Preoperative patient factors that predict achieving the minimal clinically important difference following arthroscopic treatment of snapping scapula syndrome.

BACKGROUND: The aim of this study was to define the minimal clinically important difference (MCID) values for patient-reported outcomes (PROs) after arthroscopic treatment of snapping scapula syndrome (SSS) using a distribution-based method, and to identify demographic, clinical, and intraoperative factors significantly associated with the achievement of MCID. It was hypothesized that subjective satisfaction scores after the procedure would be strongly associated with the achievement of MCID thresholds for the PROs and that pain, preoperative response to injection, and a scapulectomy in addition to bursal resection would be predictive of clinically relevant improvement. METHODS: Patients who underwent arthroscopic treatment of SSS between October 2005 and September 2020 with a minimum of 2-year short-term postoperative follow-up were enrolled in this retrospective single-center study. The MCID was calculated using a distribution-based approach for the following PROs: 12-Item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) pain "today" and "at worst." The association between achievement of the MCID and postoperative subjective satisfaction was investigated, and factors associated with achievement of MCID were determined using bivariate analysis. RESULTS: Of a total of 190 patients assessed for eligibility, 77 patients (38.1 ± 14.3 years; 36 females) were included. Within the study population, statistically significant improvements in postoperative SF-12 physical component summary (PCS) (P < .001) and mental component summary (MCS) (P < 0.034), ASES (P < .001), QuickDASH (P < .001), SANE (P < .001), and VAS pain (P < .001) scores were observed at the minimum 2-year follow-up. The calculated MCID threshold values based on the study population were 5.0 for SF-12 PCS, 5.8 for SF-12 MCS, 11.3 for ASES, -10.5 for QuickDASH, 14.7 for SANE, 1.5 for VAS pain, and 1.7 for VAS pain at worst. Reaching the MCID was strongly associated with postoperative satisfaction (rated on a scale of 1-10). Across the PROs, younger age, favorable preoperative response to injection, partial scapuloplasty or scapulectomy, no prior surgery, and pain and function at baseline were significantly associated with attaining MCID. CONCLUSIONS: Patients who underwent arthroscopic treatment for SSS experienced clinically significant improvements in functional scores, pain, and quality of life. This study demonstrated predictive roles for certain patient-specific factors and diagnostic variables for achieving MCID in PROs, which may help surgeons preoperatively assess the probability of success and manage patient expectations.

Arthroscopic treatment of chronic calcific tendinitis with intraosseous migration: a case report.

We present a case of calcific tendinitis in the shoulder, where calcifications were observed within both the tendon and the adjacent bone. At the time of acute onset, radiographs (including a plain radiograph) and magnetic resonance imaging revealed calcific tendinitis with intraosseous migration. The patient's symptoms did not improve after 5 months of conservative treatment. The patient underwent arthroscopic debridement of the calcific deposits, and the defect was repaired using the double-row repair technique. The patient's symptoms improved 3 months after arthroscopic treatment. We share our unusual experience with arthroscopic debridement in the treatment of chronic calcific tendinitis with intraosseous migration.

Anterior Ankle Impingement Syndrome With Spur Fragmentation: Is It an Os Talotibiale?

Background: Bone fragments are often found in ankles with anterior bony impingement. However, whether they are detached osteophytes or accessory bones remains unknown. Methods: Among the 66 continuously enrolled cases of ankles with anterior bony impingement, 32 had a fragment located at the anterior margin of the tibia. The cases of posterior impingement, lateral instability, osteochondral lesions, or free bodies simultaneously treated were excluded. The enrolled subjects were classified into 2 groups: ankles without (group A) and with remarkable spurs (group B). The patients' backgrounds, location of the fragments, clinical scores, and other parameters required to resume sports were compared. The Japanese Society for Surgery of the Foot (JSSF) ankle rating scale was used to evaluate preoperative and postoperative ankle conditions, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) was used to evaluate postoperative sports abilities. Results: Eight (seven subjects) and 11 ankles were classified into groups A and B, respectively, and the mean age of the 18 patients was 25.4 (range, 16-37) years. No statistical differences in patient backgrounds or fragment sizes between the groups existed. In group A, the fragments were located on the lateral plateau in 7 of the 8 ankles, whereas in group B, their locations varied. The patients were followed up for a median of 48 months (range, 24-168). No complications were observed. The postoperative JSSF and SAFE-Q sports activity scores were significantly higher in group A than in group B (P <.01 and <.001, respectively). The postoperative term to return to their original sports activities was significantly shorter in group A (P < .05). Conclusion: Anterior bony fragments of the ankle without a remarkable spur were located at a specific site, and the results of arthroscopic treatment were better than in those with remarkable spurs. Such a fragment may be called an os talotibiale. Level of Evidence: Level III, retrospective cohort study.

Efficacy of Lavage by Tube under Local Anesthesia versus Arthroscopic Treatment of Acute Septic Arthritis of Native Knee.

Although arthroscopic treatment is a minimally invasive surgery that effectively treats septic arthritis of the knee joint, it requires general or regional anesthesia. This study aimed to compare the clinical results of lavage after tube insertion versus arthroscopic treatment. Patients treated with arthroscopic treatment were included in group I (n = 76), while those treated with lavage by tube were included in group II (n = 34). We investigated the following in all patients: demographics, underlying disorders, initial serum white blood cell (WBC) count, C-reactive protein (CRP) level, synovial fluid WBC and polymorphonuclear cell counts, causative organism, initial Kellgren-Lawrence grade, lavage number, interventional delay, hospitalization days, CRP normalization time, and Western Ontario McMaster Universities Osteoarthritis index scores for clinical outcomes at 3 months postoperative. The mean interventional delay was significantly greater in group I (23.6 ± 15.6 h vs. 8.7 ± 9.3 h, p < 0.001). The lavage by tube featured a significantly shorter interventional delay time than arthroscopy, while the CRP decrease rate did not differ between groups. Moreover, lavage by tube showed no significant differences in outcomes, including laboratory results and functional outcomes at 3 months postoperative.

A Modified Endoscopic Technique with Three Incisions for Rockwood Types III and V Acromioclavicular Joint Dislocation.

OBJECTIVE: Acromioclavicular joint dislocation is one of the most common shoulder injuries in young men. With the advancement of minimally invasive technology, arthroscopy of acromioclavicular joint dislocation has been recognized for its good curative effect. This study aimed to explore the technical details and clinical efficacy of a modified minimally invasive endoscopic treatment for acromioclavicular joint dislocation. METHODS: Clinical data of patients receiving the three-incision endoscopic treatment were retrospectively reviewed between July 2013 and July 2019. A total of 72 patients with acromioclavicular joint dislocation of Rockwood type III (n = 42) and type V (n = 30) were included in this study. Postoperative routine radiography was performed to evaluate acromioclavicular joint reduction and fixation. In addition, functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. Differences between the preoperative and postoperative data were compared using paired t-tests. RESULTS: All patients underwent loop plate elastic fixation under endoscopy during 24 to 48 months of follow-up. Postoperative radiography showed that the acromioclavicular joint achieved anatomical reduction. The ASES score (91.1 ± 4.2) was significantly improved compared to the preoperative ASES score (62.4 ± 3.1) (t = 46.65, P < 0.0001). The Constant-Murley score (93.1 ± 4.6) was also significantly higher than that before the operation (40.7 ± 6.4) (t = 56.41, P < 0.0001). No postoperative complications occurred. During follow-up, four patients had mild acromioclavicular joint degeneration but no obvious pain symptoms. CONCLUSION: The modified three-incision endoscopic technique optimizes the surgical incision, reduces trauma, is minimally invasive, and provides rapid rehabilitation with satisfactory clinical outcomes.

Tratamiento artroscópico de pacientes con cuerpos libres articulares en la rodilla

Introducción: Existe escasa información en la literatura nacional sobre los cuerpos libres articulares en la articulación de la rodilla. Estos ocurren como consecuencia de lesiones traumáticas, degenerativas, inflamatorias e isquémicas. Objetivo: Actualizar los conocimientos en los aspectos más generales de los cuerpos libres articulares en la rodilla y de su tratamiento mediante la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 59 días (1 de enero al 28 de febrero de 2023) y se emplearon las siguientes palabras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 211 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline. Se empleó el gestor de búsqueda y administrador de referencias EndNote. Del total se utilizaron 33 contribuciones seleccionadas para realizar la revisión, 32 fueron de los últimos cinco años. Desarrollo: Se hace referencia al diagnóstico positivo basado en los antecedentes, cuadro clínico e imagenología. En relación al diagnóstico diferencial de esta entidad se hace especial énfasis con todas las afecciones que producen bloqueo articular. En específico, se revisan las lesiones de menisco, así como las clasificaciones más empleadas según tamaño, origen, cantidad y movilidad. En relación al tratamiento artroscópico se describen las cuatro etapas que consisten en: identificación, atrapamiento, extracción y revisión. Consideraciones finales: La vía artroscópica por sus múltiples ventajas representa la modalidad quirúrgica más efectiva para el diagnóstico y tratamiento de pacientes con cuerpos libres articulares de la rodilla.

Introduction: Currently, there is a lack of information in the national literature concerning joint loose bodies in the knee joint. These occur as a consequence of traumatic, degenerative, inflammatory and ischemic injuries. Objective: To update knowledge on the most general aspects concerning joint loose bodies in the knee and the use of the arthroscopy procedure on its treatment. Method: Search and analysis of the information was performed on 59 days (January 1 to February 28, 2023) and the following keywords were used: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Based on the information obtained, a bibliographic review was made of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases. The EndNote search manager and reference manager was used. Of the total of articles, 33 contributions selected for the review were used, 32 were published the last five years. Development: It was refered in the study on the positive diagnosis based on the history, clinical picture and imaging. In relation to the differential diagnosis of this entity, special emphasis is made up with all the conditions that produce joint blockage. Specifically, meniscal lesions are reviewed, as well as the most commonly used classifications according to size, origin, quantity and mobility. In relation to the arthroscopic treatment, the following four stages were described: identification, trapping, extraction and revision. Final considerations: The arthroscopic approach, due to its multiple advantages, represents the most effective surgical modality for the diagnosis and treatment of patients with joint loose bodies in the knee.

Introdução: Há poucas informações na literatura nacional sobre corpos articulares livres na articulação do joelho. Ocorrem como consequência de lesões traumáticas, degenerativas, inflamatórias e isquêmicas. Objetivo: Atualizar o conhecimento nos aspectos mais gerais dos corpos livres articulares no joelho e seu tratamento por via artroscópica. Método: A busca e análise das informações foi realizada em um período de 59 dias (1º de janeiro a 28 de fevereiro de 2023) e foram utilizadas as seguintes palavras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Com base nas informações obtidas, foi realizada revisão bibliográfica de um total de 211 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline. O mecanismo de busca EndNote e o gerenciador de referências foram usados. Do total, 33 contribuições selecionadas foram utilizadas para realizar a revisão, sendo 32 dos últimos cinco anos. Desenvolvimento: Refere-se ao diagnóstico positivo baseado na história, quadro clínico e imagiologia. Em relação ao diagnóstico diferencial desta entidade, é dada especial ênfase a todas as condições que causam bloqueio articular. Especificamente, são revisadas as lesões meniscais, assim como as classificações mais utilizadas quanto ao tamanho, origem, quantidade e mobilidade. Em relação ao tratamento artroscópico, são descritas as quatro etapas, que consistem em: identificação, encarceramento, extração e revisão. Considerações finais: A abordagem artroscópica, por suas múltiplas vantagens, representa a modalidade cirúrgica mais eficaz para o diagnóstico e tratamento de pacientes com corpos livres articulares do joelho.

Ten-year outcome following surgical treatment of femoroacetabular impingement : does the evolution of surgical technique influence outcome?

AIMS: The primary aim of this study was to determine the ten-year outcome following surgical treatment for femoroacetabular impingement (FAI). We assessed whether the evolution of practice from open to arthroscopic techniques influenced outcomes and tested whether any patient, radiological, or surgical factors were associated with outcome. METHODS: Prospectively collected data of a consecutive single-surgeon cohort, operated for FAI between January 2005 and January 2015, were retrospectively studied. The cohort comprised 393 hips (365 patients; 71% male (n = 278)), with a mean age of 34.5 years (SD 10.0). Over the study period, techniques evolved from open surgical dislocation (n = 94) to a combined arthroscopy-Hueter technique (HA + Hueter; n = 61) to a pure arthroscopic technique (HA; n = 238). Outcome measures of interest included modes of failures, complications, reoperation, and patient-reported outcome measures (PROMs). Demographic, radiological, and surgical factors were tested for possible association with outcome. RESULTS: At a mean follow-up of 7.5 years (SD 2.5), there were 43 failures in 38 hips (9.7%), with 35 hips (8.9%) having one failure mode, one hip (0.25%) having two failure modes, and two hips (0.5%) having three failure modes. The five- and ten-year hip joint preservation rates were 94.1% (SD 1.2%; 95% confidence interval (CI) 91.8 to 96.4) and 90.4% (SD 1.7%; 95% CI 87.1 to 93.7), respectively. Inferior survivorship was detected in the surgical dislocation group. Age at surgery, Tönnis grade, cartilage damage, and absence of rim-trimming were associated with improved preservation rates. Only Tönnis grade was an independent predictor of hip preservation. All PROMs improved postoperatively. Factors associated with improvement in PROMs included higher lateral centre-edge and α angles, and lower retroversion index and BMI. CONCLUSION: FAI surgery provides lasting improvement in function and a joint preservation rate of 90.4% at ten years. The evolution of practice was not associated with inferior outcome. Since degree of arthritis is the primary predictor of outcome, improved awareness and screening may lead to prompt intervention and better outcomes.Cite this article: Bone Jt Open 2022;3(10):804-814.

Arthroscopic Treatment of Popliteus Tendinitis Using the Accessory Portal.

Introduction: This study aimed to evaluate the effect of arthroscopic treatment of popliteus tendinitis via an auxiliary extreme lateral approach and to investigate the pathogenesis and treatment of popliteus tendinitis. Materials and Methods: From 2016 to 2020, arthroscopic popliteus tendon ablation was performed in 15 patients (15 knees) with popliteus tendinitis via an auxiliary extreme lateral approach. Clinical outcomes were assessed using the Lysholm knee scoring scale, the Tegner score, the International Knee Documentation Committee (IKDC) score and the visual analogue scale (VAS) pain score at the 24-month follow-up after surgery. Results: A total of 15 patients (mean age, 51.1 ± 7.1 years) were included. They had a mean body mass index of 23.8 ± 2.1 kg/m2. The minimum follow-up period was 24 months. Comparing the postoperative state to the preoperative state, the mean postoperative Lysholm score, Tegner score, and IKDC score improved significantly from 70.0 ± 5.0, 3.0 ± 0.9, and 62.3 ± 5.5 to 89.3 ± 4.2, 4.6 ± 0.61, and 80.5 ± 4.4, respectively (p < 0.01). The preoperative VAS score for pain improved from 6.4 ± 0.5 to 0.9 ± 0.4 (p < 0.01). No patients were lost to follow-up. Conclusions: Following arthroscopic-assisted treatment, all the patients with popliteus tendinitis achieved satisfactory clinical outcomes in terms of pain relief and improved function. Level of Evidence: Level IV.

Arthroscopic Treatment of Calcific Tendinitis of Gemellus Superior and Gemellus Inferior: A Case Report and Literature Review.

BACKGROUND: Tendon calcification is a common disease, and it could happen in the tendons of the shoulder, wrist, etc. However, tendon calcification in the superior and inferior gemellus is rare, and in this region is likely to be misdiagnosed. CASE PRESENTATION: Here, our case report first reported a 53-year-old female patient with an unusual case of calcific tendinitis of the gemellus superior and gemellus inferior muscles. The patient presented with severe pain in the right hip and lower extremities, not relieved using nonsteroidal anti-inflammatory drugs (NSAIDs). The preoperative physical examination indicated an abnormality in the hip joint. Preoperative imaging confirmed the results of the physical examination and showed a right hip lesion. We did not make a definite diagnosis preoperatively but considered that the patient might have an osteochondroma. However, surgical findings indicated that the lesion was not in the hip capsule on subsequent arthroscopic surgery, which suggested that the preoperative diagnosis might be wrong. We opened the posterior capsule and found a "toothpaste-like" lesion in the superior and inferior gemellus muscles' tendon. We thought this might be the calcified tendon. Then the arthroscopic surgery was finished to remove the lesion, and the removed tissue was sent to the pathology department for pathological examination. The pathological report confirmed the diagnosis of the calcified tendon. Postoperative follow-up was conducted. The effect of the operation was noticeable. Postoperative symptoms were relieved. CONCLUSIONS: Calcification of the tendons of the superior and inferior gemellus muscles can be easily misdiagnosed, and the disease can be treated minimally with arthroscopy.

Arthroscopic treatment of massive acromioclavicular joint ganglion cysts with color-aided visualization: a case series of 4 patients.

Background: Acromioclavicular joint ganglion cysts are rare lesions that mainly arise from the degeneration of the acromioclavicular joint in elderly patients. Although surgical management may be required because of their high recurrence rate after aspiration, few reports have described arthroscopic surgical procedures to treat acromioclavicular ganglion cysts. We report the surgical results of arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts. Methods: This retrospective case series examined patients identified with massive ganglion cysts that were localized above the acromioclavicular joint. All patients underwent an arthroscopic removal of subacromial synovium and subsequent injection of indigo carmine into the ganglion. The distal end of the clavicle was excised arthroscopically from the inferior surface, and the ganglion stalk was confirmed using indigo carmine for enhanced visualization and magnification. A ganglion portal was created, and the ganglion cyst was resected with the aid of the dye. Results: Four female patients, aged 78-90 years, were identified with a massive acromioclavicular joint ganglion cyst. Plain radiography showed joint degeneration in the acromioclavicular joint, and magnetic resonance imaging scans showed fluid-filled mass formation. Although all patients initially underwent multiple aspirations of the ganglion cyst, we opted for surgical intervention because of its persistent recurrence. Three patients exhibited concurrent rotator cuff tears, and one patient had a prior history of cuff repair with no retear. After arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts, none of the patients have shown recurrences at 2 years postoperatively. Conclusion: Novel aspects of this case series include the use of indigo carmine to provide a better visualization and identification of the ganglion stalk under arthroscopy. Furthermore, a ganglion portal is useful for achieving complete resection of the indigo carmine-stained ganglion cyst. Color-aided visualization using indigo carmine and the construction of a ganglion portal were useful techniques for performing arthroscopic ganglionectomy in patients with a massive acromioclavicular joint ganglion cyst.

Arthroscopic Latarjet Procedure With 2-Screw Stabilization: Results of Treatment of 156 Cases with a Minimum of 2-Year Follow-Up. Multicenter Study.

BACKGROUND: Various arthroscopic stabilization procedures are associated with recurrence rates ranging from 10.8% to 21.1%. Recurrences occur especially in young male patients participating in contact sport activities. Bony defects of the humeral head and the glenoid predispose not only to subsequent dislocations but also to failure of surgical treatment. This is the group where "bony" procedures such as arthroscopic Latarjet are recommended to provide better stability as the primary treatment. MATERIAL AND METHODS: Patients with traumatic unidirectional anterior shoulder instability treated from 2009 to 2016 with an arthroscopic Latarjet procedure operated on in two centres. Clinical results, including range of motion, Subjective Shoulder Value and Walch-Duplay score, and postpoperative complications were evaluated. RESULTS: 156 patients were available for follow-up at a minimum of 2 years after surgery. The mean follow-up was 4318 months. Mean age at the time of surgery was 27.9 (16-53) years. At final follow-up, 8 cases of recurrent instability were identified, including 6 cases of recurrent dislocation and two cases of recurrent subluxation. Mean Walch-Duplay score increased from 3019 preoperatively to 8316 (p<0.05) at the last follow-up. An average loss of external rotation of 11.8 (0-70) (p<0.05) when compared with the contralateral shoulder was observed at the last follow-up. Mean Subjective Shoulder Value score was 92.89.4%. 8 (5%) patients presented with loss of shoulder stability. 25 (15.8%) patients reported subjective return to sport anxiety. Eleven (7%) patients complained of anterior compartment pain. The total number of revision surgeries was 14 (8.9%). CONCLUSIONS: 1. The arthroscopic Latarjet procedure can achieve satisfactory clinical outcomes for the treatment of anterior shoulder instability 2. The rate of complications and recurrence does not increase with time and is comparable at a minimum of 2 years follow-up to early results described in literature.

Knee Septic Arthritis Caused by Pantoea agglomerans.

Introduction: Septic arthritis usually affects native joints and represents an invasion of the joint space by a wide variety of microorganisms, most commonly bacteria, such as Staphylococci, Streptococci, and Gram-negative rods. An extremely rare case of septic knee arthritis caused by Pantoea agglomerans in a 67-year-old male is presented. Case Report: The patient was initially treated with arthroscopic debridement, but due to persistent symptomatology open surgical debridement 3 days after initial surgery was also performed. Cultures yielded P. agglomerans and Streptococcus agalactiae. He was commenced on causative antimicrobial treatment including intravenous linezolid, ciprofloxacin, and clindamycin. He was discharged 10 days later, on oral linezolid and ciprofloxacin for 3 months. Conclusion: Delayed diagnosis in septic arthritis cases and inadequate control of the infection may lead to insufficient treatment and devastating consequences for the patient. The treatment includes surgical debridement and proper antimicrobial agents. Cultures dictate the proper treatment; hence, microbiological examination is of utmost importance, since it may reveal unusual organisms for which empirical treatment may prove insufficient.

Fully arthroscopic treatment of medial Hoffa fracture associated with anterior cruciate ligament tear: case report and surgical technique.

A Hoffa fracture is a rare intra-articular injury consisting of a coronal plane fracture of one or both of the distal femoral condyles. Because of the rarity of medial Hoffa fractures, only a few reports have described this injury and its arthroscopic management. In this article, we present a rare case involving a 32-year-old man with a displaced medial Hoffa fracture associated with a proximal anterior cruciate ligament tear. He was treated by a single-stage fully all-inside arthroscopic technique. Arthroscopic-assisted internal fixation ensured fragment stability and enabled us to visualize the fracture reduction, monitor the screw insertion, and reconstruct the anterior cruciate ligament tear at the same time. This technique is a novel but demanding treatment method for medial Hoffa fractures and is particularly useful for properly selected patients with associated intra-articular knee injuries.

Arthroscopic coracoclavicular button fixation versus anatomic locking plate fixation for unstable distal clavicular fractures.

HYPOTHESIS: Neer type II distal clavicle fractures are unstable and associated with high nonunion rates. The aim of this retrospective study was to compare the clinical and radiographic outcomes of anatomic locking plate fixation and arthroscopic coracoclavicular button fixation for unstable distal clavicle fractures. METHODS: Forty-seven patients with Neer type II distal clavicle fractures were treated surgically using either anatomic locking plate fixation (group 1, n = 20) or all arthroscopic coracoclavicular button fixation (group 2, n = 27) between 2012 and 2019 in 2 centers. Clinical and radiographic outcomes after an average follow-up period of 49 months for group 1 and 32 months for group 2 were assessed using the American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, visual analog scale score and X-rays. RESULTS: At the final follow-up, the mean American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, and visual analog scale score for group 1 and group 2 were 92.5 ± 3.9 (range 88.3-98.3), 93.6 ± 4.0 (range 90-100), and 0.6 ± 0.6 (range 0-2) and 95 ± 3.3 (range 86.6-100), 96.2 ± 3.0 (range 88-100), and 0.4 ± 0.5 (range 0-1), respectively (P = .32, P = .15, and P = .59, respectively). At the final follow-up, acceptable reduction and bone healing were achieved in all patients. All patients in both groups were able to resume work as well as sports activities. Postoperative complications included 1 case of acromioclavicular joint arthritis and 1 case of screw penetration in group 1 and 2 cases of coracoid process fracture that did not require additional surgery in group 2. Five patients underwent hardware removal owing to skin irritation and dissatisfaction with the cosmetic appearance in group 1. CONCLUSION: Both distal anatomic locking plate fixation and arthroscopic coracoclavicular button fixation provide satisfactory functional and radiological outcomes. Both procedures can be used to treat distal clavicle fractures because they have a minimal risk of complications and present similar, high union rates.

Outcomes following surgical management of femoroacetabular impingement: a systematic review and meta-analysis of different surgical techniques.

Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures.

Clinical Characteristics and Surgical Outcomes for Collision Athletes with Traumatic Posterior Instability.

BACKGROUND: Diagnosis and treatment of traumatic posterior instability of the shoulder have not been described in detail. The author investigated surgical outcomes for traumatic posterior shoulder joint instability in collision athletes. METHODS: The author surgically treated patients with a diagnosis of traumatic shoulder joint instability and investigated those that had been followed up for >2 years after surgery. RESULTS: Seven shoulders in six collision athletes with a history of traumatic injury were examined. All cases were negative for the general laxity sign and positive for the posterior jerk test; five shoulders showed positive anterior apprehension. Posterior glenoid osseous defects were found in three shoulders, and one shoulder injury involved anterior and posterior osseous lesions. As surgical treatment, one posterior capsulolabral lesion, two posterior osseous lesions, and three combined anterior and posterior capsulolabral lesions were repaired arthroscopically. In a patient with a combined anterior and posterior osseous lesion, the Bristow procedure was perfromed after arthroscopic osseous repair. Patients returned to competition at an average of 6.8 months after surgery. One patient developed anterior subluxation at 7 months, and another exhibited posterior re-dislocation at 8 months after returning to competition. CONCLUSION: Traumatic posterior instability in collision athletes often involves glenoid osseous lesions and is frequently accompanied by anterior apprehension and lesions. Although collision athletes can return to play after arthroscopic repair, such activity is associated with a risk of re-dislocation.

Stiffness after unicompartmental knee arthroplasty: Risk factors and arthroscopic treatment.

INTRODUCTION: One of the principal complications after total knee arthroplasty (TKA) is stiffness. There are no publications concerning stiffness after unicompartmental knee arthroplasty (UKA). Study objectives were to describe the incidence of stiffness after UKA, to look for risk factors, and to describe safe and effective arthroscopic treatment. METHODS: There were 240 UKA performed between March 2016 and January 2019 included. Robotic-assisted surgery was performed in 164 patients and mechanical instrumentation in 76 patients. Stiffness was defined as flexion < 90° or a flexion contracture > 10° during the first 45 post-operative days. Patients with stiffness were treated with arthroscopic arthrolysis. Several factors were studied to look for risk factors of stiffness: body mass index, gender, age, mechanical or robotic instrumentation, preoperative flexion, previous meniscectomy, and anticoagulant treatment. Arthrolysis effectiveness was evaluated by flexion improvement and UKA revision rate. RESULTS: 22 patients (9%) developed stiffness. Mechanical instrumentation significantly increased the risk of stiffness with OR = 0.26 and p = 0.005. Robotic-assisted surgery decreased the risk of stiffness by five-fold. Before arthrolysis, mean knee flexion was 79°, versus 121° (53% improvement) after arthroscopic arthrolysis. Only 2 patients (9%) underwent UKA revision after arthrolysis. DISCUSSION: Stiffness after UKA is an important complication with an incidence of 9% in this study. Arthroscopic arthrolysis is a safe and effective treatment with a range of motion improvement of > 50%. Robotic-assisted surgery significantly decreases the risk of postoperative stiffness. LEVEL OF EVIDENCE: Level III, therapeutic study, retrospective cohort study.

Treatment of non-arthritic pseudoparetic shoulders with irreparable massive rotator cuff tears: arthroscopic procedures yield comparable midterm results to reverse arthroplasty.

BACKGROUND: Irreparable massive rotator cuff tears (IMRCTs) are a well-known cause for functional limitation and difficult to treat. Although several joint-preserving as well as joint-replacing procedures were found to provide pain relief and gain of function, midterm results are scarce, particularly in pseudoparetic shoulder joints unaccompanied by severe osteoarthritis. The purpose of this study was to compare the midterm functional outcomes of arthroscopic procedures to those of reverse total shoulder arthroplasty (RTSA) in pseudoparetic shoulders with IMRCTs unaccompanied by severe osteoarthritis. METHODS: All patients who underwent either joint-preserving (group A) or joint-replacing (group B) procedures for IMRCT unaccompanied by severe osteoarthritis with a pseudoparetic shoulder function were retrospectively included. Clinical assessment included the Constant Score (CS), the Subjective Shoulder Value (SSV) and the Visual Analog Score (VAS) at baseline and at latest follow-up. Furthermore, the complication and revision rates were assessed. RESULTS: Overall, a total 56 patients were included of whom each 28 patients formed group A (male, 36%) and B (male, 53%) with a mean patient age at time of surgery of 70 ± 7 years and 72 ± 7 years, respectively. The mean follow-up period was 56 ± 17 months. At final follow-up, the total CS (group A: 66 ± 14 points; group B 54 ± 15 points) was significantly increased after arthroscopic treatment when compared to RTSA (p=0.011). However, no significant differences were detected with SSV (p=0.583) and VAS (p=0.536). Although complication rate (11% versus 18%) was not significantly different (p=0.705), number of revision surgeries was significantly higher in group B when compared to group A (p=0.041). CONCLUSIONS: In non-arthritic pseudoparetic shoulders, both joint-preserving and joint-replacing procedures yielded good clinical midterm outcomes for the treatment of degenerative IMRCTs. Despite of comparable functional and satisfactory functional improvement, increased complication rates and surgical invasiveness outweigh the benefits of primary RTSA and therefore reserve this procedure to a second-line treatment in pseudoparetic patients without any signs of severe cuff arthropathy.

Comparison of Functional and Radiographic Outcomes of Talar Osteochondral Lesions Repaired With Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate vs Microfracture.

BACKGROUND: Microfracture (MF) has been used historically to treat osteochondral lesions of the talus (OLTs), with favorable outcomes reported in approximately 80% to 85% of cases. However, MF repairs have been shown to degrade over time at long-term follow-up, suggesting that further study into optimal OLT treatment is warranted. The use of adjuvant extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) has not been extensively evaluated in the literature. We present a comparison of patient-reported and radiographic outcomes following ECM-BMAC repair vs traditional MF. METHODS: Patients who underwent MF (n = 67) or ECM-BMAC (n = 62) treatment for an OLT were identified and their charts were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) was evaluated and patient-reported outcome scores, either Foot and Ankle Outcome Scores (FAOS) or Patient-Reported Measurement Information System (PROMIS) scores, were collected. MRIs were scored by a radiologist, fellowship trained in musculoskeletal radiology, using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) system. Radiographic and clinical outcomes were compared between groups. RESULTS: On average, patients treated with ECM-BMAC demonstrated a higher total MOCART score compared to the MF group (73 ± SD 11.5 vs 54.0 ± 24.1; P = .0015). ECM-BMAC patients also had significantly better scores for the Infill, Integration, and Signal MOCART subcategories. Last, patients treated with ECM-BMAC had a lower rate of revision compared to those treated with MF (4.8% vs 20.9%; P = .007). FAOS scores were compared between groups, with no significant differences observed. CONCLUSION: When comparing outcomes between patients treated for an OLT with ECM-BMAC vs traditional MF, we observed superior MRI results for ECM-BMAC patients. The rate of revision surgery was higher for MF patients, although patient-reported outcomes were similar between groups. The use of ECM-BMAC as an adjuvant therapy in the treatment of OLTs may result in improved reparative tissue when compared to MF. LEVEL OF EVIDENCE: Level III, comparative series.

Six out of ten patients with sinus tarsi syndrome returned to pre-injury type of sport after subtalar arthroscopy.

PURPOSE: The purpose of this study was to determine multiple return to sport rates, long-term clinical outcomes and safety for subtalar arthroscopy for sinus tarsi syndrome. METHODS: Subtalar arthroscopies performed for sinus tarsi syndrome between 2013 and 2018 were analyzed. Twenty-two patients were assessed (median age: 28 (IQR 20-40), median follow-up 60 months (IQR 42-76). All patients were active in sports prior to the injury. The primary outcome was the return to pre-injury type of sport rate. Secondary outcomes were time and rate of return to any type of sports, return to performance and to improved performance. Clinical outcomes consisted of Numerous Rating Scale of pain, Foot and Ankle Outcome Score, 36-item Short Form Survey and complications and re-operations. RESULTS: Fifty-five percent of the patients returned to their preoperative type of sport at a median time of 23 weeks post-operatively (IQR 9.0-49), 95% of the patients returned to any type and level sport at a median time of 12 weeks post-operatively (IQR 4.0-39), 18% returned to their preoperative performance level at a median time of 25 weeks post-operatively (IQR 8.0-46) and 5% returned to improved performance postoperatively at 28 weeks postoperatively (one patient). Median NRS in rest was 1.0 (IQR 0.0-4.0), 2.0 during walking (IQR 0.0-5.3) during walking, 3.0 during running (IQR 1.0-8.0) and 2.0 during stair-climbing (IQR 0.0-4.5). The summarized FAOS score was 62 (IQR 50-90). The median SF-36 PCSS and the MCSS were 46 (IQR 41-54) and 55 (IQR 49-58), respectively. No complications and one re-do subtalar arthroscopy were reported. CONCLUSION: Six out of ten patients with sinus tarsi syndrome returned to their pre-injury type of sport after being treated with a subtalar arthroscopy. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. LEVEL OF EVIDENCE: IV.