The Outcome of Posterior-Stabilized, Rotating Platform Total Knee Arthroplasty at a Minimum Ten-Year Follow-Up, a Middle East Institution Experience.

Posterior-stabilized, rotating platform knee prosthesis design was aimed to decrease polyethylene wear for the sake of improving implant survivorship. The purpose of the present prospective study was to evaluate the long-term clinical and radiographic results as well as the survival rate after using a rotating platform, posterior-stabilized knee prosthesis at a minimum of 10 years at a Middle East institution. We compared the results with reports in the literature on western populations. From January 2002 to June 2008, 96 patients (106 knees) underwent total knee arthroplasty (TKA) using a cemented rotating platform posterior-stabilized knee prosthesis. At a mean of 11.5 ± 1.3 years, 85 patients (95 TKAs) were available for clinical, radiographic, and implant survival analysis. At the final follow-up, 78.9% of the patients had excellent Knee Society Scoring system score, the average knee flexion was 110 ± 17 degrees, the average anatomical knee coronal alignment was 186 ± 2 degrees and 187 ± 3 degrees for varus and valgus knees, respectively. Five (5.2%) knees were revised of these: two for bearing dislocation, two for aseptic loosening, and one for infection. The Kaplan-Meier survival rate was 94.7% for all revisions and 97.8% when only revision for aseptic loosening considered as the end point. At a long-term follow-up, reasonable clinical and radiographic outcomes had been achieved after using a rotating platform, posterior-stabilized knee prosthesis in our population with acceptable survival rate reaching up to 95%, which is comparable to reports from the western population.

Does arthroscopic patellar denervation with high tibial osteotomy improve anterior knee pain?

PURPOSE: Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. METHODS: Forty-five patients [females/males, 27/18; age, 30-59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. RESULTS: After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p < 0.001). For group A, the average KOOS improved from 42.73 to 72.38 (p < 0.001) and the Kujala score improved from 42 to 74.1 (p < 0.001), whereas in group B, the average KOOS improved from 39.22 to 56.84 (p < 0.001) and the Kujala score improved from 39.7 to 56.4 (p < 0.001). CONCLUSION: Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. LEVEL OF EVIDENCE: Level I prospective randomised control clinical trial.

Arthroscopic Reduction and Fixation by Cerclage Wire Loop for Tibial Spine Avulsion in Adults: Short-term Results.

BACKGROUND: Several arthroscopic techniques for the treatment of avulsion tibial spine fractures have been described in the literature. PURPOSE: To evaluate the outcomes of the arthroscopically assisted stainless steel wiring technique in the treatment of avulsed tibial spine in adults. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This retrospective study involved 28 patients (28 knees), 16 to 42 years of age, with tibial spine avulsion fracture that was treated using arthroscopic reduction and cerclage wire fixation by a single surgeon between March 2015 and August 2018. The degrees of avulsion in these patients were type II (n = 12), type III (n = 10), and type IV fractures (n = 6). Clinical assessment included International Knee Documentation Committee (IKDC) objective score (which noted swelling), range of knee movement, Tegner activity scale, Lachman test, and pivot-shift test compared with the normal opposite knee. RESULTS: The mean follow-up period was 24.1 months (range, 18-30 months). The mean IKDC score was 93.7 (range, 88.5-98.9); the IKDC score was normal in 22 patients and nearly normal in 6 patients. The Lachman test was grade 1 in 25 patients and grade 2 in 3 patients, whereas the pivot-shift test was grade 0 in 26 patients and grade 1 in 2 patients. All patients achieved their preinjury Tegner activity levels. Radiological assessment showed healing in all patients within a mean of 12 weeks after surgery. CONCLUSION: The outcomes of all patients were satisfactory; fixation by cerclage wiring permitted reduction of tibial spine fragment anatomically to its fracture bed, provided stable fixation in displaced tibial spine avulsion, and allowed for early rehabilitation and weightbearing because of stable fixation.

Dexamethasone and Dexmedetomidine as an Adjuvant to Intraarticular Bupivacaine for Postoperative Pain Relief in Knee Arthroscopic Surgery: A Randomized Trial.

BACKGROUND: Knee arthroscopy causes minimal trauma, however, good analgesia is required for early rehabilitation and return to normal life in the patients. OBJECTIVE: We aimed to compare the analgesic effects of intraarticular dexamethasone and dexmedetomidine added to bupivacaine with those of bupivacaine alone. STUDY DESIGN: This study uses a double-blind, randomized, controlled design with allocation concealment in a 3-armed parallel group format among patients undergoing arthroscopic meniscal surgery. SETTING: The study was conducted at Assiut University Hospital in Asyut, Egypt. The study duration was from July 2016 to February 2017. METHODS: After the ethics committee approval, 60 patients, with the American Society of Anesthesiologists (ASA) physical status of I or II, 20 - 50 years old, and scheduled for arthroscopic meniscal surgery were randomized in a double-blind manner to receive 18 mL intraarticular bupivacaine 0.25% with either dexamethasone 8 mg (group I), dexmedetomidine 1 ug/kg (group II), or 2 mL of normal saline (group III). The total volume of injectate used in each group was 20 mL. All of the patients received spinal anesthesia. Postoperatively, oral paracetamol 1000 mg was given every 8 hours, and oral tramadol 50 mg was administered, as needed, for rescue analgesia. The visual analog scale (VAS) pain scores, time to first analgesic request, and total dose of postoperative analgesics were recorded for 3 days postoperatively. RESULTS: The VAS scores were lower in groups I and II compared with group III. The time to the first analgesic was significantly shorter in group III compared with groups I and II (P = 0.001). The total dose of rescue paracetamol was higher in group III compared with groups I and II (P = 0.001). No need for tramadol rescue analgesia was recorded in any of the groups. No significant differences between groups I and II were noticed. LIMITATIONS: The limitations of this study include the lack of previous research to compare the effect of both intraarticular dexamethasone and dexmedetomidine added to bupivacaine for postoperative analgesia in arthroscopic knee surgery. Additionally, there was a short observation period for the detection of chondrotoxicity, if occurred. CONCLUSION: The addition of dexamethasone or dexmedetomidine to a solution of bupivacaine 0.25% provided better analgesia than using bupivacaine alone. CLINICAL TRIAL REGISTRATION: NCT02818985. KEY WORDS: Intraarticular, knee arthroscopy, bupivacaine, dexmedetomidine, dexamethasone, postoperative pain.

Arthroscopic Treatment of Type 1B Triangular Fibrocartilage Complex Tear by "Outside-In" Repair Technique Using Transcapsular Transverse Mattress Suture.

Triangular fibrocartilage complex (TFCC) injuries are increasingly recognized as a cause of ulnar-sided wrist pain. Palmer grouped these tears into either traumatic or degenerative, with various subclassifications. Magnetic resonance imaging (MRI), arthrogram, and arthroscopy are the methods used to establish the diagnosis. Several arthroscopic methods of TFCC repair including outside-in, inside-out, and all-inside techniques have been described. The outside-in repair, which involves piercing the TFCC via the ulnar side of the wrist, has been described by several authors, but the technique varies among authors with respect to instrumentation and subtle surgical modifications. The purpose of this article was to present the technique of arthroscopic outside-in repair using transverse mattress suture for type 1B TFCC tear by modifying classic vertical mattress sutures into sutures that pass completely through the disc.

Arthroscopic Reduction and Fixation of Tibial Spine Avulsion Fractures by a Stainless Steel Wiring Technique.

Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. These techniques include the use of various fixation devices such as screws, K-wires, wiring, sutures, and suture anchors. In this study, we evaluate a new wiring technique for the treatment of these injuries. This technique involves fixation by stainless steel tension wires passed over the fractured spine and tied over a bone bridge. The advantages of this technique are that it aids in reduction, allows for compression of the tibial spine fragment anatomically in its fracture bed, provides stable fixation in difficult comminuted fractures, and allows for early mobilization and weight bearing because of the solid fixation.

Short-term evaluation of arthroscopic outside-in repair of ulnar side TFCC tear with vertical mattress suture.

BACKGROUND: There has been controversy regarding the pathogenesis and treatment of TFCC tear. Different surgical techniques for the treatment of TFCC are prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic outside-in repair of the ulnar side TFCC tear with vertical mattress suture. METHODS: In this study, arthroscopic outside-in repair of the ulnar side TFCC tear was done. 37 patients with TFCC tear with failure of conservative treatment for a minimum of 6 months had surgery. Outcomes were assessed using modified Mayo wrist score (MMWS), the Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS) for pain and satisfaction criteria, and patient-related wrist evaluation score (PRWE), in addition to the range of motion and grip strength. RESULTS: After arthroscopic surgery, overall satisfaction was extremely positive, and out of the 37 patients, 91.9% of the patients are satisfied. The mean score for pain improved from 7.6 to 2.9 points. The mean MMWS was improved from 62.1 to 91.2 points. DASH score also improved from 29.9 to 10.2 points and PRWE improved from 60 to 33 points. The ROM was improved from 85.8% to 92% of the normal side. The grip strength of the affected side improved from 82.5% to 89% of the normal side. All improvements are statistically significant (P < 0.05). CONCLUSION: Arthroscopic outside-in repair of ulnar side TFCC tear with mattress suture is a reproducible method with a marked improvement in function within a short period.

Arthroscopic grading of common wrist disorders and its role in management.

Palmer devised a classification system to guide treatment of triangular fibrocartilage complex tears in 1989. The main division is between traumatic Type I and atraumatic Type II tears. The wrist arthroscopy makes diagnosis and treatment of ulnar impaction syndrome possible in a less invasive way. Arthroscopy is the most valuable tool for diagnosis and treatment of acute scapholunate and lunotriquetral dissociation. Arthroscopic grading of Kienböck's disease better describes articular damage compared with plain radiographs and can help surgical treatment. The wrist arthroscopy generally makes it possible to make the diagnosis of the chondral lesion before they are visible by the usual imaging.

Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex.

BACKGROUND: There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores. METHODS: In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria. RESULTS: After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P < 0.05). CONCLUSION: Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex.