Surgical Outcomes in Endoscopic Versus Open Bursectomy of the Septic Prepatellar or Olecranon Bursa.

In this study, the authors investigated the viability of endoscopic bursectomy as a treatment for septic prepatellar and olecranon bursitis. Conventional treatment of septic bursitis consists of aspiration, antibiotics, and rest. When conservative treatment fails, however, surgical intervention is sometimes required to resolve the infection. Typical surgical intervention consists of open bursectomy, in which the infected bursa is excised via an incision in the region of the skin directly above the bursa. The tenuous nature of the blood supply to this region of the skin results in a rather high rate of wound healing issues such as necrosis and wound dehiscence. Recently, endoscopy has been proposed as a less invasive means of bursectomy, although initially it was only recommended for cases of aseptic bursitis. A degree of uncertainty has persisted in the literature as to whether endoscopic bursectomy allows for sufficient debridement of the infected tissue to avoid recurrence of bursitis. The authors report on 27 cases in which endoscopic bursectomy was performed for recalcitrant septic bursitis. Fourteen of these cases were septic olecranon bursitis and 13 were septic prepatellar bursitis. The authors reported good results, with no wound healing complications and only 1 minor recurrence. They also reported much shorter hospital stays than have been reported both for more conservative treatments of septic bursitis and in other case series on endoscopic bursectomy. The authors conclude that endoscopic bursectomy is a superior alternative to open bursectomy for the treatment of recalcitrant septic prepatellar and olecranon bursitis. [Orthopedics. 2019; 42(4):e381-e384.].

A preliminary report on the effects of sustained administration of corticosteroid on traumatized disc using the adult male rat model.

STUDY DESIGN: A novel degenerative disc disease model and sustained delivery method for corticosteroid in male Sprague-Dawley albino rats. OBJECTIVES: To develop a model of degenerative disc disease and to determine the effect of continuous sustained release of corticosteroid on the process of degeneration within the traumatized disc. SUMMARY OF BACKGROUND DATA: The current modalities of treating symptomatic degenerative disc disease are either conservative or surgical. However, there is no cure for the degenerative process and prevention, therefore, is the ideal treatment. An understanding of the mechanisms involved in disc degeneration is crucial to develop new methods for prevention and treatment, including appropriate delivery systems and dosages of repair factors. METHODS: The L5-L6 intervertebral disc was pierced with a 23-gauge needle in 18 rats. The animals received either sham or corticosterone-charged tricalcium phosphate ceramic capsules. The rats were euthanized at 4 weeks. Chondrocytes in the transition zone areas were counted and compared statistically. RESULTS: The surgical technique induced degeneration of the nucleus without evidence of inflammation at adjacent levels when compared with nontraumatized controls. The number of chondrocytes per area was significantly less in the sham group than in the control group. Corticosteroid treatment showed chondrocyte numbers similar to control in 4 of 5 different views of the disc. The anterior region of the disc had 50% less chondrocytes per area than the control; however, the chondrocyte numbers were 50% greater than in the same site from discs of sham animals. CONCLUSIONS: The results show the development of a degenerative disc animal model that can be used to test the effects of growth enhancing factors in disc repair. Administration of continuous sustained release of corticosterone can slow the process of degeneration within the traumatized disc in the rat model.