy is presented, and normal variational arthroscopic anatomy of the shoulder is described. This report was based on the diagnostic findings of 118 patients (120 shoulders) who, over a 26-month period, presented with pain, popping, or instability of the shoulder and who underwent diagnostic or operative shoulder arthroscopy. The average duration of symptoms prior to surgery was 12 months. Arthroscopic examination revealed one or more abnormalities in 88% of the patients. We found that diagnostic arthroscopy of the shoulder is systematic and reproducible when attention is given to normal and variational shoulder anatomy and consistent technical detail.

Purpose: The purpose of this study was to compare arthroscopic versus open examination of the proximal long head of the biceps tendon (LHB) in patients undergoing open, subpectoral tenodesis. Methods: Eighty consecutive patients were prospectively enrolled, of whom 62 were included in the study. During arthroscopy, the most distal extent of the LHB visualized was marked with a Bovie device. The tendon was pulled into the joint with an arthroscopic grasper, showing additional LHB and was again marked with the device. LHB fraying, flattening, redness, and degeneration were graded as absent, mild, moderate, or severe. During open subpectoral tenodesis, the grossly visualized LHB was graded in the same manner and the locations of both marks plus the total length of the LHB observed during open visualization were measured and recorded. After subpectoral tenodesis, the excised portion of the LHB was histologically graded as normal, fibrosis/ tendinosis, or inflamed. Results: On average, during open tenodesis, 95 mm (range, 75 to 130 mm) of LHB was visualized. This was greater than the length visualized during diagnostic arthroscopy of 16 mm (range, 5 to 28 mm), or 17%, and the lengthvisualizedwhilepullingthetendonintothejointwithanarthroscopicgrasperof30mm(range,15to45mm),or32%. The difference in LHB length observed during open versus arthroscopic examination with a grasper was statistically significant (P < .0001). In addition, when compared with LHB pathology observed in an open manner, arthroscopic visualization showed only 67% of pathology, underestimated noted pathology in 56% of patients, and overestimated noted pathology in 11% of patients. Histologic evaluation showed fibrosis/tendinosis in 100% of cases but inflammation in only 5%. Conclusions: When compared with open inspection during subpectoral tenodesis, arthroscopic examination of the LHB visualizes only 32% of the tendon and may underestimate pathology. Level of Evidence: Level II, diagnostic studyddevelopment of diagnostic criteria based on consecutive patients with universally applied gold standard.

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.

Limited treatment options exist for glenohumeral osteoarthritis in a young and active patient. To address the pain and limitation of significant osteoarthritis while avoiding a total shoulder arthroplasty (TSA), we have been using a minimally invasive technique to resurface both the glenoid and the humeral head using osteochondral allografts. After identifying the areas of most severe chondral damage during a diagnostic arthroscopy, a transhumeral tunnel is drilled using a transhumeral guidepin. Through this tunnel the allograft donor sites are prepared by retrograde reaming the humeral head and antegrade reaming the glenoid socket. Allograft constructs are sized and cut intra-operatively on a back table, inserted through the anterior portal and secured into the graft sites using chondral darts for the glenoid and a press fit for the humeral head.

[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

This chapter provides the operative setup for the dorsiflexion method, and it describes the routine portals and accessory portals.

Background: Magnetic resonance (MR) imaging is an accurate imaging modality of the knee. The role of MR in clinical practice has not been precisely defined, largely due to the relative expense of the technique. Methods: For each new patient with a knee problem who was referred for MR, a provisional diagnosis was made together with a level of certainty regarding the diagnosis. The waiting time for the scan was recorded. To assess clinical usefulness the MR diagnosis was compared with the provisional diagnosis and classified according to the following descending order of value: unexpected negative (no intra-articular pathology), confirmatory negative, unexpected positive or confirmatory positive. To assess accuracy of the MR diagnosis, the operative diagnosis was compared to the MR diagnosis in those patients who underwent arthroscopy. Results: Fifty-two per cent of scans were assessed as being very useful and a further 20% were assessed as being moderately useful. Magnetic resonance had a 95% accuracy for medial meniscal tears, 91% accuracy for lateral meniscal tears, and 98% accuracy for anterior cruciate ligament tears, similar to previously reported studies. The diagnostic arthroscopy rate in the patients who underwent MR scanning was similar to that in patients for whom the surgeon was more confident about the diagnosis and who therefore did not undergo MR scanning. The diagnostic arthroscopy rate could have been reduced if surgery had not been performed in 14 patients who had a negative MR scan. Conclusions: There is a role for selective use of MR in the assessment of knee conditions. In particular, MR can be used to reduce the diagnostic arthroscopy rate.

Arthroscopic reduction and internal fixation of tibial plateau fractures has been well documented over the last 15 years. Better visualization, less traumatic surgery, reconstruction of accompanying injuries and early mobilization have encouraged arthroscopic surgeons to use this technique more widely. With experience, surgeons became more comfortable in using arthroscopy-assisted surgery not only in split fractures of the lateral tibial plateau (41-B1) but also in more complex tibial and femoral fractures. In this study, 31 patients with intra-articular fractures of the lateral tibial plateau were operated on between 1991 and 1996. The fractures were classified as follows: x12 AO-type B1, x7 B2, x10 B3, x2 C3. Diagnostic arthroscopy and repair of soft tissue injuries was followed by arthroscopic reduction in all patients and supplemented with internal fixation in 29 patients. Postoperatively, an aggressive physical therapy regimen was performed with immediate mobilization and early partial weight bearing. All patients were examined for follow-up after 15-32 months (mean 25.1). In all cases the fractures were stable and allowed full weight-bearing. At follow-up, 25 patients had anatomic reduction. Anatomical reduction cannot be restored in all cases of open reconstruction because of cartilage defects. Fracture reduction using arthroscopic techniques is a suitable alternative for joint fracture repair because additional soft tissue damage can be minimized.

Lack of definitive findings specific to SLAP lesions in patient history, physical examination, and diagnostic tests make this entity difficult to diagnose. Although magnetic resonance arthrography shows much promise, diagnostic arthroscopy remains the gold standard for identifying this lesion. The type of lesion identified at the time of arthroscopy determines the treatment. Type I and III SLAP lesions are debrided. Type II lesions and many type IV lesions are repaired.

This pilot study was developed to compare the relative diagnostic accuracies of physical findings, magnetic resonance imaging (MRI) and arthroscopy for internal derangements in knee osteoarthritis (OA) patients. Nine patients with locking and/or giving way in 10 knees underwent MRI and arthroscopy; the relative diagnostic accuracies for meniscal tears were studied and compared with physical findings. Eleven meniscal and no cruciate ligament tears were noted by MRI and/ or arthroscopy. Using arthroscopy as the comparison standard, the sensitivity of MRI for meniscal tears was 33.3%, specificity was 96.6%, and diagnostic accuracy was 75.0%. No significant correlations between physical findings and MRI or arthroscopy findings were found. It seemed that participants with normal radiographs had false positive MRIs more frequently. These preliminary data suggest that physical findings may not be adequate for the diagnosis of meniscal tears in patients with associated knee OA. A larger study may be warranted to further test this hypothesis. Because the presence of a meniscal tear may change therapy toward specific physical therapy modalities and/or meniscal repair, knee OA patients with mechanical symptoms may require an MRI or arthroscopy to establish the presence of a meniscal tear. Further testing is required to confirm the suggestion from these cases that patients with normal or minimally abnormal radiographs may require a diagnostic arthroscopy rather than an MRI to demonstrate a meniscal tear.

Meniscal ossicle, or bone within the substance of meniscus, is a rare entity and commonly confused with a loose body both clinically and radiologically. MRI is the modality that can definitely diagnose meniscal ossicle and avoid unnecessary diagnostic arthroscopy. Here we report one such case diagnosed using MRI; this patient is doing well without surgery one year after diagnosis.

Six patients with snapping in the knee were evaluated with clinical history, examination, radiographs, and other imaging. All patients were younger than 40 years and none had an arthritic process. Onset was traumatic in three patients, spontaneous in two, and post-surgical in one. The popping was on the direct lateral aspect of the knee. A consistent examination finding was that the popping was more prominent when the knee was loaded with varus stress during passive flexion and extension cycling, and that it was easily palpated midway between the lateral epicondyle and lateral joint line. Four patients were treated nonoperatively and two had operations. Of those treated without surgery, two had spontaneous resolution of the popping, in one the popping persisted, although not symptomatic enough to require surgery, and one had surgery later. In the surgical group, one patient was treated with popliteus tendon release and one with tenodesis of the popliteus tendon to the fibular collateral ligament. Both procedures were curative and neither led to complicating problems. Follow-up information was not available for the patient with late surgery. Snapping of the popliteus tendon should be recognized as a cause of lateral popping in the knee. It is easily confused with more common sources of mechanical symptoms. Awareness will allow accurate diagnosis and treatment, avoiding unnecessary diagnostic arthroscopy.

Purpose: This article reports on the results of a study of the arthroscopic findings in the joint surfaces of osteoarthritic temporomandibular joints (TMJs).Patients and Methods: Arthroscopy was performed in the upper joint compartment of 40 TMJs in 40 patients. Thirty-one TMJs that were diagnosed with osteoarthritis (OA) constituted the Ok group. On the basis of the presence of symptoms related to disc displacement and perforation, OA subgroups were defined. Nine TMJs that were not involved with OA constituted the control group. During the examination, various arthroscopic variables were recorded. Differences between groups and between subgroups were tested statistically.Results: In the OA group, several arthroscopic variables were found significantly more frequently than in the control group. These included retrodiscal tissue redundancy, adhesions, and heightened attachment to the posterior wall of the glenoid fossa; articular disc displacement and limited mobility; and cartilage degeneration in the articular eminence. Moreover, in the OA group, disc displacement was found significantly more frequently in the period after 6 months than during the first 6 months of clinical signs and symptoms. Anterodiscal hypervascularity was found significantly more frequently during the first year than after the first year, as well as more during the first 2 years than after the first 2 years of clinical signs and symptoms, whereas a lowered attachment on the anterior slope of the articular eminence was found significantly more often after 2 years than during the first 2 years of clinical signs and symptoms.Conclusions: The findings in this study suggest that OA of the TMJ may initially result in synovial tissue hypervascularity, creeping synovitis, and redundancy, and subsequently in adhesion formation and a reduction of the posterior and anterior recess. Because of cartilage fibrillation on the articular eminence, and the subsequently reduced surface smoothness, the articular disc may become displaced. Eventually, disc mobility is limited, and adhesions and a reduced posterior and anterior recess prevail.

PURPOSE In glenohumeral instability, CT arthrography and MR arthrography of the shoulder joint were compared to assess accuracy in diagnosis of labral lesions and other internal derangements of the joint, and to evaluate relevance of both imaging methods for therapy. METHODS 38 patients with symptoms of shoulder instability were examined clinically, arthrographically with CT and MRI, and arthroscopically. Arthrography with CT and MRI was performed in a double-contrast technique after single puncture and simultaneous injection of the contrast agents for both imaging methods. Type and extent of lesions on arthrographic imaging were criteria for planning therapy to a conservative, sole arthroscopic, or open surgical approach. RESULTS Sensitivity in diagnosis of labral lesion (26 defects) was 85% in CT, 88% in MRI and 100% if both methods were used. Full-thickness tears of the rotator cuff were visualised in CT in 73%, and in MRI in 100%. Diagnostic accuracy increased from partial to complete to total defects. An open surgical approach was correctly predicted on MRI in 90% and on CT in 71%. A sole arthroscopic therapy was correctly foreseen on both arthrographic techniques in only 38% due to difficulties to assess glenohumeral ligaments. CONCLUSIONS CT arthrography and MR arthrography were excellent for diagnosing labral lesions. MRI is superior to CT in the imaging of all joint structures. Surgical approach can be accurately predicted with both imaging methods but special surgical techniques cannot be effectively planned to replace diagnostic arthroscopy in all cases.

Elbow arthroscopy remains a technically demanding procedure requiring a thorough understanding of the pertinent local anatomy. Arthroscopy of the elbow is currently an area of rapid innovation. Improvements in equipment, techniques, and anatomic understanding will lead to an inevitable increase in both diagnostic and therapeutic applications.

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.

Often, tears of the meniscus tissue occur in the zone of poor vascularity and are not amenable to repair. In these scenarios, the torn meniscus tissue must be excised. The goals of meniscectomy surgery are to essentially remove the damaged fragment and leave behind a smooth contour in the remaining meniscus tissue. The careful positioning of the patient and portal placement are essential for navigation through the joint without damage of the native tissue. A thorough diagnostic arthroscopy should always be performed first prior to intervention to ensure that no pathology is missed and to decrease the need for reoperation. Once a nonviable piece of torn meniscus is located, it may be removed using various arthroscopic tools such as biters and shavers to reach the goals of the surgery.

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.

We present our technique for isolated arthroscopic rotator interval closure in the treatment of mild symptomatic glenohumeral instability in the absence of a labral tear. A careful history, physical examination, and imaging help to identify a select subset of atraumatic instability patients who may benefit from this procedure, and diagnostic arthroscopy can provide further evidence. By use of a posterior viewing portal with anterior and anterolateral working portals, the anterior capsuloligamentous complex is mobilized, and the rotator interval is closed with carefully placed sutures to advance the capsule superiorly and provide tension through decreased capsular volume.

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.

Background: The use of surgical simulation in orthopaedic education is increasing; however, its ideal place within the training curriculum remains unknown. The purpose of this study was to determine the effectiveness of training novice surgeons on an anatomic dry model of the knee prior to training them to perform diagnostic arthroscopy on cadaveric specimens. Methods: Fourteen medical students were randomly assigned to two groups. The experimental group was trained to perform diagnostic arthroscopy of the knee on anatomic dry models prior to training on cadaveric specimens. The control group was trained only on cadaveric specimens. Proficiency was assessed with use of a modified version of a previously validated objective assessment of arthroscopic skill, the Basic Arthroscopic Knee Skill Scoring System (BAKSSS). The mean number of trials required to attain minimal proficiency when performing diagnostic knee arthroscopy was compared between the groups. The cumulative transfer effectiveness ratio (CTER) was calculated to measure the transfer of skills acquired by the experimental group. Results: The mean number of trials to demonstrate minimum proficiency was significantly lower in the experimental group (2.57) than in the control group (4.57) (p < 0.01). The mean time to demonstrate proficiency was also significantly less in the experimental group (37.51 minutes) than in the control group (60.48 minutes) (p < 0.01). The CTER of dry-model training for the task of performing diagnostic knee arthroscopy on cadaveric specimens was 0.2. Conclusions: Previous training utilizing an anatomic dry knee model resulted in improved proficiency for novice surgeons learning to perform diagnostic knee arthroscopy on cadaveric specimens. A CTER of 0.2 suggests that dry models can serve as a useful adjunct to cadaveric training for diagnostic knee arthroscopy but cannot entirely replace it within the orthopaedic curriculum. Further work is necessary to determine the optimal amount of training on anatomic dry models that will maximize transfer effectiveness and to determine how well skills obtained in the simulated environment transfer to the operating room.

Patient was identified and the affected extremity was marked in the preoperative holding area. An IV was started. He was brought to the Operating Room and positioned supine on the operative table. General anesthetic was induced. IV antibiotics were given. A tourniquet was placed on the right/left leg that was prepped and draped in the standard fashion. A standard lateral infrapatellar portal was made. The arthroscope was introduced and a diagnostic arthroscopy performed (Findings). The medial infrapatellar portal was made under direct visualization. A superolateral portal was then created through which a 70° arthroscope was inserted.

The so-called intrinsic ligamentous structures, scapholunate and pyramido-lunate are implied in the instabilities which are said to be dissociative. Just like ‘noninvasive’ imagery (MRI and arthroscanner), arthroscopy is a means to study these ligamentous structures. It has even been reported that the arthroscanner has an excellent ‘sensitiveness’ to detect breaches in the interosseous ligaments [1]. Nevertheless, arthroscopy’s superiority is to be found in the dynamic aspect of this exam, which not only enables to study the mechanical qualities of these ligaments but also to analyse the consequences of a ligamentous lesion resorting to dynamic tests. Only one diagnostic stage is enough to prove a ligamentous injury and, even more important, to demonstrate the consequences of this injury on the dynamics of the carpal bones, asserting or invalidating the existence of an instability or a dissociation. To end up, the same exam enables to accurately analyse the chondral impact of the instability and thus contributes to evaluate how long it has been lasting. The quality of the ligamentous stumps can also be studied to judge whether a fixing by direct suture is possible or not. For all these reasons, arthroscopy remains the gold standard to diagnose dissociative instabilities.

Elbow arthroscopy has made great advances since the Andrews and Carson article in [1]. Early limited indications of diagnostic arthroscopy and removal of loose bodies have expanded to include debridement of conditions such as arthritis, synovitis, and epicondylitis. As surgeons have gained familiarity with the elbow joint, instrumentation and techniques have improved.

SummaryThere have been few prospective studies on the complications of arthroscopy, and most authors vary in the definitions of the complications which they report. Although the prospective study conducted by AANA in 1988 is generally regarded as the standard, the precise incidence of each complication is not known for all joints. There is general agreement throughout the literature, however, that arthroscopic surgery has a lower morbidity than otherwise equivalent open procedures. The incidence of complications increases with the complexity of surgical intervention, and the complication rate following diagnostic arthroscopy is very low. This low incidence of complications has, however, been achieved through a sound knowledge of local anatomy, a strict adherence to surgical principles and a willingness to publish reports of complications when they occur.

A postoperative follow-up study of internal derangement with persistent closed lock after arthroscopic surgery of the temporomandibular joint was performed in 9 patients, 11 joints.Using a triangulation technique via a second puncture, diagnostic arthroscopy was performed, followed by arthroscopic lysis and lavage operation of the temporomandibular joint to increase mobility of condyle-disk complex. This was accomplished by using power instrumentation (Microdebrider-Small Joint Microelectric Arthroplasty System) in conjunction with an irrigation system.We evaluated the efficiency of this instrument and irrigation system for temporomandibular joint arthroscopic surgery.According to the criteria of the American Society of Oral and Maxillofacial Surgery and those of Takahashi and Shibata, the surgical success rate was 88.9%. Postoperatively, there was no complication or severe discomfort.

When compared to diagnostic arthroscopy in patients with knee complaints consistent with internal derangement, MR imaging emerges as a cost effective diagnostic supplement to clinical examination. This article concludes that the results of MR imaging can be used as a guide for the management of knee pain.

SUMMARY The arthroscope can play an important diagnostic role in the arthritis patient. The major utility of this procedure is in the patient with unexplained knee pain and swelling or in the patient with an established knee arthritis whose symptoms are disproportionate to radiographic findings or refractory to standard-course medical therapy. Technologic advances have led to the production of smaller instruments, making office-based diagnostic arthroscopy a practical, cost-effective alternative in the evaluation of these patients, and supporting the clinical argument for it as a procedure distinct from conventional arthroscopy. Separate clinical scenarios further subdivide the indications for diagnostic arthroscopy and define potential intra-articular abnormalities that, if found, can justify alterations in or additions to therapeutic plans, including arthroscopically directed tissue resection and modification or application of tissue-modifying agents. The research capabilities of needle arthroscopy are only just beginning to be realized; opportunities now exist for design of prospective clinical trials in which patients are randomized based on intra-articular abnormalities, and for the serial assessment of specific treatment effects on gross, microscopic, and molecular features of target tissue as identified by the arthroscope.

Arthroscopic procedures for diagnosis and treatment of temporomandibular joint (TMJ) diseases are widely used. Few adverse effects of the procedures have been reported. In this in vivo study, diagnostic arthroscopy was performed in the left TMJ of seven castrated male goats, the right TMJ serving as a control. The goats were killed 1, 2, and 3 months after the arthroscopy. Macroscopic and microscopic examination revealed no apparent pathologic changes in two animals, minor changes in two, and severe degenerative changes in three. This study indicates that arthroscopic intervention in the TMJ may cause irreversible changes in the articular tissues.

Methods We examined 58 children with juvenile idiopathic arthritis. Clinical, serological and x-ray manifestations were analyzed in children and correlated with the genotypes. For detection erosion bone process we used ultrasound, x-ray, MRI and diagnostic arthroscopy with synovial biopsy. We investigated (PCR-RFLP) the status of p53 gene this children with juvenile idiopathic arthritis and 100 healthy children living in Russian Federation.

Kienbock disease is an isolated disorder of the carpal lunate associated with characteristic, and often progressive, clinical and radiographic changes. Appropriate intervention at specific disease stages represents the best opportunity to achieve good outcomes. As understanding of the disease improves, new therapeutic and diagnostic innovations have surfaced that further augment existing treatment options. Biologic, not just traumatic, processes may explain the onset and progression through the disease continuum. In addition to observing the obvious osseous changes, there has been renewed interest in understanding the vascular and cartilaginous manifestations of the disorder. Recognition of these factors can permit focused areas of intervention, including gene and cell-based therapies in the earliest stages. New diagnostic techniques are also being investigated. Advanced imaging modalities can facilitate the earlier recognition of Kienbock disease and enhance the assessment of lunate vascularity. Moreover, diagnostic arthroscopy permits us to directly visualize and characterize affected structures, including cartilage. Finally, there has been much recent interest in the natural history of Kienbock disease. Infantile, juvenile, and geriatric forms have been described. It has been suggested that the disease pathway in these individuals may differ from the typical adult patient population. Integrating these contemporary findings with the classic information on Kienbock disease can permit a more sophisticated approach to stage-specific treatment. This article reexamines the current classification systems to account for these emerging concepts.

Throwing athletes may develop a multitude of problems in the glenohumeral joint and subacromial area. On occasions when rehabilitation is unsuccessful, diagnostic arthroscopy and arthroscopic management of these disorders may be indicated. The present study demonstrates several common injury patterns noted on arthroscopic examination of the throwing shoulder.

Summary MRI has a proven role in the evaluation of the damaged knee, replacing arthrography and diagnostic arthroscopy. It is also of proven value in assessing the effects of trauma on the shoulder joint and rotator cuff. In the spine, MRI has rendered myelography an obsolete procedure. MRI is not widely used, within the UK, for the evaluation of trauma to muscles and tendons, probably because of the scarcity of this expensive resource. Recent technical developments have increased the flexibility and image quality of MRI to such a degree that the accurate assessment of damage to small tendons and peripheral joints is now a reality.

Anatomical open reduction is the choice treatment method in patellar fractures and the sole approach to study the cartilage surface healing is arthroscopy. This study is to evaluate the cartilage healing, long after the complete union of the fractures and the long-term effects of simple transverse patellar fractures with perfect results on patellofemoral cartilage surface. Free of charge standard diagnostic arthroscopy was done on 22 patients whose simple transverse pattelar fractures had happened at least 3 years ago with the mean age of 36.4 years. Fractures had happened at least 3 years ago and all cases had excellent union results. The data collected from cartilage surface studies were recorded. No other statistical tests were used except for X2 test to study the relation between clinical and radiological findings and arthroscopies. The elapsed time from the fracture occurrence to the arthroscopy was 39.2 months, at least 36 months. Five patients (22.6%) showed complete cartilage healing in cartilage surface arthroscopy and 10 patients (45.2%) proved to have Grade I chondral lesions. Four patients had Grade II chondral lesions and 3 patients had Grade III chondral lesions along with fibrillation. In 2 patients mirror cartilage lesions were observed in the opposite trochlea. In 3 patients with normal radiological signs, step-off was observed on cartilage surface. There was no relation between clinical signs and radiological characteristics of the patients with the healing on cartilage surface (p = 0.84). Having a diagnostic arthroscopy in an appropriate time after fusion, especially during extracting the metal instrument, is effective on evaluating patient's prognosis. Extracting metal instruments along with the simultaneous chondroplasty has low cost and complications, though leading to a decrease in the prevalence of secondary osteoarthritis and probably the eruptive swelling due to the debris released from probable fibrillations.

Surgical Principles Diagnostic arthroscopy and arthroscopic treatment of all meniscal lesions. Anteromedial “mini”-arthrotomy and small lateral incision for the placement of the bone tunnels and the passage of the graft. Use of a drill guide system with a “test prosthesis” to improve the precision of the graft placement. Immediate high fixation strength of the graft through screw fixation.

A study was performed to determine whether magnetic resonance (MR) imaging is cost-effective and reduces the need for diagnostic arthroscopy of the knee. During a 9-month period, 103 consecutive patients with knee injury that justified diagnostic arthroscopy underwent MR imaging. The MR images were interpreted by means of consensus of three radiologists and reviewed with the referring sports medicine orthopedists. After the examination, 44 patients (42.7%) underwent immediate arthroscopy. The 59 other patients (57.3%) did not undergo arthroscopy; follow-up was performed in 55 of these 59 patients (93%) at a mean of 22 months. The outcome was successful in 49 of 55 patients (89%); 40 patients had normal function and no limitation in activity, six patients with chronic injury of the anterior cruciate ligament underwent reconstruction, and three patients underwent arthroscopy with negative findings. Without the use of MR imaging, all patients in this study would have undergone diagnostic arthroscopy. Because of the diagnoses based on MR images, 53 patients (51.4%) avoided a potentially unnecessary diagnostic arthroscopy, and, as a result, the net savings was $103,700 in the 103 patients.

The simple diagnostic arthroscopy in the out-patient clinic was developed and applicated to 28 patients (30 joints) with closed lock of the temporomandibular joint. The equipments were the needle arthroscope of 0.9 mm in diameter, its cannula, and the mandlin. The technique was consisted of superior compartment puncture by a 20 gage needle, local anesthesia by a pumping action, insertion of the mandlin through the needle, switching the needle to the cannula as a guide for the mandlin, and diagnostic arthroscopy under the circulation of saline.On all of 30 joints, the technique was completed successfully and safely, without any severe complications.This technique will expand via its diagnostic arthroscopy indication, similar to another diagnostic imaging.

Disruptions of the anterior Cruciate Ligament (ACL) in children are rarely reported. We had experienced five girls of disruptions of the ACL. These cases were aged 9 to 13 years old, and had open physes. All cases were injured in sports. Diagnostic arthroscopy was performed in all cases. In this series, two cases were treated conservative and three cases, who had experienced recurrent episodes of giving way, underwent intraarticular reconstructions after growth plates were fused. We must take the disruption of the ACL consideration into the differential diagnosis of the child suffering from knee trauma.