Clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement / 中国骨伤

OBJECTIVE@#To evaluate the clinical effects of tranexamic acid in arthroscope for femoroacetabular impingement.@*METHODS@#Totally 34 patients (34 hips) with femoroacetabular impingement underwent hip arthroscopy from June 2016 to December 2018, were randomly divided into two groups named as tranexamic acid group and control group, 17 patients in each group. In TXA group, there were 10 males and 7 females, aged from 20 to 49 years old with an average of (32.1±7.6) years old;15 mg/kg TXA was intravenous drops before operation incision performed at 10 min. In control group, there were 11 males and 6 females, aged from 20 to 49 years old with an average of (30.9±6.2) years old;100 ml normal saline was intravenous drops before operation incision performed at 10 min. Introopertaive and total bloodloss between two groups were compared. Visual analogue scale (VAS) at 3 and 7 days after opertaion were used to evaluate pain relief of hip joint. Modified Harris Hip Score(mHHS) of hip joint at 3, 6, 9 and 12 weeks after oeprtaion were applied to evaluate clinical effects.@*RESULTS@#All patients were obtained follow up over 12 weeks. Incision healed well without infection and deep vein thrombosis. There were no statistical difference in opertaion time bewteen two groups(@*CONCLUSION@#Preoperative application of tranexamic acid could effectively reduce blood loss in arthroscopy for femoroacetabular impingement, thereby improving surgical field of vision, reducing difficulty of surgical operation, which could promote early and rapid rehabilitation of hip function.

Rotating Arm Internally Can Change the Arthroscopic Diagnosis of a Partial-thickness Tear of the Subscapularis

BACKGROUND: The aims of this study were (1) to examine the footprint of the subscapularis tendon using the traditional posterior portal and 30° arthroscope by simple internal rotation of the arm during surgery, and (2) to classify the pattern of a subscapularis partial-thickness tear. METHODS: This study analyzed a total of 231 patients with a partial-thickness subscapularis tear from 550 consecutive patients undergoing an arthroscopic operation who had a visualization of the subscapularis tendon footprint by internal rotation of the arm. First, the patients were classified into four categories according to the tear pattern: (1) stable lamination, (2) unstable lamination, (3) avulsion, and (4) laminated avulsion. Randomized arthroscopic videos were reviewed blindly by two independent orthopedic surgeons. The pattern of the tear of the subscapularis at the neutral position and after internal rotating the arm were assessed and compared with the treatment decision (level IV case series). RESULTS: Stable lamination, unstable lamination, avulsion, and laminated avulsion were observed in 9.1% (n=21), 20.8% (n=48), 41.1% (n=95), and 29.0% (n=67) of cases, respectively. In 145 out of 231 cases (62.8%), the decision was changed after inspecting the footprint after internal rotation of the arm, and the treatment method was changed in 116 (50.2%) cases. CONCLUSIONS: In a subscapularis tendon partial-thickness tear, inspecting the footprint of the subscapularis tendon is essential to diagnosing and deciding on the appropriate treatment. In addition, simply internal rotating the arm during surgery when using the traditional posterior portal and 30° arthroscope can be a valuable method.

Unilateral Biportal Endoscopic Spinal Surgery Using a 30° Arthroscope for L5–S1 Foraminal Decompression

Foraminal decompression using a minimally invasive technique to preserve facet joint stability and function without fusion reportedly improves the radicular symptoms in approximately 80% of patients and is considered one of the good surgical treatment choices for lumbar foraminal or extraforaminal stenosis. However, proper decompression was not possible because of the inability to access the foramen at the L5–S1 level due to prominence of the iliac crest. To overcome this challenge, endoscopy-based minimally invasive spine surgery has recently gained attention. Here, we report the technical skills required in unilateral extraforaminal biportal endoscopic spinal surgery using a 30° arthroscope to enable foraminal decompression at the L5–S1 level. Two 0.8-cm portals were created 2 cm lateral from the lateral border of the pedicles at the L5–S1 level. After sufficient working space was made, half of the superior articular process (SAP) in the hypertrophied facet joint was removed using a high-speed burr and a 5-mm wide osteotome, whereas the remaining inside part of the SAP was removed using a Kerrison punch and pituitary punch. The foraminal ligamentum flavum should be removed to inspect the conditions of the L5 exiting root and disc. Removing of the extruded disc could decompress the L5 root. The extraforaminal approach using a 30° arthroscope is considered a minimally invasive alternative technique for decompressing foraminal stenosis at the L5–S1 level that preserves facet stability and provides symptomatic relief.

Inadvertent thermal injury following knee arthroscopic surgery in a pediatric patient / 대한마취과학회지

Inadvertent thermal injury can occur in pediatric patients under general anesthesia during knee arthroscopic surgery. Here, we report the case of a 10-year-old boy who underwent knee arthroscopic surgery under general anesthesia. After the surgery, he complained of pain in the left lower part of his chin and was diagnosed as having a thermal burn. At three-month follow-up, he recovered without any abnormalities except mild hypertrophy of the wound area. Although rare, arthroscopic surgery has the potential to cause thermal injury from the light source. We recommend that the light source should be connected to the arthroscope before switching the power on and disconnected after a considerable time of switching the power off when not in use.

Advantages of Scorpion Suture Passer and 70 Degrees Arthroscope in Arthroscopic Bankart Repair: Usefulness for Inferior Labral Repair

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

Advantages of Scorpion Suture Passer and 70 Degrees Arthroscope in Arthroscopic Bankart Repair: Usefulness for Inferior Labral Repair

BACKGROUND: The blunted tip of a reusable with multiple uses can cause problems with the passing procedure in arthroscopic Bankart repair. This study assessed the advantage of Scorpion with a 70° arthroscope in arthroscopic Bankart repair compared to hook typed suture passer. METHODS: Scorpion in 19 patients, the hook type suture passer (conventional group) in 18 patients were used. All patients underwent the same procedure except for the type of suture passer used. Another different point of the procedure were telescopes and the number of portals used; three arthroscopic portals (posterior, anterorsuperiorlateral, and mid-anterior) and a 30° arthroscope in the conventional group, but two portals and a 70° arthroscope as well as the 30° one in the Scorpion group. The surgery time and the surgical complications including an iatrogenic axillary nerve injury were recorded. RESULTS: The Scorpion group showed a significant decrease in surgery time compared to the conventional group. In contrast to the conventional group, Scorpion provided an easy estimation of the exit of suture passing, no iatrogenic labral injury during the passing procedure with straight movement and the sharp tip of the knife installed. Iatrogenic supraspinatus injuries could be avoided when making an accessory anteosuperiorlateral portal due to the 70° arthroscope. CONCLUSIONS: In arthroscopic Bankart repair, the use of the Scorpion suture passer and a 70° arthroscope can reduce the surgery time, avoid unnecessary supraspinatus injury, and avoid iatrogenic axillary nerve damage through the relatively easy and precise suture passing and saving of the anterosuperior portal.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

Arthroscopic Treatment of Elbow Osteoarthritis and Arthroscopic Ulnar Nerve Decompression

Although arthroscopic surgery has been used conventionally, it has not been widely adopted yet due to the risks of complications, including nerve damage, technical difficulties, and limited indications. As shown in other joints, however, the use of an arthroscope will gradually increased in the elbow joint (‘Arthroscopy always wins’). Herein, arthroscopic treatments and arthroscopic ulnar nerve decompression will be discussed in cases of elbow osteoarthritis.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

Arthroscopic Treatment of Elbow Osteoarthritis and Arthroscopic Ulnar Nerve Decompression

Although arthroscopic surgery has been used conventionally, it has not been widely adopted yet due to the risks of complications, including nerve damage, technical difficulties, and limited indications. As shown in other joints, however, the use of an arthroscope will gradually increased in the elbow joint (‘Arthroscopy always wins’). Herein, arthroscopic treatments and arthroscopic ulnar nerve decompression will be discussed in cases of elbow osteoarthritis.

Fatores preditivos de resultados desfavoráveis da meniscectomia medial artroscópica em pacientes com mais de 50 anos de idade / Predictors of poor outcomes of arthroscopic medial meniscectomy in patients over 50 years old

A evolução do conhecimento acerca das funções dos meniscos e do tratamento das suas lesões, impulsionada pelo advento da cirurgia artroscópica, consagrou e popularizou a meniscectomia por esta via, por ser uma técnica menos invasiva, com menor morbidade e menores custos hospitalares, a ponto de torná-la, atualmente, a cirurgia ortopédica mais frequentemente realizada no mundo. Embora a maior parte dos pacientes submetidos a esta intervenção cirúrgica tenha resultados favoráveis e resolução rápida dos sintomas, percebe-se que parte considerável dos pacientes, especialmente os mais idosos, não apresenta uma evolução póscirúrgica satisfatória, apresentando piora dos sintomas e, eventualmente, necessitando de nova cirurgia. Partindo da hipótese que em determinados pacientes a meniscectomia, em vez de tratar, precipita e acentua um desequilíbrio biomecânico do joelho, o autor realizou estudo observacional prospectivo não-controlado com 86 pacientes de ambos os gêneros, com idade superior a 50 anos (média de 60,2 ± 7,1 anos), submetidos à meniscectomia artroscópica para tratamento de lesão do menisco medial de natureza degenerativa, com o objetivo de determinar variáveis demográficas, clínicas, anatômicas e cirúrgicas relacionadas aos resultados desfavoráveis. As avaliações funcionais pré e pós-operatórias foram realizadas utilizandose o Índice do KOOS (Knee Injury and Osteoarthritis Outcome Score), aplicado a todos os pacientes antes da cirurgia e 60 meses depois. Após análise estatística dos resultados obtidos, o autor verificou que 10 fatores podem ser considerados preditivos das meniscectomias mediais artroscópicas neste grupo etário, sendo quatro fatores fortemente associados aos resultados desfavoráveis: lesão da raiz posterior do menisco medial, dor pré-operatória intensa, claudicação antes da cirurgia e tempo decorrido entre o início dos sintomas e a cirurgia; dois fatores foram considerados moderadamente associados aos resultados...

The evolution of knowledge concerning meniscal functions and the treatment of their injuries, boosted by the development of arthroscopic surgery, has established and popularized arthroscopic meniscectomy due to its less invasiveness, less post-operative morbidity and lower hospital costs, to the point it has become, nowadays, the most frequently performed orthopedic procedure in the world. Although the majority of patients undergoing this operation is quite pleased with the outcomes and with the prompt resolution of their symptoms, it is noticeable that a considerable amount of patients with meniscal injuries, mainly the older, does not have a satisfactory postoperative outcome, with worsening of symptoms after being operated on and occasionally requiring another surgery. Based on observations of his medical practice and on the assumption that meniscectomy, rather than treat, can hasten and accentuate a biomechanical imbalance of the knee in those patients, the author conducted an observational prospective uncontrolled study with 86 patients of both genders, aged over 50 years old (average 60.2 ± 7.1 years), who underwent arthroscopic meniscectomy for the treatment of degenerative medial meniscal lesions, aiming to determine demographic, anatomical, clinical and surgical variables related to poor outcomes. The functional pre and post-operative evaluations were performed using the KOOS index (Knee Injury and Osteoarthritis Outcome Score) applied to all patients before surgery and 60 months later. After statistical analysis of the results, the author found that 10 factors can be considered predictors of arthroscopic medial meniscectomy in this age group: four factors were strongly associated with unfavorable results - posterior root lesion of the medial meniscus, intense pre-operative pain, claudication before surgery and time elapsed between onset of symptoms and surgery; two factors were moderately associated with unfavorable results - bone marrow...

Cirugía mínimamente invasiva en Venezuela: estado actual de la atención pública / Minimally invasive surgery in Venezuela: public attention current status

El propósito del trabajo es describir el estado actual de la cirugía mínimamente invasiva (CMI) en Venezuela, con el fin último de incentivar políticas públicas dirigidas a dotar a los hospitales del país con el recurso humano e instrumental necesarios para el desarrollo de procedimientos diagnósticos y terapéuticos destinado a solucionar el problema que representa el cupo quirúrgico en la población de menores recursos económicos. La metodología de investigación está guiada por el paradigma positivista lógico, de enfoque empirico análitico, de raíz epistémica positivista, utilizando lenguaje cuantitativo. Desde el punto de vista heurístico la información procede del Ministerio del Poder Popular para la Salud, Sociedad Venezolana de Cirugía, círculos quirúrgicos, bibliografía nacional e internacional. El estudio de la investigación de campo y del marco teórico referencial nos permite contextualizar el tema y generar conclusiones, así como recomendaciones acordes con el fenómeno de estudio

The purpose of the study is to describe the minimally invasive surgery current state in Venezuela with the last end of motivate public policies toward provide the country's hospitals with the human resource and the necessary instrumental for the development of diagnostic and therapeutic procedures in order to solve the problem of the surgical needs in the population with low economic resources. The research methodology is guide by the logic positivist paradigm, with the empirical analytic focus and using quantitative language. From the heuristic point of view the data comes from the popular health agency. Venezuelan surgical society, surgical circles, national and international bibliograpy. The field research study permits to contextualize the theme and generate preliminary considerations and also recommendations in concordance with the phenomenon in study

Procedimento de latarjet artroscópico: avaliação da segurança em cadáveres / Arthroscopic latarjet procedure: safety evaluation in cadavers

Objetivo: Avaliar a segurança do procedimento de Latarjet artroscópico em cadáveres. Métodos: roze ombros foram submetidos ao procedimento de Latarjet artroscópico em nosso laboratório de artroscopia, por quatro cirurgiões diferentes. Após a cirurgia os espécimes foram submetidos a exames radiográficos e avaliados por um examinador independente. Dezenove parâmetros foram avaliados, incluindo a fixação do enxerto do coracoide, o posicionamento e a angulação dos parafusos, lesões neurológicas e a integridade dos tendões. Resultados: quatro dos procedimentos foram considerados satisfatórios, sem diferença entre os cirurgiões. A angulação média dos parafusos foi de27,2°. A incisão no tendão do subescapular foi, em média, a 17,8mm da sua borda superior. O enxerto coracoide foi corretamente posicionado em relação ao equador da glenoide em 11 casos. Não houve lesão nos nervos axilar ou musculocutâneo. As principais complicações encontradas foram: interposição de tecidos moles, lesão do nervo supraescapular, desvio articular do enxerto, diastase e lesão do tendão conjunto. Conclusão: o procedimento de Latarjet artroscópico é uma técnica complexa, em que cada etapa deve ser precisa para diminuir o risco de complicações. Nosso estudo demonstrou um alto risco de insucesso do procedimento. Nível de Evidência IV, Série de Casos.

Objective: To evaluate the safety of arthroscopic Latarjet procedure in cadavers. Methods: twelve cadaveric shoulders underwent arthroscopic Latarjet procedure in our laboratory for arthroscopy, by four different surgeons. Following surgery, the specimens weresubjected to radiographic examination and evaluated by an independent examiner. Nineteen parameters were evaluated, including the coracoid graft fixation, positioning and angulation of the screws, neurological damage and integrity of tendons. Results: four procedures were considered to be satisfactory, with no difference among the surgeons. The mean angulation of the screws was 27.2º. The subscapularis splitting was, on average, 17,8mm from the upper edge. The coracoid graft was properly positioned relative to equator of the glenoid in 11 cases. There were no injury to the axillary or musculocutaneous nerves. The main complications were: interposition of soft tissue, suprascapular nerve injury, articular deviation of the graft, diastasis and conjoined tendon injury. Conclusion: thearthroscopic Latarjet procedure is a complex technique in which each step must be precise to reduce the risk of complications. Our study showed a high risk of failure of the procedure. Level of Evidence IV, Case Series.

Arthroscopic Treatment of Septic Arthritis of the Hip in a Child: A Case Report / 대한고관절학회지

Recommended treatment options for acute septic arthritis in children include repeated aspiration, open arthrotomy, and arthroscopic drainage. However, reports of arthroscopic treatment of septic arthritis of the hip in a child are rare. We experienced a case of arthroscopic management of acute septic arthritis of the right hip joint in a three-year-old child using a 30degrees, 2.7 mm arthroscope for the ankle joint through manual traction without use of a traction table. The patient had complete range of motion in the right hip joint two weeks after surgery and recurrent infection was not observed at the final follow-up two years postoperatively.

Clinical Results of Direct Arthroscopic Excision of Popliteal Cyst Using a Posteromedial Portal

PURPOSE: To evaluate the efficacy of the direct arthroscopic excision of a popliteal cyst without additional skin incision using a posteromedial portal based on minimum 2 year follow-up clinical results. MATERIALS AND METHODS: From January 2003 to January 2010, 105 patients (111 cases) with popliteal cyst have been treated by a direct arthroscopic excision. Direct arthroscopic excision using a 70 degree arthroscopy and posteromedial portal can correct the valvular mechanism of capsular fold and reduce the complications with no additional skin incision at the popliteal area. In all cases, preoperative magnetic resonance imaging (MRI) was performed to detect combined intraarticular pathology. At 2 years postoperatively, a follow-up ultrasonography or MRI was performed to detect the recurrence of cysts. We used Rauschning and Lindgren criteria for clinical evaluation. RESULTS: All cases had neither recurrence nor complaints of pain, swelling, or functional impairment more than 2 years after the surgery. At ultrasonography or MRI, no recurrence was found, and 5 complications were 1 skin lesion and 4 hematoma. Postoperatively, Rauschning and Lindgren criteria were more than grade 1. CONCLUSIONS: Direct arthroscopic excision using 70 degree arthroscope and posteromedial portal is an effective method for the treatment of popliteal cyst.

Ankle Arthroscopy: Anatomy, Portals and Instrument / 대한족부족관절학회지

Major technologic advances in fiberoptic light transmission, video cameras, and instrumentation have allowed great advances in small-joint arthroscopy. Arthroscopy in particular is now well established procedure for accurate diagnosis and operative management of certain ankle disorders. The small size of the ankle and significant periarticular soft tissue structures make placement and advancement of the arthroscope and instrumentation more difficult than in larger joints. Successful arthroscopy of the ankle requires knowledge of the regional anatomy and a familiarity with the available arthroscopic portals. This review article is going to describe the gross and arthroscopic anatomy of the ankle as it relates to current arthroscopic techniques. Particular emphasis is placed on the anatomic relations of the important osseous and soft tissue structures for a safe, reproducible approach to arthroscopic treatment of ankle pathology. Also, current arthroscopic equipment and instruments are included.

Ganglion of the Triangular Fibrocartilage Complex: A Case Report

Ganglions are the most common mass occurred in the wrist and hand. Ganglion usually arises from the dorsal aspect of the radiocarpal joint that may lead to the wrist pain. We report a patient with a ganglion of the triangular fibrocartilage complex. Using arthroscopic technique, ganglion located in triangular fibrocartilage complex was successfully excised.

Development and innovation of arthroscopic techniques / 中国骨伤

In this special issue, several papers related to clinical application of arthroscopic surgery are published, which present the current situation of arthroscopic techniques in our country. As a technique of minimally invasive orthopedics, arthroscopy is used in examination, diagnosis and treatment of joint diseases, which is the trend of modern surgery. Arthroscopy has been widely used in surgical procedures in knee diseases, and now it expands the scope of application to other joints, such as shoulder, elbow, wrist, hip, ankle and even smaller joints. The application scope of arthroscopy has spread from arthroscopic debridement to reparative and reconstructive surgery. Some innovation has been made in extra-articular surgeries. Researchers conduct in depth study and exploration in the basic and clinical application of arthroscopy. Arthroscopic surgery has become an indispensable branch of modern orthopedics.

Treatment of ankylosis of the knee through a mini-incision assisted by arthroscope / 中国骨伤

<p><b>OBJECTIVE</b>To investigate therapeutic effects of mini-incision assisted by arthroscope for the treatment of ankylosis of knee.</p><p><b>METHODS</b>From July 2007 to August 2009, 18 patients with ankylosis of knee were treated with mini-incision assisted by arthroscope. Among the patients, 15 patients were male and 3 patients were female, ranging in age from 27 to 56 years, with an average of 33.6 years. Before operation, 5 patients had comminuted fractures in the distal end of femur (including 1 patient with open fracture), 9 patients had comminuted fractures of tibial plateau, 2 patients had comminuted fractures of patella, 1 patient had comminuted fractures of patella combined with comminuted fracture of capitulum fibulae and injuries of complex structure at lateral knee, and 1 patient had floating knee. The duration between the primary operation and the arthrolysis ranged from 6 to 31 months (averaged, 10.6 months). The therapeutic effects were evaluated according to Judet criteria.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 3 to 25 months (averaged, 11.4 months). All the patients had incision healing at the first stage without infection, wound dehiscence and liquifaction necrosis. The preoperative knee flexed motion ranged from 30 degrees to 80 degrees, with a mean of (44.72 +/- 11.60) degrees; and postoperative knee flexed range of motion improved to an average of (109.17 +/- 10.31) degrees (ranged, 95 degrees to 135 degrees). According to Judet evaluation, 16 patients got an excellent result, 2 good.</p><p><b>CONCLUSION</b>Treatment of ankylosis of the knee through a mini-incision assisted by arthroscope has advantages such as reducing the complications of incision on knee, little trauma and early recovery, which is a good operative mode to treat ankylosis of the knee after operation or trauma.</p>

Arthroscopic Assisted Treatment of Intraosseous Ganglion of the Scaphoid Associated with Occult Ganglion: A Case Report

Intraosseous ganglion of the scaphoid associated with occult ganglion is rare. A 27-year-old man who presented with a 4-month history of progressive left wrist pain visited our institution. The patient was diagnosed intrasosseous ganglion of the carpal scaphoid assosiated with occult ganglion. We obtained satisfactory result by arthroscopic procedure and report this case focusing on surgical technique with literature review.