ABSTRACT
BACKGROUND: Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the results obtained by reconstructing the scapholunate ligament with a bone-ligament-bone autograft through an arthroscope-assisted minimally invasive approach. METHODS: Thirty-six patients were enrolled initially but only 31 constituted the final population study (23 male, eight female; median age, 38 years; age range, 18 to 55 years). Radiographic (posteroanterior and true lateral radiographs to assess the scapholunate gap, radiolunate, and capitolunate angles; computed tomographic scan; magnetic resonance images), functional [grip strength (Jamar test and pinch test), active range of motion], and subjective (patient-rated wrist evaluation test) outcome measurements were collected. Minimum follow-up was 50 months. RESULTS: Grip strength and wrist mobility were significantly improved from the preoperative values and improved over time. No scapholunate synostosis or carpal bone necrosis was observed. No wrist showed any sign of arthrosis or progression towards wrist instability. Only four patients had scapholunate gap greater than 3 mm. CONCLUSIONS: The proposed technique for scapholunate reconstruction, providing a biologic reconstruction of both the volar and dorsal portion of the scapholunate ligament and avoiding extensive capsulotomy, obtained significant functional outcomes improvement that was maintained over time and prevented degenerative changes to the articular surfaces. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Subject(s)
Joint Instability , Lunate Bone , Scaphoid Bone , Humans , Male , Female , Adult , Adolescent , Young Adult , Middle Aged , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/surgery , Scaphoid Bone/injuries , Arthroscopes/adverse effects , Retrospective Studies , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Wrist Joint/diagnostic imaging , Wrist Joint/surgery , Joint Instability/etiology , Joint Instability/surgery , Range of Motion, ArticularABSTRACT
OBJECTIVE: The aim of this study was to analyse the pattern of portal-tract healing, to compare the healing time of anteromedial and anterolateral portal tracts and to assess the impact of portal-tract delayed healing on the post-operative sub-acute and chronic anterior knee tenderness. METHODS: The study included 104 patients (68 males and 36 females; mean age: 49 ± 3.16 years (range; 17-66)) who have undergone knee arthroscopy. Puncture wounds were divided into two groups, (1) anteromedial and (2) anterolateral groups. Each group contained 104 portal-tracts. Healing of portal tracts was evaluated using sequential superficial ultrasonographic examinaitons. Visual analogue scale (VAS) was used to measure pain related to delayed tract healing and its association with the post-operative sub-acute and chronic anterior knee tenderness. RESULTS: Anteromedial and anterolateral tracts total healing time average values were 47 days and 28 days respectively. The VAS average values of anteromedial tracts after 2 weeks, one month, three months, six months and one year were 8.2, 6.3, 4, 1.9 and 0.6 respectively, and for the anterolateral tracts 7.4, 5.5, 2.8, 1.2 and 0.2 respectively. A statistical significance was detected between the two groups at the first and third months with P values 0.042 and 0.0035 respectively. CONCLUSIONS: Anteromedial tracts closed later than anterolateral tracts. Both portal-tracts delayed closure is a potential for post-operative sub-acute and chronic anterior knee tenderness after arthroscopic surgery. Four grades of tract healing were recognized. Portal-tract ultrasonography is advised in persistent post-operative sub-acute and chronic anterior knee tenderness. LEVEL OF EVIDENCE: Level III, Therapeutic study.
Subject(s)
Arthralgia , Arthroscopy/adverse effects , Knee Joint , Postoperative Complications/diagnosis , Aged , Arthralgia/diagnosis , Arthralgia/etiology , Arthroscopes/adverse effects , Arthroscopy/instrumentation , Arthroscopy/methods , Female , Humans , Knee Joint/diagnostic imaging , Knee Joint/surgery , Male , Middle Aged , Outcome Assessment, Health Care , Visual Analog Scale , Wound HealingABSTRACT
PURPOSE: To analyze the rare complications of arthroscopic surgeries in the temporomandibular joint (TMJ) and to investigate the preventive and treating methods. PATIENTS AND METHODS: In this study, 2,034 consecutive patients (2,431 joints), diagnosed as TMJ internal derangement, were treated by arthroscopic surgeries when visiting the TMJ clinic at the Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, between May 2001 and September 2009. The clinical complications were analyzed to investigate cause, prevention, and control measures. RESULTS: Of all 2,034 cases, the complications were shown as follows: 5 joint hemorrhages of the lateral pterygoid muscle vascular, injuries of the lateral pterygoid muscle nerve in 5 joints, 3 joints with broken instruments, rejection reaction in 2 joints, and perforation of tympanic membrane in 2 joints. CONCLUSIONS: Arthroscopic surgery was a safe and effective method to treat TMJ internal derangement; its complications were limited and acceptable, but an experienced operator was required for this surgical technique.
