Extra-Articular Endoscopic BP Decompression-Surgical Technique.

We describe all-endoscopic brachial plexus (BP) decompression. Surgery is performed with the patient in the beach-chair position with the usual arthroscopic instruments and pump. The first step is to create 2 portals at the area of the coracoid process and decompress the infraclavicular part of the BP at area of thoracic aperture and coracoid. The second step includes performing 2 portals at supraclavicular fossa and performing decompression of BP at interscalene space. The postoperative period includes a short period of sling immobilization (3-5 days), immediate passive motion after surgery, and active motion after removal of the sling.

Gait analysis and knee kinematics before, and 6 and 18 months after corrective valgus osteotomy.

BACKGROUND: The study objective was to assess clinical outcomes and gait biomechanics in patients after 6 and 18 months after varus deformity (VD) surgical correction at knee joint (KJ). METHOD: The study included 20 patients with medial osteoarthritis (OA) of the knee of grade 2-3 and a VD of >4°. A total of 21 surgeries were performed on the patients. Full length weight bearing (FLWB) X-ray and KJ assessments were done using the KSS, KOOS and VAS scoring systems were obtained from all the patients. Biomechanical gait parameters were captured using an inertial sensor system at timepoints before, and 6 and 18 months after surgery. Temporal and kinematic parameters of walking were analyzed. RESULTS: The radiological parameters showed a stable VD correction. According to the KOOS, KS and VAS scores, there was a moderate dynamic improvement in the operated knee function during the study. The biomechanical parameters remained virtually unchanged throughout the entire follow-up period. In the following year, there were some subjective improvements but without any significant changes in gait biomechanics or knee kinematics. CONCLUSIONS: Thus, the main changes in the joint clinical condition and function occur in the first 6 months after surgery. According to the study data-assessments by VAS, KOOS, and KSS-there was a moderate clinical improvement during the long-term follow-up period, however, the biomechanical changes were minor.

Gait analysis and knee joint kinematics before a and 6 month after of corrective valgus osteotomy at patients with medial knee arthritis.

PURPOSE: A varus deformity (VD) of the lower limbs results in greater loading of the medial compartment of the knee joint (KJ), leading to its degenerative changes and, eventually, to progressive osteoarthritis (OA) of the joint. The aim of the study was to investigate the mid-term changes in gait biomechanics and clinical symptoms in patients with VD of KJ and OA before and six months after surgical correction. METHODS: The study enrolled 25 patients with medial OA of grade 2-3 according to Kellgren-Lawrence and a VD of > 3°, who underwent arthroscopic lavage and debridement of the knee joint followed by corrective osteotomy. The control group included 20 healthy adults. Clinical and biomechanical assessments were done twice: immediately prior to and six months after the surgical treatment. Biomechanical parameters of gait were recorded using an inertial sensor system. RESULTS: According to our findings, there was a statistically significant post-operative increase in the knee extension amplitude by 1.4° in female patients and an insignificant extension increase in male patients. The mean postoperative KOOS score was 66.7 points (46 to 91) in the patient group, 67.1 points (54 to 91) in males, and 59.5 points (46 to 64) in females. As early as six months after a valgus osteotomy, we already observed improved biomechanics of the KJ motions compared to pre-operative data. By that time, the swing flexion amplitude of the affected KJ had increased and became symmetrical, which had not been the case before surgery. We observed a total of three changes in the KJ kinematics after surgery: increased swing flexion amplitudes in both KJs, a decreased extension amplitude in the affected KJ, and increased first flexion amplitudes in both KJs. CONCLUSION: According to our study, the midterm outcomes after a valgus osteotomy showed clinical improvements based on the VAS and KOOS scores, which were however less pronounced than in similar studies with a longer assessment term after surgery. We also found a significant increase in the amplitude of joint extension, but only in females. As the function of the operated joint is concerned, valgus osteotomy restored the kinematics of walking movements to a nearly normal gait with increased first and second flexion amplitudes. The function of KJ becomes symmetric though the non-operative side. Thus, the healthy and functionally more capable side is copying the movement pattern of the affected side. Hence, the non-operative leg is functioning less efficiently than it is required by the walking pace.

Biomechanical Changes in Gait Patterns of Patients with Grade II Medial Gonarthritis.

Deforming osteoarthritis (OA) of the knee is a progressive disease associated with pain and compromised function of the joint. Typical biomechanical modifications in the gait of subjects with medial knee OA are characterized by decreased gait speed and overload on the affected limb. The borderline stage for conservative versus surgical management is Grade II OA. The aim of this research was to study preoperatively the specific features of gait, knee, and hip function in patients with Grade II medial OA. We examined 26 patients with Grade II unilateral gonarthritis with varus deformity and 20 healthy adults. Biomechanical parameters of gait were recorded using an inertial sensor system. The gait cycle (GC) slightly increased both for the affected and for the intact limb. The hip joint movements showed significant symmetrical reduction in the first flexion amplitude, as well as a symmetrical delay in full hip extension at the end of the stance phase. In the knee, the first flexion amplitude was significantly reduced on the affected side compared to healthy control. The extension amplitude in the single support phase was significantly increased in both the affected and the intact lower limbs. The swing amplitude was significantly reduced on the affected side. On the affected side, the changes were more pronounced, both in incidence and in severity. The affected knee showed a syndrome of three reduced amplitudes. In patients, walking is characterized by several groups of symptoms: those of unloading of the affected limb, those of limiting the load on the affected joint and the musculoskeletal system as a whole, and those of gait harmonization. The symptoms of unloading the affected side and those of harmonization are the common symptoms of adaptation, typical for several pathological conditions with a relatively preserved function. The intensity of the observed symptoms can help assess changes in the subject's functional condition over time and during the treatment.