Outcomes of arthroscopic coracoclavicular management for acromioclavicular joint injuries: A systematic review.

Introduction: Various surgical procedures for coracoclavicular (CC) ligament repair have been described for symptomatic acromioclavicular joint dislocations, with none emerging as a clear gold standard. There has been increased interest in arthroscopic approaches. This systematic review evaluates clinical outcomes after arthroscopic surgeries used to treat chronic and acute AC joint dislocations. Methods: We searched three databases (PubMed, EMBASE, and OVID [MEDLINE]) from database inception to December 20, 2022. Studies were included if they met the following criteria: studies evaluating humans, English language studies, level of evidence I to IV, and studies investigating clinical outcomes in patients following arthroscopic surgery for coracoclavicular ligament reconstruction. Studies on open reconstruction techniques only were excluded. Primary outcomes included function/pain scores, coracoclavicular distances, complications, and revision rates. Results: Fifty-two studies were included. In 33 studies, postoperative Constant-Murley scores ranged from 82.8 to 99 points. Postoperative VAS scores ranged from 0.3 to 4.1 in 16 studies. In 46 studies, revision rates ranged from 0 % to 44.4 %. We did not observe a difference in revision rates between chronic and acute cases (P = 0.268). Complications were more common in chronic than acute cases (25.5 % vs. 16.4 %; P < 0.001). Conclusions: Arthroscopic surgery for chronic and acute CC ligament injuries exceeds the MCID and PASS for several outcomes, with low failure rates. Arthroscopic CC reconstruction is a safe and effective alternative for chronic AC joint dislocations. Level of evidence: IV (Systematic Review of Level I-IV Studies).

Retrospective Comparison of Quadratus Lumborum and Pericapsular Nerve Group Blocks for Postoperative Pain Management of Patients Undergoing Outpatient Hip Arthroscopy.

Introduction: Hip arthroscopy is commonly performed as an outpatient procedure and effective postoperative pain management is important to provide quality patient care and enable timely discharge. Multiple regional nerve blocks have been described for pain relief after hip arthroscopy, but there is no consensus on the optimal technique. This retrospective investigation aimed to compare quadratus lumborum (QL) and pericapsular nerve group (PENG) blocks to determine if there are differences in analgesic outcomes after outpatient hip arthroscopy. Methods: A total of 50 consecutive patients that received QL block and 50 that received PENG block for outpatient hip arthroscopy were identified and compared to determine if there were any differences in the primary outcome of total perioperative opioid consumption prior to discharge from the surgery center. Important secondary analgesic outcomes include postoperative opioid consumption, verbal rating scale (VRS) pain scores or total time in the recovery area. Summary statistics of relevant variables are compared and reported between study groups (QL versus PENG). Results: For QL and PENG groups, no significant differences were observed in total perioperative oral morphine equivalents (OME) (69.5 vs 60mg; p=0.40), postoperative OME (15 vs 15.3mg; p=0.96) or maximum pain scores in the recovery area (7.0 vs 6.0; p=0.41). Postoperatively, QL block patients were in PACU for a greater length of time after surgery than PENG block patients (89.5 vs 72 minutes; p<0.001). No patients had uncontrolled pain requiring emergency room visits or hospital admission within 24 hours. No neurologic complications or instances of motor weakness were reported after QL or PENG blocks. Conclusion: This retrospective study observed similar opioid requirements and pain scores for patients receiving QL versus PENG block for hip arthroscopy, though PENG block patients had shorter times in the recovery area. Prospective, controlled trials are required to further explore and confirm these findings.

A retrospective cohort study: dual cannula combined with modified shoelace continuous capsular closure technique versus nonrepair in hip arthroscopic surgery of femoroacetabular impingement.

BACKGROUND: Over the years, with the improvement of diagnostic and therapeutic capabilities for hip joint diseases and the advancements in surgical technology, hip arthroscopy has been extensively used. At present, there is ongoing controversy among scholars about whether it is necessary to close the joint capsule after hip arthroscopy. In addition, the clinical effect of repairing the hip joint capsule after hip arthroscopy remains uncertain. PURPOSE: To evaluate the effect of our modified shoelace suture technique on postoperative hip function and to investigate whether complete closure of the hip capsule is reliable and safe. STUDY DESIGN: Retrospective study; Levels of evidence: III. METHODS: A retrospective review was conducted on patients undergoing hip arthroscopy by a solitary high-volume hip arthroscopic surgeon. The patients were categorized into two groups. The first group consisted of patients who underwent the modified shoelace continuous capsular closure technique. The other group consisted of those who did not receive capsular closure after hip arthroscopy. Patient-reported outcomes including modified Harris Hip Score (mHHS), Hip Outcome Score of Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and visual analogue scale (VAS) were obtained at a minimum of 12 months. Any complications during follow-up were identified and recorded. RESULTS: A total of 100 patients were followed up for 12-15 months, with an average of (12.3 ± 5.3) months in the study. There were 50 patients in the shoelace capsular closure group (CC group) and 50 patients in the non-capsular closure group (NC group). The surgical time in the suture group was significantly longer than that in the non-suture group. However, there was no statistically significant disparity in the length of hospital stay between the two groups. The mHHS, HOS-SSS, HOS-ADL, and VAS of the CC and NC group were significantly improved compared to preoperative scores at 6 and 12 postoperative months (P < 0.001). Compared with the NC group, the CC group showed a significant improvement in the mHHS, HOS-SSS, HOS-ADL, and VAS at 6 postoperative months (t = 4.885, P<0.001; t = 5.984, P<0.001; t = 4.279, P<0.001; t = 3.875, P<0.001). The mHHS, HOS-SSS, HOS-ADL, and VAS at 12 postoperative months were significantly better in the CC group than in the NC group (t = 5.165, P<0.001; t = 3.697, P<0.001; t = 4.840, P<0.001; t = 3.579, P = 0.001). There were no serious complications during the perioperative period. CONCLUSION: The modified shoelace continuous capsular closure technique is a reliable and secure method that can be used as an alternative to the conventional capsular closure. It is recommended to perform routine intraoperative repair of the articular capsule at the end of hip arthroscopy, as this has a positive influences on the functional results at short-term follow-up.

Analysis of risk factors and construction of nomogram model for arthroscopic single-row rivet repair.

BACKGROUND: The factors influencing the clinical outcome of arthroscopic rotator cuff repair are not fully understood. PURPOSE: To explore the factors related to the postoperative outcome of arthroscopic single-row rivet rotator cuff repair in patients with rotator cuff injury and to construct the related nomogram risk prediction model. METHODS: 207 patients with rotator cuff injury who underwent arthroscopic single-row rivet rotator cuff repair were reviewed. The differences of preoperative and postoperative Visual Analogue Score (VAS) scores and University of California, Los Angeles (UCLA) scores were analyzed and compared. The postoperative UCLA score of 29 points was taken as the critical point, and the patients were divided into good recovery group and poor recovery group, and binary logstic regression analysis was performed. According to the results of multivariate logistic regression analysis, the correlation nomogram model was constructed, and the calibration chart was used, AUC, C-index. The accuracy, discrimination and clinical value of the prediction model were evaluated by decision curve analysis. Finally, internal validation is performed using self-random sampling. RESULTS: The mean follow-up time was 29.92 ± 17.20 months. There were significant differences in VAS score and UCLA score between preoperative and final follow-up (p < 0.05); multivariate regression analysis showed: Combined frozen shoulder (OR = 3.890, 95% CI: 1.544 ∼ 9.800), massive rotator cuff tear (OR = 3.809, 95%CI: 1.218 ∼ 11.908), More rivets number (OR = 2.118, 95%CI: 1.386 ∼ 3.237), lower preoperative UCLA score (OR = 0.831, 95%CI: 0.704-0.981) were adverse factors for the postoperative effect of arthroscopic rotator cuff repair. Use these factors to build a nomogram. The nomogram showed good discriminant and predictive power, with AUC of 0.849 and C-index of 0.900 (95% CI: 0.845 ∼ 0.955), and the corrected C index was as high as 0.836 in internal validation. Decision curve analysis also showed that the nomogram could be used clinically when intervention was performed at a threshold of 2%∼91%. CONCLUSION: Combined frozen shoulders, massive rotator cuff tears, and increased number of rivets during surgery were all factors associated with poor outcome after arthroscopic rotator cuff repair, while higher preoperative UCLA scores were factors associated with good outcome after arthroscopic rotator cuff repair. This study provides clinicians with a new and relatively accurate nomogram model.

Efficacy of Outside-In Hip Arthroscopy without Traction in the Treatment of Hip Synovial Osteochondromatosis.

Arthroscopic treatments of hip synovial osteochondromatosis are mostly performed under traction, resulting in neurovascular injury or iatrogenic damage to the labrum or cartilage. This study aimed to assess the effectiveness of outside-in hip arthroscopy without traction in treating hip synovial osteochondromatosis. This retrospective study was conducted on a series of patients with hip synovial osteochondromatosis treated using outside-in hip arthroscopy without traction in our hospital between 2018 and 2020. Plain radiography and magnetic resonance imaging (MRI) scans were obtained. The Harris hip score (HHS), hip range of motion (ROM), and visual analog scale (VAS) scores were analyzed. The preoperative scores and last follow-up scores were compared with a paired-sample t test. The complications and recurrence postsurgery were recorded. This study included five patients (three male and two female) with an average age of 41 years (range 28-54 years). The mean follow-up time was 25.2 months (range 18-36 months). All patients experienced groin pain relief and improved ROM. The mean VAS score was significantly lower postoperatively (0.4 ± 0.5) than preoperatively (3.2 ± 0.8) (p < 0.001). The mean HHS improved from 58.6 ± 12.7 (range 43-73) to 89.8 ± 5.26 (range 81-95) (p < 0.001). No major complications, including infection, perineal numbness and swelling, neurotrosis, thromboembolism, or severe persistent pain, were reported. Synovial osteochondromatosis recurred in one patient after 2 years of follow-up without any obvious symptoms such as hip pain or joint locking. Therefore, no further treatment was necessary. This study showed that outside-in hip arthroscopy without traction might be a viable option for treating hip synovial osteochondromatosis, effectively and safely relieving symptoms with minimal complications, especially in patients without lesions in the central compartment.

A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis.

Regenerative medicine, specifically bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), has become a novel adjunct that orthopedic surgeons have started to use with surgical rotator cuff repairs (RCR). Thus, we are conducting this systematic review to determine if either RCRs with BMAC alone or with BMAC and PRP result in superior functional outcomes. We conducted a comprehensive search using five databases including PubMed, Web of Science, Embase, Scopus, and Cochrane. After duplicates were removed, 1205 studies were screened by title and abstract using Rayyan, resulting in three included studies (one BMAC with PRP and two BMAC only). Only studies that reported functional outcomes using the American Shoulder and Elbow Surgeons Shoulder Score and the University of California Los Angeles Shoulder Score were included. Changes in assessment scores from baseline to follow-up evaluation were quantified using the effect size and used in the meta-analysis for each group. Interpretation of treatment efficacy was represented using Cohen's d. The effect size of BMAC with PRP (Cohen's d = 2.19) was not significantly different (p = 0.76) from that of BMAC alone (Cohen's d = 2.35). Between-group differences in functional outcomes were Cohen's d = 0.16, which was not significant. Given the lack of superiority and the small sample size, more research is required before a conclusion can be drawn as to the benefits of combining PRP with BMAC for RCR. If functional outcomes are the same, using BMAC alone as an adjunct may be optimal to reduce resources used and cost. Future studies should be conducted with a larger pool as our primary limitation is that only three studies were included.

Treating Extensive Spontaneous Osteonecrosis of the Tibia by the Medial Opening Wedge High Tibial Osteotomy Procedure: A Case Report.

Osteonecrosis of the tibia is less common than that of the femoral condyle, with no consensus on surgical indications. In this study, a medial opening wedge high tibial osteotomy (OWHTO) was performed to treat the very extensive osteonecrosis of the tibia. This case demonstrates significant symptomatic relief and functional improvement following OWHTO for spontaneous tibial plateau osteonecrosis. The findings support the hypothesis that changes in mechanical stress contribute to disease progression. The promising results of this case study highlight the need for further studies to confirm its efficacy in a larger patient cohort, sparking interest in the future of this field. This case report is complemented by a literature review, which provides insights into management based on the patient's clinical course.

Adolescent Symptomatic Medial Meniscal Ossicle Treatment and Probable Etiology.

Meniscal ossicles are rare, especially in children and adolescents. The clinical exam is often benign, but intra-articular calcification can be evident on radiographs. MRI is beneficial for differentiating between potential diagnoses. Management is usually conservative, with arthroscopy reserved for symptomatic cases that fail conservative treatment. The etiology is unknown, but several theories exist. This case report describes a 16-year-old female athlete who presented with catching in her left knee and occasional pain when jumping hurdles. Radiographs were suggestive of a bony ossicle in the posterior aspect of her medial compartment. Conservative treatment provided little relief. MRI identified an intrameniscal ossicle and a posterior root tear of the medial meniscus. During arthroscopy, compression of the ossicle between the femur and tibia was visualized when the knee was positioned in terminal knee flexion and external rotation. Surgical treatment consisted of partial medial meniscectomy with excision of the ossicle and meniscal repair. The athlete gradually returned to full activity and sports. Although the exact etiology is unknown, trauma is the most likely cause. The patient's young age and absence of calcification on prior radiographs negate degenerative and congenital causes, respectively. Meniscal ossicles in adolescents are rare but need to be considered when intra-articular calcification is present on radiographs.

Lateral meniscus posterior root repairs show superior healing, reduced meniscal extrusion and improved clinical outcomes compared to medial meniscus posterior root repairs: A systematic review.

PURPOSE: To systematically review and summarize the available literature on (1) postoperative healing rates, meniscal extrusion (ME) and clinical outcomes following lateral (LMPRR) versus medial (MMPRR) root repair and (2) potential correlations between residual ME and healing outcomes. METHODS: A comprehensive literature search was conducted using the Scopus, PubMed and Embase databases. Clinical studies evaluating healing status on second-look arthroscopy and magnetic resonance imaging (MRI) after LMPRR and MMPRR were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria and the modified Coleman Methodology Score. RESULTS: Twenty-three studies comprising 871 patients with LMPRR (n = 406) and MMPRR (n = 465) were included. Overall, 223 (54.9% of total) and 149 (32.04% of total) patients underwent second-look arthroscopy in the LMPRR and MMPRR groups, respectively. Complete root healing was observed in 190 (85.2%) patients in the LMPRR group versus 78 (52.3%) in the MMPRR group (p < 0.001). There were six (2.7%) failed repairs in the LMPRR group compared to 21 (14.09%) in the MMPRR group (p < 0.001). On postoperative MRI, 109 (75.7%) root repairs were healed in the LMPRR group compared to 192 (53.3%) in the MMPRR group (p < 0.001). Failure rates were lower after all-inside and transtibial pullout repairs in the LMPRR group but higher in the MMPRR group, with no significant mean difference between preoperative and postoperative ME in the MMPRR group (p = 0.95). Significantly better clinical outcomes were observed in the LMPRR group compared to the MMPRR group. A greater degree of postoperative ME was associated with lower healing rates (R = -0.78, p < 0.0005). Postoperative ME did not influence clinical outcomes (R = 0.28, p = 0.29). CONCLUSIONS: Lateral meniscus posterior root repairs showed higher healing rates compared to MMPRR on both second-look arthroscopy and postoperative MRI. Meniscal extrusion decreased after LMPRR but not after MMPRR. Greater residual ME correlated inversely with healing rates, as more extrusion was associated with lower healing. Postoperative clinical improvement did not affect ME or healing status. STUDY DESIGN: Systematic review of level III and IV studies. LEVEL OF EVIDENCE: Level IV.

Arthroscopic subscapularis augmentation of the classic Bankart repair leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss.

PURPOSE: The long-term failure rate of the arthroscopic Bankart repair may reach unacceptable values, raising the need to augment this classic procedure. Arthroscopic subscapularis augmentation is the tenodesis of the upper part of the subscapularis tendon to the anterior glenoid rim. The aim of the study was to evaluate the mid-term clinical and functional outcomes of patients operated with arthroscopic subscapularis augmentation of the classic Bankart repair due to recurrent anterior shoulder instability. METHODS: This is a retrospective single-centre case series study with prospectively collected data. All patients suffered from recurrent anterior shoulder instability and had glenoid bone loss less than 13.5% of the inferior glenoid diameter (subcritical glenoid bone loss). Patients with greater anterior glenoid bone defect, engaging Hill-Sachs lesions, multidirectional instability or subscapularis insufficiency were excluded. Postoperatively, all patients were evaluated for recurrence and apprehension. The patient's shoulder range of motion and functional scores were recorded. RESULTS: The final study cohort included 34 patients with a mean age of 29.3 ± 10.2 years. The mean follow-up period was 42.4 ± 10.7 months (range, 24-62 months). Two out of 34 patients (5.8%) experienced a re-dislocation postoperatively, while one additional patient had a subjective feeling of apprehension. External rotation at the last follow-up was lower compared to preoperative values or the healthy side, but only one patient had restrictions in his sporting activities. The functional scores were significantly increased compared to the preoperative values. Twenty-two out of 26 patients (84.6%) returned to the same level of sporting activities, and 30/34 patients (88.2%) were highly satisfied with the results. CONCLUSION: Arthroscopic subscapularis augmentation of the classic Bankart repair reduces the dislocation recurrence rate and leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss. LEVEL OF EVIDENCE: Level IV.

Knotless Arthroscopic Dorsal Scapholunate Capsulodesis: A Simplified Technique.

Background Partial dorsal tears of the scapholunate ligament are a common soft-tissue injury in the wrist. These injuries have been a challenging problem and have gone through evolutionary changes over time from different open to arthroscopic techniques. Objectives This study describes a knotless arthroscopic dorsal scapholunate (SL) capsulodesis technique using both the radiocarpal and midcarpal joint portals, indicated for acute or chronic reducible scapholunate instability. Methods Using arthroscopy, we pierce the dorsal capsule on both sides of the dorsal torn remains of the SL ligament with two 18-gauge needles, one loaded with a 2-0 suture and the other with a nitinol wire loop. The 2-0 suture is weaved through the nitinol loop to create a knotless mattress stitch within the midcarpal joint and reduce the torn SL ligament. Results In this article, we present the outcomes of a patient treated with this arthroscopic inside knotless technique in treating scapholunate instability. Conclusions This knotless arthroscopic scapholunate capsulodesis technique provides a simple method to performing an arthroscopic dorsal capsulodesis.

Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease.

Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.

MCP-1 in synovial fluid as a predictor of inferior clinical outcomes after meniscectomy.

PURPOSE: To evaluate knee intra-articular cytokine concentrations in patients undergoing isolated meniscectomy and determine if these concentrations are associated with clinical outcomes. METHODS: Concentrations of ten biomarkers were quantified in synovial fluid aspirated from the operative knees of patients who underwent isolated meniscectomy from 10/2011-12/2019. Patients completed a survey at final follow-upincluding VAS, Lysholm, Tegner, and KOOS Physical Function Short Form (KOOS-PS). Failure was defined as subsequent TKA or non-achievement of the Patient Acceptable Symptom State (PASS) for knee pain defined as VAS > 27/100. Regression analysis investigating the relationship between cytokine concentrations and failure was performed. RESULTS: The study consisted of 100 patients, including 50 males (50.0%) with a mean age of 51.1 ± 11.7 years, a median BMI of 28.9 kg/m2 [25.5, 32.4], and a mean follow-up of 8.0 ± 2.2 years. There were no demographic or clinical differences between failures (n = 41) and non-failures (n = 59) at baseline. Monocyte Chemotactic Protein 1 (MCP-1) concentration was significantly higher in failures than in non-failures (344.3 pg/ml vs. 268.6 pg/ml, p = 0.016). In a regression analysis controlling for age, sex, BMI, symptom duration, length of follow-up, and ICRS grade, increased MCP-1 was associated with increased odds of failure (p = 0.002). CONCLUSIONS: The concentration of MCP-1 on the day of arthroscopic meniscectomy was predictive of failure as defined by an unacceptable pain level at intermediate- to long-term follow-up. This finding may help identify patients at high risk for poor postoperative outcomes following isolated meniscectomy and serve as a target for future postoperative immunomodulation research.

Bioinductive Collagen Implant Has Potential To Improve Rotator Cuff Healing - A Systematic Review.

PURPOSE: The purpose of this study was to systematically review the literature to evaluate the clinical studies on bioinductive collagen implant (BCI) for the treatment of rotator cuff tears. METHODS: A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies reporting following BCI for rotator cuff tears were included. Quantitive and qualitative data was evaluated. RESULTS: A total of 21 studies were included. In patients with full thickness tears, 7 of the 8 studies with pre- to postoperative ASES scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 75%-100% of patients meeting the MCID. In those with partial thickness tears, 7 of the 8 studies with pre- to postoperative ASES scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 54.4%-100% of patients meeting the MCID. For studies that quantified percent increases in tendon thickness, the reported increases ranged from 13% in 44% full thickness tears, and 14% to 60% in partial thickness tears. There were 6 studies that evaluated rotator cuff re-tears after BCI treatment in the full thickness cohort, with rates reported ranging from 0-9%. There were 5 studies that evaluated rotator cuff re-tears after BCI treatment in the partial thickness cohort, with rates reported ranging from 0-18%. Two of the included studies found that BCI was cost-effective due to the increased tendon healing with cost savings of $5,338-$13,061 per healed rotator cuff tendon. CONCLUSION: The literature on rotator cuff tear augmentation with BCI has shown consistently reported good results. Additionally, there was evidence of low retear rates and consistently improved tendon thickness with BCI, with two randomized controlled trials showing improved tendon healing with BCI. However, there appears to be a higher rate of adhesive capsulitis reported. LEVEL OF EVIDENCE: Level IV, Systematic review of Level I, III and IV studies.

Arthroscopic partial meniscectomy versus exercise therapy for degenerative meniscal tears: 10-year follow-up of the OMEX randomised controlled trial.

OBJECTIVE: To evaluate radiographic knee osteoarthritis (OA) progression, development of knee OA, patient-reported outcomes and knee muscle strength at 10-year follow-up after arthroscopic partial meniscectomy (APM) or exercise therapy for degenerative meniscal tears. METHODS: Randomised controlled trial including 140 participants, with a degenerative meniscal tear and no or minimal radiographic OA changes. Participants were randomised to either APM or 12 weeks of exercise therapy (1:1 ratio). The primary outcome was knee OA progression assessed by the Osteoarthritis Research Society International (OARSI) atlas sum score (sum of medial and lateral compartment joint space narrowing and osteophyte score). Secondary outcomes included incidence of radiographic and symptomatic knee OA, patient-reported pain and knee function and isokinetic knee muscle strength. RESULTS: The adjusted mean difference in change in the OARSI sum score was 0.39 (95% CI -0.19 to 0.97), with more progression in the APM group. The incidence of radiographic knee OA was 23% in the APM group and 20% in the exercise group (adjusted risk difference 3% (95% CI -13% to 19%)). No clinically relevant differences were found in patient-reported outcomes or isokinetic knee muscle strength. CONCLUSION: No differences in radiographic knee OA progression and comparable rates of knee OA development were observed 10 years following APM and exercise therapy for degenerative meniscal tears. Both treatments were associated with improved patient-reported pain and knee function. TRIAL REGISTRATION NUMBER: NCT01002794.

[Synovial chondromatosis : Results from the histopathological arthritis register of the German Society for Orthopedic Rheumatology]. / Die Synoviale Chondromatose : Ergebnisse aus dem histopathologischen Arthritisregister der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh).

BACKGROUND: Synovial chondromatosis, or osteochondromatosis, is a rare benign disorder that occurs in joints, tendon sheaths, or bursae, characterized by cartilage proliferations of varying sizes and shapes, often with ossifications. In this study the prevalence, sensitivity, gender predominance, differential diagnoses, and primary localization of synovial chondromatosis are analyzed within the Histopathological Arthritis Registry of the German Society for Orthopedic Rheumatology. METHODS: All cases of patients diagnosed with "synovial chondromatosis" from the Histopathological Arthritis Registry of the German Society for Orthopedic Rheumatology were retrospectively examined, covering the period from 1 January 2018, to 31 December 2022. RESULTS: Between 1 January 2018, and 31 December 2022, there were 14 cases of synovial chondromatosis out of a total of 13,222 cases in the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology. The available data include primary localization, and age and gender of the patients. Among the 13,222 cases in the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology, 14 were histopathologically confirmed as synovial chondromatosis. This resulted in a prevalence of 0.1% or 1.13 per 1,000 cases. The correct clinical presumptive diagnosis was made in 5 cases, yielding a sensitivity of 35.7%, 95% confidence interval (CI) 12.8% to 64.9%. DISCUSSION: Differential diagnoses for this condition include pigmented villonodular synovitis, tenosynovial giant cell tumor, and chondrosarcoma. Synovial chondromatosis frequently occurs in large joints such as the knee, hip, and the temporomandibular joint. A peak incidence is described in the fifth decade of life. However, the disorder can also occur in children. For the first time, the study was able to provide data for Germany based on a large sample. Additionally, initial statements regarding the prevalence and sensitivity of synovial chondromatosis could be made. The aim of this work is to raise awareness of this very rare disease to enable faster and more efficient diagnosis. The study also highlights the importance of histopathology in the diagnosis of synovial chondromatosis.

Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?

PURPOSE OF REVIEW: As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia. RECENT FINDINGS: Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.

Trends of Ankle Arthroscopy in Italy: Analysis of an official National Database.

OBJECTIVES: Ankle arthroscopy has become increasingly popular as a less invasive surgical diagnostic and therapeutic procedure for a variety ankle disorder previously managed with open surgery. Despite literature reports encouraging outcomes and low complication rates, nationwide trends in ankle arthroscopy have been poorly investigated. To fully understand the burden of an emerging surgical approach as well as helping to create global standards for the diagnosis and treatment of ankle diseases, this study aimed to evaluate the incidence and demographics of patients undergoing ankle arthroscopy in Italy from 2001 to 2016. METHODS: Data were obtained from the National Hospital Discharge Records (SDO) provided by the Italian Ministry of Health. The patient's age, gender, length of hospital stays, primary diagnosis, and primary procedure are among the anonymized data. Population data were obtained from the National Institute for Statistics (ISTAT). According to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) ankle arthroscopy was defined by the following procedure code: 80.27. RESULTS: A total of 23,644 procedures were performed in Italy. The 25-29 and 30-34 age groups underwent this type of surgery at most. The majority of patients were males. The median length of hospital stay was 2.1 ± 2.3 days. Each year in Italy, this surgery costs an average of 2,133,401€ ± 342,143€. The main primary codified diagnoses were: "Contracture of joint, ankle and foot" (13.4%), "Articular cartilage disorder, ankle and foot" (8.6%), "Late effect of sprain and strain without mention of tendon injury" (7.5%) and "Other joint derangement, not elsewhere classified, ankle and foot" (6.4%). CONCLUSIONS: The present study evaluated the burden of ankle arthroscopy on the national health care system and the distribution of the main diseases requiring this type of surgery. Surgeons and policy makers can allocate healthcare resources more effectively and provide patients with high-quality care by having a better understanding of national practice patterns. LEVEL OF EVIDENCE: III.

Surgical treatment of anterior glenohumeral instability: a historical review.

BACKGROUND: Glenohumeral instability is a common pathology, particularly in young, active patients. METHODS: A narrative review was performed to describe the history of surgical treatments for anterior shoulder instability. RESULTS: Open surgical techniques were first described by Bankart in 1923. Techniques include both anatomic soft tissue repairs and nonanatomic procedures to provide constraint to motion and dislocation. Osseous techniques to address glenoid bone loss include both autograft techniques, such as the Latarjet procedure, and the use of various allografts. Technologic advances, particularly arthroscopy, have continued to drive the evolution of treatments. The concept of the glenoid track has furthered our understanding of this pathology to guide appropriate treatment to reduce recurrence. CONCLUSIONS: Surgical treatment for anterior shoulder instability continues to evolve in an effort to restore function and prevent additional injury.