Tratamiento artroscópico de la epicondilitis lateral crónica. Resultados a corto plazo de tres casos / Arthroscopic treatment of chronic lateral epicondylitis. Short-term results of 3 cases

Resumen: Objetivo: Mostrar el resultado a corto plazo de la liberación artroscópica en pacientes que presentan epicondilitis crónica lateral. Material y métodos: Se realiza liberación artroscópica de tres pacientes con epicondilitis lateral. Seguimiento de seis meses. Se utiliza la escala de Clínica Mayo para valoración de resultados. Se lleva a cabo revisión y discusión de la literatura. Resultados: Dos pacientes del género femenino y uno del género masculino dedicados a las actividades cotidianas, no deportistas. El dolor fue el síntoma capital que afectó el puntaje de la escala de valoración. Estos puntajes mejoraron luego de la cirugía. Se logró retorno precoz a sus actividades cotidianas. No se reportaron complicaciones neurológicas. Discusión: El tratamiento artroscópico resultó una alternativa segura y eficaz para el tratamiento de la epicondilitis lateral en estos tres pacientes, el cual permite realizar simultáneamente exploración articular con fines diagnósticos y tratar patologías asociadas. Se requieren series más amplias y estudios comparativos a fin de establecer protocolos definitivos en nuestra casuística.

Abstract: Objective: To assess the outcome of arthroscopic release in three patients with chronical lateral epicondylitis. Material and methods: Arthroscopic release in three patients with lateral epicondylitis is performed. Mayo Clinic scale for evaluation of results is used. A review and discussion of the literature is made. Results: Three patients, two female and one male, the common activities was principal labors, not athletes. Patients had significant pain. It was the principal symptom that affect the score of the rating scale. These scores improved after surgery. It was achieved early return to normal daily activities. No neurological complications were reported. Discussion: Arthroscopic treatment was an alternative safe and effective for treating chronical lateral epicondilitis in this three cases. It allows simultaneous joint exploration for diagnostic purposes and to treat associated pathologies. Broader Series and studies are necessary in order to establish definitive protocols in our cases.

Entrenamiento de habilidades artroscópicas: desarrollo de un simulador efectivo y de bajo costo / Arthroscopic skills training: development of an effective and low-cost simulator

Los equipos de simulación artroscópica son costosos y de difícil acceso. El objetivo de este trabajo es desarrollar un modelo de entrenamiento artroscópico básico, efectivo y de bajo costo, para residentes de ortopedia y traumatología. Materiales y métodos:Se diseñó un simulador con materiales de bajo costo para reproducir y registrar maniobras artroscópicas básicas. Se reclutaron 9 residentes de traumatología, quienes ejecutaron un programa de entrenamiento, incluyendo ejercicios de triangulación, exploración y motricidad fina. Fueron evaluados antes y después del entrenamiento mediante 3 diferentes pruebas orientadas a los ejercicios mencionados, comparando sus resultados, medidos en tiempo (segundos) frente a los obtenidos por un cirujano artroscopista experto. Se consideraron como aprobados aquellos que tardaban menos del 20 por ciento sobre el tiempo del experto y no aprobados si tardaban más. Mediante la prueba estadística de MacNemar se evaluó la probabilidad de mejorar habilidades entrenando con el modelo. Se consideró significación estadística un valor alfa=0,05. Resultados: Los tiempos promedio de los residentes para cada prueba al inicio y final del entrenamiento fueron respectivamente: triangulación 85+/-25,6seg y 54,4+/-14,2seg (p<0,001), cuerpos libres 204,9+/-39,5seg y 232,4+/-82,4seg (p=0,876), motricidad fina 81,8+/-37,7seg y 60,1+/-12,7seg (p=0,054). El número de aprobados en cada prueba inicial y final fue respectivamente: triangulación 0 y 6 sujetos (p=0,0143), cuerpos libres 5 y 8 (p=0,0833) y motricidad fina uno y 7 (p=0,0143). Conclusión: El número de residentes que logró aprobar las estaciones aumentó después del entrenamiento en todas las pruebas, mejorando significativamente el tiempo en triangulación y movimientos finos. Se desarrolló un simulador para el entrenamiento simple, de bajo costo y efectivo para habilidades artroscópicas básicas simuladas...

Arthroscopic training models are expensive and with restricted access. The aim of this work is to develop an effective, low-cost, basic arthroscopic simulator for orthopaedic residents. Materials and methods:A simulator was designed, with low-cost materials, that was able to reproduce and register basic arthroscopic techniques. We enrolled 9 orthopaedic residents who received a training program including triangulation, exploration, and fine movements exercises. The residents were evaluated before and after the training, and their performances were compared to a senior arthroscopic surgeon. We considered “approved” those residents who took less than 20 percent over the senior surgeon's time in each test, and “not approved” those who took more than 20 percent The MacNemar test was used to determine the probability of improving those skills using this training model. We set the statistical significance at alpha=0.05. Results:The resident's performance for each test before and after training were, respectively, triangulation 85+/-25.6s and 54.4+/-14.2s (P<0.001), loose bodies 204.9+/-39.5s and 232.4+/-82.4s (P=0.876), fine movements 81.8+/-37.7s and 60.1+/-12.7s (P=0.054). The number of approved residents for each test before and after were, respectively, triangulation 0 and 6 subjects (P=0.0143), loose bodies 5 and 8 (P=0.0833), and fine movements 1 and 7 (P=.0143). Conclusion: The number of residents who were approved in the stations improved after training in all tests, improving their time in triangulation and fine movements. We developed an effective, low-cost arthroscopic training simulator which improves simulated basic arthroscopic skills...

Endoscopic radiofrequency ablation versus traditional open surgeries for treatment of gluteal muscle contracture:a meta analysis / 中国组织工程研究

BACKGROUND:A large number of studies have reported that endoscopic radiofrequency ablation surgeries were better than traditional open surgeries for gluteal muscle contracture, but there is no meta-analysis on the clinical outcomes of endoscopic surgeries versus traditional open surgeries. OBJECTIVE:To evaluate the effects of endoscopic radiofrequency ablation surgeries versus traditional open surgeries in the treatment of gluteal muscle contracture. METHODS:Eligible studies were identified from electronic databases including EMbase, Medline, PubMed, OVID, Cochrane Library, Springerlink, CNKI, WanFang, and VIP between January 1970 and May 2014. The literatures about the clinical efficacy of endoscopic radiofrequency ablation surgeries versus traditional open surgeries in the treatment of gluteal muscle contracture were retrieved. We screened the retrieved literature according to the inclusion and exclusion criteria and performed a Meta analysis with the software RevMan 5.2 after identification of the relevant data. RESULTS AND CONCLUSION:A total of 830 patients from 14 studies were included for the analysis, including 394 patients who underwent endoscopic surgeries and 436 patients who underwent traditional open surgeries. Among the main outcomes measured, the incidence of postoperative pain (relative risk=0.33, 95%confidence interval (CI):0.27-0.42, P0.05) between the two groups. Endoscopic radiofrequency ablation surgeries are similar to traditional open surgeries in the curative effects, recurrence rate and surgery duration, and are better than traditional open surgeries in the incisional length, postoperative pain, postoperative off-bed activity time, postoperative hospitalization and postoperative complication.

Sinovite vilonodular pigmentada localizada: relato de caso / Localized pigmented villonodular synovitis: case report

O caso em questão é o de uma paciente do sexo feminino que apresentava queixa de dor na região anterior do joelho esquerdo durante e após atividades esportivas, seguidas de bloqueio articular havia três meses. Exames de imagem: radiografias simples do joelho normais e ressonância magnética mostrando formação expansiva sólida podendo corresponder a condroma de partes moles ou a sinovite nodular focal. Realizada ressecção artroscópica da lesão com diagnóstico de tumor de células gigantes difuso símile/sinovite vilonodular pigmentada localizada (SVNPL) após resultado do exame anatomopatológico. A paciente apresenta boa evolução clínica com desaparecimento dos sintomas e retorno às atividades físicas.

This case concerned a female patient with a complaint of pain in the anterior region of her left knee during and after sports activities, followed by joint blockage three months ago. From imaging examinations, simple radiography of the knee was normal and magnetic resonance showed a solid expansive mass, possibly corresponding to soft-tissue chondroma or focal nodular synovitis. Arthroscopic resection of the lesion was performed, and the diagnosis of diffuse giant cell tumor resembling localized pigmented villonodular synovitis (PVNS) was made from the result of the anatomopathological examination. The patient presented good clinical evolution, with disappearance of symptoms and return to physical activities.

Arthroscopy of the Wrist and Ulnar Shortening Osteotomy for the Treatment of the Ulnar Impaction Syndrome / 대한정형외과학회잡지

PURPOSE: This is a retrospective analysis of patients with ulnar impaction syndrome, who were diagnosed by wrist arthroscopy and treated by simultaneous ulnar shortening osteotomy. MATERIALS AND METHODS: Six patients with ulnar impaction syndrome, in whom there was an arthroscopic diagnostic confirmation of the disease had an arthroscopic debridement and ulnar shortening osteotomy. Conservative treatment over a period of more than six months had failed in each patient. The minimum duration of the follow up was one year. The ulnar variance was measured using Kreder's method, and the results were clinically analysed using Chun and Palmer's wrist score as well as radiographically. RESULTS: The Palmer's stages of TFCC injury were 2A (one), 2B (four), 2C (one) on arthroscpic finding. The results were excellent in 4 and good in 2 (preoperative: 3 were fair, and 3 were poor). The wrist score increased from 63 to 94. The ulnar variance changed from +3 mm to -1 mm. CONCLUSION: When an ulnar impaction syndrome is suspected on clinical grounds and by radiographic findings, the pathoanantomy should be assessed arthroscopically. If the arthroscopy reveals Palmer's stages 2A, 2B, 2C, arthroscopic debridement and ulnar shortening osteotomy is a useful method for the treatment of ulnar impaction syndrome.

Clinical application on the radiofrequency coblation technology in treatment of meniscal injury under arthroscopy / 中华显微外科杂志

Objective To observe and compare the short-time outcome in meniscal lesions with radiofrquency coblation technology or normally mechanical technology under the arthroscopy. Methods Thirty-eight patients with mentisci injury was selected, and divided into radiorfequency and normal group according to the standards. The patients in former group were treated with menisci reformation by radiofrequency, while in later group by menisci parthial excision. Some criteria were analysised and evaluated by comparison of operation-time, post-operation effusion of joint and improvement on the degrees of flexion and extension, clinical symptoms, functional restoration of knee joint of both groups. Results The average operation-time in radiofrequency group was less than that of normal group apparently. It was less possible for effusion of joint happened in the radiofrequency group after operation. The improvement on the degrees of flexion and extension and functional restoration of joint in the radiofrequency group exceeded in another group. Conclusion The radiofrequency under the arthroscopy is simper and less leading the surrounded tissue injury with more excellent functional restoration fo knee joint, also it has more advantage than the normal menisci partial excision mechanically.