Hypermobile Anterior Horn of the Lateral Meniscus: A Retrospective Case-Series Study of Presentation, Imaging, Treatment, and Outcomes.

Background and Objectives: Hypermobility of the lateral meniscus is typically associated with the posterior part of this structure, with occurrences in the anterior part rarely reported. However, a hypermobile anterior horn of the lateral meniscus can manifest clinical symptoms. This study aimed to increase awareness regarding hypermobility in the anterior horn of the lateral meniscus by presenting its clinical presentations, magnetic resonance imaging (MRI) findings, arthroscopic findings, treatment approaches, postoperative protocols, and clinical outcomes. Materials and Methods: A retrospective case-series involving patients diagnosed as having hypermobile anterior horn of the lateral meniscus through arthroscopy. The clinical presentations, preoperative image findings, arthroscopic findings, treatments, postoperative protocols, and clinical outcomes following meniscal stabilization were all reviewed. Results: A total of 17 patients (17 knees) with a mean age of 45.9 ± 18.4 years were analyzed. The mean follow-up period was 18.2 ± 7.6 months (range, 6-24 months). Primary symptoms included anterior lateral knee pain, tenderness in the lateral joint lines, and a locking sensation in six of the knees. MRI revealed hypodense lesions anterior to the meniscus, fluid accumulation, degenerative changes, and anterior horn deformities. Following meniscal stabilization, the Lysholm Knee Scoring Scale score increased from 65.8 ± 12.7 before surgery to 91.1 ± 9.6 at the final follow-up (p < 0.001). All the analyzed knees achieved a full range of motion by the final follow-up, with no patient experiencing any complication or requiring reoperation. Conclusions: There is no specific sign or test that can be used to detect a hypermobile anterior horn of the lateral meniscus. A thorough arthroscopic examination is essential for diagnosing hypermobility in the anterior horn of the lateral meniscus. Arthroscopic meniscal stabilization yields favorable outcomes.

Aspergillus niger as a rare cause of postarthroscopy knee septic arthritis in a healthy patient.

This case report outlines the diagnostic and therapeutic challenges encountered in a man in his 70s suffering from knee septic arthritis caused by Aspergillus niger It is the second published case in the literature with osteoarticular infection from A. niger and the first one in the last 40 years. Following knee arthroscopy, the patient experienced persistent pain, swelling and discomfort, prompting further investigation. Postoperative knee cultures were negative for infection, but symptoms were not ameliorated. Therefore, an arthroscopic debridement was performed that revealed severe joint inflammation and degeneration. Cultures from the synovial fluid and tissue samples identified infection from A. niger sp. Antimicrobial treatment with voriconazole finally led to significant clinical improvement and eradication of infection. This case highlights the intricacies involved in diagnosing and managing fungal osteoarticular infections in healthy patients without concomitant medical diseases or comorbidities.

Effect of low-volume ropivacaine in ultrasound-guided superior trunk block on diaphragmatic movement in patients undergoing shoulder arthroscopy: a randomized controlled trial.

OBJECTIVES: The incidence of hemidiaphragmatic paresis (HDP) in superior trunk block (STB) usually depends on the dose of local anesthetic. This study aimed to further evaluate the impact of a lower volume (10 mL) of the same low concentration (0.25%) ropivacaine compared to a conventional volume (15 mL), on diaphragmatic function and analgesic efficacy under a multimodal analgesia regimen for shoulder arthroscopy. METHODS: Patients scheduled to undergo shoulder arthroscopy were randomized allocated to receive either 10 mL or 15 mL of 0.25% ropivacaine in the STB under ultrasound guidance prior to general anesthesia. The primary outcome was the percentage reduction in diaphragm excursion (ΔDE) between baseline and 30 min after block. Secondary outcomes included DE and diaphragm thickening fraction (DTF) before and after block, incidence of HDP, onset of sensory/motor block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity, pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, and adverse events post-surgery. RESULTS: Compared with 15 mL volume, 10 mL ropivacaine significantly reduced the incidence of post-block HDP (as measured by ΔDE: 39.47% vs. 64.10%; and by post-block DTF: 13.16% vs. 33.33%). There was no significant difference in onset of sensory block, duration of analgesia/motor block, dermatomal coverage area of the block, postoperative pain severity between the two groups, except that the onset of motor block was significantly slower in the 10 mL group than in the 15 mL group. Pre- and post-block respiratory function and intraoperative hemodynamic parameters, the use of other anesthetic and analgesic drugs, post-block complications, or postoperative adverse events were not significantly different between the two groups. CONCLUSION: In shoulder arthroscopy, STB with 10 mL of ropivacaine can reduce the incidence of HDP with no significant difference in analgesic effects under a multimodal analgesia regimen compared with 15 mL. TRIAL REGISTRATION: We registered the study at chictr.org ( ChiCTR2200057543 , 14/03/2022. https://www.chictr.ogr.cn.

Comparison of Arthroscopic Microfracture and Retrograde Subchondral Drilling in the Treatment of Osteochondral Lesions of Talus.

PURPOSE OF THE STUDY: In our study, it was aimed to evaluate the efficacy of microfracture and retrograde subchondral drilling on clinical outcomes in patients who underwent ankle arthroscopy due to osteochondral lesion of medial talus. MATERIAL AND METHODS: Twenty eight patients with osteochondral lesion of talus less than 1.5 cm2 treated with ankle arthroscopy were evaluated retrospectively. Microfracture was performed in 16 patients and retrograde subchondral drilling was performed in 12 patients that there was no loss of integrity in the cartilage layer or cartilage layer is partially preserved during ankle arthroscopy. Postoperative evaluations of the patients were done with Foot and Ankle Ability Measure (FAAM) and results of both group were compared statistically. RESULTS: The mean activities of daily living scale was 93.4±3.2 and sportive activity scale was 90.1±5.7 in the retrograde drilling group. In the micro-fracture group, mean activities of daily living scale was 93.8±4.1 and mean sportive activity scale was 88.9±9.5. No significant difference was found as a result of statistical comparisons of both groups results. DISCUSSION: It has been determined that the size and preservation of the integrity of talar osteochondral lesions are important factors on clinical results. Results of arthroscopic debridement, microfracture and drilization are not good in lesions larger than 1.5 cm2 and lesions with impaired integrity. In our study, depending on the general literature, osteochondral lesions in talus were less than 1.5 cm2 in patients who underwent arthroscopic micro fracture and retrograde drilling. CONCLUSIONS: Both microfracture and retrograde subchondral drilling are effective treatment methods with good clinical results for talar osteochondral lesions less than 1,5cm2 . Retrograde subchondral drilling can be an alternative treatment method with the reliability of clinical results in patients with no loss of the integrity of the cartilage layer or cartilage layer is partially preserved. KEY WORDS: talus, osteochondral lesion, microfracture, subchondral drilling.

Arthroscopic surgery is not superior to conservative treatment in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trails.

BACKGROUND: Studies comparing the effectiveness of arthroscopic knee surgery and conservative treatment on knee osteoarthritis (OA) came up with inconsistent results. Systematic review on this topic still is still lacking. This systematic review and meta-analysis aimed to evaluate the effectiveness of arthroscopic knee surgery on knee OA, compared to conservative treatments. MATERIALS AND METHODS: Literature searches were performed in PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published before on 1st July 2024. Studies comparing the effectiveness of arthroscopy and conservative treatments only on knee OA were included. Quality of included studies was evaluated by risk of bias 2 (ROB2). Long-term results in terms of pain relief, functional recovery and patients reported satisfaction were meta-analyzed to evaluate the therapeutic effectiveness. RESULTS: Ten studies were included in this review, among which only 1 was considered as low risk of bias. Five studies were involved in meta-analyses and no difference was found in therapeutic effectiveness of arthroscopic surgery and conservative treatment on knee OA, in the evaluation of VAS (p = 0.63), WOMAC (p = 0.38), SF-36 (p = 0.74) and patient satisfaction (p = 0.07). CONCLUSION: The evidence does not support the effectiveness of arthroscopic knee surgery compared to conservative treatments in knee OA.

[Efficacy of transdermal lidocaine 5% patches in postoperative analgesia following knee arthroscopy]. / Efectividad del parche transdérmico de lidocaína 5% en la analgesia postoperatoria después de la artroscopía de rodilla.

INTRODUCTION: knee arthroscopy is a common orthopedic procedure associated with postoperative pain, so optimizing pain management is essential for patient recovery and satisfaction. Lidocaine, a local anesthetic with well-established safety profiles, offers a potential alternative to traditional analgesic methods. Research regarding lidocaine patches has been conducted in several types of surgeries (laparoscopy, gynecological surgery, prostatectomy, etc.) showing promising results for some. This study investigates the effectiveness of transdermal lidocaine 5% patches as a novel approach to postoperative analgesia after knee arthroscopy. MATERIAL AND METHODS: a randomized, single-blind, placebo-controlled trial was conducted with participants undergoing knee arthroscopy. Patients were divided into two groups: one receiving transdermal lidocaine 5% patches and the other a placebo, both along traditional postoperative pain management, and using opioid only in cases with moderate-severe pain. Pain scores, opioid consumption, and patient-reported outcomes were assessed at various postoperative intervals. RESULTS: there was a significant reduction in pain scores and opioid consumption in the lidocaine patch group compared to the placebo group. CONCLUSIONS: transdermal lidocaine 5% patches emerge as a promising adjunct to postoperative pain management in knee arthroscopy patients. Their ease of application, minimal side effects, and opioid-sparing effects contribute to a multifaceted analgesic approach. This study underscores the potential of transdermal lidocaine patches in enhancing the overall postoperative experience for knee arthroscopy patients, advocating for their consideration in clinical practice.

INTRODUCCIÓN: la artroscopía de rodilla es un procedimiento ortopédico común asociado con dolor postoperatorio, por lo que optimizar el manejo del dolor es esencial para la recuperación y la satisfacción del paciente. La lidocaína, un anestésico local con perfiles de seguridad bien establecidos, ofrece una alternativa potencial a los métodos analgésicos tradicionales. Se ha llevado a cabo investigación sobre los parches de lidocaína en diversos tipos de cirugías (laparoscopía, cirugía ginecológica, prostatectomía, etcétera), mostrando resultados prometedores en algunos casos. MATERIAL Y MÉTODOS: se realizó un ensayo clínico aleatorizado, ciego simple y controlado con placebo que incluyó participantes sometidos a artroscopía de rodilla. Los pacientes fueron divididos en dos grupos: uno recibió parches transdérmicos de lidocaína al 5% y otro un placebo, ambos junto con el manejo tradicional del dolor postoperatorio y utilizando opioides sólo en casos de dolor moderado a severo. Se evaluaron las puntuaciones de dolor, el consumo de opioides y los resultados informados por los pacientes en varios intervalos postoperatorios. RESULTADOS: se registró una reducción significativa en las puntuaciones de dolor y el consumo de opioides en el grupo de parches de lidocaína en comparación con el grupo de placebo. CONCLUSIONES: los parches transdérmicos de lidocaína al 5% emergen como un complemento prometedor para el manejo del dolor postoperatorio en pacientes sometidos a artroscopía de rodilla. Su facilidad de aplicación, mínimos efectos secundarios y efectos ahorradores de opioides contribuyen a un enfoque analgésico multifacético. Este estudio destaca el potencial de los parches de lidocaína transdérmica para mejorar la experiencia postoperatoria general de los pacientes con artroscopía de rodilla, abogando por su consideración en la práctica clínica.

Functional benefit of joint surgery in patients with non-vascular Ehlers-Danlos syndrome: results of a retrospective study.

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a hereditary disease characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Hypermobile EDS (hEDS is the more frequent subtype. Joint surgery may benefit certain patients after failure of medical treatments, but there is no consensus on the optimal surgical management of patients with hEDS. The aims of this retrospective study were to chart the surgical management of patients with hEDS, to determine the role of arthroscopy and to evaluate the functional results of joint surgery, including the reintervention rates. RESULTS: A total of 69 patients with non-vascular EDS were evaluated (60 female; 87%). Mean (SD) age at first surgery was 25.6 ± 11.1 years. Among the 69 patients, first surgeries were carried out on the knee (n = 50; 39.4%), ankle (n = 28; 22.0%), shoulder (n = 22; 17.3%), wrist (n = 18; 14.2%) and elbow (n = 9; 7.1%). One-fifth of all first operations (20.8%) were carried out by arthroscopy, most often on the knee (36% of knee surgery cases). At the time of primary surgery, the surgeon was alerted to the diagnosis or suspicion of hEDS in only 33.9% of patients. The rate of reoperations (2 to ≥ 5) was 35.7% (10/28) for the ankle, 40.9% (9/22) for the shoulder, 44.4% (4/9) for the elbow, 50% (9/18) for the wrist and 60% (30/50) for the knee. Local or regional anaesthesia was badly tolerated or ineffective in 27.8%, 36.4% and 66.6% of operations on the wrist, shoulder and elbow, respectively. Overall, the majority of patients (> 70%) were satisfied or very satisfied with their surgery, particularly on the non-dominant side. The lowest satisfaction rate was for shoulder surgery on the dominant side (58.3% dissatisfied). CONCLUSIONS: Surgery for joint instability has a greater chance of success when it is carried out in patients with a known diagnosis of EDS before surgery. The majority of patients were satisfied with their surgery and, with the exception of the knee, there was a low rate of reoperations (≤ 50%). Arthroscopic procedures have an important role to play in these patients, particularly when surgery is performed on the knee.

Treatment of Refractory Osteochondral Lesions of the Talus with a Novel Transmalleolar Drilling Technique: A Case Report.

CASE: A 15-year-old adolescent girl underwent revision surgery for a posteromedial osteochondral lesion of the talus (OLT). To provide anatomic reduction of her lesion, fluoroscopy and ankle arthroscopy facilitated a transmalleolar tunnel for screw fixation. Now, 8 years after surgery, the patient reports high patient satisfaction and pain-free functional use of her ankle. CONCLUSION: A transmalleolar tunnel technique provides an alternative method to treat posteromedial OLT. This minimally invasive procedure allows patients to be spared potential complications from a medial malleolar osteotomy or a posteromedial incision. Most importantly, this case report demonstrates a positive long-term patient outcome.

Unlocking the Temporomandibular Joint: CT, MRI, and Arthroscopic Correlation.

The temporomandibular joint constitutes a synovial connection between the mandible and the skull base and plays a pivotal role in functions such as jaw movement, chewing, and verbal and emotional expression. Temporomandibular joint dysfunction is observed in about 30% of the population, with a higher prevalence in young to middle-aged women. Interestingly, a majority of individuals affected do not report pain, and only 5%-10% of symptomatic cases necessitate therapeutic intervention. The most common temporomandibular joint disorder manifests as pain in the masticatory muscles and is referred to as myofascial syndrome. However, articular disorders are also very common, usually due to disk displacement and degenerative or inflammatory arthropathies. Less frequently, the temporomandibular joint may be affected by a range of congenital and acquired conditions such as trauma and neoplasms. Imaging becomes necessary for the small percentage of patients who do not respond to conservative management or when there is uncertainty in the diagnosis. A comprehensive understanding of the normal imaging appearance of the temporomandibular joint as well as the wide range of potential pathologic conditions is essential for conducting an accurate radiologic assessment. Moreover, collaboration among multidisciplinary teams and the correlation of imaging findings with arthroscopic observations are crucial to advancing the diagnosis and treatment of temporomandibular joint dysfunction. ©RSNA, 2024 Supplemental material is available for this article.

[Treatment of massive rotator cuff tears with modified Chinese-way technique].

OBJECTIVE: To explore clinical effect of modified Chinese-way technique under shoulder arthroscopy in treating massive rotator cuff tears. METHODS: From January 2019 to June 2022, 22 patients with massive rotator cuff tears who underwent arthroscopic rotator cuff repair with improved Chinese-way technique, including 10 males and 12 females, aged from 46 to 76 years old with an average of(64.14±7.45) years old;the courses of disease ranged from 5 to 14 months with an average of(8.32±2.42) months;19 patients were complete repaired, and 3 patients were partial repaired. Visual analogue scale (VAS) and University of California at Los Angeles (UCLA) scale were used to evaluate pain and function of shoulder joint preoperatively and 1 year postoperatively. Postoperative complications, the integrity of reconstructed tissue structure and the size of subacromial space were observed. RESULTS: All patients were followed up from 12 to 34 months with an average of (17.14±5.93) months. Re-tear were occurred in 4 patients during MRI follow-up, but clinical symptoms of patients were improved significantly and they were satisfied with the treatment, the others were no complications such as incision infection, peripheral nerve injury, loosening and falling off of internal fixation anchors. Preoperative and 1 year after operation VAS were (8.05±1.12) and (1.82±1.50), UCLA scores were (7.45±1.65) and (31.41±2.87) respectively, and the difference was statistically significant (P<0.05). CONCLUSION: The modified Chinese-way technique under shoulder arthroscopy for the massive rotator cuff tear could relieve pain obviously and recovery postoperative function well, with satisfactory curative effect.

Clinical comprehensive of microfracture, autologous chondrocyte implantation, and periosteum-covered iliac bone grafting for Hepple stage IV-V lesions.

Chronic ankle pain significantly impairs daily activities and athletic performance with osteochondral lesions of the talus (OLT) in Hepple stages IV and V, which are often causative factors. This study aimed to assess the efficacy and safety of autologous osteochondral transplantation (AOT) for the treatment of these conditions. This retrospective study was conducted from May 2020 to May 2023 at Cangzhou Traditional Chinese and Western Medicine Combined Hospital, including patients with a diagnosis of Hepple stage IV or V OLT confirmed by magnetic resonance imaging (MRI) and arthroscopy. Surgical interventions involved arthroscopic debridement, followed by AOT or limited arthrotomy based on the location and size of the lesion. Preoperative and postoperative evaluations used the Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale, MRI-Based Cartilage Repair Tissue Scoring, and the International Knee Documentation Committee Knee Evaluation Form. Statistical analysis was conducted using paired-sample t tests to compare the preoperative and postoperative data. Twenty patients were included, revealing significant postoperative improvements in Visual Analog Scale, American Orthopedic Foot and Ankle Society, and MRI-based cartilage repair tissue scores (P < .05). The radiographic findings suggested effective cartilage regeneration. No adverse effects were observed in the donor knee sites, as confirmed by the stable pre- and postoperative International Knee Documentation Committee Knee Evaluation Form scores. Recovery of physical abilities was achieved on average within 7.3 weeks for daily activities and 13.4 weeks for sports activities. AOT effectively treats Hepple stage IV-V OLT, improves ankle function, promotes cartilage regrowth, and allows quick resumption of daily and athletic activities without compromising donor-site integrity.

Arthroscopic-assisted uni-portal ligament flavum sparing bone anchoring annular suture technique for lumbar disc herniation: A case report and literature review.

RATIONALE: Lumbar disc herniation (LDH) manifests in diverse forms. If the nucleus pulposus or endplate tissues protrudes, the location of annular tears also varies, which poses various challenges for the annular suture technique. Tears at the annular attachment area at the edge of the vertebral body (cephalad or caudad) are considered a prohibitively challenging area for annular suturing. PATIENT CONCERNS: A 37-year-old woman presented with a gradual onset of symptoms, experiencing leg pain and numbness over the left leg for 1 year before presentation. The pain radiated to the left S1 dermatome. Despite undergoing continuous medical therapy for more than 6 months, her symptoms showed no improvement. The strength of the left plantar flexion in the ankle and great toe was rated at 4 out of 5. The straight leg-raising and strengthening tests were positive for the left sides. Lumbar computed tomography and magnetic resonance imaging revealed left-sided disc herniation at the L5-S1 level, and nerve root compression, confirming the diagnosis of LDH. DIAGNOSES: The preoperative impression was LDH, intraoperative confirmation of a tear in the annular attachment area at the vertebral body edge. INTERVENTIONS: This patient was treated with an arthroscopic-assisted uniportal spinal surgery (AUSS) technique focusing on ligament flavum (LF) preservation, protruding nucleus pulposus removal, nerve root decompression, and vertebral edge tear was then sutured using a bone anchoring annular suture with the Smile suture device. OUTCOMES: This technique was performed successfully in a patient with LDH. Significant improvements were observed in postoperative pain and numbness, Visual Analog Scale, and Japanese Orthopaedic Association scores. No postoperative instability or complications were observed, with computed tomography and magnetic resonance imaging confirming complete decompression. To the best of our knowledge, this is the first used AUSS with LF preservation and bone anchoring annular suture technique for LDH. LESSONS: This case study demonstrates the AUSS combined with LF preservation and the bone anchoring annular suture technique provides favorable clinical and imaging outcomes and is a safe and effective technique for the treatment of LDH.

Analysis of related factors influencing the sleep quality in patients with rotator cuff tear after arthroscopic surgery.

Recent studies have reported a prevalence of sleep disturbance in patients undergoing arthroscopic rotator cuff repair. The purpose of our study was to explore patient-reported factors correlated with sleep disturbance in patients with arthroscopic rotator cuff repair. We retrospectively evaluated 133 patients who underwent arthroscopic rotator cuff repair for 6 months. We obtained the Pittsburgh Sleep Quality Index (PSQI) scores, the visual analog scale (VAS) pain score, the University of California-Los Angeles Shoulder Rating Scale score (UCLA score), the Hospital Anxiety and Depression Scale (HADS), and patient demographics. According to the PSQI scores, participants were divided into a sleep disorder group (A group, PSQI ≥5) and a normal sleep group (B group, PSQI <5). Statistical analyses included Student t test, Mann-Whitney U test, chi-square test, and binary logistic regression analysis to determine which patient-reported factors were associated with sleep disturbance. The mean VAS, UCLA score, UCLA Flexion, HADS-Anxiety (HADS-A), and HADS-Depression (HADS-D) scores in group A were 3.54, 26.36, 3.25, 5.43, and 5.93, respectively; in group B, the mean scores were 1.49, 30.72, 4.50, 2.11, and 1.79, respectively. There were statistically significant differences in the VAS, UCLA, UCLA Flexion, HADS-A, HADS-D scores between the 2 groups (P < .05). In the categories of sex, age, body mass index, and tear size, there was no statistical significant difference between the 2 groups. (P > .05). HADS-D and UCLA Flexion were independent factors affecting sleep disturbance after arthroscopic rotator cuff repair at 6 months (P < .05). Our study demonstrated that patients with sleep disturbances after arthroscopic shoulder surgery had a close relationship with the HADS-D, UCLA Flexion scores and had more pain, more dysfunction, and more pronounced psychological abnormalities. Therefore, more emphasis on psychotherapy and rehabilitation is required for patients with sleep disturbance.

Arthroscopic Management of the Contact Athlete with Anterior Instability.

Anterior glenohumeral instability is one of the most common injuries suffered from sport. Despite padding and conditioning, the shoulder joint remains particularly vulnerable to injury, especially in the setting of contact. The overall rate of anterior instability is reported to be 0.12 injuries per 1000 athlete exposures, although this is increased up to 0.40 to 0.51 in the contact athlete. Successful treatment requires consideration of restoring stability while minimizing loss of glenohumeral motion. Common treatment strategies involve addressing the pathology that results from anterior shoulder dislocation including labral detachment as well as bony defects to the humeral head and glenoid.

Open Bankart Repair: Technique and Outcomes for the High-Level Athlete.

Historically considered the gold standard technique for glenohumeral instability, the open Bankart repair is being performed at decreased rates because of the current trends favoring arthroscopic Bankart repair and the lack of consistent training of the open technique. However, open Bankart repairs may be more appropriate for certain high-risk populations (ie, high-level collision athletes) because of their reduced recurrent instability rates. Further investigations are needed to identify the indications for arthroscopic versus open Bankart repair and compare their outcomes in high-level athletes. This review highlights the indications, surgical technique, and clinical outcomes following open Bankart repairs in athletes.

Current Evidence and Techniques for Arthroscopic Bone Augmentation.

The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR.

Arthroscopic Management of Posterior Shoulder Instability.

Posterior shoulder instability is a distinct subcategory of shoulder instability with an incidence higher than previously reported. Pain is typically the primary complaint, with pathology due to repetitive microtrauma being more common that a specific traumatic event. If nonoperative treatment fails, arthroscopic posterior capsulolabral repair has been shown to result in excellent outcomes and return to sport, with American football players having the best outcomes and throwers being slightly less predictable. Risk factors for surgical failure include decreased glenoid bone width, rotator cuff injury, female gender, and the use of less than 3 anchors.

Current Concepts in Assessment and Management of Failed Posterior Labral Repair.

Recurrent posterior shoulder instability after primary repair is uncommon, but presents a challenging clinical scenario. Most revisions in failed labral repair were associated with glenoid bone morphology related to critical bone loss, retroversion, or dysplasia. A variety of treatment options exist which include revision labral repair with or without capsular plication, glenoid osteotomy, humeral rotational osteotomy, or glenoid bone augmentation. No single technique has been shown to be superior and each technique has strengths and limitations. Therefore, thoughtful evaluation and planning is critical to address each patient's individual pathology to maximize success after revision surgery.

Synovial Fluid Biomarker Alternatives Can Plasma and Urine Samples Shed Light on the Post-Traumatic Intra-Articular Microenvironment?

The purpose of this study was to analyze the relationship between the intra-articular inflammatory response and any associated systemic inflammatory response following knee injury requiring operative management. Patients undergoing primary knee arthroscopy provided synovial fluid, blood, and urine samples immediately prior to surgery. Samples were analyzed using a multiplex magnetic bead immunoassay for the concentrations of cytokines and growth factors that have been shown to be associated with post-injury inflammation. One hundred and fifty-one patients undergoing arthroscopic management of meniscus, ACL, and focal chondral lesions were included in the analysis. After correction for multiple tests, there were no statistically significant correlations between synovial fluid biomarkers and biomarkers in plasma or urine for any of the intra-articular pathologies assessed. This analysis suggests that the most accurate measurement of the post-injury inflammatory response must be sampled from the intra-articular space. In the post-traumatic knee, there is no substitute for synovial fluid biomarker analysis.

Recurrent ganglion cyst in the anterolateral portal following knee arthroscopy.

Ganglion cysts (GC) are an uncommon complication following arthroscopic knee surgery. Due to high rates of recurrence following GC resection, many symptomatic patients can experience pain and discomfort for years. The presence of a GC at the site of an arthroscopic knee portal has only been reported once before in the literature. This case report details the history, physical and treatment of an active-duty soldier who had undergone various aspirations and surgical resections with limited improvement until the most recent operative intervention. At 18 months postoperatively, the patient had not experienced recurrence and had returned to all activities. We believe this surgical technique yielded resolution of the GC because following resection, the joint was checked to exclude areas of fluid extravasation, the capsule closure was performed with non-absorbable barbed suture and the operative extremity was immobilised in extension for 2 weeks to promote soft tissue rest and healing.