Tratamiento artroscópico de pacientes con cuerpos libres articulares en la rodilla

Introducción: Existe escasa información en la literatura nacional sobre los cuerpos libres articulares en la articulación de la rodilla. Estos ocurren como consecuencia de lesiones traumáticas, degenerativas, inflamatorias e isquémicas. Objetivo: Actualizar los conocimientos en los aspectos más generales de los cuerpos libres articulares en la rodilla y de su tratamiento mediante la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 59 días (1 de enero al 28 de febrero de 2023) y se emplearon las siguientes palabras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 211 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline. Se empleó el gestor de búsqueda y administrador de referencias EndNote. Del total se utilizaron 33 contribuciones seleccionadas para realizar la revisión, 32 fueron de los últimos cinco años. Desarrollo: Se hace referencia al diagnóstico positivo basado en los antecedentes, cuadro clínico e imagenología. En relación al diagnóstico diferencial de esta entidad se hace especial énfasis con todas las afecciones que producen bloqueo articular. En específico, se revisan las lesiones de menisco, así como las clasificaciones más empleadas según tamaño, origen, cantidad y movilidad. En relación al tratamiento artroscópico se describen las cuatro etapas que consisten en: identificación, atrapamiento, extracción y revisión. Consideraciones finales: La vía artroscópica por sus múltiples ventajas representa la modalidad quirúrgica más efectiva para el diagnóstico y tratamiento de pacientes con cuerpos libres articulares de la rodilla.

Introduction: Currently, there is a lack of information in the national literature concerning joint loose bodies in the knee joint. These occur as a consequence of traumatic, degenerative, inflammatory and ischemic injuries. Objective: To update knowledge on the most general aspects concerning joint loose bodies in the knee and the use of the arthroscopy procedure on its treatment. Method: Search and analysis of the information was performed on 59 days (January 1 to February 28, 2023) and the following keywords were used: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Based on the information obtained, a bibliographic review was made of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases. The EndNote search manager and reference manager was used. Of the total of articles, 33 contributions selected for the review were used, 32 were published the last five years. Development: It was refered in the study on the positive diagnosis based on the history, clinical picture and imaging. In relation to the differential diagnosis of this entity, special emphasis is made up with all the conditions that produce joint blockage. Specifically, meniscal lesions are reviewed, as well as the most commonly used classifications according to size, origin, quantity and mobility. In relation to the arthroscopic treatment, the following four stages were described: identification, trapping, extraction and revision. Final considerations: The arthroscopic approach, due to its multiple advantages, represents the most effective surgical modality for the diagnosis and treatment of patients with joint loose bodies in the knee.

Introdução: Há poucas informações na literatura nacional sobre corpos articulares livres na articulação do joelho. Ocorrem como consequência de lesões traumáticas, degenerativas, inflamatórias e isquêmicas. Objetivo: Atualizar o conhecimento nos aspectos mais gerais dos corpos livres articulares no joelho e seu tratamento por via artroscópica. Método: A busca e análise das informações foi realizada em um período de 59 dias (1º de janeiro a 28 de fevereiro de 2023) e foram utilizadas as seguintes palavras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Com base nas informações obtidas, foi realizada revisão bibliográfica de um total de 211 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline. O mecanismo de busca EndNote e o gerenciador de referências foram usados. Do total, 33 contribuições selecionadas foram utilizadas para realizar a revisão, sendo 32 dos últimos cinco anos. Desenvolvimento: Refere-se ao diagnóstico positivo baseado na história, quadro clínico e imagiologia. Em relação ao diagnóstico diferencial desta entidade, é dada especial ênfase a todas as condições que causam bloqueio articular. Especificamente, são revisadas as lesões meniscais, assim como as classificações mais utilizadas quanto ao tamanho, origem, quantidade e mobilidade. Em relação ao tratamento artroscópico, são descritas as quatro etapas, que consistem em: identificação, encarceramento, extração e revisão. Considerações finais: A abordagem artroscópica, por suas múltiplas vantagens, representa a modalidade cirúrgica mais eficaz para o diagnóstico e tratamento de pacientes com corpos livres articulares do joelho.

Prognostic Factors after Arthroscopic Treatment of Infectious Knee Arthritis / 대한정형외과학회잡지

PURPOSE: This study examined the effects of gender, age, underlying disease, duration after onset of symptoms, preoperative invasive procedures, bacterial culture of joint fluid, and stage of infection by the Gächter classification on the prognosis of patients with infectious knee arthritis who underwent arthroscopic surgery. MATERIALS AND METHODS: From June 2014 to December 2016, 51 patients who underwent arthroscopic surgery for infective knee arthritis were enrolled in this study. The average follow-up period was 14.2±2.1 months (range, 12–20 months). The subjects were 27 men (52.9%) and 24 women (47.1%), with an average age of 55.1±17.6 years (range, 13–84 years). A preoperative evaluation of the joint aspiration with a count of more than 50,000 leukocytes and a polymorphonuclear leukocyte count of 95% or more was performed. All patients underwent arthroscopic surgery and postoperative continuous joint irrigation. RESULTS: The initial mean value of the C-reactive protein decreased from 9.55±6.76 mg/dl (range, 1.51–31.06 mg/dl) to a final mean of 0.74±1.26 mg/dl (range, 0.08–6.77 mg/dl); the mean duration of C-reactive protein normalization was 27.6±18.9 days (range, 8–93 days). Among the 51 patients who received arthroscopic surgery and antibiotics, 44 patients (86.3%) with infectious knee arthritis completed treatment with improved clinical symptoms, such as fever, pain, and edema, and the C-reactive protein decreased to less than 0.5 mg/dl. Finally, 5 cases were treated with two or more arthroscopic operations, and 2 cases were converted to arthroplasty after prosthesis of antibiotic-loaded acrylic cement. CONCLUSION: The duration of surgery after the onset of symptoms and the stage according to the Gächter classification are important prognostic factors for predicting the successful treatment of infectious knee arthritis. On the other hand, the other factors were not statistically significant. Nevertheless, patients with bacteria cultured from the joint fluids appear to reflect the treatment period because the period of normalization of the C-reactive protein is shorter than that of the control group.

Arthroscopic Treatment of Subchondral Bony Cyst in Early Osteoarthritis of the Hip Joint Using Allogeneic Bone Graft: A Report of Two Cases / 대한고관절학회지

Subchondral bony cyst, large solitary or multiple cysts in acetabular dome usually exacerbate progression to degenerative osteoarthritis in the hip joint. But it can be treated through arthroscopic intervention. We report two cases that treated by arthroscopic curettage and bone graft for subchondral bony cysts in early osteoarthritis of the hip joint, and it may delay progression to moderate osteoarthritis.

Arthroscopic Treatment of Cam Type Femoroacetabular Impingement: Short Term Results / 대한고관절학회지

PURPOSE: We evaluated the short term results after treatment of cam type femoroacetabular impingement (FAI) by arthroscopy. MATERIALS AND METHODS: We evaluated the clinical and radiological results of arthroscopically treated cam type FAI in patients who had failed conservative treatment with hip pain, with at least 12 months follow-up, from November 2010 to December 2012. There were 19 males and six females. Mean age of patients was 32.9 years (19-57 years) and mean follow up period was 17.2 months (13-31 months). We analyzed the alpha angle, head neck offset, visual analogue scale (VAS), and modified Harris hip score (MHHS). RESULTS: Mean alpha angle improved from 64.8degrees to 39.9degrees and mean head neck offset also improved from 0.8 to 7.6 mm. Peripheral longitudinal and radial fibrillated labral tear was the most common in the anterosuperior quadrant. Damage to acetabular cartilage was identified in 14 patients. Mean VAS improved from 6.3 to 0.9 and mean MHHS improved from 51.7 to 73.6. Complications associated with the operation included three cases of femoral head articular cartilage injury, two cases of pudendal nerve injury, and two cases of lateral femoral cutaneous nerve injury. CONCLUSION: Although the short term results for arthroscopically treated cam type FAI were satisfactory, care must be taken to reduce the complications associated with arthroscopy and long term follow is needed in order to determine whether or not it can reduce osteoarthritis of the hip.

Arthroscopic Treatment of Femoroacetabular Impingement in Young Taekwondo Players / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical results and the radiological and arthroscopic findings of femoroacetabular impingement (FAI) in young Taekwondo players and to investigate the rate of returning-to-play Taekwondo and the recurrence rate. MATERIALS AND METHODS: Twenty Taekwondo players (16 males and, 4 females) who were arthroscopically treated for FAI from September 2003 to July 2008 were retrospectively analyzed. Their mean age was 21.6 years old (range: 17 to 32 years) and the mean follow up was 33.7 months (range: 24 to 71 months). Plain radiographs and 3 dimensional computed tomography were taken in all patients and magnetic resonance arthrography was performed in 11 with suspicious soft tissue lesions. Labral injury, cartilage injury and associated lesions were evaluated by arthroscopy. The preoperative and postoperative visual analogue scale (VAS), the modified Harris hip score (MHHS), the sports frequency score (SFS), and the non-arthritic hip score (NAHS) were compared. We investigated the rate of returning-to-play at postoperative 1 year and at postoperative 2 years and the recurrence rate within 2 years after surgery. RESULTS: There were 10 cam types, 1 pincer type and 9 mixed types. The mean alpha angle improved from 65.8 degrees preoperatively to 43.2 degrees postoperatively (p<0.001). Acetabular labral tears were accompanied in all cases and the most common tear site and type were at 2 o'clock and degenerative tear, respectively. In descending order, the acetabular cartilage injuries were located in the anterosuperior, posteroinferior and anterior portion, respectively. The femoral cartilage injuries were mostly located in the anterosuperior portion. The range of motion at the final follow-up showed improvement in all except abduction (p=0.262). The VAS, MHHS and SFS showed statistically significant improvement (p<0.001). The NAHS was improved, but without statistical significance (p=0.31). The rates of returning-to-play at postoperative 1 year and postoperative 2 years were 85% (17/20) and 75% (15/20), respectively. The recurrence rate within postoperative 2 years was 15% (3/20). CONCLUSION: As screening test for FAI in young Taekwondo players is necessary at the beginning of Taekwondo. Arthroscopic treatment in symptomatic Taekwondo players is an effective procedure that can improve the postoperative exercise frequency and function. Returning-to-play Taekwondo is associated with the clinical improvements and the patients' will.

The meniscal cyst : Arthroscopic decompression and modified outside-in suture repair of the anterior horn of lateral meniscus.

This article describes a modified suture technique designed for the vertical repair of the ante-rior horn of the meniscus after arthroscopic decompression of a large meniscal cyst. This procedure comprises of three steps: first, the meniscus was pierced vertically using a suture hook and a No. II PDS suture. Second, both ends of the No. II PDS on the femoral and tibial surfaces of the meniscus were pulled to the out-side of the joint capsule using a spinal needle pre-loaded with suture material. Finally, a skin incision was made adjacent to the suture materials, and both ends were tied. We recommend this technique not only for the vertical repair of the anterior horn of the meniscus after decompression of large meniscal cyst, but also to repair a longitudinal tear of the meniscus.

The Etiology of Residual Symptoms after Hip Arthroscopic Treatment of Femoroacetabular Impingement: Analysis Using Finite Element Modeling / 대한정형외과학회잡지

PURPOSE: To analyze, using finite element model analysis, the causes of postoperative pain in patients who had arthroscopic treatment for femoroacetabular impingement (FAI). MATERIALS AND METHODS: Ten patients with FAI treated by arthroscopic surgery between July 2004 and July 2007 were selected. Five cases whose condition improved to a pain score of 3 postoperatively were assigned to comparative group A and 5 cases who had a second operation done due to a pain score of 1 were assigned to experimental group B. Finite element model analysis was done for the impingement test position. Femoral offset and alpha angle were measured to compare with contact pressure or von Mises stress. RESULTS: Preoperative von Mises stress and contact pressure were all higher in group B than group A. Maximal stress and pressure location was the anterolateral surface of the femoral head and neck, and this location was removed more accurately in group A. CONCLUSION: Finite element model analysis of FAI indicated that incomplete removal of a bump was the cause of pain, and that accurate location of the lesion and adequate bump removal are the definitive factors in reducing pain.

Arthroscopic Treatment of Acromioclavicular Joint Dislocation Using TightRope(R): Preliminary Report

PURPOSE: To evaluate the clinical and radiologic results of the arthroscopic treatment using TightRope(R) (Arthrex, Inc, Naples, FL) for management of acute acromioclavicular dislocation. MATERIALS AND METHODS: Twelve patients with acromioclavicular joint dislocation Rockwood type V are underwent the arthroscopic acromioclavicular joint reconstruction using TightRope(R) between March, 2008 and March, 2009. The average age was 40.4 years (range 25~63 years) and mean follow-up was 10 months (range 8~16 months). The shoulders were evaluated using parameters include radiologic measurements by comparing the clavicle posteroanterior and lateral radiographs with the contralateral one. Clinical evaluation was made for pain, function, and range of joint motion by Constant score and KSS (Korean Shoulder Score). RESULTS: All twelve patients returned to their work without pain in 3 months after operation. The average Constant score and KSS score was 98.4 (range 97~100) and 97.8 (range 97~100) at the last follow-up. Because of technical error and indication error, two patients showed failures of TightRope(R) fixation on the coracoid side and the acromioclavicular joint was redislocated, so these cases were excluded. 10 patients were satisfied with functional results and cosmetic appearance. CONCLUSION: Considering its less morbidity, less hospitalization, excellent cosmesis, early rehabilitation, this new technique offers an attractive alternative in acromioclavicular joint stabilization if the early technical error would be overcome.

Arthroscopic Treatment with Suture Anchor for the Isolated Subscapularis Tear

PURPOSE: We wanted to evaluate the results of arthroscopic management of an isolated rupture of the subscapularis tendon using suture anchors. MATERIALS AND METHODS: Twenty nine patients with unilateral ruptures of the subscapularis tendon and who underwent arthroscopic repair between February 2001 and October 2007 were reviewed prospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon. In 19 patients the tear was localized to the superior one third, in 7 cases the tear was localized to the upper two thirds and the entire tendon was involved in 3 cases. The mean follow up period was 12.2 months (range: 6-26 months). The results of the treatment were assessed by evaluating the constant shoulder score and the pain score before surgery and after surgery. RESULTS: The constant shoulder score improved from 49.9+/-7.3 to 73.8+/-3.0 points compared to before surgery and the pain score improved from 4.3+/-3.2 to 11.2+/-3.0 points postoperatively. CONCLUSION: Arthroscopic repair of isolated ruptures of the subscapularis tendon using suture anchors is a good option for effectively managing these tears.

Arthroscopic Treatment of Secondary Piriformis Syndrome by Perineural Cyst on the Sciatic Nerve: A Case Report

Secondary piriformis syndrome may develop under several conditions. We report on the method and usefulness of arthroscopic treatment of the piriformis muscle and benign perineural cyst of the sciatic nerve. Arthroscopic assessment was performed to a perineural cyst on the sciatic nerve seen through EMG and hip MRI. Through the posterior and posteroinferior portal, the lesion below the piriformis muscle was confirmed following release of the tendon. The incision and drainage of the perineural cyst was done so as to achieve decompression. The excision of the lesion was not carried out so as to avoid injury to the sciatic nerve. Symptoms did not recur during 10 months of follow up appointments.

Conservative and Arthroscopic Treatment of Calcific Tendinitis

PURPOSE: We evaluated calcium resolution and clinical improvement of calcific tendinitis after conservative and arthroscopic treatment. MATERIALS AND METHODS: We reviewed 126 patients of calcific tendinitis treated from January,2002 to April, 2005. Average age was 53 and female dominant in 77% of the cases. Calcium deposits were involved in supraspinatus tendon in 84% of the cases. We compared clinical changes for 64 cases treated with injection, and 12 cases treated by arthroscopic decompression with 6 month follow-up. RESULTS: 77%(49/64)of the cases with steroid injection showed symptom improvement. Even though complete resolution of calcific deposit occurred in 36%(23/64), incomplete resolution in 17%(11/64) and no change in 47%(30/64), Pain was relieved in 87%(20/23), 82%(9/11) and 67%(20/30), respectively. With arthroscopic treatment, calcium deposit completely resolved in 83%(10/12), and all cases showed pain free motion after 6 months. CONCLUSION: Conservative treatment with steroid injection was effective for acute pain in resorptive phase. In cases of arthroscopic treatment, there was no need for complete removal of calcium deposit during the procedure, but clinical symptoms improved with resolution of the deposit.

Arthroscopic Treatment of Osseous Abnormalities as a Cause of Femoroacetabular Impingement : Preliminary Clinical Results / 대한정형외과학회잡지

PURPOSE: To report the preliminary clinical results for arthroscopic treatment of osseous abnormalities as a cause of femoroacetabular impingement (FAI). MATERIALS AND METHODS: We evaluated 26 patients diagnosed with FAI who were treated by arthroscopic debridement of the labrum, spur resection, and bump resection from March 2004 to March 2005. Osseous abnormalities of FAI were evaluated for the presence or absence of asphericity, pistol grip deformity, coxa vara, coxa valga, retroversion of the acetabulum, and protrusion of acetabulum were present or not. We evaluated the clinical manifestations based on patient satisfaction, sequential JOA pain scores and ranges of motion of the hips. RESULTS: 24 patients were satisfied postoperatively. The average JOA pain score preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months, were 0.85, 0.71, 1.50, 1.71, and 1.86, respectively. At 2 weeks preoperatively, the clinical symptoms were aggravated and 6 months postoperatively, the clinical symptoms were improved. 11 patients could not take a cross-legged position preoperatively: but 10 of the 11 patients could take a cross-legged position postoperatively. CONCLUSION: Preliminary clinical results for arthroscopic treatment of osseous abnormalities were satisfactory. We need to perform a follow-up study of the clinical results about the early detection of which findings and decompression of which osseous abnormalities will prevent or delay the progression of osteoarthritis through mid and long-term follow up.

Intra-articular Avulsion Fractures of the Malleolus in Chronic Ankle Pain / 대한족부족관절학회지

PURPOSE: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. MATERIALS AND METHODS: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. RESULTS: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were 74.0+/-5.5, which improved to 89.3+/-6.7 at the follow-up after the treatment (P<0.001). CONCLUSION: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

Intra-articular Avulsion Fractures of the Malleolus in Chronic Ankle Pain / 대한족부족관절학회지

PURPOSE: We report our results of arthroscopic treatment of symptomatic avulsion fracture of the malleolus in chronic ankle pain, and also analyzed the clinical and radiological features for evaluating the good candidate for arthroscopic treatment. MATERIALS AND METHODS: Fourteen patients who were diagnosed with intra-articular avulsion fractures of the malleolus received arthroscopic surgery and were followed up for at least a year. The clinical and radiological characters including MRI and arthroscopic findings were reviewed. Clinical assessments were done according to the AOFAS score system. RESULTS: There was a history of inversion type of the injury in most cases and local tenderness of lesion site was a unique. MRI study showed thickened anterior talofibular ligament (ATFL) in 8 cases (57%) and discontinued ATFL in 3 cases (21%). Enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 12 cases (86%). Preoperative score of all patients were 74.0+/-5.5, which improved to 89.3+/-6.7 at the follow-up after the treatment (P<0.001). CONCLUSION: Most patients had history of injury and localized tenderness in the area coinciding with radiological findings. Thickened ATFL and contrast enhancement around the ossicle were frequently found. Symptomatic avulsion fractures of the malleolus associated with the clinical and radiological findings above could be a good candidate for arthroscopic treatment.

Arthroscopic Treatment of the Lipoma Arborescens in All Compartments of the Knee: A Case Report / 대한정형외과학회잡지

Lipoma arborescens is a villous proliferation of fatty tissue in the synovial membrane, and known causes are trauma, meniscal injury, inflammation, infection, degenerative change, tumor, and so forth. The reported cases are extremely rare. We report a case of lipoma arborescens developed in all compartments of the knee joint, and treated well with arthroscopic surgery.

Radiologic and Clinical Findings of Anterior Femoroacetabular Impingement in Early Osteoarthritis of the Hip / 대한정형외과학회잡지

PURPOSE: A patient diagnosed with early osteoarthritis due to hip pain who went through arthroscopic treatment were studied in the radiologic aspect and clinical aspect of anterior femoroacetabular impingement (FAI). MATERIALS AND METHODS: The subjects were 43 early osteoarthritis patients from May 1995 to May 2003 who underwent arthroscopic treatment and were able to be followed for at least 1 year. These patients were divided into two groups, the first group with patients who had no osteoarthritis on simple radiograph but with degenerative changes of the labrum and cartilage on MR arthorgram and arthroscopy, and the second group with osteoarthirtic findings on simple radiograph. Both groups were checked to see if they showed signs of anterior FAI at the acetabulum and proximal femur on radiograph and MR arthrogram. Improvement after surgery was evaluated using the JOA (Japanese Orthopaedic Association) pain score. RESULTS: About FAI, 6 patients (29%) out of 21 in group 1 showed radiologic evidence of FAI, while 12 of out 22 (56%) had it in group 2, with a total of 18 patients (42%). The pain score of pre/post operation were improved in group 1 which showed evidence of FAI and while the score of group 2 were improved from 0.83 to 1.83 and 0.92 to 1.67 in group 2. And the pain score of the group 1 which showed no evidence of FAI were improved from 0.73 to 2.60 and the score of group 2 were improved from 0.60 to 2.10. As a result, there was small improvement in pain scores of patient group with FAI. CONCLUSION: Among the patients who were diagnosed with early primary osteoarthritis of th hip, we could find anterior femoroacetabular impingement in the radiogram in some cases and the patients with FAI have low pain relief. Therefore we can expect more improved clinical result with inspection of the anterior FAI.

Meniscal Cysts of the Knee

PURPOSE: To investigate the clinical characteristics and the results of arthroscopic treatment of meniscal cysts. MATERIALS AND METHODS: From 1995 to 2002, 16 patients with meniscal cysts were treated by arthroscopic partial meniscectomy and cyst decompression. Five men and eleven women comprised the study group and had an average age of 31.9 years. The follow-up period ranged from 12 to 52 months (average 27). All patients were assessed by modified Ryu and Ting's method. RESULTS: The mean interval from onset of symptoms to surgery was 30 months. Minimal or absent trauma appeared responsible in 87.5% of all case. Eight of the cysts were lateral and eight were medial. It was difficult to palpate the cyst in three cases. All were noted to have a meniscal tear with horizontal tear at the time of surgery. There have been no recurrences, and all patients returned to their previous level of activity and were satisfied to their results. CONCLUSIONS: Meniscal cysts occur predominantly in women and almost same as often in the medial compartment as in the lateral compartment. Parameniscal cysts may result from synovial fluid tracking through a cyst tract of horizontal cleavage component. Satisfactory results can be expected from only arthroscopic partial meniscectomy and decompression of meniscal cysts without repair.

Current Concepts in Arthroscopic Treatment of Anterior Shoulder Instability / 영남의대학술지

In the past, the report of shoulder instability undergoing open shoulder stabilization had satisfactory outcomes of greater than 90%. However, the functional loss of open procedure is severe in abduction and external rotation especially. Current arthroscopic techniques for shoulder instability result in success rate equal to open surgical procedure when the labrum is properly fixed to the glenoid rim using suture anchors, the capsule is tightened, and associated bony and soft tissue pathology is addressed. The arthroscopic surgery facilitates the view within shoulder joint for more accurate diagnosis, reduces operating time, minimises postoperative pain, reduces operative morbidity, improves shoulder function, and provides the possibility to perform other procedure simultaneously. However, to accomplish a successful arthroscopic stabilization procedure and to prevent complications, numerous advanced arthroscopic skill must be mastered. Although the arthroscope provides means to visualize new lesions, the pathomechanism and biomechanical explanation is not clear yet. Further studies are necessary to develop for shoulder reconstruction.

Arthroscopic Treatment in Degenerative Arthritic Knee with Moderate Joint Space Narrowing / 대한정형외과학회잡지

PURPOSE: This study was performed to determined by follow-up observation, the result of the arthroscopic treatment for advanced degenerative arthritis of the knee joint. MATERIALS AND METHODS: During the period from January 1991 to December 1995, 270 cases had been followed for more than one year after arthroscopic treatment for degenerative arthritis of the knee joint. There were 66 males and 204 females of average age 61 years. On the Kellgren and Lawrence radiological grading system, follow-up radiography was conducted after the treatment in those cases Grade III before the treatment. A clinical assessment was performed pain, range of motion and the Hospital for Special Surgery (HSS) knee score before and after operation, and the Baumgaertner scale was used for the 2 and 48 month follow-up after operation. Recurrence was considered to have occurred when conditions were the same as before treatment. RESULTS: According to the Baumgaertner scale, clinical assessment showed overall rates of excellent and good in 191 cases (70.8%) at 2 month post-operatively, and 157 cases (58.1%) at 48 month post-operatively. Comparing the radiologic results before and after treatment using Baumgaertner's scale. the radiologically lower grade was the better result And a degenerative symptom was aggravated an average of 3.8 years. CONCLUSION: This study shows that the arthroscopic treatment is an effective option if used during the early stage of degenerative arthritis of the knee joint.

Arthroscopic Treatment of Degenerative Arthritis of the Knee

PURPOSE: To evaluate the efficacy and the prognostic factors in arthroscopic treatment of degenerative arthritis of the knees MATERIALS AND METHODS: The results of 115 knees in 110 patients had been treated arthroscopically from Jan. 1990 to June 1999 were analysed. Mean age was 56 years old and mean follow-up period was 1 years 9 months(range: 1 year-7 year). Pain, Range of motion, Lysholm score, and changes of subjective symptoms were assessed for clinical evaluation, Preoperative and postoperative X-rays of the knees and arthroscopic findings were also reviewed and statistical analysis was performed. We tried to find out the clinical results and prognostic factars in arthroscopic treatment of the degenerative arthritis. RESULTS: The best clinical improvement was observed in postoperative 1-2 year period and the clinical improvement was continued by 3 years after surgery. Sixty two percents of patients had significant improvement of subjective symptoms for 1-2 year postoperatively, and 52% for at least 3 years after surgery. The patients of younger age, normal weight, normal alignment of lower leg(1 degrees - 7 degrees degree of tibio-femoral angle) and shorter duration of preoperative symptoms showed better clinical results. Eighty percents of improvement of subjective symptoms has been obseved in the group of patient who had the mechanical symptoms preoperatively. In the knee with mild cartilage degeneration(according to Jack-sons classification, stage I or II) and with torn meniscus showed better clinical improvement after surgery compared with those of severe cartilage degeneration or intact menisci. CONCLUSION: Arthroscopic treatment can be considered as a succesful treatment method for temperary relief of symptoms in the degenerative arthritis of knees. However, careful selection of patients looks mandatory for favorable results. The favorable prognostic factors in the study were younger age, no obesity, shorter duration of symptoms, nearly normal alignment of knees, less cartilage degeneration, mechanical symptoms, and torn meniscus.