Anatomical repair of anteroinferior shoulder instability

This work aimed to evaluate the results of identifying the causes and pathological disorders of anteroinferior shoulder instability and accordingly treating the condition. Eighteen patients suffering from persistent disabling shoulder instability were selected after failure of conservative treatment. Patients with anteroinferior instability were examined clinically, radiologically and arthroscopically if available to reach the etiological and pathological underlying factors. Redundancy of the capsule and capacious inferior pouch were detected in all cases of anteroinferior instability. Tear of the labrum and Hill Sachs lesion were found in some patients. Capsular shift procedure and repair of Bankart lesion if present were done. The technique which allows performing the two procedures was described. The results were satisfactory in all patients except two cases. It was concluded that anatomical repair including capsuloplasty and obliteration of the capacious inferior capsular pouch gave good results in treating recurrent anteroinferior shoulder instability

new technique for intraoperative localization of osteoid osteoma under combined local and general anesthesia using the wake up test

In this prospective study, a new method of intraoperative localization was described using the wake up test. Eight patients were included in the study and were diagnosed to have osteoid osteoma. Local infiltration with xylocaine 2% was carried out over the lesion. The soft tissue over the lesion was anesthetized, while the lesion itself was not affected due to its histopathological feature. This gave a clue to localize the lesion after the fentanyl-propofol were given IV to provide general anesthesia. The wake up test and response to surgical stimulation were the guidance to successfully localizing and removing the tumor. The blood propofol concentrating was measured two minutes after injection and after retrieving the response to surgical stimulation. The half life of alpha-phase of distribution was 1.794 minutes indicating rapid distribution of propofol. All patients were satisfied as the characteristic pain completely disappeared postoperatively. The patients were followed up from one-three years [average 2.2 years], no one of the patients experienced the recurrence of the characteristic pain of osteoid osteoma. The wake up technique is a good, feasible and cheap method to localize and assure complete excision of osteoid osteoma. It can be also employed in similar surgeries of the same characteristics

Arthoscopic management of meniscal cysts

Meniscal cysts are underestimated cause of knee pain commonly associated with meniscal tears. The aim of this prospective study was to evaluate the technique of arthroscopic meniscectomy and cystostomy as a method of treatment of such a meniscal disorder. Eleven patients were included in this study. The results were excellent in seven patients, good in three and fair in one patient. This technique preserves the meniscal tissue and has the advantages of antroscopic surgery