When and What to Consider Knee Arthroscopy Surgery in Post-COVID 19 Infected Patients

Coronavirus disease 19 (COVID-19) is the worst pandemic ever recorded in history, as of this day more than 545 million people infected and more than 6 million cumulative deaths. COVID 19 is primarily respiratory disease, however non-respiratory presentations that could be manifested are venous and arterial thromboembolic events. Both pulmonary embolism (PE) and deep vein thrombosis (DVT) are the most frequently thrombotic events in COVID-19. Knee arthroscopy surgery is the one of the most common orthopedic surgical procedures nowadays, with the most common procedures are meniscectomy, meniscal repair and cruciate ligament reconstruction. Although knee arthroscopy is known to be a safe procedure, several complications could be found with the 3 most common complications are DVT, effusion and synovitis, and PE. We reported a case series of four patients with DVT post knee arthroscopy anterior cruciate ligament reconstruction during 2021. The DVT diagnosis was retained on clinical presentation and elevated of D-dimer testing. The patient's mean age was 35,25 years, and all of the patients had no risk factors of DVT, although they had COVID-19 infection within 3 months before surgery. The most common clinical presentation was swelling on the lower leg (around the ankle) with slightly pain and numbness. Only one patient had severe pain around the thigh. All of the patients had elevated D-dimer testing result with mean of D-dimer 1250 (normal value < 500). Only one patient had sonography testing and found proximal DVT. One of the patients had DVT at post operative day (POD) 3, one at POD 4 and the other two at POD 5. Three of the patients improved with oral anticoagulant therapy using rivaroxaban (XARELTO). In one patient the symptom was not improved after two days oral anticoagulant therapy and underwent thrombectomy by vascular surgeon. DVT is the most common complication of knee arthroscopy and also the most common non-respiratory events of COVID-19 infection. Routinely administration of thromboprophylaxis agent was not recommended, pre-operative risk assessment of DVT should be used, especially in post-COVID 19 patients.

The impact of COVID-19 pandemic on the rehabilitation of patients after arthroscopic knee surgery at IPRM in UCM Maribor, Slovenia.

OBJECTIVES: We wanted to analyze the impact of the pandemic on the treatment and rehabilitation of these patients. BACKGROUND: The COVID-19 pandemic has had a major impact on medical services globally and it also affected the field of elective surgery and rehabilitation medicine. Among the most common procedures is the arthroscopic knee surgery, which is an intervention that warrants postoperative physical therapy. METHODS: The study included 105 patients subdivided in three groups, namely those treated before the pandemic, those treated during lockdown and those treated during the pandemic. We compared the decline in the number of patients and the rehabilitation outcome of the referred patients. The rehabilitation outcome was assessed by measuring the range of knee flexion. RESULTS: There were 132 patients included in the analysis of the decline in the number of referred patients during the pandemic. The decline was 36 %. Out of these patients, 105 were included in the analysis of the effectiveness of rehabilitation, and we demonstrated that there were no statistically important differences in improvement among the groups (p=0.246). CONCLUSION: Shorter treatment due to the COVID-19 pandemic did not have a statistically significant effect on the achieved knee flexion, but we noticed a reduction in the number of patients referred to our ward after knee arthroscopy (Tab. 6, Ref. 14).

Effects of the COVID-19 Pandemic on the Epidemiology of Knee and Shoulder Arthroscopy.

The purpose of our study was to comprehensively assess the effect of the COVID-19 pandemic on knee and shoulder arthroscopy performed in an orthopedic department of a university hospital in Poland. This study compared the data on all shoulder and knee arthroscopy procedures performed in two different periods: The period of the COVID-19 pandemic in Poland (from March 4, 2020, to October 15, 2020) and the corresponding period prior to the pandemic (March 4, 2019, to October 15, 2019). The study evaluated epidemiological data, demographic data, and hospital stay duration. The total number of arthroscopy procedures conducted in the evaluated period in 2020 was approximately 8.6% higher than that in the corresponding 2019 period. The mean duration of hospital stay for orthopedic patients after their knee or shoulder arthroscopy was 3.1 days in 2020 and 2.8 days in 2019. Our study revealed the mean age of arthroscopy patients during the pandemic to be lower at 48.4 years than the 51.2 years recorded in 2019. The male-to-female ratio was shown to be lower at .85 during the pandemic, having decreased from 1.5 in 2019. The COVID-19 pandemic did not reduce the number of arthroscopy performed at our center, and the mean age of the patients did not change. However, the pandemic had a marked effect on the mean duration of hospital stay and male-to-female ratio.

The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Meniscal Repair or Chondral Restoration Surgery in Active Duty Military: A Randomized Controlled Trial.

CONTEXT: Recently, blood flow restriction (BFR) training has gained popularity as an alternative to high-load resistance training for improving muscle strength and hypertrophy. Previous BFR studies have reported positive treatment effects; however, clinical benefits to using BFR following meniscal repair or chondral surgery are unknown. The purpose of this study was to determine the effect of resistance exercises with BFR training versus exercises alone on self-reported knee function, thigh circumference, and knee flexor/extensor strength postmeniscal or cartilage surgery. DESIGN: Single-blinded randomized controlled trial in an outpatient military hospital setting. Twenty participants were randomized into 2 groups: BFR group (n = 11) and control group (n = 9). METHODS: Participants completed 12 weeks of postoperative thigh strengthening. The BFR group performed each exercise with the addition of BFR. Both groups continued with the prescribed exercises without BFR from 12 weeks until discharged from therapy. Thigh circumference and self-reported knee function were measured at 1, 6, 12, and 24 weeks postoperatively along with knee extensor and flexor strength at 12 and 24 weeks. Change scores between time points were calculated for knee function. Limb symmetry indices (LSI) were computed for thigh circumference and knee strength variables. RESULTS: Seventeen participants were included in the final analyses (BFR = 8 and control = 9) due to COVID-19 restrictions. There were no interactions or main effects for group. Time main effects were established for change in knee function scores, thigh circumference LSI, and knee extensor strength LSI. However, knee flexor strength LSI had no main effect for time. CONCLUSION: The outcomes of this trial suggest that resistance exercises with and without BFR training may result in similar changes to function, thigh atrophy, and knee extensor strength postmeniscus repair/chondral restoration, though further study with larger sample sizes is needed.

A Prospective Assessment of Knee Arthroscopy Skills Between Medical Students and Residents-Simulator Exercises for Partial Meniscectomy and Analysis of Learning Curves.

BACKGROUND: The Covid-19 pandemic has created the largest disruption of education in history. In a response to this, we aimed to evaluate the knee arthroscopy learning curve among medical students and orthopaedic residents. METHODS: An arthroscopy simulator was used to compare the learning curves of two groups. Medical students with any prior knowledge of arthroscopy (n=24) were compared to a residents group (n=16). Analyzed parameters were "time to complete a task," assessment of the movement of tools and values scoring damage to the surrounding tissues. RESULTS: After several repetitions, both groups improved their skills in terms of time and movement. Residents were on average faster, had less camera movement, and touched the cartilage tissue less often than did students. Students showed a steeper improvement curve than residents for certain parameters, as they started from a different experience level. CONCLUSION: The participants were able to reduce the time to complete a task. There was also a decrease in possible damage to the virtual surrounding tissues. In general, the residents had better mean values, but the students had the steeper learning curve. Particularly less experienced surgeons can especially train their hand-eye coordination skills required for arthroscopy surgery. Training simulators are an important training tool that supplements cadaveric training and participation in arthroscopic operations and should be included in training.